You probably won’t get AIDS

"If you look at the data we have right now, it is very clear what is driving the AIDS epidemic in the United States. It's not sustained heterosexual transmission, it is not IV drug use, it's basically in African American men who have sex with men. HIV in heterosexuals persists only because you have inflow either from other countries, from high prevalence areas for example, or from other risk groups such as intravenous drug users or men who have sex with men."

On Susan Sontag’s “Illness as Metaphor”

This essay is a discussion of the ways certain illnesses (tuberculosis and cancer) are and were portrayed in our culture as anything other than what they are. Metaphor is used as an attempt to understand illness:

“As TB was represented as the spiritualizing of consciousness, cancer is understood as the overwhelming or obliterating of consciousness (by a mindless It). In TB, you are eating yourself up, being refined, getting down to the core, the real you. In cancer, non-intelligent ("primitive," "embryonic," "atavistic") cells are multiplying, and you are being replaced by the non-you. Immunologists class the body's cancer cells as "nonself". “

and an attempt to use an illness as a social tool:

"The Romantics invented invalidism as a pretext for leisure, and for dismissing bourgeois obligations in order to live only for one's art. “

and an attempt to assert our will over illness (more later.)

Sontag says, with a certain lack of precision, that these metaphors distract us from the ‘reality’ of a disease. As soon as we cure cancer, and she thinks it will be soon, we’ll stop fearing it and the disease will cease being fascinating and terrifying and romantic and will become banal and unartistic. Right now, however, using disease as a metaphor is ‘not morally permissible’, or something like that.

This essay is a lovely work of social history. As soon as she introduces moral prohibitions, it gets vague and ungraspable and unconvincing. For one thing, I’ve always thought that the human process of thought is, more than anything,--insofar as I can sum it up in one word--metaphorical. How precisely are we to comprehend the ‘reality’ of a disease? I can’t imagine understanding something new except through relating it to what I already know. What Sontag is really saying is that, rather than using metaphors which empower cancer by describing it as similar to demonic possession or tuberculosis, we should be understanding it as we would a common cold or a stubbed toe.

Which would be a completely inhuman and unnatural way of looking at it. As long as we can’t cure cancer, we will fear it; as long as we fear it, our way of understanding it will be somewhat exaggerated and colorful. If we cure cancer, there will be something else for us to fear and romanticize.

Sontag’s whole book reeks of an odd sort of optimism; a refusal to acknowledge disease as the spiritual threat it is. Sometimes, in fact, she seems to be denying that the mind plays any part in disease:

“Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it…A large part of the popularity and persuasiveness of psychology comes from its being a sublimated spiritualism: a secular, ostensibly scientific way of affirming the primacy of "spirit" over matter.”

Sontag would prefer to affirm the primacy of matter over spirit. She herself died of leukemia, and the spiritual challenge presented by that disease is not one mere oncology can meet.

There is a middle ground between a purely scientific approach to disease and a bullshit New-Age homeopathic one. On the one hand, the mind does demonstrably affect the body, in terms of creating, changing and curing illnesses, not to mention creating the habits which lead to illnesses. And I don’t use the term ‘demonstrably’ lightly. Look, for instance, at the prevalence of modern hysterias such as chronic fatigue syndrome and Morgellon’s syndrome .

On the other hand, blaming sick people for their illnesses is an artificial way to assert our will over our bodies. If I can believe they did something wrong, then I’m safe. And not just safe, but pretty damn superior. I can’t tell you how many times I personally have seen someone coughing, or complaining about all the foods she can’t eat, and felt contemptuous. If I don’t have to have allergies, you don’t have to, so it must be your fault. Seeing a sick person gives us a nice little ego boost; we come up with some ridiculously superficial explanation (their parents were too careful with them; they must have eaten too much McDonald’s) and sidestep the reality that a simple accident of genetics or psychological trauma might easily put us in the same position.

Incidentally, Sontag throws this off:

“Twentieth-century women's fashions (with their cult of thinness) are the last stronghold of the metaphors associated with the romanticizing of TB in the late eighteenth and early nineteenth centuries.”

Partially, but not completely, true. I’ll write more on thinness (and its relation to politeness) later.