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COVID-19 as Metaphor: The Immuniversity, Not War

What would Sontag say about COVID-19?

Source: Pixabay

(This is a condensed version of a recent talk, with full video appended below.)

Susan Sontag writes in her opening to Illness as Metaphor:

“Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”

We’re all subject to old age, illness and death – that’s the First Noble Truth. Sontag goes on to describe how tuberculosis and cancer, as mysterious ailments with uncertain causes and no remedies for much of human history, became projections of our emotional lives and fears. How tuberculosis was thought to spiritualize a life, winnowing the dying person down to their essence, while cancer was a predator that ate away life and personality. I’m wondering how coronavirus will affect society as a whole – will it remind us of our essence, our compassion – or will it wear away at us. I think it is a matter of will and choice, what we cultivate and pay attention to.

Tuberculosis, a disease of the lungs, the air, the spirit, was metaphorically a disease of the soul. Cancer ate away the soul. They were thought to be caused by alternately an abundance of passion or emotion, or its suppression. Tuberculosis was treated by moving to all kinds of environments, from tropical to desert, but in all cases away from the city, which by then was thought of as a disease itself. Cancer patients were lied to about their diagnoses, because the disease was considered obscene, and also the word itself was thought to worsen the disease. Letters from clinics were sent in unmarked envelopes so as not to cause the patient backlash in profession or relationships. The 1966 Freedom of Information Act specifically excluded cancer treatments from disclosure. A cancer diagnosis was considered top-secret, shameful and portentous.

Outbreaks of disease were thought to make moral corruption manifest. “the plague that broke out in Athens in 430 B.C. spawned disorder and lawlessness” and the writing about the plague in Florence in 1348 stressed how badly citizens behaved. Indeed, pogroms against Jews were linked to outbreaks of the plague. The pogroms stopped as soon as the plagues abated. Diseases often spawn scapegoats, and Coronavirus is no different, with Asian Americans and Asians around the globe being blamed and verbally and physically attacked because of disease fears. Asian Americans have started campaigns to literally proclaim “I am not a virus.”

Sontag writes “Any important disease whose causality is murky, and for which treatment is ineffectual, tends to be awash in significance…Feelings about evil (and I would say, danger and threat) are projected onto the disease. And the disease (so enriched with meanings) is projected onto the world.” Nazism and its anti-Semitism, it turns out, was driven by an irrational fear of syphilis. “Illnesses have always been used as metaphors to enliven charges that a society was corrupt or unjust,” and illnesses were taken as evidence of corruption. While Asian American’s must insist that “we are not the virus” in order to blunt the hatred directed at them, others proclaim that COVID19 has spread precisely because we, humanity, are the virus. Human society is corrupt, polluted by its food, agricultural and environmental actions. COVID19 is taking us down for a reason, they say, and we deserve it.

Sontag writes further:

“Before it was understood as, literally, a cancer-causing (carcinogenic) environment, the city was seen as itself a cancer—a place of abnormal, unnatural growth and extravagant, devouring, armored passions. In The Living City(1958), Frank Lloyd Wright compared the city of earlier times, a healthy organism (‘The city then was not malignant’), with the modern city. ‘To look at the cross-section of any plan of a big city is to look at the section of a fibrous tumor.’”

Anything we disapprove of we call a disease, “a pox” or “a cancer.” Just as we apply disease metaphors to society, we apply social metaphors to disease, particularly the metaphors of war. President Trump and others say we are on a ‘war footing’ and ‘at war’ with coronavirus. ICU’s and ER’s are “war zones,” with doctors and nurses the soldiers. Presumably our Victory Gardens are our home mask-sewing enterprises. Rosie the Riveter is now Rosie the 3-D printer, downloading patterns from the internet for the proclaimed war effort.

Sontag concludes that illness is not a metaphor. We should stick to reason and understanding of pathogenesis and treatment to deal with disease. Coronavirus has been demystified for most of us – most of us understand how it is caused and transmitted, though we are still unsure of remedies, and magical cures are proposed, even by the president (for example, hydroxychloroquine and zinc.) Coronavirus carries less cultural baggage though than AIDS just 40 years ago.

But we’re still using the war metaphor, and I think that’s a problem. First, it generates an antagonism that is clearly being misapplied to Asian Americans. We’ve had so many wars – wars on drugs, wars on poverty, cultural wars – that have negatively impacted minority communities. When the majority culture goes to war, vulnerable people are often put at more risk. Coronavirus is far more deadly in the African American and Latino communities, and they are being blamed for this even by the current Surgeon General, Dr. Jerome Adams. When we use the war metaphor, we open the floodgates to blame.

Moreover, the antagonism of the war metaphor takes us away from deeper understanding of the illness and the world. If we are to use a metaphor, it must be both accurate and insightful. I like the way some immunologists describe antigens as ‘tutors’ to the immune system. Thus, the metaphor I would like to introduce is that Coronavirus is taking us to “immuniversity.” It is a horrible disease, and many have died and will die, but we must engage as students of the virus and as students of society, I think, to understand the conditions exposed by the pandemic and to grow.

The strengths and failings of our culture, from egos to partisanship to health care systems to government, are being made plain. And human society’s impact and interdependence with the natural world is getting closer scrutiny. I can only hope that more of us will learn from this terrible lesson and that we can ‘graduate’ the distress of immuniversity to become a more responsible, caring, compassionate community.

Of course, the immune system is sensitive to emotional states and social wellness, and these may play a role in all disease and recovery. Compassion meditation boosts the immune system; being socially connected protects against disease, all mediated by cortisol, interleukins and other chemicals. Contempt weakens the immune system, and I don’t doubt that institutionalized contempt, in the form of institutionalized racism and sexism, damages the well-being of whole communities.

The core curriculum of Immuniversity is compassion. Compassion is broken down into four stages. One, noticing suffering. Two, having an emotional, sympathetic, caring response to suffering. Three, generating the will to help. And fourth, taking action to relieve suffering. Today I will give you two techniques to help you on that path and to cultivate the inner reservoir that boosts compassion. Taking internal mental action is an important step that boosts your resilience, prevents burnout, and likely boost your own immune response.

(c) 2020 Ravi Chandra, M.D., D.F.A.P.A.

Contagious Compassion #4: COVID19 as Metaphor - the Immuniversity