by Olivia Laing
Illness as Metaphor is a strange book, displaying Sontag’s genius for aphorism as well as her lamentable propensity for cherry-picking facts. She tears away at stigma like a person stripping ivy from a wall. But throughout the entire performance – the ravishing argument about tuberculosis in nineteenth-century literature; the ardent, necessary refutation of the sick body as anything other than itself – there can be discerned a faint bat squeak of panic: is it my fault, is it my fault? As Denis Donoghue observed in his New York Times review, ‘it is my impression that Illness as Metaphor is a deeply personal book pretending for the sake of decency to be a thesis.’
What she was afraid of was exactly what she was arguing against: that her own cancer was a judgement, a drastic physical reaction to her failings as a person. Later, recalling her diagnosis in the book’s 1989 sequel, AIDS and its Metaphors, she presented an impregnable self, drily describing her doctors’ ‘gloomy’ prognosis and her own refusal to give way to fears about what her cancer meant. Other patients, she notes, ‘seemed to be in the grip of fantasies about their illness by which I was quite unseduced.’
Quite unseduced. It wasn’t true. She was as scared as anyone. Her body was newly unreachable, ‘opaque’, while her mind had become something to fear. She couldn’t help worrying over the role her own self played in her illness, the vexed and obscure link between biography and disease. Was it something to do with her mother? ‘I felt my tumour + the possibility of hysterectomy’, she wrote in her diary, ‘as her bequest, her legacy, her curse.’ Had her repressed feelings somehow caused her sickness? ‘I feel my body has let me down. And my mind too. For, somehow, I believe the Reichian version. I’m responsible for my cancer. I lived as a coward, repressing my desire, my rage.’
The ‘Reichian version’ she mentions here is not character armour. It refers instead to the strange developments that Reich’s ideas underwent in the late 1930s. Back when he was just beginning his medical training, Reich had longed to discover a vital essence that animates all beings. Freud’s notion of libido had seemed to answer this desire, and when his own patients started to describe streaming in the 1920s he became increasingly certain that libido was not a metaphorical force, but a real and tangible energy: a biological substance that he could isolate and measure in scientific tests. By the time he arrived in America in 1939, he was convinced of three things: that there was a life force, which he called orgone; that it could become blocked because of emotional trauma or repression; and that these blockages had profound physical consequences. As he argued in his self-published 1948 book The Cancer Biopathy, they brought about a cellular process of stagnation and putrefaction that would ultimately lead to illness, especially cancer.
Despite its pseudoscientific nature, this idea was enormously influential after Reich’s death in 1957. His work was much circulated in the counterculture of the 1960s, and his theory of illness chimed with a growing feeling that repression of all kinds was dangerous and inimical to health. In 1974, the year before Sontag was diagnosed with cancer, The Cancer Biopathy was brought back into print by her own publishers, Farrar, Straus and Giroux (they would eventually republish twenty-one of his books). Reich believed sexual repression was particularly significant in cancer but, as Sontag observes, by the 1970s it was more often associated with repressed rage.
By way of example, she relays a dismal anecdote about the novelist, cultural commentator and card-carrying misogynist Norman Mailer, whose references to Reich in his influential and frankly barmy 1957 essay ‘The White Negro’ were at least partially responsible for the resurgence of his ideas. In the autumn of 1960, Mailer hosted a party at his uptown apartment to celebrate the launch of his campaign to be mayor of New York. After getting drunk and picking fights with many of his guests, he stabbed his wife Adele Morales twice with a rusty penknife. It punctured her pericardium and almost killed her. ‘Let the bitch die,’ he told onlookers.
Mailer claimed that in stabbing his wife he rid himself of ‘a murderous nest of feeling’, adding that if he hadn’t done so, he would have died of cancer himself within a few years, never mind the nest of fear and rage he doubtless bequeathed to his wife. Though Sontag doesn’t mention it, this cancer argument was an actual defence prepared by Mailer’s lawyers. A woman’s body exists as a receptacle for male anger, we all know that. Sontag saves her scorn for Mailer’s woolly thinking, his belief that feeling toxifies if unexpressed, taking on its own occult and sinister life, even though her diaries clearly demonstrate that she too was susceptible to the same belief.
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Do emotions have physical consequences? Sontag’s painful question in Illness as Metaphor also haunts one of my favourite films. Safe was made in 1995 by Todd Haynes, and is about a wealthy white woman assailed by a mysterious disease. Carol White, played by an exquisitely repressed, almost lobotomised Julianne Moore, is a Californian housewife, living with her husband and stepson in the San Fernando valley. She wanders her futuristic house like a baffled child, dressed in pastel clothes, dwarfed by the furniture, asking the housekeeper for glasses of milk, the only food she consumes with relish.
At first Carol seems merely tense, fragile, anxious, absent, with her perfect make-up and sweet, confused smile. Despite her beauty, she doesn’t seem wholly at ease in her body. In fact, she’s a perfect example of Reich’s character armour. She can barely raise her voice above a whisper, she windmills her arms a beat behind the others in her aerobics class. The first sign that something more serious is wrong comes when she almost collapses while driving behind a truck with a filthy exhaust. Later, at the hairdresser, she asks in her tentative, breathy voice for a perm. As she watches the process in the mirror, a thin trickle of blood starts to leak from her nose. These scenes and the ones that follow – a seizure at the dry cleaners, an asthma attack at a baby shower – are as icily constructed and alive with dread as anything by Hitchcock. In fact, they’re shot exactly like a horror film: a horror film in which there is no monster, no demonic force beyond the nightmare of a malfunctioning body, the isolation and terror of not understanding why or being believed.
Carol’s doctor can’t find anything wrong and advises her sceptical husband to take her to a psychiatrist. But Carol is sure her problems aren’t inside her head. At the gym she spots a flyer describing a new disease, environmental illness, also known as multiple chemical sensitivities. This must be it, she decides: she’s experiencing an extreme immune reaction to the luxurious, toxic world in which she lives. ‘I’m allergic to the couch,’ she tells a friend; also to make-up, milk, pesticides, her husband’s cologne. She responds to this poisonous onslaught by retreating to a New Age community in Montana, a safe zone presided over by a creepy, charismatic leader, Peter Dunning. Peter’s message is that each person is responsible for their own illness, which they alone can heal, by confronting their unhappiness and self-hatred, their anger and despair.
At first Carol seems to thrive in the ultra-protective bubble of Wrenwood, but it also encourages her neurasthenic terror of the world. She retreats further and further from other people, other possible sources of contamination. In the final scene, she’s insisted on moving to an even more extreme safe house, a pod so devoid of potentially allergenic furnishings that it resembles a prison cell. Her husband and stepson have left and she’s dressed in scrubs. Alone, she stares at her own face in the mirror, a strange bruise or blotch on her forehead. ‘I . . . love . . . you?’ she says, in a tiny voice. ‘I . . . love . . . you?’ Cut to black. Maybe she’ll get better. Maybe she won’t.
Safe tackles the same weird border between self and world that Sontag patrolled, but it’s far more resistant to simple conclusions. Is Carol sick because she’s using her body to say things she can’t, or is the outside world truly poisoning her? Is this an environmental message about the toxicity of the twentieth century or a feminist parable about the constriction of Carol’s life, her limited sphere of influence and control? ‘I’ve been under a lot of stress,’ she tells her docto
r, though the most taxing thing we see her do is order a new couch. But there’s stress and stress, the attenuating wear and tear of overwork versus the exhausting psychic fray of living the wrong life. You could view Carol as a kind of Stepford Wife version of Herman Melville’s famous character Bartleby the Scrivener: a non-participant, abruptly and inexplicably unable to perform her role, from having sex with her husband to laughing at his boss’s misogynistic stories, engaged in a form of passive resistance no less powerful for being entirely unconscious.
‘There’s nothing wrong with you, Carol,’ her doctor keeps saying. I used to see so many people like that in my own practice, armed with a diagnosis of last resort, like chronic fatigue or M.E., unaware that it was often a physician’s shorthand for saying I don’t know, or go away, the so-called dustbin diagnoses. They knew something wasn’t right, but it wasn’t showing up in tests, and they were shamed for not fitting into diagnostic categories. Sometimes it was plain they were depressed or anxious, and that their feelings were being somatised, manifesting on a physical level. But what about the woman who was so allergic to perfume she quit her job, or on the other hand the girl with amenorrhea who turned out after months to be anor-exic? There was no clean line between the emotional and the physical, no safe border between self and world.
Part of what’s so radical about Safe is that it reveals how open that boundary really is. It presents the body as a permeable vessel, not just susceptible to invasion but requiring by its very nature ongoing and risky exchange with the outside world. Carol is terrified of being swamped or invaded, whether by a disease or by people with larger and more forceful personalities than her own. The poisons she encounters damage her, but they also expose the many frightening ways in which her own body is leaky, open, uncontained. Acts like coughing and bleeding involve a body spilling out, exceeding its bounds; shaking, fitting, choking are manifestations of a body no longer under conscious control.
Though it portrays an exceptionally rarefied world, Safe is a political film. Haynes made it at the peak of the Aids crisis. It’s set in 1987 and was released in 1995, a year before the invention of combination therapy meant that being diagnosed HIV positive was no longer an automatic death sentence. Haynes was in ACT UP, the Aids activist group that fought for treatment and education, and part of his impulse with Safe was to explore the horror of being attacked by something invisible, which no one around you understands and against which even wealth is not a prophylactic. Watching it in the autumn of 2019, it was impossible not to recall Aids panic, the confusion and fear attaching to an inexplicable cough or a purple mark on the face. By the spring of 2020, images of Carol in her hazmat suit were circulating on the internet, newly resonant amidst the lockdown of Covid-19, when tens of thousands were dying across the world of a mysterious virus and invisible transmission was once again a source of global terror.
Peter, the leader of the community to which Carol retreats, is loosely based on Louise Hay, the bête noire of my years as a herbalist, who became famous in large part because of her intense and controversial involvement with Aids. As Sontag observes in AIDS and its Metaphors, in the early years of the crisis people with Aids were regarded as polluting and perverse, the markers of their disease exposing them as members of a society of deviants and pariahs, widely regarded by politicians, journalists and religious leaders as deserving their appalling fate.
Hay, on the other hand, embraced people with Aids. She hosted massive, charismatic, cathartic weekly meetings in Los Angeles called Hayrides, at which patients, carers and loved ones were encouraged to testify and share their stories. She believed the disease was caused by a lack of self-love and encouraged people to use visualisation and affirmation to strengthen their ability to fight – a strength that would, of course, be enhanced by purchasing her books and tapes. The problem was that when people did inevitably get sicker or die, it became their own fault, their failure to love themselves enough, rather than the ravaging effects of a virus on their immune system, or the political consequences of a government and health-care system disinclined to fund research and treatment.
It was Hay’s book on Aids that provided Haynes with the initial impetus for Safe. As he put it in an interview in Bomb in 1995: ‘Her book literally states that if we loved ourselves more we wouldn’t get sick with this illness. And that once you get it, if you learn how to love yourself in a proper way, you can overcome it. That’s scary. I kept thinking of the people who have no answers to their situation and who turn to this.’ In a different interview that same year, he asked precisely the question that had baffled Sontag: ‘Ultimately, what was it in people who were ill that made them feel better being told that they were culpable for their own illness than facing the inevitable chaos of a terminal illness?’
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There’s no one I can think of who more clearly articulated an answer to this question than the writer Kathy Acker. Like Sontag, Acker was diagnosed with invasive breast cancer in her forties. Unlike Sontag, she refused chemotherapy, pinning all her hopes on alternative medicine. She had absolute faith in the meaningfulness of disease, right up until it killed her.
The first time she found a lump in her breast was in 1978, when she was thirty-one. A biopsy revealed it was benign, but an overspill of terror ran into Blood and Guts in High School, the novel she was working on at the time. Two things especially stood out. Cancer was political, since the doings of the body, particularly a woman’s body, were always political. And cancer was inextricably bound up with reproduction, a horrible simulacrum of pregnancy that provoked the question of how you care for and tend the body. (‘A demonic pregnancy,’ Sontag called it that same year.)
There were more scares in the decades ahead, always benign. And then in April 1996, around the time of her forty-ninth birthday, she found another lump. Although she was by now an acknowledged star of the avant garde, it was a perilous time. Her books weren’t selling well and she had taken an adjunct teaching job at San Francisco Art Institute. This time, the biopsied cells were malignant. The tumour was five centimetres in diameter, but the doctor believed it was unlikely to have spread. Acker was offered several choices, including a lumpectomy and radiation. She decided on a double mastectomy, double because she didn’t want to have one breast. A few days after the surgery, she was given the results. Six out of eight lymph nodes tested were cancerous. All of us are going to die, the surgeon said flatly.
She refused chemotherapy and radiation, even though she now knew for certain the mastectomy had failed to excise all cancerous cells. She believed the lymph nodes were the body’s filter and that the cancer had accumulated there because it was leaving, not proliferating. Like Carol in Safe, she seceded from conventional medicine, putting her faith in a retinue of alternative healers, two of whom would later be indicted for medical fraud (her acupuncturist refused to treat her, saying acupuncture could not cure cancer). She severed relationships with friends who disagreed with her decisions. As for the surgeon, she never contacted him again.
Among the therapists she consulted was Georgina Ritchie, a certified Louise Hay healer, who informed her in a session of past-life regression that her mother had tried to abort her. She told Acker that health was based on forgiveness, that she needed to forgive herself. She told her, à la Reich, that disease was trauma, a blockage caused by the scars of past events. ‘A healthy person’, she said, ‘is one who can say, “I no longer have scars from the past that will keep me from doing what I have to do today.” ’ She made Acker sit on the floor, clutching a stuffed pig, her body rigid, plunged back into the memory of being an unloved infant. It seemed the past lived on inside what she called her emotional body. It was just as Reich had predicted: ‘a piece of life history which is preserved in another form and is still active.’
The experience of illness was bringing back old feelings, aspects of her dismal childhood she’d never properly dealt with, despite the fact that they provided the atmosphere and architecture of all her books. A striking fe
ature of Acker’s fiction is that it’s populated by alter-egos – Janey, Pip, Hester, Eurydice, Electra, O – who remain abject little girls no matter how old they are, abandoned, unloved, precociously sexualised, lost in a psychic landscape that is filthy, dangerous and often deadly. The lineaments of her own family recur in novel after novel, a repeating cast itemised in Chris Kraus’s illuminating biography After Kathy Acker as ‘a girlish mother, a boorish stepfather, a wealthy but disappeared biological father.’
The odd thing about this familial dynamic is that it was also shared by Sontag. Like Acker, Sontag was a poor little rich girl, emotionally impoverished despite erratically plentiful financial resources. Though they took up opposing poles in the cultural landscape, one the epitome of reason and the other a prophetess of chaos, they carried the burden of startlingly similar origin stories. Both women were born in New York City to wealthy Jewish families (Kathy’s family on her mother’s side, the Weills, had made a fortune as glove makers). Both had unhappy relationships with their mothers, were brilliant students, took refuge in their intelligence, were unpopular, lonely children. Both got married when they were still in their teens, and soon discarded their first husbands. Both were bisexual, and both converted themselves by an act of pure will into icons, instantly recognisable, though not perhaps that easy to get close to.