by Peter Watson
Such debate, bitter at times, has often made cancer seem far more dreadful than other diseases, and it was this that provoked Susan Sontag, herself recovering from cancer, to write the first of two celebrated essays on illness. Her chief argument in Illness as Metaphor (1978) is that disease in general and cancer in particular in the late twentieth century is used as a metaphor for all sorts of political, military, and other processes, which demonise the illness and, more to the point, separate the sufferer from her/his family, friends, and life.19 In many combative passages, she compares cancer now to TB a few generations ago. Illness, she says, ‘is the night-side of life, a more onerous citizenship.’20 There is, or is supposed to be, something uniquely frightening about cancer, so that even today, in France and Italy, it is still the rule for doctors to communicate a cancer diagnosis to the patient’s family, not the patient. Since getting cancer jeopardises one’s love life, chances of promotion, or even a job, people learn to be secretive. In literature, she points out, TB represents disintegration – it is ‘a disease of liquids’ – whereas cancer symbolises degeneration, ‘the body tissue turning to something hard … a demonic pregnancy.’21 TB affects the lungs, the ‘spiritual’ part of the body, whereas ‘cancer is notorious for attacking parts of the body (colon, bladder, rectum, breast, cervix, prostate, testicles) that are embarrassing to acknowledge.’ Having a tumour generally arouses some feelings of shame, but ‘in the hierarchy of the body’s organs, lung cancer is felt to be less shameful than rectal cancer.’22 The most striking similarity between TB and cancer, she says, is that both are diseases of passion – TB a sign of inward burning, romantic agony, whereas cancer ‘is now imagined to be the wages of repression.’ Surveying a wide range of literature from Wings of the Dove to The Immoralist to The Magic Mountain to Long Day’s Journey into Night to Death in Venice, she finds the transformation of TB, a dreadful disease, into something romantic as ‘preposterous,’ a distortion as she sees it, and one that she does not want repeated with cancer.
Illness as Metaphor, provoked by Susan Sontag’s own experience, was described by Newsweek as ‘one of the most liberating books of our time.’ In AIDS and its Metaphors, published a decade later, in 1989, Sontag returned to the attack.23 AIDS she saw as one of the most ‘meaning-laden’ of diseases, and her aim was to ‘retire’ some of the many metaphors it had acquired. Sontag wanted – fiercely – to combat the aspect of punishment that was attaching to AIDS, to challenge ‘a predictable mix of superstition and resignation [that] is leading some people with AIDS to refuse antiviral chemotherapy.’24 She reserved special venom for those like the Christian right who argued that AIDS was a retribution for the sins and indulgences, the ‘moral laxity and turpitude,’ of the 1960s, and for those above all who were homosexual, understood as in some way abnormal. This Kulturkampf, she said, went beyond America. In France, where she lived part of the time, one right-wing politician had dismissed certain opponents as sidatique (‘AIDS-ish’), or as suffering from ‘mental AIDS.’ But, she asked, could not AIDS better be understood as a capitalist-type disease of the consumer society in which ‘appetite is supposed to be immoderate…. Given the imperatives about consumption and the virtually unquestioned value attached to the expression of self, how could sexuality not have come to be, for some, a consumer option: an exercise of liberty, of increased mobility, of the pushing back of limits? Hardly an invention of the male homosexual subculture, recreational, risk-free sexuality is an inevitable reinvention of the culture of capitalism.’25 She thought that the metaphors of AIDS have diminished us all. They have, for example, helped introduce the sad form of relationship that appeared in the late 1980s – telephone sex, which had the merit, if that is the word, of being safe. We have been further diminished by the widespread campaigns for the use of condoms and clean needles, which, she said, are ‘felt to be tantamount to condoning and abetting illicit sex, illegal chemicals.’26 It was time to understand illness, cancer, and AIDS for what they are: diseases of the body, with no moral or social or literary layers of meaning.
Other factors helped account for the changing perception of AIDS. Also relevant was the nature and quality of the victims themselves. When the Hollywood Reporter ran an item of news in its issue of 23 July 1985 saying that the handsome film actor Rock Hudson was suffering from AIDS, the illness finally received the publicity that in truth, given its killing power, it deserved.27 But in addition to being the first AIDS victim most people had heard of, Hudson was also significant in being an actor. Over the following years, the arts and the humanities lost hundreds of bright lights as, despite the isolation of the virus responsible, AIDS took its toll: Michel Foucault, philosopher, June 1984, aged fifty-seven; Erik Bruhn, ballet dancer, 1986, aged fifty-eight; Bruce Chatwin, travel writer, January 1989, aged forty-eight; Robert Mapplethorpe, photographer, March 1989, aged forty-two; Keith Haring, graffiti artist, February 1990, aged thirty-one; Halston, fashion designer, March 1990, aged fifty-seven; Tony Richardson, film director, November 1991, aged sixty-three; Anthony Perkins, actor, September 1992, aged sixty; Denholm Elliott, actor, October 1992, aged seventy; Rudolf Nureyev, the most famous dancer of his day, who had defected from Russia in 1961, who had been director of the Paris Opera Ballet and danced for every leading company in the world, in January 1993, aged fifty-four. No disease this century has produced such carnage in the intellectual and artistic field.28
Carnage of a different kind took place in the psychiatric ward. On 29 March 1983 Dr John Rosen surrendered his medical licence in Harrisburg, Pennsylvania. He did this in order to avoid being tried by the State Board of Medical Education and Licensure of the Department of State of Pennsylvania, which was preparing to accuse him of sixty-seven violations of the Pennsylvania Medical Practices Act and thirty-five violations of the rules and regulations of the Medical Board.29 Some of the abuses Rosen had subjected his patients to were horrific, none more so than in the case of Janet Katkow, who was taken to see him by her parents (the following details are taken from court documents, part of the public record). On their very first meeting, in front of her parents, Rosen asked Katkow if she had enjoyed her first sexual experience. She did not reply. When she expressed the wish to return to her home in the mountains of Colorado, he immediately made a ‘deep interpretation’ and explained that the snow-capped mountains were ‘the next best thing’ to ‘a breast filled with mother’s milk.’ ‘Defendant then told Plaintiffs mother that he had something better for Plaintiff to suck on and he simultaneously patted his groin with one hand.’30 For the next seven years, Rosen forced Katkow to suck his penis during therapy. These sessions were invariably followed by vomiting on her part, which, he explained, was her throwing up her mother’s milk. Another patient of Rosen’s, Claudia Ehrman, who was treated by two of his assistants, was found dead in her room on 26 December 1979, having been heavily beaten, it emerged, by the assistants as part of therapy, in ‘an attempt to force her to speak to them.’
An account of Dr. Rosen’s extraordinary theories and practices, known in the psychiatric profession since 1959 as ‘direct analysis,’ and which culminated in the 102 charges against him being dropped, in exchange for his licence, forms the central chapter of Jeffrey Masson’s book Against Therapy, published in 1988. Masson had himself trained as a psychoanalyst and was briefly projects director of the Sigmund Freud Archives, but he came to the conclusion that there was something very wrong with psychotherapy, whatever its genealogy. Masson’s was an attack on psychoanalysis from a direction not seen before – that it was by definition corrupt and thereby irreconcilably flawed.
Masson began his book by going back to Freud himself and reexamining the very first patient, Dora. Masson’s argument was that Freud had his own problems that he brought to the sessions with Dora, that they interfered with his interpretation of her condition, that she understood him every bit as well as he understood her, and that Freud ‘simply ignored her needs in the service of his own, which was to find more evidence for the correct
ness of his psychological theories.’31 In other words, psychoanalysis was flawed from the very beginning. From there, Masson moved forward, examining Sandor Ferenczi’s secret diary (not published until 1985, although he had died in 1933), which showed that he too had had his doubts about the therapeutic relationship, to the point of even considering a variant, namely ‘mutual analysis,’ in which the patient analyses the therapist at the same time that the therapist is analysing the patient. He also looked at Jung’s involvement with the Nazis, his anti-Semirism, and his mysticism, once again finding that Jung, like Freud, was an authoritarian, reading his own thoughts into whatever stories his patients told him, on the basis that the therapist is healthy, devoid of neuroses, and the patient is in this sense unclean. Masson also looked at the newer therapies, of Carl Rogers, for example, at Fritz Perls’s Gestalt therapy, and the work of Rollo May, Abraham Maslow, and Milton Erickson.32 Everywhere he found a great deal of authoritarianism and, more perniciously, a great concern with sex, especially sex within the therapeutic relationship. For Masson, it was clear that with many therapists the therapeutic situation served their needs as much as, or more than, the needs of the so-called patients, and for this reason he thought that therapy per se was impossible, that this is why the figures showing the inefficacy of psychoanalysis had to be right.
Much wittier than Masson’s attack was Ernest Gellner’s in The Psychoanalytic Movement (1985), which must rank as one of the greatest intellectual putdowns of the century.33 Gellner, born in Paris in 1925 and educated in Prague and England, became professor of both philosophy and sociology at the London School of Economics, then William Wye Professor of Social Anthropology at Cambridge. The subtitle of his book was ‘The Cunning of Unreason,’ and nothing in psychoanalysis – no non sequitur, no inconsistency, no piece of sloppy reasoning or logical laxity, no hypocrisy – was allowed to escape. His chief target is the unconscious, which he says is the new version of original sin.34 Its official principle, he says, in only one of many wonderful belittlings, is ‘Softlee Softlee Catchee Unconscious.’ It is as if, he says, there is an Unconscious Secrets Act; the unconscious is not merely hidden from consciousness but seeks actively to remain so.35 ‘Neither intelligence nor conscious honesty nor theoretical learning in any way increase the prospects of by-passing and surmounting the counter-intelligence ploys of the Unconscious.’36 By some strange set of events, however, Freud was able to break down this seemingly impregnable barrier and passed on the secret to others in a secular Apostolic Succession. But, asks Gellner, if the unconscious is so clever, why didn’t it see Freud coming and disguise itself even more thoroughly? Gellner’s aim was not simply to return to the statistical arguments against cure by psychoanalysis, however, but to debunk it. He quoted the Nobel Prize winner Friedrich von Hayek: ‘I believe men will look back on our age as an age of superstition, chiefly connected with the names of Karl Marx and Sigmund Freud.’37 Yet Gellner really had no need of help from others. ‘The Unconscious,’ he wrote, ‘is like some low hostelry just across the border, where all the thieves and smugglers indulge themselves with abandon, free of the need for camouflage and disguise which they prudently adopt, for fear of the authorities, when they are this side of the frontier … [The unconscious] is like meeting all one’s friends, enemies and acquaintances, but at the carnival and in fancy dress: one may be a bit surprised at what they get up to but there are few … surprises as to personnel.’38
Freud was not alone in being debunked. At the end of January in 1983 the New York Times ran a front-page story headed: ‘NEW SAMOA BOOK CHALLENGES MARGARET MEAD’S CONCLUSIONS.’ The book was the work of the New Zealand-born Australian anthropologist Derek Freeman, who had been working in Samoa since 1940, mostly in an area some 130 miles from Ta’u, the village where Mead had done her fieldwork. His conclusion was that Mead had completely misunderstood Samoan society, and by implication drawn the wrong conclusions. The Samoans, said Freeman, were just as troublesome as people anywhere, and they had ‘resented the way they were portrayed in Coming of Age,’ as simple, playful people for whom sex was largely a game and whose nature was very different from that of people in other cultures.39
The New York Times story ran for 47 column inches, occupying almost a page inside the paper, and ignited a furious debate. Harvard University Press brought forward publication of Freeman’s book Margaret Mead and Samoa: The Making and Unmaking of an Anthropological Myth, and he was invited on to television programs all over America. Several scientific seminars were held to consider his findings, the most important of which was a meeting of the American Anthropological Association.40 Here Freeman’s motivation was called into question. It was noted that he had hitherto been an obscure academic, working in Samoa by his own admission since 1940. Could he not have presented his arguments before, while Mead was alive to defend herself? He replied that he had put his preliminary doubts to her, and she had acknowledged certain shortcomings in her data, but it was not until 1981, when he was granted permission to examine Samoan court records, that he could conclude that Western Samoa was just as violent a society as elsewhere.41 Other anthropologists doubted Freeman’s account at this point; they had had no problem getting access to court records many years before. A bigger issue, however, was where Freeman’s revelations, if revelations they were, left Franz Boas’s ideas that culture, and not nature, is more important in determining behaviour patterns. Freeman was not himself a biological determinist, but there is no question that if he was right, his revision of Mead’s findings provided support for a less ‘cultural’ understanding of human nature. The issue was never satisfactorily resolved, but Mead, like Freud, now has a definite shallow over her seminal work (no one doubts that many of her other findings were real).
In 1997 Roy Porter published The Greatest Benefit to Mankind: A medical history of humanity from antiquity to the present. In his chapter on clinical science, Porter quotes Sir David Weatherall, Regius Professor of Medicine at Oxford. Weatherall, as Porter reports, asked of modern medicine this question: How are we doing? and reached a surprisingly sombre conclusion. ‘We seem to have reached an impasse in our understanding of the major killers of Western society, particularly heart and vascular disease, cancer and the chronic illnesses whose victims fill our hospitals…. Although we have learned more and more about the minutiae of how these diseases make patients sick, we have made little headway in determining why they arise in the first place.’42
Weatherall’s scepticism is realistic; his argument is well made. Triumphalism in science is unscientific. The same goes for the revisions of Freud, Jung, and Mead. The irony – and absurdity – of having a therapeutic sensibility when the therapies don’t work cannot escape anyone. Porter’s own conclusion, after his masterly survey of medicine, was hardly less pessimistic than Weatherall’s: ‘The root of the trouble is structural. It is endemic to a system in which an expanding medical establishment, faced with a healthier population, is driven to medicalising normal events like menopause, converting risks into diseases, and treating trivial complaints with fancy procedures. Doctors and “consumers” are becoming locked within a fantasy that everyone has something wrong with them, everyone and everything can be cured.’43 This is one explanation, of course, for why the ‘cure rates’ for psychoanalysis are so dismal. Many who seek analysis have nothing wrong with them in the first place.
38
LOCAL KNOWLEDGE
In 1979 the U.S. space probe Pioneer 11 reached Saturn and travelled through its surrounding rings, which were found to be made of ice-covered rocks. The business use of personal computers was vastly expanded after the first software for spreadsheets was introduced. In the same year the Phillips Company launched its Laser Vision video disc system, and Matsushita brought out its pocket-size flat-screen TV set. Physicists at Hamburg observed gluons – elementary particles that carry the strong nuclear force that holds quarks together. Science and technology were continuing to make impressive advances, though there was one blot on the la
ndscape – almost literally, in the form of a major accident at the Three Mile Island nuclear power station in Pennsylvania, which lost its water buffer through operator error, allowing the escape of a small amount of radioactive material, with the reactor itself undergoing a partial meltdown. No one was injured, but everyone was chastened.
Although science was, far more often than not, offering material advance and intellectual excitement for those who wanted it, by 1979 there were also many countervailing voices. This was not simply antiscience in the old-fashioned sense, of the creationists, say, or the religious fundamentalists. By the end of the 1970s the critique of science, the scientific method, and science as a system of knowledge had become a central plank in postmodern thinking. The Postmodern Condition, by Jean-François Lyotard, was the first in a whole raft of books that began to question the very status of science. It is important to give the subtitle of Lyotard’s book, ‘A Report on Knowledge’, for he was a French academic, at the Institut Polytechnique de Philosophie of the Université de Paris VIII (at Vincennes), who was commissioned by the Conseil des Universités of the government of Quebec to prepare an investigation.’ Though a philosopher, Lyotard had begun adult life in postwar Paris as a left-wing political journalist. Later, while completing his academic qualifications in philosophy, he had developed an interest in psychoanalysis, trying to marry Freud and Marx, as so many colleagues were doing, and in the arts. His early writing he had grouped into the ‘The Libidinal,’ ‘The Pagan,’ and ‘The Intractable.’2 The first category clearly carried psychoanalytic overtones, but beyond that the use of the libidinal was meant to imply that, as he viewed the world, motivating sources were personal, individual, and even unconscious, rather than overtly political, or deriving from some particular metanarrative. Similarly, in using the term pagan, Lyotard intended to imply not so much false gods as alternative gods, and many different varieties, that one’s interests in life could be satisfying and rewarding even when they had nothing to do with the official, or most popular ‘truths.’ By intractable he meant that some areas of study, of experience, are simply too complex or too random ever to be predicted or understood.
