by Pierre Brouard
Is it possible to have theory in an epidemic? Paula Treichler asked in the early years of AIDS.
In an essay, AIDS, Homophobia, and Biomedical Discourse: An Epidemic of Signification, Treichler argued that “AIDS is not merely an invented label, provided to us by science and scientific naming practices, for a clear-cut disease entity caused by a virus. Rather, the very nature of AIDS is constructed through language and in particular through the discourses of medicine and science; this construction is ‘true’ or ‘real’ only in certain specific ways – for example, insofar as it successfully guides research or facilitates clinical control over the illness.”
Not only was Treichler alerting us to the power of language to frame disease responses, she is suggesting that the words we use to name diseases are themselves reliant on specific social, political, cultural and global moments: through the naming we “make” and “remake” the disease, we “construct” its meaning and our response to it.
Her question about theory was, as I see it, both academic and moral. It is a valid academic duty because it is necessary to think even when we are held in thrall to a new disease – how we think can affect how we respond in the midst of the drama and panic.
And it is moral because there is a suggestion, even now as we deal with Covid-19, that to theorise is to be frivolous, an unnecessary, and even dangerous, displacement activity when so many systems have to be set up and lives in peril saved.
Someone else who brought theory to AIDS was Susan Sontag. As a 1989 review of her book AIDS and its Metaphors by Paul Robinson in the New York Times notes, “Susan Sontag’s purpose in ‘AIDS and its Metaphors’ is to show how the way we talk and think about AIDS makes the disease even worse than it actually is. The metaphorical packaging of AIDS, she argues, increases the suffering of the afflicted while creating unneeded anxiety among the population at large.”
Yes Covid-19 is contagious in ways which HIV is not, but it is worth asking if our response so far has managed or exacerbated the epidemic of anxiety we are now seeing, and enabled agency in individuals, families, communities and countries.
Sontag was building on her earlier work, Illness as Metaphor, in which she noted how language could distort perceptions of diseases and, in some instances, prevent patients from acting rationally. With AIDS she saw how certain metaphors, invoked in describing the disease, were employed with varying effects.
One metaphor was the botanical or zoological one: the disease has stages (from being infected with HIV to having “full blown AIDS”), the stages have a biological inevitability (one will die). As Robinson notes, “it is an invitation to despair, causing much misery in its own right and also diverting victims from a sensible medical attitude toward their condition.”
Sontag was trying here to combat some of the fatalism which can come from notions of inevitability. If the disease progresses in ways which seem unstoppable, or indeed if a country is seen to go through “stages” (a virus arrives and spreads, takes hold, picks off the weak and the elderly, then containment and testing follow, resulting in a situation where hospitals struggle to deal with the numbers, ending perhaps with “herd” immunity), a sense of anxiety and panic is manifest, and may even be created.
Other scholars have written about the challenges (and to be fair, opportunities) of military metaphors (we are said to be waging a “war” against the virus). When we use these metaphors of course we can talk about casualties in casual ways (Gauteng was said to be “leading the pack” in Covid-19 infections, according to a recent news report), about collateral damage in dispassionate terms, and even view those with the virus as the enemy, to be managed in ways which deny civil liberties and some key human rights.
And words which incite fear, words like “dread” and “terror” and “horror” are used quite casually in news stories. Recently our minister of health sought to challenge complacency about our relatively low number of (known) infections, warning of what was to come ahead of the upcoming flu season.
“This will flood our hospitals and clinics and create a fertile ground for the coronavirus to spread or to be masked in its presentation. This means with this small growth in numbers we may be experiencing the calm before the devastating storm. We need to be aware that there may not be many further warnings before the pounding descends…”
The words “devastating, pounding, flood, fertile ground” are profoundly emotive. Do they create panic, do they help us to feel ready, or do they induce further helplessness? Their invocation of natural disasters, acts of God if you like, carry the weight of Old Testament predictions of doom.
A second metaphor Sontag explored was the idea of AIDS as a ”plague” (in contrast to an ”epidemic,” the term she preferred).
In her view, virus as plague invoked questions of punishment, not only of the sick person but society at large. In the case of HIV, the punishment was for the moral “weakness” of those infected (not surprising since most of the early known infections were in socially marginalised gay men, sex workers and drug users), and perhaps even a sign of moral “decay” in the broader society. Many conservative religious leaders saw AIDS as God’s punishment for societal ills, including anything that strayed from the heternorm, abortion, contraception, etc.
In South Africa we have already seen examples of how communities have rounded on those identified with Covid-19, wishing to drive them out in Salem-like witch hunts. We have also seen questions of blaming and othering. Mark Gevisser, in a recent New York Times piece, speaks of how black South Africans have called this new virus a “white-man’s disease”; callers to radio stations say “white people are obeying the lockdown but not black South Africans”, implying greater moral and patriotic fibre in the former community.
Like the biological stage metaphor, the plague metaphor contributes to the aura of inevitability: ”The plague metaphor is an essential vehicle of the most pessimistic reading of the epidemiological prospects. From classic fiction to the latest journalism, the standard plague story is of inexorability, inescapability,” says Robinson.
The pessimism evident in parts of South Africa, some of the languaging in news reports here and beyond our shores (references to a “deadly” disease or “killer bug”), and the awareness that it is poorer and marginalised South Africans who are likely to be most at risk, all may lead to feelings of inevitability, and fatalism. Fatalism which can be helpful – as a coping mechanism it is a way of avoiding emotional overload – or a hindrance – in some instances it can lead to behaviour which disregards the risks to self and other.
Contrary to the depictions of some of her contemporaries, Sontag challenged the idea that AIDS was dehumanizing or degrading, even though early images of people with HIV were of men in their prime looking haggard and disfigured. We could debate this, because it is awful to imagine the inner anguish of some of the early HIV patients, but what is interesting, in the context of Covid-19, is our current media interest in images and stories which convey the idea that the social body has become degraded. Desperate patients on ventilators, field hospitals which look efficient but are often quite basic, stories of cruise ship holidaymakers trapped in their cabins as their ship sails ineffectually from port to port, awaiting permission to land, tell a story of a globe gone bad.
Of course, as Sontag said, ”one cannot think without metaphors,” so we may ask which metaphors are useful, or problematic, or at least we should be open to seeing how our metaphors may hinder or help our response. Metaphors can be well or poorly chosen. They would be poorly chosen if they misrepresented the disease, contributed to its victims’ pain or lowered the threshold for risk behaviour. They may be well chosen if they tell a story which neither diminishes individuals with a “feared” virus nor engenders panic, anxiety, helplessness and “anti-social” behaviour.