Cultural Identity and Metaphors of Disease in Literature

224 Cultural Identity and Metaphors of Disease in Literature María Victoria Utrera Torremocha Abstract: This article argues that the vision of illness in literature is a sign of cultural identity. In this sense, disease in literature corresponds to a cultural and social model and often becomes a metaphor that identifies social problems and deficiencies or that claims personal authenticity. Whether collective or individual, metaphors for disease in literary and non-literary discourses point to a series of ideological and value implications that are rooted in a given culture. Keywords: illness, metaphor, culture, literature, identity. Metaphorical generation and interpretation are processes generated by the cultural aspect of Rhetoric, and are therefore related to the field of Cultural Rhetoric (Albaladejo, 2013; 2019a; 2019b), which is itself linked to General Textual Rhetoric (García Berrio, 1984) and to Studies in Culture (Albaladejo, 2019c: 562). Within this theoretical framework, the present study focuses on certain cultural aspects of disease as a rhetorical device in literary texts (Albaladejo, 2019c: 563). Scientific knowledge and, more specifically medicine, has traditionally featured as a socio-cultural reference in many essays and literary texts. On October 12, 2020, on the occasion of Spain’s National Feast, the traditional military parade was replaced by an austere celebration at the “Plaza de la Armería”, within Madrid’s Royal Palace, just the site where the victims of coronavirus had been honored earlier on, in July. Members of the Spanish Royal Family along with some of the highest authorities in the country were present at that event, even if their number had been limited because of the pandemic. Some representatives of the Spanish National Health Service attended the celebration too. The role of health workers, already hailed as heroes in the July tribute to the virus casualties, had also been emphasized by journalists and politicians throughout 2020. The fact that health workers were asked to attend a military event points to a warlike view of the COVID-19 pandemic, a view also held by people in other countries. Doctors and nurses, together with such public servants as members of the police or the fire department, were regarded as soldiers at war against a virus in an unevenly matched combat, the sick and the dead 225 being their casualties. A tweet from the Ministry of Defense—whose minister is Margarita Robles—confirmed that the country’s top priority was war against COVID, a struggle in which all citizens should be involved in order to overcome the disease. Various foreign leaders shared a similar view. Ms. Angela Merkel, for instance, in her speech of March 18, 2020, pointed out that the new virus was Germany’s greatest challenge since World War II. War imagery has a long tradition in the medical and artistic fields. Various metaphors have been employed to explain a disease’s process. In medical terms, the presence of a pathogen is often viewed as an invader, an enemy the immune system tries to repel with the help of drugs. Literature has repeatedly dwelled on the idea of disease as an invader that has to be driven out. Epidemic stories all seem to point in that direction, as it will be shown below. If the war metaphor with regards to COVID-19 is deeply ingrained in society, the same rings true for other diseases like cancer, mental illness or AIDS. Nevertheless, in the case of coronavirus, as in other types of plagues, war images are not only employed to refer to the very individuals who have to fend off the sickness, but to all members of society, at war against a common enemy. Hence, the politicians’ constant calls for patriotic unity and solidarity in order to defeat such serious threat. This idea is certainly linked to that of a welfare state in which health is considered a common good, the individual is regarded as being part of a strong social framework and scientists are considered trustworthy. In other types of societies however, it is a common belief that nature must take its course and people should overcome all diseases or plagues either by praying to their gods or through their own physical resources. Contrary to our own enlightened, modern approach, a primitive, naturalistic view prevails in those societies. Failure at acknowledging the disease or its medical treatment may have another, more pragmatic origin: the belief that economic gain and the functioning of the current global system are placed well above any personal interest. In those cases, there is a certain ideology that permeates all discourses. In this manner, the disease itself and the way people deal with it become a social and ideological issue. Philosopher and psychiatrist Karl Jaspers explains the influence exerted by certain diseases at some specific moments in history, and the way 226 disease is viewed depending on the cultural background. With regards to schizophrenia, for instance, he discusses the impact of some schizophrenic artists and writers on twentieth-century aesthetics. Whereas hysteria had been considered of paramount relevance in the past, up to the 18th century—the case of Saint Teresa, for instance—the spirit of the modern age—more prone to dreams and to the mysterious, the inner life and the primitive—became more interested in schizophrenia (Jaspers, 2001: 258). The significance and the very meaning of disease may vary according to current social and cultural values. A similar approach is held by Michel Foucault in his historical and social study of madness (Foucault, 1964). In this regard, as Karl R. Popper (1994) points out, all studies and facts relating to medicine should be viewed within its own historical context, and the relationship between subjectivity and objectivity should be considered as well. As Luis Rojas Marcos highlights, our cultural background determines the way we perceive our experiences. He considers that such feeling as optimism is presented in a negative light in Europe, owing to a long philosophical tradition: Hobbes, Hume, Voltaire, Kierkegaard, Kant, Nietzsche, Heidegger, Ortega y Gasset, Sartre, and so on. Similarly, “la visión de la enfermedad y las metáforas que se generan a partir de ella tienen un profundo asiento cultural” (Rojas Marcos, 2020b: 36). 101 In this regard, the difference between hysteria and neurosis, linked respectively to women and men, the concept of madness and melancholy in relation to creativity, or the connection of epilepsy to sacredness, are clear instances of that. In many cases, disease achieves a special, social, communal significance that turns its very concept into 101 “The view of disease and the metaphors that go with it are ingrained in their own cultural background” (the author’s own translation). Rojas Marcos states in a recent interview: “Ejemplos de enfermedades de reconocimiento relativamente reciente con profundas connotaciones sociales y culturales incluyen el SIDA, la demencia de Alzheimer, la anorexia, la bulimia, la obesidad, las adicciones y el TDAH. El significado de estas dolencias y su tratamiento hacen brotar un sinnúmero de enjuiciamientos y debates basados en costumbres, valores sociales y principios culturales. Y esos juicios o prejuicios varían dependiendo de la enfermedad en cuestión, así como la edad, el sexo, el estado civil y la clase social del paciente que la sufre.” (Rojas Marcos, 2020a: 222-223). “Examples of newly acknowledged diseases with deep social and cultural connotations include AIDS, Alzheimer’s dementia, anorexia, bulimia, obesity, addictions, and ADHD. The significance of these ailments and their treatment give rise to countless opinions and debates based on customs, social values and cultural principles. Those opinions and prejudices vary depending on the type of disease, and also on the patient’s age, sex, marital status and social class.” (the author’s translation). 227 a sign of individual character, activity or social paralysis. Needless to say, this view helps create new metaphorical constructs from specific diseases. Certain metaphors help explain the disease and its functions—the war images with regards to COVID-19, for instance—but the disease itself can also be used as a social or individual metaphor. Political and social unrest is commonly expressed through disease images. In this regard, José Ortega y Gasset describes Spain’s historical problem, that of being a fragmented, decadent society, as a disease –the “grave enfermedad que España sufre” 102 (Ortega y Gasset, 2002: 89). Spain’s lack of moral values and, above all, its lack of a united national spirit together with its hatred of its most gifted citizens seem to be some of the symptoms of that disease. In Ortega y Gasset’s opinion, Spain would have never been truly healthy, its decay originating in the “alma misma de nuestro pueblo” 103 (Ortega y Gasset, 2002: 207). Thanks to the medical discourse, the idea of disease as a sociopolitical image is a recurrent feature in the Western literary tradition. In the Hippocratic tradition, health has to do with man’s inner balance of the bodily humors, and also with the harmony between man and nature. 104 Likewise, illness is the result of internal and external disorder. Even if Plato states in Phaedrus that the sole concern of the Hippocratic medical view is the body itself, Hippocratic physicians did also pay attention to the psyche and to man’s environmental circumstances, as it may be noticed in such treatises as On the Nature of Man or Regime. In this regard, inner and physical balance is linked to moral conduct. According to those approaches, sickness is related to physical or mental imbalance, to an outburst of emotion, or to any other type of natural or social disorder. As is patent in Greek tragedy, hybris not only drives man to personal destruction, but also to disease. So, it is not surprising that disease, originated in external or internal disorder, can be linked to a sinful, decadent, immoral conduct (Laín Entralgo, 1982: 88-89). Its 102 The “serious disease Spain suffers from” (the author’s translation). 103 The “very soul of our people” (the author’s translation). 104 By means of the theory of humors, Hippocratic physicians highlighted several basic human types: phlegmatic, choleric, sanguine and melancholic. This theory had followers in many physicians and thinkers of the Middle Ages and the Renaissance. A well-known example is humanist and physician Juan Huarte de San Juan (Torre, 1977: 101-102; 1984: 127-128). 228 use as an image for social and personal imbalance has certain moral, ideological, political and aesthetic connotations. Beyond any individual consideration, the classical approach to illness as a moral problem also applies to plagues or epidemic diseases. In the Hippocratic works (Epidemics, for instance), a plague is explained as an imbalance of the social environment. In On Airs, Waters and Places, attributed to Hippocrates, for instance, a line is drawn between Europeans and Asians, as they differ from one another depending on several factors of which climate and geographical location are essential (López Ferez, 1986; García Gual, 1983). Not surprisingly, classical literature attributes the origin of plagues and epidemics to Eastern countries. The moral notion of disease and particularly of plagues is quite evident, for example, in Thucydides whose History of the Peloponnesian War mentions a plague originating in Ethiopia that ravaged Athens in 430 BC. The Athenian epidemic broke out in the midst of such natural phenomena as solar eclipses, droughts and earthquakes. Thucydides describes in great detail the terrible symptoms and the effect the disease had on the Athenians, often resulting in cases of improper or immoral behavior. A similar view on plagues recurs in various other works. The narrative frame of the Decameron, for instance, dwells on the moral attitude of the Florentines with regards to the plague of 1348. The ethical aspect of diseases and plagues very often involves the commonplace topic of divine punishment. Susan Sontag has studied the influence that moral prejudices exert on the origin of plagues and epidemics, very often regarded as punishments inflicted upon corrupt societies. That topic, which recurs in various books of the Bible, is found in some classical works too. A plague, viewed as divine punishment, is described in Samuel (II, 24). Similarly, when Agammenon offends priest Crises’s daughter in the first canto of the Iliad, Apollo takes revenge by sending a devastating plague on the Achaeans. The plague is presented as divine punishment for the unpunished murder of Laius in Sophocles’ tragedy Oedipus Rex. Sontag, who has dedicated several works to the study of the disease imagery both in literature and in real life, focuses mainly on such diseases as AIDS, syphilis and cancer, but she offers an overview of disease as a recurrent topic in Western literature and thought (Sontag, 1990: 39-40). 229 The moral issue is a common topic in most epidemic stories (Sánchez Lozano, 2019: 53ff.). A favorite topic with regards to diseases that result in death is that of the plague. Owing to its horrifying death toll the very term plague has become synonymous with all sorts of collective disasters, 105 to the extent that it is employed as a synecdoche to refer to other epidemic diseases, such as cholera or AIDS. That is the case, for instance, of Gabriel García Márquez’s One Hundred Years of Solitude, as the inhabitants of Macondo suffer from the insomnia plague. Epidemic stories usually address the topic of man’s mortal nature which is normally cast in a mythical, tragic light, with some obvious moral implications. That is quite evident, for instance, in Daniel Defoe’s A Journal of the Plague Year (1722), which deals with the outbreak of the bubonic plague in London in 1665, in Alessandro Manzoni’s The Betrothed (1827), about the 1630 Milanese plague, or in Poe’s allegorical tale “The Mask of the Red Death” (1842) ; 106 also in Thomas Mann’s Death in Venice (1912), about cholera, in Margarite Yourcenar’s The Abyss (1968) which is set against the social background of a plague, and of course in existentialist author Albert Camus’s novel The Plague (1947) that deals with a bubonic plague in Oran. All those stories take place in the past, though there are certain dystopian narratives set in a future age, such as Mary Shelley’s The Last Man (1826), or Jack London’s The Scarlet Plague (1912) which follows in the footsteps of both Poe and Mary Shelley. Shelley’s narrative is particularly interesting, for despite its clear apocalyptic, dystopian mood, The Last Man offers certain existential, philosophical undertones which tend to be overlooked. Like other epidemic stories, its ideological message is conveyed by means of the disease imagery. In the novel, the plague becomes a metaphor for personal loneliness and also for the moral and political failure of the main characters, whose utopian goals get eventually shattered because of the pandemic and the frailty of human nature. Mary Shelley’s narrative seems to be highly critical with regards to utopian and revolutionary romantic principles, while remaining quite skeptical, in 105 Plague “has long been used metaphorically as the highest standard of collective calamity, evil, scourge … as well as being a general name for many frightening diseases.” (Sontag, 1990: 132). 106 Perhaps influenced by Manzoni, Edgar Allan Poe also wrote the allegorical burlesque tale “King Pest the First” in 1835. 230 line with the philosophy of David Hume or Immanuel Kant (Sterrenburg, 1978; Mellor, 1988: 77ff., 136; Lokke, 2003). In this regard, locating the plague in a future age makes perfect sense, for in this manner there is little room for an idyllic life, either in the past— those of the family circle—or in the future, when dealing with human and political goals. Here, as in so many other epidemic stories, disease is viewed as an external pathogen that originates in the East and then becomes a sign of total devastation. War and struggle images permeate this work in which the plague is personified as Queen of the World and Destroyer of mankind. The moral implications of the disease are quite evident in Shelley’s novel, for its characters get infected as they deteriorate in a moral and social sense. As a destroying agent, Evadne becomes a synecdoche of the physical and moral pestilence, for she interferes in Perdita and Raymond’s marriage. The plague has also a negative effect on the people’s moral attitude, for city dwellers seek immediate pleasure through dissipation, parties, and debauchery, drawing out the worst traits of human nature. In this manner, the plague becomes synonymous with the monstrous: an active monstrosity in moral degradation and collective disorder, and a passive monstrosity shown through horrible images of piled up corpses. The way the author describes space dwells on the monstrous nature of the plague itself, for in deadly, quiet, numb Constantinople, a personified pestilence rules over the city from Saint Sophia’s Church. Plague is described as a gigantic, monstrous ghost whose objective correlatives are the various natural, empty locations of the novel. As in other epidemic accounts, the disease imagery spreads over all places, since neighborhoods and cities become metonymies and metaphors for the calamity. In this regard, as in the old classical works, landscapes and locations help explain once again the extent of human calamities. The recurrent topic of epidemics originating in foreign countries is forever present. Thus, Venice becomes a labyrinthine sick city to all foreign visitors in Death in Venice; dead rats coming up from the underground invade Oran in Camus’s The Plague; the London plague in Defoe’s work comes as a visitor. The metaphorical use of disease suggests certain aesthetic implications. Mary Shelley’s ideological critique of Romanticism and her defense of balance, morality, and health are not alien to the traditional literary view of sickness. In this sense, according to Horace’s Ars poetica, artistic and literary works must be ruled by harmony and balance whereas any 231 outbursts of violent attitudes and feelings, or the chaotic world of nightmares, ought to be banned. In the Horatian poetics, mimetic consistency should rule out all absurd, meaningless images, which are significantly compared to a sick man’s dreams (“velut aegri somnia”) (Horace, 2010: 87). Thus, Horace’s aesthetics seem to run parallel to the classical medical view which recommends natural balance as the key to a healthy body, whereas chaos and disorder bring about disease. According to the logic of Horace’s poetics, it seems that aesthetics and its moral implications are directly related to the duality ancient-modern, classic-romantic. In this regard, the disease topic becomes an important aesthetic source of inspiration in literature and the arts, as disease is always a disruption of the established order and natural harmony (Aullón de Haro, 2000). That is why disease, assumed as a metaphor, may give rise to a new type of literature that breaks away from conventions and classical patterns (Utrera Torremocha, 2015). Johann Wolfgang Goethe’s distinction between the classic and the modern must be considered within this framework, for he identifies the former with health and the latter with disease in his conversation with Eckermann of April 2, 1829. The difference between classical and romantic poetry is also based on other similar concepts such as order and harmony versus chaos and disruption, an ideal beauty versus the grotesque, light versus sublime darkness and abyss, social order versus individual genius, reason versus madness, good versus evil. That is to say health versus disease. In this manner, disease achieves both a moral and an aesthetic significance. That implies that illness is cast in a positive light in the works of romantic writers, since it becomes a feature of the individual, regardless of the nature of the disease. That would also explain the artistic implications of a disease such as consumption (T.B.). According to Susan Sontag, consumption came to be regarded as beneficial since it dissolved the body but developed the mind, thus enlarging its psychological power. That is why certain authors tended to associate consumption or tuberculosis with a special sensitivity in the case of artists and writers. On the other hand, being healthy could be regarded as a banal, vulgar state. In this sense, Novalis, Blake, Poe, Gautier, Nerval, Byron, Shelley or Keats linked illness to poetic creativity, introspection and a visionary personality (Sontag, 1990: 25-31). Illness would lead to an enlightenment of the mind and, subsequently, to an open, rich imagination and creativity. 232 The new view brought about by Romantic poetics often entails the disruption of some well-established categories within the traditional literary canon, categories which up to then had been considered immutable. The relevance of concepts such as the sublime, the infinite, the unconscious, the mysterious, the hidden, dreams and nightmares brought about an idea of the arts in which chaos, disorder and the bizarre played an active role. From that moment onwards, disease, death, evil and, above all, the explicit subversion of classical balance and harmony became quite significant and got integrated into the very concept of beauty. The modern aesthetics of the antithetical, the bizarre and the grotesque supported by Victor Hugo or Charles Baudelaire must be viewed in this context, in which disease becomes an important item in a somewhat new, revolutionary literature, and both writers and artists are regarded as sick people. The new aesthetics is also linked to big cities and to the ennui of modern life (Steiner, 1971; Culler, 1989; Jauss, 1989). And that ennui becomes essential in the new writers’ identity, for it is at the very root of their own creative impulse, very much like melancholy had been in previous authors. And it is in this context that illness becomes a defining trait for the new artist. It is also an ideological and social paradigm: illness is now considered a key feature in the rebellious mood of writers and artists, who pose as revolutionary, anti-religious, forever engaged in a personal inner crisis. Ultimately, the notion of the artist as a sick man parallels that of homme révolté put forward by Albert Camus (1951). That is why disease can also be related to satanic dandyism and to the praise of evil and the strange, as can be noticed in Charles Baudelaire’s poetics of dissonance, or in Arthur Rimbaud’s visionary, wild poetics. In both cases, deformity stems from the monstrous, just precisely to show the intellectual superiority of the artist, who is a sick though untamed person. There are moral issues at stake here too, but the subversive moral of the new writers rejects all previous social and aesthetic standards. The concept of moral degeneracy associated with a sick, decadent literature is recurrent throughout the 19th century. New literary forms and the breaking away from old classical aesthetic standards are identified with imbalance and delirious linguistic expressions (Deleuze, 1993: 9), as well as with monsters, the devil and evil imagery. The new artistic goals are permeated by the outlandish, gruesome and decadent, hence the model of the decadent artist as a sick man, as may be noticed, for instance, in such emblematic decadent icon as Duke Jean Floressas des Esseintes, the main character in the novel Against Nature by 239 Pujante, D. (2018), Oráculo de tristezas. La melancolía en su historia cultural, Barcelona, Xoroi Edicions. Pujante, D. (2020), “La misteriosa relación del carácter melancólico con la excelencia de los seres humanos: genio y melancolía”, in María Victoria Utrera Torremocha (coord.) (2020), pp. 81-96. Rojas Marcos, L. (2020a), “Medicina, Ética y Literatura”, in María Victoria Utrera Torremocha (coord.) (2020), pp. 215-226. Rojas Marcos, L. (2020b), Optimismo y salud. Lo que la ciencia sabe de los beneficios del pensamiento positivo, Barcelona, Grijalbo. Sánchez Lozano, C. (2019), El tratamiento de la enfermedad y de la salud como paradigma en la novela española y alemana moderna: Pío Baroja y Thomas Mann, Madrid, Verbum. Sontag, S. (1990), Illness as Metaphor, Illness as Metaphor and AIDS and Its Metaphors, New York, Anchor Books Doubleday. Steiner, G. (1959), Tolstoy or Dostoevsky. An Essay in the Old Criticism, New York, Alfred A. Knopf. Steiner, G. (1971), “The Great Ennui”, in In Bluebeard’s Castle. Some Notes Towards the Redefinition of Culture, New Haven, Yale University Press, pp. 3-25. Sterrenburg, L. (1978), “The Last Man: Anatomy of Failed Revolutions”, Nineteenth-Century Fiction, 33, pp. 324-347. Torre, E. (1977), Ideas lingüísticas y literarias del doctor Huarte de San Juan, Universidad de Sevilla. Torre, E. (1984), Sobre lengua y literatura en el pensamiento científico español de la segunda mitad del siglo XVI, Universidad de Sevilla. Utrera Torremocha, M. V. (2015), Poéticas de la enfermedad en la literatura moderna, Madrid, Dykinson. Utrera Torremocha, M. V. (2020), “Genio artístico y locura, de Karl Jaspers. Hacia una comprensión de la totalidad psíquica creadora”, in María Victoria Utrera Torremocha (coord.) (2020), pp. 97-115. Utrera Torremocha, M. V. (coord.) (2020), Medicina, Ética y Literatura, vol. 3, Metodologías Humanísticas en la Era Digital, Madrid, Instituto Juan Andrés de Comparatística y Globalización.