In her 1978 book, "Illness as Metaphor," Susan Sontag argued that societal myths and metaphors surrounding disease can kill. How? By instilling shame and guilt in the sick. Sontag was the first writer to point out the basically accusatory tone of the metaphors we use to describe illness and its causes, as well as the essence of its cure. Examples she cited included tuberculosis, which was once popularly thought of as an illness that afflicted only individuals with delicate temperaments. Because they were supposedly constitutionally weak, these individuals were prone to wasting away. Accordingly, the "cure" for tuberculosis involved "rest" -- a prolonged stay in a sanatorium.
Sontag applied the same reasoning to debunk what she thought were myths surrounding cancer: It is not a curse or punishment, she argued. Our personality does not make us more or less likely to get cancer, and its successful treatment is not essentially a matter of our outlook. We do not get cancer because we are angry, or because we are lacking in some spiritual quality. To quote Sontag, "Theories that diseases are caused by mental states and can be cured by will power are always an index of how much is not understood about a disease." That was true for tuberculosis in the 20th century, and it is true today for cancer. Despite that truth, some cancer patients -- and in particular those who have been diagnosed with metastatic breast cancer that has spread to other organs -- continue to experience what amounts to a societal stigma. Consider the following correspondence between me and Ellen, who has metastatic breast cancer:
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Skin cancer is the most common of all cancers, afflicting more than two million Americans each year, a number that is rising rapidly. It is also the easiest to cure, if diagnosed and treated early. When allowed to progress, however, skin cancer can result in disfigurement and even death.