The Country of the Ill

Illness and Culture in the Postmodern Age. By David B. Morris. Berkeley, Calif.: University of California Press, 1998. 345 pages. $42.50.

IN HER GROUNDBREAKING BOOK, Illness as Metaphor, SUSAN SONTAG DEFINED illness as both the landscape of biological disease and a socially constructed system of meaning. Together, biology and culture created another country, "the kingdom of the ill," a country one could enter at any time, perhaps never again receiving the return passport for the "kingdom of the well." ¹ Sontag's book was a philosophical meditation on the cultural meanings ascribed to tuberculosis and cancer (and, in a second edition, AIDS). She chose not discuss her own experience of cancer, which had been the original spark for her researches.

Since then, however, we have seen more and more books by both doctors and patients that intertwine personal experience with cultural analysis. Some prominent examples are: Arthur Kleinman's The Illness Narratives, Audre Lorde's The Cancer Journals, Kay Redfield Jameson's An Unquiet Mind, and Arthur W. Frank's At the Will of the Body: Reflections on Illness and The Wounded Storyteller: Body, Illness, and Ethics. ² In At the Will of the Body, Frank makes an important distinction between "disease" and "illness" that is helpful to cultural analysis. Disease is the supposedly "objective" phenomenon of the malfunctioning body--defined by "medical talk" that "uses disease terms that reduce the body to physiology"; disease makes "my body, my ongoing experience of being alive, [become] the body, an object to be measured and thus objectified." Illness, in Frank's definition, is the subjective "experience of living through the disease," an experience that is shaped both by medical treatment and cultural attitudes. ³ Thus, in order to describe his experience of cancer as illness, Frank devotes one chapter to chemotherapy (required by the disease) and another to stigma (socially connected to the illness):

Whenever I told someone I had cancer I felt myself tighten as I said it. Saying the word "cancer," my body began to defend itself. This did not happen when I was having heart problems. A heart attack was simply bad news. But I never stopped thinking that cancer said something about my worth as a person. This difference between heart attack and cancer is stigma. (91)

The distinction between disease and illness resembles that between sex and gender, body and race, differently functioning bodies and disability, symptom and diagnosis--a physical phenomenon intertwined with a social and cultural system of signification. ⁴ Although intellectually we may separate the biological and the cultural--after all, we have different words for these realms--in reality biology and culture are so interpenetrated that an individual's felt experience of disease/illness is shaped by both.

In Illness and Culture in the Postmodern Age, an invigorating, synthetic work which intertwines postmodern theories of culture and representation, the social history of medicine, and contemporary cultural analysis, David B. Morris, author of The Culture of Pain, looks at the ways in which illness is always "in part created or interpenetrated by culture." ⁵ He acknowledges that currently "a science-based biomedical model" of illness still dominates that "reduces illness to the operation of mechanical processes" (what Arthur Frank calls "medical talk") (4). This prevailing medical view wants to separate biology from culture and view physical or mental impairments as body-based disease. In this book, Morris--who placed the experience of pain in a cultural and historical context in his previous book--wants to challenge the hegemony of the biomedical model, contending that "Illness is always constructed at the crossroads of biology and culture" [italics mine] (5). This is, he contends, a "historically new way of understanding illness" that has begun to emerge during the last half of the twentieth century (5). Here he is overlooking earlier theorists of "biocultural" understandings of illness, including nineteenth-century American physicians like George M. Beard who viewed the major source of neurasthenia as the speeded...