6.2 Concepts of Illness
Sontag (1979) wrote about the metaphors we use to describe illness. Metaphors are ways of speaking about something as if it were something else which is imaginatively but not literally applicable, for instance calling a new moon a sickle. Sontag was mainly concerned with life-threatening illnesses such as cancer and AIDS, and how the metaphors we use can serve to stigmatise the sufferers, for instance referring to AIDS as a gay plague. But people use metaphors to explain illness to themselves, and these metaphors can tell us a lot about how people experience and cope with illness.
In the French study mentioned in Section 2, Herzlich (1973) explored with her interviewees their concepts of illness. She found that they categorised illness in four ways:
serious, possibly fatal illnesses
trivial illnesses such as colds and flu
From her respondents’ replies Herzlich was able to identify three metaphors for illness.
The illness as destroyer metaphor was held by those who saw illness as curtailing everyday life and social interaction. For them illness was to be avoided or denied.
The illness as occupation metaphor was held by those who accepted the illness but who strove to fight against it, putting all their resources into the fight.
The illness as liberator metaphor, on the other hand, provided the opportunity to opt out of one's responsibilities and avoid stressful situations to gain sympathy.
Williams (1990) was concerned with how older people in Aberdeen cope with illness or the threat of it. Throughout his analysis, Williams reminds us that his respondents rarely operated with unified concepts, that inconsistency was the norm. What Williams does is to identify themes, patterns and dilemmas.
He found five broad premises or assumptions which were held by his respondents in considering how to cope with illness. These were as follows:
Illness as controlled by normal living:
Carrying on with everyday activities, doing housework, gardening and other essential chores was thought to keep ailments at bay without the need to take on extra physical activity. The demands of normal living also helped to prevent any condition from deteriorating.
Illness as a continuous struggle:
‘Determination’ was the key to overcoming illnesses which were restricting but not serious, such as varicose veins, breathlessness or back trouble. It was a determination not to give in to it.
Illness as an alternative way of life:
This was not a common response but there was a minority of respondents who, when faced with restrictions which could not be overcome such as failing eyesight, would listen to ‘talking books’, or if their mobility was restricted by a stroke would take up more sedentary activities.
Illness as a loss to be endured:
This was a much more negative response to illness than the first three, although it was characterised by a sense of stoicism. Being lost or finished refers to the person one once was, who has been wiped out by illness. It was often accompanied by resignation or accepting one's limitations and not hankering after activities one used to do but getting on with things it was still possible to do. This acceptance of changed and restricted circumstances helped to prevent resentment and bitterness.
Illness as a release from effort:
There was a degree of ambivalence in this last attitude between self-reproach and deservedness.
As well as these categories, Williams noted certain coherent patterns made up from these premises. One which he called ‘illness as exile’ was a combination of 1 and 4. This was similar to Herzlich's ‘illness as destroyer’. In this type of response illness has to be avoided at all costs because it represents such a threat to the self. A combination of 1 and 2 represented what Williams called ‘illness as a test of achievement’ and was similar to Herzlich's ‘illness as occupation’. Illness either had to be struggled against or struggled with, but it was always a preoccupation. Herzlich's category of ‘illness as liberator’ was also recognisable in Williams’s sample and was represented by a combination of 4 and 5, which Williams called ‘illness as disengagement’.
Activity 11: Categorising illness
Return to your response to Activity 10 and think about your own experience of illness. How does it relate to the categories identified by Herzlich and Williams? If you are a health worker draw on your experience to think of examples from your practice.
Hopefully you will not have had much personal experience of serious illness and so some of the categories like ‘illness as destroyer’ or ‘illness as exile’ would not be significant. Those of you who are healthcare practitioners will probably have plenty of examples to draw on.
In terms of illness as achievement I can recall a time when I had a bad back through pulling up old carpets when we moved house. I can remember going through a period of trying to carry on – illness as achievement – but eventually being bedridden for a couple of weeks. Then there was an element of illness as liberator when I could do nothing but stay in bed and disengage from my pressing commitments.
Again those of you who can draw on your practice experience will probably have encountered many people who heroically struggle on with quite debilitating diseases. Certainly those who work with terminally ill people will have met those who ‘fight’ their disease and see every month of extra life as an achievement. They would also recognise the liberating effects that can come with giving up the struggle and concentrating on improving the quality of the life that is left.
So far we have not differentiated between acute and chronic illness nor between life threatening and non-life threatening illness. Acute illnesses such as flu or pneumonia can be life threatening or non-life threatening, but they are usually of short duration and if they are non-life threatening the person either recovers without medical intervention or with medical treatment. Chronic illness, as the term suggests, is of much longer duration and even if it is not ultimately life threatening like arthritis, it is not amenable to curative treatment. Although acute illnesses which are non-life threatening can be frightening and unpleasant, chronic illness can pose a much greater threat to the long-term wellbeing of sufferers.