Some say that illness is morally improving, others that there is nothing good about being sick.
One evening, on the way home from a tiring conference, the philosopher Havi Carel, a professor at the University of Bristol, fell into conversation with her taxi driver.
He was curious about the oxygen cylinder she carried. I have a chronic lung condition, Carel explained, the tubes of the cylinder hissing in the still night air. When they pulled up at her house, the driver, a devout Muslim, promised to pray for her. ‘I pity you,’ he said, kindly.
From pangs of compassion to undisguised horror and sheer coldness – the emotions that healthy people express in the presence of disease can seem like natural responses to its awfulness. Being unwell is usually treated as a categorically negative experience. Health is linked to ideas of agency, capability, freedom and possibility, standard entries in the roll-call of human flourishing.
Illness, by contrast, comes with constraint, fragility, loss and restriction, the darker dimensions of what Susan Sontag called ‘the night-side of life’.
But is there something valuable about sickness? In Illness: The Cry of the Flesh (2008), Carel writes that her lung disease has brought ‘plenty of bad, but also, surprisingly, some good’. Philosophers tend to celebrate humanity’s sense of truth, goodness and beauty as our most defining and elevated features. But it might be truer to say that our existence is characterised by dependence and affliction.
For sure, we think, speak, create and love, but we also age, sicken and eventually die. And as humans live longer, the prospect of many years of incapacity looms larger.
‘Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick,’ Sontag wrote in Illness as Metaphor (1978). ‘Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.’ If philosophy is about the pursuit of the good over the course of a human life, surely there’s an obligation to examine what’s worthwhile in the near-universal encounter with illness.
Bookshops are already filled with memoirs, diaries, accounts and letters by, for and about the ill. We seem to be living through a veritable ‘golden age of pathography’, as the historian Thomas Lacqueur observed recently. The desire for life lessons from writers in extremis is certainly part of the appeal. But Lacqueur notes that asking deep questions isn’t the same as being able to answer them, or even being able to write well. That’s true of thinking, too. So our enthusiasm should not be for pathography or even illness in itself, but for those aspects of the experience that promise to yield moral growth.
Am I rose-tinting or romanticising something that’s inherently unpleasant? No doubt such upbeat talk might comfort ill persons and their carers, you might say, but ultimately sickness robs us of what we need to live well. Epicurus advised that the main ingredients of a happy life are friendship, freedom and tranquility of mind – but these are often the first things to go during chronic illness. Former friends stop calling, freedom of body and mind disappear, and tranquillity is forever banished by pain and frustration.
The writer Barbara Ehrenreich skewered the cultural placebo of positive thinking in her book Smile or Die (2009), where she attacked the ‘near-universal bright-siding’ of breast cancer in the developed world. It’s difficult to escape the triumphalist talk of illness as a journey, she says, destined to end in the revitalisation of one’s life, career, relationships and character – a narrative that excludes those who don’t witness much personal growth, or those who don’t recover.
Yet is it possible to defend the idea that illness can be a positive thing, while also acknowledging its destructive power? Yes: I think we can find a balance between bright-siding and despair. What I want to show is that illness can be edifying, for certain people – conducive to the cultivation and exercise of various virtues. If this is right, then it is indeed a life-transforming process that genuinely contains some good.
Illness isn’t absent from the history of philosophy. The Buddha arrived at the Noble Truth that ‘existence is suffering’ after encountering three men, one ill, one aged and one dead. Long periods of poor health can emancipate us from what St Augustine called ‘the frailty of the flesh’, with its lusts and hungers. Or force an appreciation of the brutal truths of the world, and ‘give birth to our thoughts out of pain’, as Friedrich Nietzsche claimed.
But the problem with these suggestions is that they rely upon specific conceptions of what it means to be human – as ‘conditioned’ beings in a world of impermanence, say, or as ‘fallen’ creatures aspiring to union with God. Some ill persons might subscribe to these, but not all do, could or should.