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There's a really amazing book by Susan Sontag, Illness as Metaphor (and a followup she wrote in the late 80s called "AIDs and its metaphors") which talks about

There's a really amazing book by Susan Sontag, Illness as Metaphor (and a followup she wrote in the late 80s called "AIDs and its metaphors") which talks about this need to speak about disease as a conflict or fight, or as a foreign invasion or corruption. It's a fascinating book also because it compares the 20th century ways of talking (or not talking) about cancer with how tuberculosis was discussed in the 19th century and before, and both the differences and similarities, especially with regard to a different understanding of how disease operates. People conceptualize their own illness in very different ways. An author I very much respect, Jenny Diski, died recently, and in her final series of essays about her life and her cancer (and impending death), she said at one point, “under no circumstances is anyone to say that I lost a battle with cancer, or that I bore it bravely. I am not fighting, losing, winning, or bearing.”

jhbadger 10y ago
Except that cancer and infectious disease really are conflicts and invasions, no metaphors needed. At the cellular level you really do have cells killing cells based on recognition of whether they are not they are recognized as "self".
- KC8ZKF 10y ago
  You are defending the metaphor by using metaphors based on the metaphor you are defending.
  - tree_of_item 10y ago
    Recognizing self/other isn't a metaphor, cells really do that.
  - ubernostrum 10y ago
    The other comment says this more briefly, but: it is true that the immune system draws this distinction. Every human cell with a nucleus presents a set of molecules on its surface, and immune system T cells use that to determine whether or not to trigger an immune response (where "immune response" means "kill the cell which presented an unacceptable set of molecules"). Autoimmune diseases occur when immune cells improperly categorize some "self" cells as "non-self" and trigger immune response on them.
    - Confusion 10y ago
      Describing the behavior of immune cells as categorizing cells in 'self' and 'non-self' is itself an example of engaging in metaphor. It's an example of anthropomorphising the behavior of cells. You can just as easily describe the behavior of immune cells as categorizing cells into 'healthy' and 'unhealthy' and killing the 'unhealthy' cells. Suddenly the disease is not about internal conflict, but about internal hygiene. And when the immune system kills 'foreign' cells, it's not because they are foreign, but because they are found to be 'unhealthy': deviating too much from what it considers 'healthy'. This is a simpler explanation. Apply Occam's razor: the immune system does not care about whether something is 'foreign': that's a more complex, and more precise, judgement than is needed to determine whether something needs to be killed. The broader category of 'unhealthy', deviating from the template/norm, is sufficient and that is the only thing the immune system needs to determine.
      - ubernostrum 10y ago
        Except that the immune system's idea of what set of molecules to accept and what set to kill is not based on a generalized idea of what a "healthy cell" looks like -- otherwise we wouldn't have such trouble matching people for organ transplants, since our immune systems would just accept any generically healthy organ. Instead it's dependent on the (specific to the individual) set of genes controlling the major histocompatibility complex, and so is very much a "self" ("derived from my genes") versus "non-self" ("not derived from my genes") determination.
        Confusion 10y ago
        Yes, what is 'healthy' looks different for each individual. That doesn't mean that something is found to be 'healthy' because it is 'self'. The immune systems primary function is housekeeping: killing cells that are still completely 'self', but are old, worn down or dysfunctional in some other way. Killing 'invaders' and cancers is minor in terms of the numbers of cells destroyed. As your transplant example shows: something foreign can be found to be entirely 'healthy' by your immune system. So self vs. foreign is too narrow.
- Confusion 10y ago
  An immune system that only kills cells determined to be 'non-self' would be woefully insufficient. It needs to kill cells that have become unhealthy, for instance clogged up with misfolded protein, all the time, even when those cells are clearly still 'self'. See also my comment to ubernostrum further downthread. There is no compelling reason to frame cancer or infectious disease as a conflict or invasion. Doing so is just as reasonable as framing housekeeping as a conflict with 'foreign dirt' or an invasion of 'the outside world into your house'.

jhbadger 10y ago

Except that cancer and infectious disease really are conflicts and invasions, no metaphors needed. At the cellular level you really do have cells killing cells based on recognition of whether they are not they are recognized as "self".

KC8ZKF 10y ago
You are defending the metaphor by using metaphors based on the metaphor you are defending.
- tree_of_item 10y ago
  Recognizing self/other isn't a metaphor, cells really do that.
- ubernostrum 10y ago
  The other comment says this more briefly, but: it is true that the immune system draws this distinction. Every human cell with a nucleus presents a set of molecules on its surface, and immune system T cells use that to determine whether or not to trigger an immune response (where "immune response" means "kill the cell which presented an unacceptable set of molecules"). Autoimmune diseases occur when immune cells improperly categorize some "self" cells as "non-self" and trigger immune response on them.
  - Confusion 10y ago
    Describing the behavior of immune cells as categorizing cells in 'self' and 'non-self' is itself an example of engaging in metaphor. It's an example of anthropomorphising the behavior of cells. You can just as easily describe the behavior of immune cells as categorizing cells into 'healthy' and 'unhealthy' and killing the 'unhealthy' cells. Suddenly the disease is not about internal conflict, but about internal hygiene. And when the immune system kills 'foreign' cells, it's not because they are foreign, but because they are found to be 'unhealthy': deviating too much from what it considers 'healthy'. This is a simpler explanation. Apply Occam's razor: the immune system does not care about whether something is 'foreign': that's a more complex, and more precise, judgement than is needed to determine whether something needs to be killed. The broader category of 'unhealthy', deviating from the template/norm, is sufficient and that is the only thing the immune system needs to determine.
    - ubernostrum 10y ago
      Except that the immune system's idea of what set of molecules to accept and what set to kill is not based on a generalized idea of what a "healthy cell" looks like -- otherwise we wouldn't have such trouble matching people for organ transplants, since our immune systems would just accept any generically healthy organ. Instead it's dependent on the (specific to the individual) set of genes controlling the major histocompatibility complex, and so is very much a "self" ("derived from my genes") versus "non-self" ("not derived from my genes") determination.
      - Confusion 10y ago
        Yes, what is 'healthy' looks different for each individual. That doesn't mean that something is found to be 'healthy' because it is 'self'. The immune systems primary function is housekeeping: killing cells that are still completely 'self', but are old, worn down or dysfunctional in some other way. Killing 'invaders' and cancers is minor in terms of the numbers of cells destroyed. As your transplant example shows: something foreign can be found to be entirely 'healthy' by your immune system. So self vs. foreign is too narrow.
Confusion 10y ago
An immune system that only kills cells determined to be 'non-self' would be woefully insufficient. It needs to kill cells that have become unhealthy, for instance clogged up with misfolded protein, all the time, even when those cells are clearly still 'self'. See also my comment to ubernostrum further downthread. There is no compelling reason to frame cancer or infectious disease as a conflict or invasion. Doing so is just as reasonable as framing housekeeping as a conflict with 'foreign dirt' or an invasion of 'the outside world into your house'.