"Illness as Metaphor"... Skin, Sickness & Mental Health

Amy Ling | 002.

Apr 10, 2023

Welcome to the second edition of The Moon Space Quarterly. This time I am delving a little deeper into the subject of health and healing.

By questioning the narrative surrounding illness, I will explore the appearance and experience of being un-well. Through literature, art, film, and theory, I am curious as to how health and disease shape our lives.

I’ve found myself reflecting on the nature of illness as a spiritual experience. The vulnerable discomfort, a cracking-open to meet ourselves at less-than-perfect health.

To clarify, this thinking is not to dispute the physical realm of illness. It is instead to give further attention and understanding to more than just the physical.

Glancing back in history, we can see the evolution from a spiritual approach of healing to a now predominantly pharmaceutical approach. Scientific advances have changed our lives dramatically. The rejection of spirituality, however, has arguably created confusion and problematic divides socially and culturally, evident in religious abuse and ‘social media wars’.

Medicine, healing, and religion have a significant and historical relationship. “Medicine carries the burden of its own troubling history. The history of medicine, of illness, is every bit as social and cultural as it is scientific,” states Elinor Cleghorn in Unwell Women (2021).

Cleghorn skillfully weaves together historical accounts, personal stories, and scientific research to provide a comprehensive overview of the various issues facing women's health. Within the context of political and social structures, she provides an insightful analysis of the gender biases, power imbalances, and social norms that have shaped how women’s bodies are approached in conventional medical environments.

Image: Cover art of Unwell Women, Penguin edition

Virginia Woolf’s short essay On Being Ill (1930) emphasises the isolation and vulnerability that come with illness while suggesting that this can lead to a heightened sense of awareness and introspection. Woolf reflects on cultural attitudes and the role that language plays in shaping our perceptions. She criticises the tendency to romanticise illness and suggests that an honest and realistic approach to discussing ill-health could be more beneficial.

Image: On Being Ill cover, 2012 edition

Illness and wellness are fluid states of being. As Susan Sontag puts it in Illness as Metaphor, “we all hold dual citizenship in the kingdom of the well and the kingdom of the sick”. Sontag argues that illness is not to be treated as a metaphor, that “the healthiest way of being ill - is one most purified of, most resistant to metaphoric thinking”.

Critics argue, however, that metaphors can in fact help us to deal with reality.

At the time of writing (1977), Sontag acknowledges to what degree topics of disease were shunned from conversation. Even the words ‘cancer’ and ‘tuberculosis’ were avoided amongst families due to superstitious beliefs. According to Sontag, doctors in France and Italy would communicate a cancer diagnosis to the patient's family, but as a rule, not to the patient. It was thought that the truth was intolerable to all, except to patients considered “exceptionally intelligent and mature”.

Image: Illness as Metaphor cover, 1977

Behaviour such as this has no doubt fed into the complicated mental and emotional navigation of physical illness. Our social approaches have thankfully evolved, yet, an element of taboo still surrounds our approach to these conversations.

Image: A drawing of a “hysterical woman”, from a book by the French physician Paul Regnard, 1884.

For centuries, as Cleghorn writes in Unwell Women, many female afflictions were reduced to “hysteria,” from the Greek word for womb.

The Yellow Wallpaper (1892) by Charlotte Perkins Gilman is a first-person narrative that follows a woman's descent into madness. Confined to a bed in a room, the narrator becomes increasingly fixated on the yellow wallpaper, which she sees as a symbol of her confinement.

The story is a powerful critique of the societal norms and medical practices of the time, particularly concerning the treatment of women's mental health. It also explores themes of gender roles, power dynamics within marriage, and the importance of self-expression and creativity.

Image: Still from The Yellow Wallpaper 2021 film adaptation

In what other ways can we meet with illness?

Bed-bound illness has found itself central to many artists work.

Frida Kahlo was famous for painting from her bed during illness and recovery from surgery. Her paintings were highly influenced by her experiences of pain and isolation.

Image: Frida painting in bed, anonymous photographer, 1940. © Frida Kahlo Museum

Tracey Emin decided to exhibit the bed that had been the setting of - in her own words - her mental breakdown. “My Bed” was on show at the Tate Gallery in 1999 after being short-listed for the Turner Prize.

Image: via Tate

The piece was highly controversial, challenging perceptions of what was considered appropriate to exhibit as ‘art’.

Some forms of illness are more visible than others. In what way does the physical appearance of illness affect the way in which we navigate our feelings towards it?

The essay below explores the mental and emotional effects of skin issues and acne from my personal perspective. I analyse how my experience has been affected and manipulated by cultural influences from the beauty and fashion industry and the body positivity movement.

Image: Still from Unquiet Skin by Patrick Taylor, 2022

Skin, beauty standards, and [a critique of] the body positivity movement.

Skin is both a barrier and a bridge between our internal and external worlds. It is a sense organ and a communicator, a surface on which we interpret each other's stories. In our culture, however, it has become a radical act to publicly present skin that is imperfect in appearance.

I was surrounded by men in perfectly white coats and emotionless expressions looking intently at my face. The doctor said very little but mentioned that Accutane was an option. Without looking at me he asked if I had ever suffered from depression. I had a turbulent home life, which my eighteen-year-old self kept very much private. I had certainly occupied some of the darker spaces of my mind. But although those thoughts could be eerily comforting, I never came close to acting on them. I replied “yes”, and for the first time, the doctor locked eyes with me. He quickly looked away again, writing out a prescription to “..see if antibiotics will help”.

The antibiotics didn’t help. In fact, my skin only got worse. Unfortunately, this and other medical experiences had put me off asking for further help. Soon later a BBC documentary aired, Dying for Clear Skin (2012). The film highlighted a connection between suicides and the acne medication, Accutane. Parents spoke of changes in their child's behaviour and the tragic results.

Desperate to find alternative answers, magazines and YouTubers convinced me I didn’t need medical advice because I could find the answers in skin-care products. This led to many years of spending and searching. Whenever I lost hope, a new product made its way to my screen, promising me that this time would be different.

In 2017, photographer Peter DeVito produced Acne Normalization, a photo series of faces with visible acne accompanied by various text placed on their skin. This was around the same time the body positivity movement was gaining momentum via social media. “I’m so fucking sick and tired of the photoshop” raps Kendrick Lamar in his hit release, HUMBLE., also 2017. An evocative line that bluntly expresses a rejection of the unreal beauty standards, now so acceptably advertised.

Image: Pete DeVito (2017) The text quotes lyrics from “HUMBLE.” by Kendrick Lemar

The previous year, designer Moto Guo sent his models out for Milan Fashion Week with visible acne and rosacea. He claimed he intended to promote empowerment by encouraging people to embrace their imperfections. However, the imperfections were not natural, his make-up artists were painting acne and blemishes onto the models who had clear, unblemished skin. An act that appeared disingenuous to those of us managing a skin disease.

Image: Instagram post by Moto Guo make-up artist @roberta.betti posted 20.06.2016

Representation can be empowering. However, painting fake acne onto the flawless skin of models could be perceived as undermining the basis of what self-acceptance and body positivity stand for.

Comments on this story mostly expressed disgust. Reading these further added to the sense of shame I had accumulated now for many years. I wondered, does body positivity (or our misunderstanding of it) verge on the historic tendency to glamourise illness? Does painting acne on runway models echo the heroin-chic aesthetic of the 90s, which we now recognise as problematic? In Consumptive Chic (2017), Carolyn Day explores the complicated relationship between beauty, fashion and disease. For example, the desire for ‘transparent skin’ in the 1800s was popularised by the physical effects of tuberculosis.

Normalising acne should not bypass our concern for health and broader understanding of the potential underlying physical and mental health issues leading to skin conditions.

Notably, celebrities and influencers have become more transparent about body issues such as acne, however, they rarely share this information without a sponsored product promising the solution. In effect, body positivity has been exploited by capitalist and neoliberal tactics, performative in nature and providing little of its originally intended cultural benefits.

Where body positivity can feel forced and performatory, acceptance is perhaps the grounded alternative. Acceptance is not asking for permission. Acceptance is an understanding, without the need to distinguish whether it is desirable or non-desirable. Patrick Taylor’s 2022 short film Unquiet Skin highlights the discomfort of skin conditions, while at the same time, gently portrays an acceptance of imperfect skin, as it is.

Overall, the body positivity movement is still growing, yet unrealistic beauty standards continue to rise. Normalising acne is more than making an aesthetic statement or gaining permission to be displayed. It is about educating ourselves on the underlying physical and mental health aspects that affect skin's appearance, in order to normalise our mentality of skin as a functional organ. This could lessen the negative mental health consequences of acne sufferers, rather than merely reducing acne to a good or bad look.

As challenging as it can be, illness has the power to reshape us, to redefine us, and often forces upon us a pause to rethink. We often view illness as only a negative experience, one to be fought against at all costs. Yet, by taking a glance at history through the lens of science, culture, literature and art, we have an opportunity to expand our perspective and curiosity about our bodies, our relationships, and our environment.