1. #SickHillary

Illness as Metaphor

While there was extensive coverage of the personal health of the presidential candidates in 2016 (and in 2020, as I will discuss in the next chapter), I was surprised by how little discussion there was in the media about the use of illness as metaphor in political rhetoric. In Illness as Metaphor, her now classic 1978 essay on the cultural politics of illness, Susan Sontag analyzed the phenomenon of illness as metaphor for individual and social weakness. Sontag’s short book chronicles a long history of the metaphorical uses of illness in literature, popular culture, and politics. Her motivation for writing Illness as Metaphor was not simply to explore a changing cultural and political landscape of illness. Instead, with her already by then legendary bravado, Sontag proposed to elucidate the uses of illness as metaphor with the goal of purifying the experience of illness of metaphorical thinking. For Sontag, this was the “most truthful way of regarding illness—and the healthiest way of being ill.”7 And yet, despite her call for the de-metaphorization of the experience of illness, in many respects the opposite has happened in the four decades since she published her polemic: illness is now more metaphorized than ever. I argue that illness politics operates through the many sticky metaphors of illness, a process which Sontag’s work helped illuminate.

We can see this metaphorization of illness at work even in relation to the reception of Sontag’s text, which has tended to focus on her metaphorical opening image more than her de-metaphorizing analysis. Sontag’s opening metaphor suggests that health and illness are a kind of dual citizenship requiring two passports: “Although we all prefer to use only the good passport,” she writes, “sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”8 In this metaphor, illness is “that other place,” an authoritarian country that restricts freedom of thought and movement—that is, it is an embodiment of the political condition of unfreedom. The endurance of Sontag’s ur-illness metaphor, as well as the failure of her intellectual argument against metaphorization, suggests the importance of the cultural work of illness and metaphor—and, indeed, illness metaphors—in contemporary social and political life.

In the 2016 race, both candidates sought to show their opponent as unfit for the presidency. Since even before he was candidate and Republican party nominee, Trump relied on a eugenics logic that portrays his opponents as weak, sick, and neurotic. For Trump, illness is a useful metaphor to suggest America’s decline and the need for a powerful leader to purge the nation of weakness.9 Before his focus on Clinton, Trump frequently suggested President Obama was a weak man whose presidency threatened the strength of the nation itself. Trump’s birther conspiracy theories didn’t simply seek to question whether Obama was born in the United States; they also worked to draw attention to his mixed race and mixed national heritage, conjuring the specter of degeneration.

A similarly indirect association was at work in attempts to suggest Clinton was unfit. Her wealth of experience seemed to preclude a bluntly sexist dismissal of her as unqualified, but not an everyday sexism that also served as a dog whistle to conspiracy theories pushed by the alt-right that she was suffering from a degenerative disease thus far kept hidden from most Americans. There are numerous examples of what was a concerted Republican effort to create questions about Clinton’s health and fitness for office, a strategy that combines sexism and ableism. By analyzing the illness politics deployed in the presidential election campaign in 2016, my intention is not simply to debunk the #SickHillary narrative. Rather, I want to ask more general questions about what makes a person fit for the presidency—or any job for that matter. What experiences prepare a person to lead and what experiences are perceived to be disqualifying? And how do we counter the ableist notion that illness and disability are disqualifying?

Clinton’s Concussion

In Clinton’s case, it is instructive to look back to the coverage of a health event in the media before she announced her run in 2016. In December 2012, then–Secretary of State Clinton fainted at home and hit her head. Her doctors Lisa Bardack and Gigi El-Bayoumi released a statement on December 15, 2012, explaining that she had fainted because of “extreme dehydration” from a stomach flu she had caught while traveling in Europe. They evaluated her and determined she had suffered a concussion. They recommended that she “rest and avoid strenuous activity.”10 This meant she was unable to continue testifying in the Benghazi hearings in the U.S. House of Representatives. Some right-wing media accused her of faking illness to avoid testifying. A New York Post editorial, for example, said “Clinton’s story beggars belief,” and in offering a summary of her story added ellipses, apparently to emphasize how dubious the story was, like a subtle eye roll after each clause: “While traveling in Europe, she contracted a stomach virus . . . which made her dehydrated . . . which made her faint at home . . . which caused her to fall and hit her head . . . which gave her a nasty concussion.”11 Thus, we see illness politics operating in the coverage of Clinton’s health condition. Her doctors seek to present an aura of transparency and calm to dispel speculation and rumors while right-wing media immediately casts aspersions on the story. While the “faking it” accusation might seem at odds with later stories that she is hiding a secret illness, the point is in the rampant circulation, not the consistency of these illness stories.

And indeed the concussion would not be the end of the story. While monitoring her concussion, doctors found a blood clot in Clinton’s brain. Her doctors issued another statement on December 31, 2012. I quote it here in full:

In the course of a routine follow-up MRI on Sunday, the scan revealed that a right transverse sinus venous thrombosis had formed. This is a clot in the vein that is situated in the space between the brain and the skull behind the right ear. It did not result in a stroke, or neurological damage. To help dissolve this clot, her medical team began treating the Secretary with blood thinners. She will be released once the medication dose has been established. In all other aspects of her recovery, the Secretary is making excellent progress and we are confident she will make a full recovery. She is in good spirits, engaging with her doctors, her family, and her staff.12

In this statement, we see Clinton’s doctors again offering clear information about her condition, treatment, and prognosis. With this further development and longer-term recovery, the initial story in the right-wing press that she was faking illness shifts to an accusation that she is hiding a more serious condition. Not surprisingly perhaps, social media became a space for speculation, and we see over the next several years a periodic resurgence of interest in Clinton’s health and recurring references back to this incident as a means of discrediting her.

In 2014, for example, Republican strategist Karl Rove floated the possibility that Clinton had suffered “brain damage” in the fall. While, technically speaking, a concussion does of course do some, at least temporary, damage to the brain, Rove clearly used the term “brain damage” to seed doubt about Clinton’s cognitive capacities. The New York Post quoted Rove voicing concerns about Clinton’s condition at a conference: “Thirty days in the hospital? And when she reappears, she’s wearing glasses that are only for people who have traumatic brain injury? We need to know what’s up with that.”13 Rove would later walk back his remarks, admitting that Clinton was not in fact in the hospital for thirty days (it was only four), shifting to a vaguer, but still concerning, assertion that she spent a “30-day period fighting something.”14 Despite Rove walking back his comments, or indeed because of how he walked them back, which did little to dampen speculation, media coverage and social media commentary about her health continued.

Her glasses garnered much attention. An ABC News report in May 2014, for example, provides a timeline of her illness and even details when and where she wore “those now-famous glasses,” as the article describes them.15 The timeline shows that Clinton returned to work on January 7, 2013, appeared in a photo-op without the glasses on January 9, and testified in the Benghazi hearing wearing the glasses, which, the timeline explains, led to “questions about her glasses.” In response to these questions, State Department spokesperson Philippe Reines stated, “She’ll be wearing these glasses instead of her contacts for a period of time because of lingering issues stemming from her concussion. With them on she sees just fine.”16 Clearly trying to use humor to dispel some of the hysteria surrounding the glasses, spokesperson Victoria Nuland repeated that “She sees just fine with them,” and added, “she also enjoyed some of the comments she saw in the press about the extra sort of diplomatic lift she gets gesturing with them.”17 Humor would be a tactic Clinton and her team would use on several occasions to counteract rumors about her health, especially as a means to deflect Trump’s frequent ableist jokes directed at her and what he persistently contended was her lack of stamina.18

Although Clinton would not officially announce her presidential bid until April 2015, even long before that announcement, most pundits thought she would run again in 2016, and thus we can see that an early and persistent Republican tactic to discredit her and her candidacy was to say she was both sick and hiding this fact. The notion that her glasses were a sign of both brain damage and deception about the damage, rather than a not very controversial means of alleviating some symptoms of concussion, shows how illness politics works via stigma and ableism. In his classic text on stigma, sociologist Erving Goffman describes stigma as “an undesired differentness from what is expected.”19 In his analysis, Goffman distinguished between two kinds of stigma—discredited and discreditable. Whereas discredited stigmas are visible, discreditable stigmas are those that are not immediately known or perceived but have the potential of being found out. In the alt-right-generated conspiracies regarding Clinton’s health, her glasses, ironically, were theorized as a sign that allowed the public to see more clearly something that Clinton tried to keep hidden: that she was sick.

Stigma Power

Once Clinton was officially the Democratic nominee for President, Republican attacks on her fitness for office ramped up. It would be impossible to cover the multiplicity of allegations, but the general strategy of attack as we have already seen was consistent and had long been cultivated by Republican strategists like Rove: she had a problem in her brain, and she wasn’t truthful about it. Following Imogen Tyler’s important recent theorization of stigma as a key aspect of power, we might describe this as a form of “stigmacraft,” or what Tyler describes as the use of stigma as a “technology of division and dehumanisation.”20 Tyler argues that “stigma power” is “crafted and cultivated as a means of leveraging political capital” and that the “exercise of stigma power is an integral component of [a recent] punitive authoritarian shift.”21 The circulation of misinformation and conspiracy theories is an exercise of stigma power. In the case of Clinton’s secret illness or illnesses, conspiracy theorists looked for (and found!) signs of illness and postulated at length on her methods of hiding illness. Like Kremlinologists trying to ascertain the health of aging Soviet leaders, people pored over still images and short videos for evidence of Clinton’s secret illness. To understand how such speculation was fostered by the media and on social media, I will first look at coverage in August 2016 of photographs of Clinton purportedly needing help walking up a flight of stairs, before turning to some of the responses following Clinton’s collapse at the ceremonies commemorating the fifteenth anniversary of September 11, 2001.

The photographs in question show Clinton climbing a short flight of stairs up to the front porch of a house in Charleston, South Carolina (Figure 1). One of the photos, by Reuters photographer Jonathan Ernst, shows Clinton, on the last step, slipping and reaching both arms out to staffers on either side of her to catch herself. Two male staffers offer support and help her keep her balance. Another man in front of her looks back and may also be reaching to help. Three men on the stairs to Clinton’s right and a woman (Huma Abedin) behind on her left do not react to the stumble. The photograph was taken in February 2016 but resurfaced on social media that August, the timing of which indicates how the circulation and recirculation of images with very little context on social media is an effective way to encourage speculation and conspiracy theories.

On August 7, 2016, The American Mirror, a right-wing news source aggregator and blog created by Kyle Olsen, published a blog post with this photo and another taken just after of Clinton at the top of the stairs still holding on to the staffers on either side of her. Olsen’s post argued that “the questionable health condition of Hillary Clinton should be a major issue in the 2016 campaign” and described the “latest evidence” as “Clinton being helped up a set of stairs by multiple individuals outside what appears to be a home.”22 Olsen’s blog and tweets with the photo were then picked up and amplified by the conservative news source Drudge Report. The circulation of these images led to widespread discussion of Clinton’s health on social media. This in turn led to other more mainstream media responding to the speculation generated by the right-wing blog and the Drudge Report. Brian Stelter, for example, covered the story for CNN in an article titled “Drudge Report Misleads Readers with Hillary Clinton Photo,” which opens with this sentence: “From the looks of Matt Drudge’s home page, Hillary Clinton is so sick, she needs help getting up a flight of stairs.”23 In his piece, Stelter critiques the Drudge Report for intentionally misleading readers. But by presenting at face value the notion that the photo shows something remarkable rather than the hardly unusual situation of someone slipping on stairs and others responding to try to prevent a fall, such fact-checking pieces contribute to the wider circulation of unreliable sources, even as they discredit them.24 Yet, I contend that we should also question more generally what is deemed disqualifying. Even if Clinton’s slip were the result of, say, foot drop caused by a neurological condition, why would that be considered disqualifying of her ability to be president?25 Weakness and vulnerability are stigmatized in American political culture, and this makes it difficult for a candidate for political office to be open about illness and disability. In this scenario, stigmatizing attitudes, rather than the illness or disability itself, become what disqualifies a person. This is what Tyler calls stigma power. And illness politics is a key component of the machinery of stigma power.

Discussion of Clinton’s health reached fever pitch after she collapsed at the ceremonies commemorating the fifteenth anniversary of September 11, 2001. WikiLeaks contributed to the speculation by tweeting an email from its cache of leaked Clinton emails and including the hashtag #HillarysHealth. The email dated January 4, 2013, was from Clinton’s aide Huma Abedin to Clinton with the subject heading “Article I mentioned” and included the text of an article by Dr. Marc Siegel titled “Hillary Clinton’s Blood Clot Treatment and the Need for Privacy,” which was published by FOX News on January 3, 2013.26 The WikiLeaks tweet did not provide any context for the article, simply noting that the article was about Clinton’s “‘life threatening’ Sinus Thrombosis.” Here we see WikiLeaks engaging in illness politics on social media by not only attempting to suggest that Clinton’s collapse was related to her earlier sinus thrombosis, but also implying that Clinton’s campaign was keeping important information about her health from the American public, and that this information was only now coming out thanks to the release of leaked emails by WikiLeaks beginning just before the Democratic National Convention in July.

Some replies to the WikiLeaks tweet point out that the article was from 2013 and not 2016 and questioned the timing of the tweet. If we actually read the article Abedin forwarded without comment to Clinton, we see that Siegel, who is identified as an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center, as well as “a member of the Fox News Medical A Team and author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health,” astutely and compassionately argues that Clinton’s “illness is a reminder to all of us in the media, journalist and physician alike, that health care is primarily a private matter, not a time for lurid interest and certainly not a time for political criticism.”27 However, considering the timing of the WikiLeaks’s tweet and the social and mainstream media attention the tweet generated, it is clear that WikiLeaks’s intention was not to encourage understanding of illness as a private matter but instead to do the opposite: to generate “lurid interest” in the question of what is wrong with Clinton, as well as “political criticism” of her. And indeed, much commentary following the WikiLeaks tweet did indeed suggest that Abedin’s email explained Clinton’s collapse at the 9/11 commemoration in New York City, even if the article was three years old at the time.

To cite just one example of the coverage following the WikiLeaks tweet, an editorial by Kerry Jackson in Investor’s Business Daily asked in its headline: “Is Hillary Clinton’s Collapse Explained in Email from Huma Abedin?”28 The headline itself makes it seem as though Abedin has herself written something in an email about Clinton’s health rather than forwarding an article by a doctor about Clinton’s fall, concussion, and blood clot published in January 2013. Jackson begins by acknowledging that “conspiracy theorists are having a grand ol’ time trying to explain what was wrong with Hillary Clinton when she fainted/fell/collapsed/seized up during Sunday’s 9/11 ceremony in New York.”29 He lists some of the theories about the incident and more general speculation about Clinton’s health, which he says have raised questions about whether “she’s suffering from dementia or Parkinson’s disease—or possibly both.”30 Again, even as he seems to try to distance himself from the conspiracy theories, he shares them before arriving at his main point: “But maybe the explanation is not so mysterious and is, in fact, hidden in plain sight.”31 The phrase “hidden in plain sight” includes a hyperlink to the WikiLeaks tweet dated September 11, 2016, of Abedin’s email from 2013. Thus, Jackson’s editorial leads to the WikiLeaks tweet, which leads to the hashtag #HillarysHealth. This is illness politics in action—two clicks and readers enter an unfiltered world in which Hillary Clinton is diagnosed as sick and thus not fit to be president.

In his editorial, Jackson clearly states that the email from 2013 contains an article by Dr. Marc Siegel discussing “Clinton’s condition—right transverse sinus thrombosis.” He then quotes Siegel’s description of sinus thrombosis and cites symptoms associated with the condition from Johns Hopkins Medicine’s online health resource. He also quotes Siegel in 2013 stating optimistically that Clinton “can look forward to a full recovery with the help of her careful devoted physicians,” and adds “so maybe Sunday’s episode wasn’t related to what he discussed in his article.” This is followed by a big “but,” wielded ominously: “But he also mentioned that she has a history of blood clots. Was her spell evidence of another? The clots can return. Once treated doesn’t always mean healed.”32 “Once treated doesn’t always mean healed” is a not-so-subtle way to show how stigma operates as a sign that sticks to and smears a person. Tyler says “stigma is a distinctly psychosocial concept,” and she adds that “it is important to pay attention to stigma precisely because it captures the movement between external and internal processes of de/valuation.”33 What Jackson doesn’t mention is Siegel’s caution against just the sort of speculative illness politics that the WikiLeaks tweet is aimed at generating. That her aide would forward Clinton an article from a doctor discussing a condition she had been hospitalized for is hardly surprising or a sign of a secret being kept from the public. The irony is that Abedin’s email, in which she forwards an article that ends with the sentence—“When it comes to celebrities and public leaders like Secretary Clinton, the urge to speculate and pontificate is high—but the high road is lined with respect and restraint”—would generate so much speculation and pontification three years after it was first published.

Later the same day that WikiLeaks tweeted Abedin’s email with the article from Siegel (September 11, 2016), in a more explicit confirmation of its goal of encouraging lurid interest and political criticism of Clinton, Wikileaks tweeted a poll asking followers to respond to this prompt: “Hillary Clinton’s collapse on Saturday, prior coughing fits & unusual facial & body movements are best explained by: Allergies & personality, Parkinsons, MS, Head injury complications.”34 Many tweets in response criticized the poll as inappropriate, especially for an organization purportedly interested in transparency. Brandy Jensen (@BrandyLJensen) replied with a tweet that went viral and pointed to the sexual politics that also seemed at play in WikiLeaks’s targeting of Clinton: “WikiLeaks is the internet’s deeply embarrassing ex-boyfriend.” WikiLeaks would eventually delete the tweet with the poll, admitting that the poll was too “speculative.”35 Yet, even in retracting their Twitter poll as too speculative, WikiLeaks effectively encouraged speculation and mistrust of what by then was the explanation given by the Clinton team: that Clinton had been suffering from pneumonia and had tried to work through it. WikiLeaks’s poll worked like Rove’s earlier brain damage comment: it suggested something was wrong with Clinton, belittled her for her condition (whatever it might be), and encouraged rumors to circulate even though the tweet was eventually deleted.

Diagnosing by GIF

In alt-right media, Clinton was constantly being “diagnosed by gif,” a phrase I use to describe the visual cultural phenomenon of using a brief clip of video shown on loop as evidence indicating a symptom of a health condition. In delineating the workings of stigma, Tyler writes that her book “seeks to capture some of the cultural practices that characterize the intensification of stigma politics in the current conjuncture, including the ascendance of stigmatising media and cultural genres: ‘stigmatainments’ in which the public are called upon to perform roles as angry and outraged citizens.”36 I would argue that diagnosing by gif is a form of stigmatainment, and we saw it in action in relation to Clinton in numerous ways. For example, there are many gifs purporting to be incontrovertible evidence of Clinton having a seizure on camera. My personal favorite is the use of a video loop of Clinton at the Democratic National Convention reacting to the balloon drop as evidence of her alleged seizure disorder. In this and other examples, Clinton’s most human gestures are pathologized—in this case, a goofy reaction to the huge number of balloons dropping from the ceiling was deemed symptomatic of illness in a way that, say, Tim Kaine’s similarly goofy responses were not.

In some cases, everyday sexism served to mask an illness-conspiracy dog whistle, as when Reince Priebus commented on Clinton not smiling during the Commander-in-Chief forum.37 On the one hand, this was clearly meant to provoke an angry response to the sexist demand from men that women smile. On the other, it gestured to fervent alt-right social media discussion about Clinton’s lack of facial expressivity that was explained as a symptom of Parkinson’s disease. One might note that Clinton’s goofy reaction to the balloons dropping contradicts the allegation that she lacks facial expressivity, but again, contradictory messages generate rather than squelch speculation. Moreover, women politicians have long had to try to walk a very fine line in terms of what is considered suitable emotional expression as they seek public office. A woman candidate is damned if does emotion and damned if she doesn’t. My point is that in these associations, sexual politics becomes illness politics. In 2016, these hidden illness narratives worked to further the impression Trump’s campaign wanted to give that Clinton was unfit because she couldn’t handle the physical demands of the office—she lacked stamina in Trump’s oft-repeated accusation—and she was keeping secrets from us. Here again we see illness politics in action, with illness crafted as an outward sign of not only physical but also moral weakness. In the next chapter, I show how Trump, who had been an astute practitioner of illness politics in 2016, became a target of its stigma power in 2020 through the hashtag #TrumpIsNotWell.