In the course of a routine checkup in 1975, Susan Sontag learned that she had cancer. Her doctors informed her that she would probably be dead within two years; they told her son that she had six months. Sontag responded by reading everything that she could find about her illness, consulting doctors in America and Europe, and eventually going to France for treatment that was not then available in the United States. After two and half years, a mastectomy, four other operations, and stringent doses of chemotherapy in hospitals in the United States and abroad, she recovered.She also responded by writing Illness as Metaphor (1978). When she first went to the hospital, she was angered by the way that cancer’s reputation increased the suffering of many of her fellow patients, leading them to feel not only hopeless but also ashamed. Partly to distract herself from her own anxieties, she drafted most of the book in her head while she was hospitalized; when she was well enough to work again, she wrote it quickly, in about two months, “spurred by evangelical zeal as well as anxiety about how much time [she] had left to do any living or writing in.”
In the hospital, she had begun to think about parallels between nineteenth century myths about tuberculosis and twentieth century superstitions about cancer. In her essay, she set out to examine the metaphors and mystifications that surrounded the two diseases. Although her own experience both prompted the book and provided it with a polemical tone reminiscent of her earliest essays, nowhere in it did she mention her cancer. “A narrative,” she decided, “would be less useful than an idea.”
The idea behind both Illness as Metaphor and AIDS and Its Metaphors is that society’s response to diseases that it does not yet understand is to construct fantasies about them. The disease is felt to be obscene, its name becomes a curse, its diagnosis a death sentence. Doctors conceal the diagnosis from their patients; patients and their families conceal it from one another. And the stigma and fantasies attached to the disease literally kill because they discourage patients from aggressively asking the questions and seeking the treatment that might save their lives. The only way to change all this, Sontag argued in Illness as Metaphor, is to “rectify the conception of the disease, to demythicize it.” This is what she set out to do—for cancer in Illness as Metaphor and for AIDS in its sequel—by insisting that “illness is not a metaphor, and that the most truthful way of regarding illness—and the healthiest way of being ill—is one most purified of, most resistant to, metaphoric thinking.” In both books, she explains in AIDS and Its Metaphors, her strategy has been not “to confer meaning, which is the traditional purpose of literary endeavor, but to deprive something of meaning: to apply that quixotic, highly polemical strategy, ’against interpretation,’ to the real world.”
When her publishers began to reissue all of her books in a uniform paperback edition in 1987, they asked Sontag to write a brief epilogue for Illness as Metaphor on the AIDS epidemic. The request was a natural one. When she wrote Illness as Metaphor, acquired immune deficiency syndrome had not yet been identified. In the intervening decade, however, AIDS had emerged and had quickly replaced cancer as society’s most feared disease—and, therefore, the disease whose metaphors now demanded clear-minded scrutiny and demythologizing analysis. In 1986 Sontag had already tried to deal with the pathos and terror of the AIDS epidemic in one of her most powerful and accomplished short stories, “The Way We Live Now.”
As Sontag worked on the epilogue in New York City during the sweltering summer of 1988, frequently leaving her writing to visit friends who were dying of AIDS, what was to have been a three-page note grew into a book as long as Illness as Metaphor itself. It, too, is an impassioned polemic and exhortation, and it, too, is as much a meditation about the way we think about illnesses—and about what the way we think about illness says about us as a society and a culture—as it is about the particular illness it examines.
One of the most distinctive characteristics of Sontag’s essays has always been the breadth of the literary and cultural allusions she brings to bear on the subjects of her analyses. In Illness as Metaphor, the generalizations she made, the arguments she marshaled in her textbook display of the technique of comparison and contrast, were supported by an especially rich array of references to the ways that tuberculosis, cancer, syphilis, and plague have been used as metaphors in works of literature. While AIDS and Its Metaphors also has its share of literary examples, these texts are neither Sontag’s primary evidence nor the...
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