AIDS and Its Metaphors

by Susan Sontag

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AIDS and Its Metaphors

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Last Updated on May 5, 2015, by eNotes Editorial. Word Count: 2018

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 focus of her analysis. Instead, Sontag directs her attention to public discourse about AIDS—official words and official language. The texts she deconstructs are government documents, medical textbooks, magazine articles, news reports. Through her critical reading of these texts Sontag identifies the premises inherent in, and the grave implications of, the meanings that have been imposed on this contemporary epidemic.

Throughout her career, Sontag has been fearless about invading the territory of specialists, applying her formidable intellect to whatever engages or enrages her at a particular moment—art, aesthetic theory, literature, politics, film, philosophy, photography, the metaphors of illness. While this has resulted in a body of work distinguished by its passion, its immediacy, and its sense of discovery, it has also led to her being condemned by some specialists as a dilettante and a popularizer. It seems likely that Sontag will once again be attacked from some quarters for having the temerity to write about an issue as technically complicated and highly charged as AIDS, but her nonspecialist’s approach is precisely what makes her essay so important and sets it apart from most of what has been written about the disease. While she has clearly read much of the medical and scientific literature on AIDS, her book is grounded in the reason of a free-lance intellectual rather than the research of a specialist. In AIDS and Its Metaphors, one of American culture’s boldest and most wide-ranging intellects confronts one of its most serious and complex challenges. The result of the confrontation is a provocative and important book that deserves to be read and discussed by the broadest possible public.

What Sontag finds in the various texts she examines is that because AIDS is not a single illness but a syndrome it is “more a product of definition and construction than even a very complex, multiform illness like cancer.” It is defined as inevitably fatal, she suggests, not because that assertion can be proven, but because it is implicit in the very construction of the disease: Doctors and health professionals have extrapolated from the cases they have treated so far to define the illness as characterized by an inexorable progression—from HIV infection, to AIDS-related complex (ARC), to AIDS. By describing AIDS in this way, as a disease of “stages,” they have constructed a definition that presumes infection will invariably lead to a third stage of illness that is terminal; and by describing that third stage as “full-blown AIDS,” discussions of AIDS incorporate a botanical metaphor which makes evolution from the first stage to the third the norm. These metaphors, Sontag argues in what promises to be the essay’s most controversial passage, lendsupport to an interpretation of the clinical evidence which is far from proved or, yet, provable. It is simply too early to conclude of a disease identified only seven years ago, that infection will always produce something to die from, or even that everybody who has what is defined as AIDS will die of it.

It is not too early, however, to conclude that thinking in terms of such metaphors has critical, even fatal, consequences. As cases in which the period between infection and illness is longer than predicted have become known—the maximum “latency period” is now generally agreed to be between ten and fifteen years—the definition of the disease as inexorable and terminal has not been altered; instead, the length of the latency period is constantly revised upward. Distinctions among the three stages of the disease are becoming increasingly blurred and deemphasized in official definitions, so that the category of those identified as diseased has gradually expanded to include not only those in the third stage of the syndrome but also those in the first. Indeed, as Sontag notes, people who test HIV positive “are regarded as people-with- AIDS, who just don’t have it yet” —as infected but asymptomatic “lifetime pariahs.” Whereas “in every previous epidemic of an infectious nature, the epidemic is equivalent to the number of tabulated cases,” in discussions of AIDS the epidemic “is regarded as consisting now of that figure plus a calculation about a much larger number of people apparently in good health (seemingly healthy, but doomed) who are infected.”

Consequently, people who fear they may be HIV positive avoid testing, diagnosis, and treatment, both because they have been convinced that treatment is pointless and because they fear the possible consequences of being identified as infected. The general public is led to fear and stigmatize all of these “future ill” as carriers of a plague they have brought on themselves, at the same time that it is told that the disease threatens everyone. And military metaphors, which describe the disease as an “invasion” and mobilize the general populace for a “war,” inevitably lead to identifying the disease’s victims as not mere pariahs but subversive enemies within. They are also identified in this way because the cause of AIDS is both clear and clearly associated with sexual and addictive behavior that the general society views as unlawful or abnormal. Because the disease’s most common means of transmission is sexual, Sontag argues, the AIDS epidemic has been encumbered with a moralistic rhetoric that has inflated a disease into a “plague” —thereby invoking fears of pollution of the entire society by foreigners, immigrants, and outcasts.

Why, Sontag asks, have the most catastrophic and punitive readings of the medical and scientific evidence about AIDS become the official and preferred ones? Her answer is that this reading is encouraged by broader trends in contemporary Western, and especially American, culture. In a time when neoconservatives and fundamentalists have sought to portray contemporary American society’s ills as a legacy of the liberation and permissiveness of the 1960’s, Sontag observes, the most catastrophic, judgmental, and inexorable view of the AIDS epidemic has proved a convenient political symbol. In a time when privatism has replaced social and political engagement, AIDS further justifies caution and suspicion in interpersonal relations and supports the contemporary emphasis on personal programs of self-management and self-discipline. In a time of fin de siecle exhaustion with secular and revolutionary ideals, AIDS reinforces religious proscriptions on personal conduct. In a time when fantasies of disaster, apocalyptic rhetoric, and future-mindedness have become a characteristic of consciousness, “the difference between the epidemic we have and the pandemic we are promised feels like the difference between the wars we have, the so-called limited wars, and the unimaginably more terrible ones we could have.” And in a time of worldwide environmental pollution and global financial markets, the AIDS crisis is one more signal that “nothing important is regional, local, limited.”

Sontag’s explanation of why the worst-case scenario for the AIDS epidemic has been so powerful and so readily and universally accepted rings true. Only time will tell whether that scenario, as expressed in the medical and scientific community’s definitions of the disease, is as true. We can only hope that it is not. We can be sure, on the other hand, that Michael Ignatieff was right when he wrote in The New Republic that, taken together, Illness as Metaphor and AIDS and Its Metaphors “are an exemplary demonstration of the power of intellect in the face of the lethal metaphors of fear.”


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Last Updated on May 5, 2015, by eNotes Editorial. Word Count: 61

Los Angeles Times Book Review. February 26, 1989, p. 8.

The Nation. CCXLVIII, May 1, 1989, p.598.

National Review. XLI, February 24, 1989, p.48.

The New Republic. CXCIX, December 26, 1988, p. 29.

The New York Times Book Review. XCIV. January 22, 1989, p. 11.

Newsweek. CXIII, January 30, 1989, p.79.

Publishers Weekly. CCXXXIV, November 11, 1988, p.46.

San Francisco Chronicle. January 29, 1989, p. REV 1.

The Times Literary Supplement. March 10, 1989, p.239.

The Washington Post Book World. XIX, January 15, 1989, p.9.

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