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Last Updated on June 19, 2019, by eNotes Editorial. Word Count: 280

This controversial book-length essay by Susan Sontag explores the way in which the figurative language used to describe diseases such as tuberculosis and cancer has often expressed a psychological judgement on people afflicted with these diseases. In effect, Sontag argues, language has served to blame victims for conditions beyond their...

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This controversial book-length essay by Susan Sontag explores the way in which the figurative language used to describe diseases such as tuberculosis and cancer has often expressed a psychological judgement on people afflicted with these diseases. In effect, Sontag argues, language has served to blame victims for conditions beyond their control.

Sontag begins with an examination of the metaphors that accumulated around tuberculosis, beginning in the nineteenth century, when a cure was yet to be found. It was believed that those suffering with the disease were literally being "consumed" by a passion that was being driven inward (hence the term "consumption"). The victims were thought to be somehow more sensitive, possessed of a superior sensibility. Sontag describes this phenomenon as "the first widespread example of that distinctively modern activity, promoting the self as an image."

As the ravages of TB began to wane due to advances in medical research, this illness replaced by cancer as the bearer of disease metaphors. The repression of intense emotion is again the source of the malady, according to popular conception, but now it takes the form of the malignant, cancerous tumor. In contrast to the romantic image of TB victims, cancer patients, Sontag claims, are psychologically stereotyped as dull, unfulfilled, bourgeois, and rigid (though these stereotypes have no basis on fact). Sontag quotes lines from Auden—"Childless women get it, / And men when they retire"—as an example of this.

Sontag proposes that the culture should abandon these stigmatizing tropes surrounding illness, which only add to the suffering of its victims, and instead adopt a purified language, which views a disease as only a disease, rather than as evidence of a terribly flawed character.


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Last Updated on October 26, 2018, by eNotes Editorial. Word Count: 1187

Illness as Metaphor, a book of social criticism by critic and novelist Susan Sontag, is an analysis of how people make meaning of disease and how those meanings can be detrimental. There are any number of mysteries behind the discovery of a new disease—what causes it, how to treat it, who is susceptible. Until science decodes what is happening with a newly discovered disease, people will continue to use illness metaphors to make meaning of that disease.

In the book, Sontag explores three categories of metaphor: personality, punishment, and warfare. Often negative in their suggestions, these metaphors end up being harmful to the person with the disease and to society in general. So common is their use and so subtle are their implications, illness metaphors are used without considering the consequences. Illness as Metaphor seeks to change this common and subtle use of metaphors.

Sontag’s personal experience with breast cancer spurred her to write this social commentary, yet she does not mention her own conflicts with cancer metaphors, which she certainly must have experienced. Instead, to identify common metaphors, Sontag uses research, insight, and criticism; gives examples of their usage in politics, philosophy, psychology, medicine, and literature; and makes a case for their eradication.

Illness as Metaphor, which is best described as a monograph (a work that is longer than an essay, shorter than a book, and focused on one theme), is organized into nine numbered sections. The book starts with Sontag explaining why Illness as Metaphor matters. Every person gets sick, and every person will wonder why he or she is the one to get sick, no matter if that illness is a bad cold or terminal cancer. Because metaphors help one understand the world, one is tempted to see illness metaphorically, as a punishment, a sign, or a war raging in one’s body, for example. Sontag explains, however, that these negative metaphors affect how a person approaches treatment. In addition, certain metaphors stigmatize the newly diagnosed person.

Historical research figures early in the book. Sontag shows that with many diseases came the misconception that they were morally contagious—that the sufferer committed a social transgression, was afflicted, and others of the same moral failings would contract the disease. This same misconception accompanied, for example, Europe’s bubonic plague in the Middle Ages before science and medicine had knowledge of germs (pathogens), bacteria, or hereditary conditions. Sontag makes the case that it is still common to attach a moral failing to the onset of disease, making moral failing (a personality metaphor) one of the most devastating metaphors, especially for people diagnosed with cancer.

To prove her point about cancer and its metaphors, Sontag makes a parallel argument about metaphors and tuberculosis. As she takes the reader step by step through each metaphor, she compares cancer with tuberculosis. For example, she notes that tuberculosis had been considered a passionate disease that affected artists who were brimming with vitality, ideas, and love: Tuberculosis affects the lungs, which is the source of breath, of inhalation, of release. In contrast, the metaphor attached to cancer is not of an expression of passion but of a repression of a desire that gets literally “balled up” in a voracious tumor. Appropriately (or so people have thought for many years), cancer can occur in parts of the body that most people do not like to talk about—the colon and the genitals, for example. Sontag’s point is that metaphors make it all too easy to say that personality alone causes a disease.

Sontag’s analyses are interspersed with examples from literature: ill characters in works by Charles Dickens and Franz Kafka; Thomas Mann’s Der Zauberberg (1924; The Magic Mountain, 1927); etymological entries in dictionaries; and even the Wild West persona of Doc Holliday, infamous gunfighter and tuberculosis sufferer. Sontag even tracks down the earliest cancer metaphor, put to words by the Austrian American psychoanalyst and psychiatrist Wilhelm Reich. Reich was fascinated with famed psychologist Sigmund Freud’s jaw cancer, and Reich supposed that Freud, once an avid talker who eventually resigned himself to doubt, caused his own jaw—the bone that helps with the act of speech—to get cancer. Reich confidently asserted that resignation and repression cause cancer, and the metaphor lingers today.

Sontag argues that such thinking places blame on the personality of the individual with cancer. Cancer, as is now known, is inherited as well as random, and it often has multiple causes. Early cancer metaphors sought to simplify a complex disease. Just as the tuberculosis/passion metaphor is ridiculous, so, too, Sontag argues, is the cancer/repression metaphor.

Having established the personality metaphor of illness, Sontag moves on to punishment metaphors. The plague, for example, was commonly thought of as a suitable punishment for a corrupt medieval society. A few centuries later, cancer retained the metaphor of punishment. That is, the individual had failed in some way, and so deserved chaotic, malignant cancer cells.

What Illness as Metaphor is perhaps best known for, however, is Sontag’s analysis of military metaphors associated with cancer. When referring to cancer and its treatment, people use phrases such as “bolstering” the body’s “defenses” and “battling” the “invasive” tumor. Blood cells get “counts,” like soldiers at the end of each day of war. Treatment uses words such as “bombard,” “neutralize,” and “kill.” People who go into remission are “survivors.”

Sontag footnotes obscure facts about chemotherapy and warfare, explaining how the earliest cancer drugs share a lineage with mustard gas, just as an early syphilis treatment used arsenic—the dark irony being that the treatments, when approached with a warfare mentality, cause a whole set of new health problems.

While arsenic is no longer used, the ongoing problem with these “battle” metaphors, she says, is threefold: First, researchers, prodded by advances in medicine, continually promise a cure but end up looking like distant generals always proclaiming that victory is near. Second, doctors are like the hardened officers in the trenches. Third, the patients are stuck in the unfair and depressing mind-set of thinking of their bodies as battlefields, their treatment as an army on the verge of defeat. Sontag argues that this is no way to approach disease in the modern age.

Sontag concludes on a hopeful note; that the language linked with cancer is bound to change in the future simply because the knowledge of cancer will improve. Carrying her argument-by-comparison through to the end, she notes that tuberculosis, now uncommon and curable, is no longer saddled with metaphors. Sontag sees that tuberculosis is a precedent. When cancer is more understood, more curable, or even eradicated, the negative metaphors attached to it will fall away, too.

Illness as Metaphor makes a sound case for change. The breadth of research, condensed into an easy-to-read book that is written in Sontag’s incisive yet informative style, still appeals to many people, including healthcare providers, patients, family members, scholars, and students. The book is frequently taught in colleges and universities, especially with its companion book, AIDS and Its Metaphors (1989). The two books gained renewed attention when Sontag died of cancer on December 28, 2004.

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