Illness as Metaphor

An incisive extended essay, Illness as Metaphor exposes mythologies connected with two of the most fearful of maladies, tuberculosis and cancer. During the greater part of the nineteenth century, tuberculosis was either romanticized and sentimentalized, or made the object of terrified speculation. Until 1882, when the tuberculosis bacillus was isolated and established as the cause of infection, the nature of the disease was believed to be mysterious. Around this mystery, which could be emotionally but not intellectually apprehended, an elaborate pattern of metaphors developed. Lacking medical facts to explain the true pathology of the illness, people invented a fanciful tuberculosis, using language that communicated their ambiguous, often contradictory feelings. Sontag points out that this fantasized tuberculosis scarcely resembles the real, scientifically described disease. As the inaccurate judgments of nineteenth century science gave way to factual investigation in our own time, so the metaphors of the past were seen to be inadequate. In the same manner, Sontag argues, contemporary metaphors applied to cancer will give way in the future to more exact language describing that malady. In time, cancer will be demythicized as tuberculosis has been. Sontag’s thesis is that we must understand the tyranny of false metaphors in order to liberate ourselves from the language of fears and superstitions that have no basis in reality.

To develop this thesis, Sontag carefully examines the older metaphorical concepts of tuberculosis as a pattern against which the reader can compare the modern metaphors of cancer. She has little interest in the medical or pseudoscientific notions of the disease prior to this century. Instead, she chooses as examples a wealth of material from literature. Because the metaphors concerning pathology either originate among writers, or because literary masters express in definitive form the most nearly representative metaphors derived from popular speech, writers serve as her primary source. With extraordinary erudition, Sontag assembles information from such diverse writers as Stendhal, Kafka, John of Trevisa, Muger, Hugo, Dickens, Henry James, Turgenev, Stevenson, Joyce, Goldsmith, Shelley, Mann, Gautier, and so on. Citing examples from fiction, drama, biography, letters, and diaries, she synthesizes enough material for a convincing essay on a topic such as “Literary Uses of Tuberculosis Prior to the Twentieth Century.” But she is less concerned with the impact of tuberculosis—either as metaphor or fact—upon literary figures than with the mythology that these writers perceived to be associated with the disease.

For most of them, tuberculosis was romanticized as an illness that spiritualized its victims. Even as the so-called consumptives seemed physically to waste away, they were believed to have gained spiritual resources. Considered sufferers from a disease of passion, tuberculars were supposed to be either individuals who were recklessly sensual, or, in contrast, people who denied themselves sexual energy. Either way, their disease was linked to excesses or repressions of love. Furthermore, victims were romantically associated with a malady that was to terminate following a prolonged but not agonizing illness. The fact that the progress of the disease seemed to be uncomfortable rather than painful, that its signs were pallor (or ruddy complexion) and emaciation rather than any horrible outward physical disfigurement, and finally that it seemed to heighten rather than diminish perception—all these observed conditions contributed to make tuberculosis seem “interesting.” Indeed, even those who were its victims appeared to accept the mythology of the disease with some satisfaction.

Yet, as Sontag demonstrates, the mythology failed accurately to describe tuberculosis as a pathology known to science. Although in its early stages the malady might seem to the victims to be only uncomfortable, in its final stages its ravages could be terrible. And the supposed spiritualization of the consumptive was actually a process of bronchial disintegration. Finally, the supposed etiology of the disease was entirely false. Passion had nothing to do with the causes of tuberculosis: a bacterial infection was responsible. As soon as Koch and others explained the nature of the disease, it lost its glamorous mythology. Contemporary writers speak of tuberculosis in accurate, rather than metaphorical language; and when a great writer, Thomas Mann, uses the older metaphors for the disease (for example, in The Magic Mountain), he can be...

(The entire section is 1877 words.)

Form and Content

In 1976 Susan Sontag discovered that she had breast cancer and—unless she underwent surgery—she had only six months to live. This experience added a fierce intensity to her life, she told a reporter in 1978, and it also led her to the writing of Illness as Metaphor. From her personal experience, then, and from the great amount of research she evidently did for the book (she cites numerous texts, mostly literary works of art but provides no bibliography), Sontag well knows of what she speaks when she prefaces the nine chapters by saying, in part:Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds a dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

While Sontag’s discussion progresses in a circular rather than a linear fashion (most of her major points expanding out concentrically into other points), and while she devotes considerable space to discussing the political uses to which illness has been metaphorically put throughout recorded history, her most salient argument is in defense of those “citizens of that other place.”

Contrary to at least one reviewer’s interpretation, this book is not primarily concerned with cancer. Indeed, as Sontag notes, the book’s subject is not physical illness itself; instead, it is “the uses of illness as a figure or metaphor. My point is that illness is not a metaphor, and the most truthful way of regarding illness—and the healthiest way of being ill—is one most purified of, most resistant to, metaphoric thinking.” While both healthy and ill people have been exposed to and prejudiced by metaphoric thinking about illness, Sontag dedicates this book to elucidating the various ways illness has been used metaphorically and to liberating those who are or will be ill from the potentially debilitating stigmas such metaphoric thinking can inflict...

(The entire section is 840 words.)

Form and Content

The first version of Susan Sontag’s Illness as Metaphor appeared in The New York Review of Books in 1978, and the hardbound book appeared soon after. Not surprisingly, the public response to acquired immunodeficiency syndrome (AIDS) led Sontag to write another work, called AIDS and Its Metaphors (1989); the two long essays are available in one volume.

Illness as Metaphor is divided into nine sections. It is a polemic that approaches its arguments from first one angle and then another, quoting from doctors, scientists, poets, novelists, and anyone else who has described tuberculosis or cancer in metaphors. Sontag’s splendid prose crackles with passion and indignation as she recounts the attitudes toward tuberculosis during the Romantic period and compares the myths surrounding that disease to later attitudes toward cancer. Sontag scorns author Norman Mailer as a “cancerphobe”—he had said that if he had not release some violent feelings by stabbing his wife he would have gotten cancer and died— and identifies psychologist Wilhelm Reich as mainly responsible for the identifica-tion of cancer with repression, which places the responsibility for cancer squarely on the patient.

To someone who has an illness, describing that illness in a metaphor is unhealthy. Illness is decidedly not a metaphor, and the best approach to it is to purge it of its metaphorical associations. To wrap up a disease in metaphor and...

(The entire section is 603 words.)


By 1975, Susan Sontag had established herself as a significant force in American letters with two novels, The Benefactor (1963) and Death Kit (1967), and three much-discussed works of criticism and social commentary, Against Interpretation, and Other Essays (1966), Trip to Hanoi (1969), and Styles of Radical Will (1969). She had also written and directed three films: Duet for Cannibals (1969), Brother Carl (1972), and a documentary on Israel, Promised Lands (1974).

Then in 1975, while finishing On Photography (1977), she learned during a routine physical exam that she had breast cancer. Her doctors estimated a 10 percent chance of her...

(The entire section is 322 words.)


Suggested Readings

Brooks, Peter. “Death of/as Metaphor.” Partisan Review 46, no. 3 (1979): 438-444. Compares Sontag’s views on metaphor to those of Alain Robbe-Grillet. Brooks doubts that people can truly free themselves from the need for metaphor and can only hope to expose metaphor for what it is. He hopes that Sontag will explore the subject further in the manner of Michel Foucault’s “archeologies.”

Bruss, Elizabeth. Beautiful Theories: The Spectacle of Discourse in Contemporary Criticism. Baltimore: The Johns Hopkins University Press, 1982.

Clare, Anthony. “The Guilty...

(The entire section is 434 words.)