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.)