Illness as Metaphor

by Susan Sontag

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Last Updated September 5, 2023.

In this analysis of the historical, literary, and social representations of all types of problems, Susan Sontag’s primary theme is the centrality of “illness” in such representations. Secondary to this is the theme of the body as metaphor for society, especially since the Enlightenment. Conversely, Sontag also argues that metaphors for social interactions, particularly violence and war, are applied to human ability to resist or survive disease. Thus, another central theme is the need to change the way that society views disease; this is urgent for patients and physicians alike. Although she uses examples of numerous diseases, she focuses on cancer and tuberculosis.

One thing that joins the emotional and physical dimensions of illness, Sontag claims, is the idea of moral responsibility. Tracing this idea back all the way to the Greeks, she reveals how diverse writers identified an individual person’s illness with social ailments, and vice versa. This habit became so ingrained that it is very difficult to write about problems without bringing in illness.

For Sontag, this propensity has become problematic because it tends to place too much responsibility on the affected person, not only for their own recovery but for being receptive to the illness in the first place. Delving into the historical background of tuberculosis, formerly called “consumption,” she exposes numerous fallacies about its causes that detracted from curing the disease. Poor people’s likelihood of contracting, for example, was linked to moral corruption automatic to lower-class status. Treatment that focused on germs and on eliminating contagion helped eradicate the disease.

Much of Sontag’s book is devoted to cancer, in large part because she was diagnosed with breast cancer and underwent successful treatment. As a writer specializing in social commentary, her reaction to diagnosis included immersing herself in related literature, both fiction and nonfiction. The propensity to blame the afflicted person and to demand they “attack” the disease so disturbed her that she decided to write this book.

The emphasis on attitude and psychological states is harmful, the author believes, because it creates the opposite effect that was apparently intended. People who do not respond well to treatment are likely to internalize this difficulty as personal shortcomings, which can spiral into depression. Sontag illuminates the paradox that, by trying to animate patient’s “fighting spirit,” physicians and counselors instead may be creating rather than exposing emotional problems. A further problem is that overemphasis on treating patients’ psychology can shifts the focus away from medical treatment and even medical research that would lead to a cure.

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