Illness as Metaphor
|Publisher||Farrar, Straus & Giroux|
|Followed by||AIDS and Its Metaphors|
Teasing out the similarities between public perspectives on cancer (the paradigmatic disease of the 20th century before the appearance of AIDS), and tuberculosis (the symbolic illness of the 19th century), Sontag shows that both diseases were associated with personal psychological traits. In particular, she says that the metaphors and terms used to describe both syndromes lead to an association between repressed passion and the physical disease itself. She notes the peculiar reversal that "With the modern diseases (once TB, now cancer), the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease–because it has not expressed itself. Passion moves inward, striking and blighting the deepest cellular recesses."
Sontag says that the clearest and most truthful way of thinking about diseases is without recourse to metaphor. She believed that wrapping disease in metaphors discouraged, silenced, and shamed patients. Other writers have disagreed with her, saying that metaphors and other symbolic language help affected people form meaning out of their experiences.
Illness as Metaphor served as a way for Susan Sontag to express her opinions on the use of metaphors in order to refer to illnesses, with her main focuses being tuberculosis and cancer. The book contrasts the view points and metaphors associated with each disease. Tuberculosis was seen as a creative disease, leading to healthy people even wanting to look as if they were ill with the disease. However, lack of improvement from tuberculosis was usually seen as lack of passion in the individual. Tuberculosis was even seen as a sign of punishment by some religions, such as Christianity, leading the afflicted they deserved their ailment.
Sontag then made the comparison between the metaphors used to describe tuberculosis and cancer, with cancer being defined as a disease that afflicts people who lack passion, sensuality, and those who repress their feelings. Sontag also mentioned how multiple studies have found a link between depression and people afflicted with cancer, which she argues is just a sign of the times and not a reason for the disease, since in previous times physicians found that cancer patients suffered from hyperactivity and hypersensitivity, a sign of their time.
In the last chapter, Sontag argues that society's disease metaphors cause patients to feel as if society is against them. Her final argument is that metaphors are not useful for patients, since metaphors make patients feel as if their illness is due to their feelings, rather than lack of effective treatment. The most effective way of thinking about illness would be to avoid metaphorical thinking, and focus on only the physical components and treatment.
Sontag wrote the treatise while being treated for breast cancer. She does not mention her personal experience with cancer in the work, but she addresses it in her related 1988 work, AIDS and Its Metaphors.
At the time that Sontag was writing, the fad in alternative cancer treatment was psychotherapy for the patient's supposed "cancer personality". According to these proponents, patients brought cancer upon themselves by having a resigned, repressed, inhibited personality. By undergoing the often blame-filled psychotherapy offered by some groups, such as the Simonton Center, the patient would overcome cancer by consciously choosing to give up the emotional benefits he or she created the cancer for, and be healed. Others have taken her idea further, showing not that there is a real "cancer" behind the metaphors, but that all we have is metaphor—even in science—to understand the behavior of a disease that remains mysterious.
The work was originally published as three long essays in the New York Review of Books. Some of the more inflammatory language was slightly toned down for republication. For example, what Sontag originally called the "inimitable looniness" of Wilhelm Reich's language was softened to the "inimitable coherence".
Illness as Metaphor is one of Sontag's widest read and most celebrated works. Kirkus Reviews called it "a small, liberating book that could become the cancer patient's Common Sense." The literary critic Denis Donoghue of The New York Times gave the book mixed praise, describing it as "a deeply personal book pretending for the sake of decency to be a thesis." He added:
As an argument, it seems to me strident, unconvincing as it stands, a prosecutor's brief that admits nothing in defense or mitigation. The brief is too brief to be just. So the reader is left with a case not fully made but points acutely established; enough, at any rate, to make him feel not only that he must in future watch his language but, with the same vigilance, watch his attitudes, prejudices, spontaneities.
Additionally, critics also brought up the argument that metaphoric thinking about diseases hasn't stopped research about disease from taking place and that humans deal with the reality of their lives through the help of metaphors.
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