Illness As Metaphor

“Of course, many tuberculars died in terrible pain, and some people die of cancer feeling little or no pain to the end; the poor and the rich both get TB and cancer; and not everyone who has TB coughs. But the mythology persists.”

The social understanding of a disease, its mythology, proceeds and succeeds any singular experience or outlying data, which is to say, even if cancer is not always painful or if TB does not always include a cough, this knowledge will have no effect on changing the terms on which each disease is understood or discussed.

“Cancer is a rare and still scandalous subject for poetry; and it seems unimaginable to aestheticize the disease.”

Tuberculosis, with its believed increases in sexual drive and appetite, has stoked a number of authors, like Henry David Thoreau, to glamorize it, but cancer’s symptoms (denigration of the body, emaciation, slow death) have made it unfathomable to give it poetic terms.

“TB was represented as the prototypical passive death. Often it was a kind of suicide.”

Tuberculosis, which came to be viewed as a fading away from life and a regression of passion, was associated with a passive death or even a suicide. What this quote suggests is that the allusion in many of these writings and testimonials is that it was not the disease that was the cause of death but rather the patient’s decision to give up. This notion, along with others, is in part to blame for humanity’s harmful relationship with diseases like TB.

“Health becomes banal, even vulgar.”

Across a number of centuries and countries, doctors, authors, poets, and playwrights have utilized metaphors of illness to describe love, passion, sex, life force, degeneration, and death. What Sontag suggests is that the continual use of this language aligns these categories and states with illness rather than with our more permanent condition of good health. Thus, health becomes boring, banal, and, in some cases, offensive.

“Indeed, the romanticizing of TB is the first widespread example of that distinctively modern activity, promoting the self as an image.”

Due to several famous authors (Shelley), musicians (Chopin), and aristocrats effectuating the look of a tubercular, the aesthetic appearance of a TB victim became something people aspired to emulate. This led to the romanticization of the illness’s effect on one’s self-image.

“No one asks ‘Why me?’ who gets cholera or typhus. But ‘Why me?’ (meaning ‘It's not fair’) is the question of many who learn they have cancer.”

Here, Sontag is making a comment about the difference between epidemics and diseases. Something like the plague or cholera, both highly contagious, attacks large groups, whereas cancer and TB strike individuals in a different pattern, leading one to feel singled out against the collective.

“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.”

As Sontag has outlined, the poetic association of the disease’s relation to one’s character (think of the melancholic romantic poet suffering from TB) has been negatively reversed over time. Now, it is the lack of expression (think of a person who bottles up their emotions) that is seen not only as characteristic of a victim but perhaps even the source of the disease’s cause.

“Popular accounts of the psychological aspects of cancer often cite old authorities, starting with Galen, who observed that ‘melancholy women’ are more likely to get breast cancer than ‘sanguine women.’”

One must read this quote in the context of Sontag’s own diagnosis of breast cancer. Sontag, a person by all accounts prone to melancholy, is dealing with the idea that runs through this chapter particularly of patients causing their diagnosis through their demeanor or spirit. If this is true, which Sontag doesn’t find to be the case, then according to Galen, she is the cause of her diagnosis.

“Theories that diseases are caused by mental states and can be cured by will power are always an index of how much is not understood about the physical terrain of a disease.

This sentence, in the context of a chapter that is designed to provide ample evidence of equating mental states with diagnoses, is a clear articulation of Sontag’s central thesis: As advanced as we may seem a society, we continue to blame the victim’s psychological makeup for their contraction of illness. Even in the face of medical advancements in the 20th century, this predilection proves that we still know little about the relation between science, etiology, and victim.

“Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.”

This sentence is the emotional crux of Sontag’s book, as it is the culmination of her historical argument about society’s association between victim and cause. How someone has acted, and their psychological makeup, has been, historically speaking, pointed to as the cause of their disease, while also making the victim believe that they have, through their demeanor and actions, brought the diagnosis upon themselves.

“As TB was the disease of the sick self, cancer is the disease of the Other.”

Throughout the book, Sontag has compared and contrasted the symptoms, treatments, and social understandings of tuberculosis and cancer. With this sentence, she identifies the definitive difference. This statement works on two levels: first, that TB was understood to have come from within the patient and how they expressed or repressed themselves, whereas cancer is seen as an alien invader; and second, that TB diagnoses were seen as a manifestation of the patient’s identity, whereas cancer is seen as something nonhuman and not localized in the patient’s identity—it is Other.

“Illnesses have always been used as metaphors to enliven charges that a society was corrupt or unjust.”

This sentence, which begins the final chapter, broadens the perspective on the use of illness as metaphor to a global level. Illness, and the use of illnesses as metaphors of impurity, is evidence that there is something tainted in our society.

“To describe a phenomenon as a cancer is an incitement to violence.”

When something is described as a cancer, it is presented as potentially fatal to its host (a social ill within a society, for example). The implication is that one must treat it as one treats cancer: with evasive, harsh tactics that aim to remove the growth entirely. For Sontag, to use this metaphor is to essentially call for violent tactics of treatment.