Illness as Metaphor by Susan Sontag
My rating: 4 of 5 stars
In 1978, when Susan Sontag wrote Illness as Metaphor, a classic work, she was a cancer patient herself. But in spite of that, it is not a book about being ill or about the travesties of being a cancer patient. In Sontag’s words, it is ‘not what it is really like to emigrate to the kingdom of the ill and live there, but the punitive or sentimental fantasies concocted about that situation‘.
Her subject is not physical illness itself but the uses of the various diseases as a figure or metaphor for completely unrelated instances. Sontag is very emphatic that ‘My point is that illness is not a metaphor, and that the most truthful way of regarding illness-and the healthiest way of being ill – is one most purified of, most resistant to, metaphoric thinking.‘ Yet, Sontag admits, it is hardly possible. But, her work still attempts to do just that – ‘It is toward an elucidation of those metaphors, and a liberation from them, that I dedicate this inquiry.‘
Sontag directs her sharp scrutiny on the two diseases have been spectacularly, and similarly, encumbered by the trappings of metaphor: tuberculosis and cancer and to other diseases such as cholera, plague, syphilis and leprosy that are used to a lesser extent.
The book’s main contention is that our fantasies are responses to diseases that are mysterious in origin and terminal and capricious in nature. TB in the last century and cancer now fits that bill and hence becomes targets of our collective imagination.
The Metaphors of TB
TB used to be the disease of choice for all sorts of metaphors throughout the last century. Many myths surrounded it.
One of the most potent myths was that it takes a sensitive person to feel melancholy; or, by implication, to contract tuberculosis. The myth of TB constitutes the last step in the long career of the ancient idea of melancholy. The melancholy character – now of the tubercular – was a superior one: sensitive, creative, a being apart. It was so well established that TB and creativity was linked in mysterious ways that it was even suggested at times that it was the progressive disappearance of TB which accounted for the current decline of literature and the arts.
The tuberculic is characterized as a dropout, a wanderer in endless search of the healthy place. Starting in the early nineteenth century, TB became a new reason for exile, for a life that was mainly traveling, as shown in many great travel novels of the era. It was a way of retiring from the world without having to take responsibility for the decision or consequences as in the story of The Magic Mountain.
In contrast to the great epidemic diseases of the past (bubonic plague, typhus, cholera), which strike each person as a member of an afflicted community, TB was understood as a disease that isolates one from the community. However steep its incidence in a population, TB – like cancer today – always seemed to be a mysterious disease of individuals, a deadly arrow that could strike anyone, that singled out its victims one by one. The disease that individualizes, that sets a person in relief against the environment, was tuberculosis and today is cancer.
Transformation of the TB Metaphors
The TB myth has been transformed in the modern age but the object of all the transference is not, of course, cancer – a disease which nobody has managed to glamorize. In the twentieth century, the romantic aspects of the TB myth has been transferred to a similarly harrowing and mysterious disease that is made the index of a superior sensitivity – Insanity.
Sontag points out that with both TB and with mental illness, there is confinement. Sufferers are sent to a “sanatorium” (the common word for a clinic for tuberculars and the most common euphemism for an insane asylum). Once put away, the patient enters a duplicate world with special rules. Like TB, insanity is a kind of exile. The metaphor of the psychic voyage is an extension of the romantic idea of travel that was associated with tuberculosis. To be cured, the patient has to be taken out of his or her daily routine. It is not an accident that the most common metaphor for an extreme psychological experience viewed positively-whether produced by drugs or by becoming psychotic-is a trip.
With the coming of the twentieth century the myth and the metaphors and attitudes formerly attached to TB has now been apportioned among two diseases:
Some features of TB go to insanity: the notion of the sufferer as a hectic, reckless creature of passionate extremes, someone too sensitive to bear the horrors of the vulgar, everyday world. Other features of TB go to cancer – the agonies that can’t be romanticized. Not TB but insanity is the current vehicle of our secular myth of self-transcendence.
Comparisons between TB and Cancer Motifs
The metaphors attached to TB and to cancer are contrasted in great detail by Sontag:
Etymology – ‘Cancer’ is imagined as malevolent growth, crawling or creeping like a crab and its etymology comes from this image. Tuberculosis was also once considered a type of abnormal extrusion: the word tuberculosis comes from the Latin tuberculum, the diminutive of tuber, bump, swelling – means a morbid swelling, protuberance, projection, or growth.
Symptoms – transparency vs opaqueness – While TB is understood to be, from early on, rich in visible symptoms (progressive emaciation, coughing, languidness, fever), and can be suddenly and dramatically revealed (the blood on the handkerchief), in cancer the main symptoms are thought to be, characteristically, invisible – until the last stage, when it is too late.
Speed and Time - TB is a disease of time; it speeds up life, highlights it, spiritualizes it. Cancer has stages rather than a “gallop”. Cancer works slowly, insidiously. Every characterization of cancer describes it as slow, growing menacingly and out-of-control, though this metaphor has speeded up since Sontag’s days.
Economics – TB is often imagined as a disease of poverty and deprivation-of thin garments, thin bodies, unheated rooms, poor hygiene, inadequate food. In contrast, cancer is a disease of middle-class life, a disease associated with excess. Rich countries have the highest cancer rates, the toxic effluvia of the industrial economy that creates affluence
Pain – TB is thought to be relatively painless. Cancer is thought to be, invariably, excruciatingly painful. TB is thought to provide an easy death, while cancer is the spectacularly wretched one. The dying tubercular is pictured as made more beautiful and more soulful; the person dying of cancer is portrayed as robbed of all capacities of self-transcendence, humiliated by fear and agony.
Parts of the Body – While TB takes on qualities assigned to the lungs, which are part of the upper, spiritualized body, cancer is notorious for attacking parts of the body (colon, bladder, rectum, breast, cervix, prostate, testicles) that are embarrassing to acknowledge. TB is, metaphorically, a disease of the soul. Cancer, as a disease that can strike anywhere, is a disease of the body. Far from revealing anything spiritual, it reveals that the body is, all too woefully, just the body.
But leukemia seems to approach TB in being romantic and deserving of a more spiritualized metaphor as in the case of the heroine of Erich Segal‘s Love Story.
After providing these comparisons and contrasts, Sontag is also quick to admit that these are only metaphors and not accurate reflections of reality – “These are contrasts drawn from the popular mythology of both diseases. 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.”
Metaphors of Cancer
Cancer has never been viewed as anything other than a scourge; it had no romantic metaphors and it was always, metaphorically, the barbarian within.
The language used to describe cancer evokes an economic catastrophe – one of unregulated, abnormal, incoherent growth. It is out of control.
Sontag elaborates on this economic metaphor thus:
Early capitalism assumes the necessity of regulated spending, saving, accounting, discipline-an economy that depends on the rational limitation of desire. TB is described in images that sum up the negative behavior of nineteenth-century homo economicus: consumption; wasting; squandering of vitality.
Advanced capitalism requires expansion, speculation, the creation of new needs (the problem of satisfaction and dissatisfaction); buying on credit; mobility-an economy that depends on the irrational indulgence of desire. Cancer is described in images that sum up the negative behavior of twentieth-century homo economicus: abnormal growth; repression of energy, that is, refusal to consume or spend.
When we pause to ponder here, we can see that in the contemporary scenario, the metaphors of cancer applied to the economic scenario has gone back to the earlier ones associated with TB. This shows how easily we adapt our metaphors to equate our worst fears with our worst illnesses.
Sontag goes on to explain that, the controlling metaphors in descriptions of cancer are, in fact, drawn not from economics but from the language of warfare: with words like “bombarding” and “invasion” and ‘radical’ populating the scientific journals.
The melodramatics of the disease metaphor in modern political discourse assume a punitive notion: to liken a political event or situation to an illness is to impute guilt, to prescribe punishment. This is particularly true of the use of cancer as a metaphor. It amounts to saying, first of all, that the event or situation is unqualifiedly and irredeemably wicked.
This metaphor is not entirely new either: The Nazis had used the cancer metaphor to modernized their rhetoric about “the Jewish problem” throughout the 1930s: to treat a cancer, they said, one must cut out much of the healthy tissue around it to kill the tumor of the Jewish power that “effortlessly and interminably multiplies.”
Sontag says that to describe a phenomenon as a cancer is an incitement to violence. And this is clearly ominous as shown in the example above. But, she also goes on to say that “It is, of course, likely that the language about cancer will evolve in the coming years. It must change, decisively, when the disease is finally understood and the rate of cure becomes much higher. It is already changing, with the development of new forms of treatment.“
Lasting Influences of the TB Metaphor
Gradually, the tubercular look, which symbolized an appealing vulnerability, a superior sensitivity, became more and more the ideal look for women-while great men of the mid- and late nineteenth century grew fat, founded industrial empires, wrote hundreds of novels, made wars, and plundered continents.
Sontag draws our attention to the fact that the myth of the spiritually beautiful TB patient has now found in the twentieth-century women’s fashions (with their cult of thinness) the last stronghold for the metaphors associated with the romanticizing of TB in the late eighteenth and early nineteenth centuries.
Movies like Twilight project this metaphor of the wan, hollow-chested young men and pallid, rachitic young women.
The Death of the TB Metaphor and Hope for Cancer
Sontag says that by validating so many possibly subversive longings and turning them into cultural pieties, the TB myth survived irrefutable human experience and accumulating medical knowledge for nearly two hundred years. The power of the myth was dispelled only when proper treatment was finally developed, with the discovery of streptomycin in 1944 and the introduction of isoniazid in 1952.
For as long as its cause was not understood and the ministrations of doctors remained so ineffective, TB was thought to be an insidious, implacable theft of a life. Now it is cancer’s turn to be the disease that doesn’t knock before it enters, cancer that fills the role of an illness experienced as a ruthless, secret invasion – a role it will keep until, one day, its etiology becomes as clear and its treatment as effective as those of TB have become. Then the negative metaphors associated with cancer too might die out, or so Sontag hopes.
But inevitably, we will find a new illness to replace it with, after all, the most powerful metaphors are the ones that scare us most. The ideal candidate would be AIDS – which forms the subject of the next Sontag book that I intend to read soon – Illness as Metaphor and AIDS and Its Metaphors.
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