Sontag, Susan. “Illness as Metaphor.” Illness as Metaphor and AIDS and Its Metaphors. New York: Picador, 1989. 1-88.

I. Illness as Metaphor

II. Tuberculosis (TB) and Cancer

A.    The etymology of both diseases suggests that they are both typologically similar in that the diseases “consume” the body.

B.   It is only after 1882, with the discovery of TB as bacterial infection and the invention of microscope in cellular pathology, that the distinction between TB and cancer was established, which resulted in the metaphors used for the two diseases becoming oppositional (11).

C.  Dissimilarity and Similarity in Myths

D.    TB and Insanity

E.  TB and Cholera

F.    Disease as Divine Judgment on Character

G.   Disease as Punishment

H.   Disease as Self-Caused

I.      Cancer and Emotions

J.     Psychologizing Illness

K. Disease as a Social Text

L.   Disease as Metaphor for Evil

M.   General and Capitalistic Metaphors for TB and Cancer

N.    Language of Warfare for Cancer

O.    Self and Other

P.    Disease Imagery as Political Discourse

A.    “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place” (3).

B. “My subject is not physical illness itself but the uses of illness as a figure or metaphor” (3).

C. “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” (3).

D.    “Any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious” (6).

E. “The very names of such diseases are felt to have a magic power,” which could cause the patient to deteriorate rapidly after knowing what s/he has gotten, i.e. tuberculosis and cancer (6).

F.  “The solution is hardly to stop telling cancer patients the truth, but to rectify the conception of the disease, to de-mythicize it” (7).

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II. Tuberculosis (TB) and Cancer

A.    The etymology of both diseases suggests that they are both typologically similar in that the diseases “consume” the body.

1.      Pulmonary TB was described as similar to consumption as early as 1398.

§ “…the word tuberculosis—from the Latin tuberculum, the diminutive of tuber, bump, swelling—means a morbid swelling, protuberance, projection, or growth” (10).

2.      Cancer was defined as “Anything that frets, corrodes, corrupts, or consumes slowly and secretly” in the Oxford English Dictionary.

§ “The earliest literal definition of cancer is a growth, lump, or protuberance, and the disease's name—from the Greek karkinos and the Latin cancer, both meaning crab—was inspired by the resemblance of an external tumor's swollen veins to a crab's legs” (10).

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B.   It is only after 1882, with the discovery of TB as bacterial infection and the invention of microscope in cellular pathology, that the distinction between TB and cancer was established, which resulted in the metaphors used for the two diseases becoming oppositional (11).

1.      Infection of Organs

a.       “TB is understood as a disease of one organ, the lung” (11)

b.      “Cancer is understood as a disease that can turn up in any organ and whose outreach is the whole body” (11)

2.      Symptoms

a.       “TB is understood as a disease of extreme contrasts: white pallor and red flush, hyperactivity alternating with languidness. The spasmodic course of the disease is illustrated by what is thought of as the prototypical TB symptom, coughing. The sufferer is wracked by coughs, then sinks back, recovers breath, breathes normally; then coughs again” (11-12).

b.      “Cancer is a disease of growth…of abnormal, ultimately lethal growth that is measured, incessant, steady” (12).

3.      Transparency of the Body

a.       “TB makes the body transparent…TB is understood to be, from early on, rich in visible symptoms…and can be suddenly and dramatically revealed” (12). Furthermore, TB is diagnosed through X-rays, which allows the patient to directly see their disease and the interior of the body.

b.      “In cancer the main symptoms are thought to be, characteristically, invisible—until the last stage, when it is too late” (12). The body is opaque in which a specialist is needed to discern through the analysis of tissues taken from the body.

4.      Vitality

a.       “TB was—still is—thought to produce spells of euphoria, increased appetite, exacerbated sexual desire” (13).

b.       “Cancer is thought to cripple vitality, make eating an ordeal, deaden desire” (13).

5.      Bodily Effects

a.       “TB is disintegration, febrilization, dematerialization; it is a disease of liquids—the body turning to phlegm and mucus and sputum and, finally, blood—and of air, of the need for better air” (13)

§ “In TB, the person is ‘consumed,' burned up” (14).

b.      “Cancer is degeneration, the body tissues turning to something hard” (13).

§ Cancer is also defined as “‘full-fledged parasites—they grow, are engendered, engender, have their structure, secrete, eat.' Cancer is a demonic pregnancy” (13-14).

§ “In cancer, the patient is ‘invaded' by alien cells, which multiply, causing an atrophy or blockage of bodily functions. The cancer patient ‘shrivels' or ‘shrinks'” (14).

6.      Time and Space

a.       “TB is a disease of time; it speeds up life, highlights it, spiritualizes it” (14)

b.      Cancer is a disease of space. “Its principal metaphors refer to topography (cancer ‘spreads' or ‘proliferates' or is ‘diffused'; tumors are surgically ‘excised'), and its most dreaded consequence, short of death, is the mutilation or amputation of part of the body” (14-15).

§ “Cancer has stages rather than gaits; it is (eventually) ‘terminal'” (14).

7.      Social Status

a.       “TB is often imagined as a disease of poverty and deprivation—of thin garments, thin bodies, unheated rooms, poor hygiene, inadequate food” (15).

b.       “Cancer is a disease of middle-class life, a disease associated with affluence, with excess…the rising incidence of the disease is seen as resulting, in part, from a diet rich in fat and proteins and from the toxic effluvia of the industrial economy that creates affluence” (15).

8.      Environment

a.       “…TB was a wet disease, a disease of humid and dank cities. The inside of the body became damp (‘moisture in the lungs' was a favored locution) and had to be dried out” by changing to high and dry environment (15).

b.      Cancer patients cannot be helped through a change in the environment because “The fight is all inside one's own body” (15).

9.      Suffering in Literature

a.       “TB is thought to be relatively painless” (16) that ends in an easy death.

§ TB in nineteenth century literature is seen as “an edifying, refined disease” (16) in which the person dying is “pictured as made more beautiful and more soulful” (17).

b.      “Cancer is thought to be, invariably, excruciatingly painful” (16).

§ “The person dying of cancer is portrayed as robbed of all capacities of self-transcendence, humiliated by fear and agony” (17).

10.  Spiritual and Bodily Images

a.       “TB takes on qualities assigned to the lungs, which are part of the upper, spiritualized body.”

§ Lungs are traditionally associated with the images of breath and life. “A disease of the lungs is, metaphorically, a disease of the soul” (18).

b.      “Cancer is notorious for attacking parts of the body (colon, bladder, rectum, breast, cervix, prostate, testicles) that are embarrassing to acknowledge” (17) and more shameful.

§ “Cancer, as a disease that can strike anywhere, is a disease of the body” (18).

11.  Death

a.       “The Romantics moralize death in a new way with the TB death, which dissolved the gross body, etherealized the personality, expanded consciousness”(19-20) that led to the aestheticism of death.

b.      “Cancer is a rare and still scandalous subject for poetry” (20)

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C.   Dissimilarity and Similarity in Myths

1.      Disease of Passion

a.       “TB was thought to come from too much passion, afflicting the reckless and sensual” (21).

§ “Fever in TB was a sign of an inward burning: the tubercular is someone ‘consumed' by ardor, that ardor leading to the dissolution of the body” (20).

b.       “Cancer is a disease of insufficient passion, afflicting those who are sexually repressed, inhibited, unspontaneous, incapable of expressing anger” (21).

2.      Disease of Repression

a.       TB and cancer are thought to be caused by repression of one's “true sexual nature” and thus the prevention was to have “a liberated sexual life” (21).

b.      “According to the mythology of cancer, it is generally a steady repression of feeling that causes the disease.”

3.      Disease of Resignation

a.       “TB sufferers may be represented as passionate but are, more characteristically, deficient in vitality, in life force” (25). “TB was represented as the prototypical passive death. Often it was a kind of suicide” (24) in literature.

b.      Wilhelm Reich defines cancer as “a disease following emotional resignation—a bio-energetic shrinking, a giving up of hope” (23).

4.      Contradictions in TB myths

a.       “It described the death of someone (like a child) thought to be too ‘good' to be sexual: the assertion of an angelic psychology. It was also a way of describing sexual feelings—while lifting the responsibility for libertinism, which is blamed on a state of objective, physiological decadence or deliquescence” (25).

b.      “It was both a way of describing sensuality and promoting the claims of passion and a way of describing repression and advertising the claims of sublimation, the disease inducing both a ‘numbness of spirit' and a suffusion of higher feelings” (26).

5.      Romanticizing TB

a.       “TB was one index of being genteel, delicate, sensitive” (28).

b.      “The TB-influenced idea of the body was a new model for aristocratic looks—at a moment when aristocracy stops being a matter of power, and starts being mainly a matter of image” (28).

c.       TB led to “Many of the literary and erotic attitudes known as ‘romantic agony'” (29). “Gradually, the tubercular look, which symbolized an appealing vulnerability, a superior sensitivity, became more and more the ideal look for women” (30).

d.      “It is with TB that the idea of individual illness was articulated, along with the idea that people are made more conscious as they confront their deaths, and in the images that collected around the disease one can see emerging a modern idea of individuality that has taken in the twentieth century a more aggressive, if no less narcissistic, form” (30).

6.      TB and Melancholy

a.       “The melancholy character—or the tubercular—was a superior one: sensitive, creative, a being apart” (32).

b.      TB was seen as a link to creativity. “It supplied an important model of bohemian life, lived with or without the vocation of the artist” (33).

§ “The Romantics invented invalidism as a pretext for leisure, and for dismissing bourgeois obligations in order to live only for one's art” (33-34).

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D.    TB and Insanity

1.      “Cholera is the kind of fatality that, in retrospect, has simplified a complex self, reducing it to sick environment” (37).

2.      Tuberculosis is “The disease that individualizes, that sets a person in relief against the environment” (37).

a.       “TB was understood as a disease that isolates one from the community” in which victims were singled out one by one (38).

b.      TB was seen as an inheritable disease similar to cancer.

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 F.    Disease as Divine Judgment on Character

1.      “The disease around which the modern fantasies have gathered—TB, cancer—are viewed as forms of self-judgment, of self-betrayal” (40). “One's mind betrays one's body” or “One's body betrays one's feelings” (40).

2.      “Even if the disease is not thought to be a judgment on the community, it becomes one—retroactively—as it sets in motion an inexorable collapse of morals and manners” (41).

3.      “Fatal illness has always been viewed as a test of moral character, but in the nineteenth century there is a great reluctance to let anybody flunk the test” (41).

a.       “Tuberculosis provided a redemptive death for the fallen…or a sacrificial death for the virtuous” (41).

b.      For characters that are less highly regarded, “the calamity of disease can clear the way for insight into lifelong self-deceptions and failures of character” (42).

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1.      “For the Greeks, disease could be gratuitous or it could be deserved (for a personal fault, a collective transgression, or a crime of one's ancestors)” (43).

2.      “With the advent of Christianity, which imposed more moralized notions of disease…The idea of disease as punishment yielded the idea that a disease could be particularly appropriate and just punishment” (43).

3.      “In the nineteenth century, the notion that the disease fits the patients' character, as the punishment fits the sinner, was replaced by the notion that it expresses character” (43).

a.       “Recovery from a disease depends on the will assuming ‘dictatorial power in order to subsume the rebellious forces' of the body” (43-44).

b.      “Disease is what speaks through the body, a language for dramatizing the mental: a form of self-expression” (44).

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 H.    Disease as Self-Caused

1.      “With the modern disease…the character causes the disease—because it has not expressed itself. Passion moves inward, striking and blighting the deepest cellular recesses” (46).

2.      “The cancer imagery is far more punishing” in which shame is attached to the disease (48).

3.      “The tubercular could be an outlaw or a misfit; the cancer personality is regarded more simply, and with condescension, as one of life's losers” (49).

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  I.    Cancer and Emotions

1.      Cancer is linked to depression; “Depression is melancholy minus its charms—the animation, the fits” (50).

2.      “Cancer victims are low-gear persons, seldom prey to outbursts of emotion” (51).

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 J.    Psychologizing Illness

1.      “Psychologizing seems to provide control over the experiences and events (like grave illnesses) over which people have in fact little or no control” (55). “Psychological understanding undermines the ‘reality' of a disease” (55).

2.      Two Complementary Hypotheses Established

a.       “Every form of social deviation can be considered an illness” (56).

§ Relieves guilt

b.      “Every illness can be considered psychologically” (57). “People are encouraged to believe that they get sick because they (unconsciously) want to, and that they can cure themselves by the mobilization of will” (57).

§ Reinstates guilt

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K.    Disease as a Social Text

1.      “There is the ‘fight' or ‘crusade' against cancer; cancer is the ‘killer' disease; people who have cancer are ‘cancer victims'” (57).

2.      “Conventions of treating cancer as no mere disease but a demonic enemy make cancer not just a lethal disease but a shameful one” (57).

3.      “In the Middle ages, the leper was a social text in which corruption was made visible; an exemplum, an emblem of decay” (58).

4.      Diseases whose origin is uncertain and which have no treatment tend to be metaphorized.

a.       “First, the subjects of deepest dread (corruption, decay, pollution, anomie, weakness) are identified with the disease” (58).

§ The disease becomes a metaphor.

b.      “Then, in the name of the disease (that is, using it as a metaphor), that horror is imposed on other things” (58).

§ The disease becomes adjectival which is used to describe other things.

5.      “Epidemic diseases were a common figure for social disorder” (58).

§         “Feelings about evil are projected onto a disease. And the disease (so enriched with meanings) is projected onto the world” (58).

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L.    Disease as Metaphor for Evil

1.      “In the last two centuries, the diseases most often used as metaphors for evil were syphilis, tuberculosis, and cancer—all diseases imagined to be, preeminently, the diseases of individuals” (59).

2.      Syphilis was seen as “an infection that corrupts morally and debilitates physically” (59) and used in late-nineteenth- and early-twentieth-century for anti-Semitic polemics.

§         The syphilis metaphor was a limited one because it is not regarded as mysterious; its cause is known.

3.      “It is diseases thought to be multi-determined (that is, mysterious) that have the widest possibilities as metaphors for what is felt to be socially or morally wrong” (61). For example, TB and cancer.

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M.   General and Capitalistic Metaphors for TB and Cancer

1.      “TB was once, and cancer is now, thought to be a pathology of energy, a disease of the will” (61-62).

a.        “Getting TB was thought to signify a defective vitality, or vitality misspent” (62).

b.      In a capitalistic society, TB can be described using an economic metaphor: “Energy, like savings, can be depleted, can run out or be used up, through reckless expenditure. The body will start ‘consuming' itself, the patient will ‘waste away'” (62).

§ “TB is described in images that sum up the negative behavior of nineteenth-century homo economicus: consumption; wasting; squandering of vitality” (63).

2.  Cancer was given the metaphors of “whatever seemed ruthless, implacable, predatory” (61).

a.        “Cancer was never viewed other than as a scourge; it was, metaphorically, the barbarian within” (61).

b.      In the language of capitalism, cancer is “that of unregulated, abnormal, incoherent growth. The tumor has energy, not the patient; ‘it' is out of control” (62-63).

§ “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” (63).

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N.    Language of Warfare for Cancer

1.      “Cancer cells do not simply multiply; they are ‘invasive'” (64).

§         “Cancer cells ‘colonize' from the original tumor to far sites in the body, first setting up tiny outposts…whose presence is assumed, though they cannot be detected” (64).

2.      “Radiotherapy uses the metaphors of aerial warfare; patients are ‘bombarded' with toxic rays” (65).

a.       “Chemotherapy is chemical warfare, using poisons” (65).

b.      “Treatment aims to ‘kill' cancer cells (without, it is hoped, killing the patient)” (65).

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O.    Self and Other

1.      “. . .TB was the disease of the sick self, cancer is the disease of the Other . . .” (68).

§         “In TB, you are eating yourself up, being refined, getting down to the core, the real you. In cancer, non-intelligent…cells are multiplying, and you are being replaced by the non-you…'nonself'” (67).

2.       “Cancer is a metaphor for what is most ferociously energetic; and these energies constitute the ultimate insult to natural order” (68).

§         Some people believe that “The disease is often experienced as a form of demonic possession—tumors are ‘malignant' or ‘benign'” (69) while others believe that “cancer signifies the rebellion of the injured ecosphere” (69-70).

3.      “TB was associated with pollution…and now cancer is thought of as a disease of the contamination of the whole world” (71).

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P.    Disease Imagery as Political Discourse

1.      “Disease imagery is used to express concern for social order . . .” (72).

a.       “Master illnesses like tuberculosis and cancer… are used to propose new, critical standards of individual health, and to express a sense of dissatisfaction with society as such” (72).

b.      “Both tuberculosis and cancer have been regularly invoked to condemn repressive practices and ideals, repression being conceived of as an environment that deprives one of strength (TB) or of flexibility and spontaneity (cancer)” (76).

2.      “…the modern metaphors suggest a profound disequilibrium between individual and society, with society conceived as the individual's adversary” (73).

a.       This is seen “…in Romantic rhetoric which opposes heart to head, spontaneity to reason, nature to artifice, country to city” (73).

b.      “The city was seen as itself a cancer—a place of abnormal, unnatural growth and extravagant, devouring, armored passions” (73).

3.      In the nineteenth century, “Disease, which could be considered as much a part of nature as is health, became the synonym of whatever was ‘unnatural'” (74).

§         “Disease (now equated with death) is what opposes life” (75).

4.      “In political philosophy's great tradition, the analogy between disease and civil disorder is proposed to encourage rulers to pursue a more rational policy”

§         Classically, illness in a society comes from imbalance. Thus, “treatment is aimed at restoring the right balance—in political terms, the right hierarchy” (76).

5.      “To perish from internal disorder—analogized to a disease—is suicide, something quite preventable: an act of will or, rather, a failure of will (that is, of reason)” (78).

6.      “Disease metaphors in modern political discourse assume a punitive notion: of the disease not as a punishment but as a sign of evil, something to be punished” (81).

a.       “…to liken a political event or situation to an illness is to impute guilt, to prescribe punishment” (82).

b.      “To describe a phenomenon as a cancer is an incitement to violence” (83), especially under the notion that cancer equals death.

§ The idea that “to treat a cancer one must cut out much of the healthy tissue around it” was used in the 1930s to treat the “Jewish problem” (83).

7.      The language of disease must change, evolve, when it is finally understood and cures found in order to partly “de-mythicize” the disease and allow more positive usage of its metaphors (86-87).

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