Monday, March 13, 2006

Susan Sontag's Illness as Metaphors - TWO

In illness as metaphor, Sontag claims, “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, metaphorical thinking.” Given the very definition of a metaphor, any word or concept can be used as a metaphor. The use of illness as a metaphor is inevitable because illness is a metaphor; it is a metaphor for a culture’s view about ill persons, their personalities, and experiences grounded on the social condition of their era. These metaphors are not just inevitable; they are sometimes necessary for people’s well being when they have succumbed to an illness.

The dangers in using illness metaphors emanate from their cultural definition. The meaning that a culture attaches to an illness, especially an incurable one, determines how the ill person is considered and what metaphors are used. Sontag notes that in the pre-modern view, the ideal state of a well-balanced character is one where expression is limited. Accordingly, a disease expresses the character of a person, implying that the people cause their diseases by expressing themselves too much or too little. This view has negative implications (as Sontag notes) for a cancer patient whose disease is believed to come from his or her repressed passions and for a tuberculosis (TB) patient (before the etiology of TB was discovered) whose disease was thought to come from his or her excess of it.

While blaming the patient is never the way to go about treatment, Sontag does not even ask what the purpose of these metaphors are in the first place. Illness metaphors are not random; society assigns them based on its observations of the characteristics of the ill persons. Take the case of TB. Afflicted people were noticed to be euphoric and to have increased appetite for food and sex. They were thought to be lively because of their rosy cheeks, which looked like a sign of health. TB was also noticed in the more reckless and sensual individuals. This brought in the notion of “more” than normally observed, or excess. The treatment then is reduction of the excess, so people were told excess expression is the cause of their illnesses, but not as a way to blame them, but rather treat them by advocating reduction of those passions. Moreover, for this view to have prevailed at the time, it must have worked to some extent; a classic example of “the placebo effect.” Studies have shown that when people believe that something will work for them, it does work for them. While this 19th century view may have gathered some negative interpretations, they are only side effects of an effective metaphor.

Illness metaphors can shape people’s perceptions of reality and the way they interact with it, as well as serve as a way to alleviate the ill from the pain of such realities as having an incurable disease. A society’s reluctance to tell patients the truth about their illness, Sontag says, is because society has not yet come to terms with the inevitability of death. She does not, however, explain why society has not yet come to terms with death. Death directly questions people’s sense of control and their expression of free will. Metaphors are developed to protect people’s definition of “self.” If people were to truly face the inevitability of death, people may discount the future in any decisions because tomorrow is not a certainty--leading to a variety of reckless and potentially damaging decisions and actions. In addition, people might be hesitant to name or call something a disease when they do not know its causes, and, consequently, people may not take their condition seriously.

Illnesses, like cancer, where there is no single cause, put more pressure on a culture to define it, and a culture does so based on its value and the experience of the ill person. Illnesses are then used as metaphors in response to this pressure. These metaphors represent the culture’s ignorance about the particular disease, which is why when the etiology of the disease is known (as Sontag observes), the metaphors more or less vanish as in the case of tuberculosis. Metaphors then are only ways we deal with illnesses whose etiologies are not yet known. This claim is further supported by the observation that diseases whose etiologies were partially known like syphilis had fewer metaphors associated with them.

Illness metaphors are also ways of preventing disease, or of maybe even discovering disease etiologies. For example, in the text, Machiavelli uses illness metaphors that call for the prudence needed to control serious disease early on in the disease stage. In the case of syphilis, for example, the metaphors of morality attached to it probably decreased the level of risk behaviors that people engaged in because having syphilis was a sign of immorality at the time. Immorality was an important method for assessing a person’s character, and the threat of syphilis would deter people from the presumed correlated behavior, such as prostitution.

Certain illness metaphors have worked to make the ill person feel better about him or herself, rather than badly as Sontag’s argument seems to suggest. In the text, Shelly comforts Keats saying, “ this [tuberculosis] is a disease particularly fond of people who write such good verses as you have done.” As Sontag notes, tuberculosis metaphors were romanticized; they depict a TB patient as a sad person, who is able to feel such sadness because of the person’s particularly sensitive nature, and it made patient seem more “interesting.”The tubercular look even became the standard for physical appearance.

Illness metaphors are also used as a mode for positive change in the way society functions. They are metaphors used to judge society as repressive. In Charlotte Perkins Gilman’s “Yellow Wallpaper,” the speaker uses her hysteria as metaphor for her feeling of oppression from her husband and her environment, using the yellow wallpaper as a means of communicating these feelings.

Sontag argues that only when a disease has been de-mystified, that is, when its etiology has been discovered, can it be morally used as a metaphor. This statement further suggests that Sontag’s claim that illness is not a metaphor is rather a plea for the disuse of metaphors because of the negative effects of using them when the cause of a disease is unknown. Sontag focuses on the negative aspects of metaphoric usage based on her observation of its use in western cultures. She does not evaluate metaphoric use in other cultures, where it is likely to play a different, more obvious positive role. Medicine and science are heavily relied upon in western cultures where elitism dominates. Since elitism plays a role in how a mysterious illness is defined, it therefore plays a role in the metaphors that are used and even the effects of both the illness definition and the metaphors associated with it. For example, when AIDS first appeared, it was believed to be a gay plague, as a punishment for immorality. This definition maintains the elites-over-the-rest-of-the-world attitude that prevails in western cultures. However, when the disease spread to include a variety of groups, this belief decreased. The point here is that in western cultures, the relationship between groups of people is relatively discrete, which makes it easier for people to be isolated, especially the sick.

I acknowledge Sontag's very important concern, and I agree that the use of illness metaphor needs to be sensitive to its effect on the patient. However, thinking about illness without using metaphor is either impossible or undesirable, and its metaphoric use will endure until humans can develop a panacea, which would make metaphors in this context unnecessary.

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At 14/2/09 4:08 AM, Anonymous Anonymous said...

As a sufferer of a chronic illness I would like to say that reading Susan Sontag's rejection of illness as a metaphor has been a great help to me.
She had cancer at the same time as my mother. At that time it was the beginning of the current new age thinking about creating your own illness.

My Mum, a non-intellectual never got caught up in any of that thinking and has survived for 30 years thru various rounds of treatment.

On the other hand when I first became ill chose to believe that I had more power than I did and was encouraged in this way of thinking.

When I finally got so ill that I could no work or look after myself I had to deal with the disbelief of all my friends. There was so much judgement about what was happening to me and why.

Unfortunately I am not well enough to expand on why her ideas helped me so much...suffice to say they did and still do

At 11/12/09 2:36 PM, Blogger Sharon said...


Since 1980, Tuberculosis has skyrocketed from over 200,000 cases to over 500,000! This astonishing number is a sign that organizations, such as yours, are important now, more than ever. As I read through your website, it is clear that we share the same passion in fighting this horrible disease. Here at,, we are dedicated to the prevention and treatment of diseases. If you could, please list us as a resource or host our social book mark button, it would be much appreciated. We may not physically heal the suffering, but lets support their cause.
If you need more information please email me back with the subject line as your URL.

Thank You,
Sharon Vegoe

At 12/12/09 4:48 PM, Anonymous Anonymous said...

I believe Sontag's Illness as Metaphor is necessary and liberating literature. Those who have never experienced life threatening or chronic health problems generally want to blame lifesyles. At work, a 27 year old young man has been diagnosticed with cancer, and the attitude, as I perceive it, is that this person is no longer the same us. He is different. He will die and we have nothing in common. He's a freak. I will not allow myself to consider an ill person as anything but a human being whose probability of getting sick and possibly dying has become a reality. The majority of people, or at least many, think illness is self inflicted, which is a terrible moralistically impovished view to say the least.


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