Susan Sontag and Illness Metaphors

Susan Sontag's writing on illness metaphors examines what happens when disease is made to signify a person's character, moral worth or social identity. Illness as Metaphor (1978) concentrates on tuberculosis and cancer; AIDS and Its Metaphors (1989) extends the argument to the imagery and stigma surrounding AIDS. Her subject is the cultural work performed by these descriptions.

Sontag is especially concerned with the additional burden created when illness becomes a judgement on the person who has it. Her essays are cultural criticism and polemic, written in particular historical circumstances. Their medical descriptions and predictions should be read in that context, rather than used as current clinical guidance.

Illness described metaphorically, and illness used as a metaphor

Two directions of comparison need to be distinguished. One describes illness through another domain, for example as an invasion or a battle. The other uses a disease name to describe a social phenomenon, for example calling corruption a cancer. The first supplies a way of imagining disease; the second borrows the disease's feared properties to condemn something else.

These directions can reinforce one another. If a disease word repeatedly stands for evil, its use in a diagnosis can carry associations beyond the medical information. Sontag's analysis asks how those associations become attached to people and groups, and how descriptions that appear merely vivid can become punitive.

Tuberculosis, cancer and imagined character

Sontag contrasts historical romanticisation of tuberculosis with images of cancer as hidden, invasive and destructive. She examines stories that associate tuberculosis with heightened sensitivity and passion, and stories that connect cancer with repression or emotional defeat. These are beliefs she scrutinises, not diagnoses she endorses.

The important distinction is between the bodily condition and the personality narrative imposed on it. A literary portrait of a sensitive consumptive character does not establish what causes tuberculosis. A metaphor of emotional blockage does not establish what caused someone's cancer. Describing the historical associations carefully prevents the discussion from reproducing them as facts.

Her critique also complicates the idea that apparently positive imagery is harmless. Romanticising an illness can obscure pain and ordinary material needs, just as condemning imagery can produce shame. Both can replace the person's circumstances with a culturally familiar script.

War, pollution and collective blame

In AIDS and Its Metaphors, Sontag discusses invasion, pollution and plague imagery, together with the move from an account of illness to the condemnation of a group. She also examines how military descriptions organise ideas of enemies, mobilisation, sacrifice and victory.

An analytical reading asks where the enemy is located and who is made responsible for defeating it. Does the person become an agent, a battleground, a threatened territory or someone judged for a supposed defeat? These roles are different. A phrase about “fighting” does not supply its complete significance without a speaker and a context.

Sontag acknowledges in the later essay that thinking cannot simply dispense with metaphor. Her argument is directed towards challenging particular images and the harm she believes they do. Describing her position as a straightforward demand to eliminate all metaphor misses that qualification.

Later research: attend to what speakers do with an image

Semino and colleagues studied online writing by 56 people with cancer and 307 health professionals, using quantitative and qualitative methods. The two collections totalled 753,302 words. Their analysis found that violence metaphors could function in empowering as well as disempowering ways, and that journey metaphors could also support either kind of use.

This finding qualifies a blanket division between harmful battle language and helpful journey language. The study concerns particular online texts and their analysis; it was not a trial demonstrating effects on treatment or survival. It complements Sontag's critique by asking how actual speakers use the imagery in context.

Comparing the implications of a description

The following examples are constructed for analysis. They are not patient quotations or recommended scripts.

Constructed wording	Feature to examine	A question left open
“She lost her battle.”	An outcome is described as defeat.	Does the passage imply that sufficient effort could have guaranteed victory?
“We are fighting for better support.”	The struggle concerns access to resources.	Who is acting, and what specific change is being sought?
“This journey has no map.”	Movement is combined with uncertainty.	Is the journey image chosen by the person or imposed by someone else?
“That group is a cancer on society.”	A disease image condemns people collectively.	What actions does the description invite, and what evidence does it replace?

The second example shows why the object of a struggle matters. Fighting for care is not identical to representing a body as a battlefield. The third shows why a journey is not automatically reassuring. The fourth brings the analysis into political rhetoric, beyond accounts of individual illness.

Reading Sontag alongside the rest of the wiki

Sontag supplies a strong challenge to the assumption that finding symbolic meaning is always beneficial. A cultural critic, a literary interpreter and a person describing their own experience have different purposes and different authority over the account. Preserving those distinctions makes room both for criticism of imposed imagery and for attention to a person's chosen words.

For this wiki, her essays are useful in examining agency, blame, personification and the ethics of interpretation. They do not supply a code for translating symptoms or a test of a therapeutic method. A careful comparison identifies whose description is being used, what it implies and how the person or group described responds to it.

Related pages

• The Ethics of Metaphor
• Personification and Agency
• Metaphor in Politics and Public Debate
• Metaphor in Therapeutic Conversation
• Metaphor and Personal Narratives
• Metaphor Research Library