Illness as Metaphor

Sontag, Susan

Primary Category: Literature / Nonfiction

Genre: Treatise

Annotated by:
Coulehan, Jack
  • Date of entry: May-20-1997
  • Last revised: Aug-29-2006


Sontag argues against the use of illness as metaphor. She states her main point on the first page of this long essay : "The most truthful way of regarding illness--and the healthiest way of being ill--is one most purified of, most resistant to, metaphoric thinking."

Tuberculosis and cancer serve as her two central examples of the human tendency to use metaphoric thinking about illness. In the 19th century, tuberculosis was considered a disease of passion, of "inward burning," of the "consumption" of life force. Sufferers were thought to have superior sensibility; the illness purified them of the dross of everyday life. The romantic image of the TB sufferer became "the first widespread example of that distinctively modern activity, promoting the self as an image" (p. 29). Metaphoric thinking about TB declined in the early part of the 20th century as the disease succumbed to science and public health measures.

Cancer has now become the predominant disease metaphor in our culture. Cancer is considered a disease of repression, or inhibited passion. The cancer sufferer characteristically suppresses emotion, which after many years emerges from the unconscious self as malignant growth. As in Auden’s poem, Miss Gee, reproduced on page 49, (see annotation in this database): "Childless women get it, / And men when they retire . . . . " Sontag uses the 19th century view of insanity as another example of malignant metaphoric thinking, while metaphor related to syphilis was somewhat more benign. She concludes the essay with an eloquent prediction that, as we learn more about the etiology and treatment of cancer, its metaphorical system will die on the vine. (I wonder if Sontag would consider my "die on the vine" an appropriate metaphor here?)


This essay is provocative and astringent. Prickly ideas and metaphors leap from every page. Sontag stimulates a careful re-evaluation of the place of metaphor in our thinking about illness. She touches upon, but doesn’t do much with, metaphor intrinsic to medicine; she alludes to the "war against cancer," but doesn’t develop the general notions of physician as warrior, physician as priest, physician as engineer, etc.

While very provocative, the essay has several limitations. First, the cancer metaphor that Sontag describes was much more limited than she claims. While the psychosomatic movement may have conceived of cancer as an emotional failure, this view was never as widespread in Western culture as the romantic consumptive. I’m even skeptical about the latter. While it was well-known in the 19th century that the urban poor died in droves from consumption, I doubt whether the "romantic" culture considered the poverty-stricken to be exceptionally fine or sensitive.

Second, Sontag never makes the second half of her case. Why is it unhealthy to think metaphorically about illness? What harm does it do to the sufferers? Has metaphoric thinking about TB or cancer inhibited our scientific study of them as diseases? Finally, Sontag seems never to consider the obvious: metaphoric (imaginative) thinking is the way we humans discover meaning in our lives. Serious illness is an important event in a life narrative. Thinking about illness (as opposed to thinking about disease) without using metaphor is probably neither desirable nor possible.


Farrar, Straus & Giroux

Place Published

New York



Page Count