This essay was written ten years after the author's Illness as Metaphor (see this database). Sontag begins by explaining the stimulus for her earlier essay: her own experience as a cancer patient. During that time, she discovered that cultural myths about cancer tended to isolate and estrange cancer patients. They suffered needlessly because of "meaning" attributed to their illness by society. A decade later, Sontag observes that attitudes about cancer have become more open and truthful. However, a new illness (AIDS) has arisen to carry forward the metaphorical banner.

AIDS brings together two powerful metaphors about illness. First, AIDS develops further the theme (seen earlier in cancer) of disease as invader: the enemy invades and destroys you from within. Thus, AIDS strengthens the use of military metaphors in medicine. The war against cancer is reincarnated as a war against AIDS. Secondly, because AIDS is a sexually transmitted disease, it also evokes the theme of plague-as-punishment.

Sontag's project in this essay is more focused than in the earlier book. She acknowledges that the medical and public health response to AIDS explicitly counters these myths. She concludes that "not all metaphors applied to illnesses and their treatment are equally unsavory and distorting" (p. 94). The metaphor she is most anxious to see eliminated is the military metaphor, both on an illness level (illness invades the person) and a societal level (social problems invade society).


This essay is considerably less shrill and polemical than Illness as Metaphor. The author brings her own story (albeit only briefly) into the picture. The tone is more balanced as she discusses the themes of plague, invasion, and retribution surrounding AIDS.

There is still some confusion between justified interpretation of facts and unwarranted prejudice or metaphor. Much of this may be accounted for, however, by the advance in knowledge about HIV virus since the essay was written in 1988. For example, the "out of Africa" scenario about the origin of HIV virus is a well-supported hypothesis, not simply a Western bias. Likewise, Sontag's assertion that AIDS is unlikely to be a new disease (p. 71) is unsupported.

Perhaps because the medical and public health response to AIDS has explicitly avoided metaphor and has worked toward dispelling societal myths, Sontag writes more evenhandedly about AIDS and its metaphors. Her focus is narrower than in the earlier essay.


Farrar, Straus & Giroux

Place Published

New York



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