Illness as Metaphor Narrative Essay

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Susan Sontag’s Illness as Metaphor is an eighty-seven-page theoretical narrative that explores and critiques the intertwining mechanisms of language and illness. As a Cancer victim herself she ironically brings candor, expertise, and a narrative to the reasoning behind her thesis. In Sontag’s words, it is “not what it is really like to emigrate to the kingdom of the ill and live there, but the punitive or sentimental fantasies concocted about that situation- stereotypes of national character”(3). She focuses on the victim-blaming metaphors frequently used to describe illness and directs sharp scrutiny towards the metaphors of TB and Cancer in particular. Sontag argues that the metaphors we utilize are at best-conjectured responses to diseases that are enigmatic and capricious.

Throughout history metaphors surrounding TB have progressed through time, as the finality of the disease has also evolved. These metaphors often interact with each other as the one metaphor evolved into the next. One extended metaphor of Tuberculosis is one of the melancholic characters. The illness experience of TB requires a distinctive personality. This myth surmises TB as the last stage of melancholia. Not to be confused with depression as Sontag describes depression as “ melancholy minus its charms- the animation, the fits” (50). The Melancholic character or the Turburcular is an elevated one; one that is set aside, creative, intelligent, and most importantly sensitive. TB is characterized as the disease of the creatives, particularly the poet as the illness narrative is erotic, “ erotic attitude is known as “romantic agony” derive from tuberculosis-.”

Sontag then addresses another prominent, yet intertwining metaphor; one of the vagabond, “a wanderer in endless search of the healthy place”(33). During TB’s height of incidence, it became the vogue predecessor for self- segregation, and exile, for a life of ease and traveling. It was a way of retiring from the world and its incessant responsibilities, almost a child-like existence as in the story of The Magic Mountain.

The idea of isolation not only characterizes the metaphors of TB it encapsulates the ideas of the entire culture, a culture in which separation is seen as a punishment and a reward; where separation is both feared and appreciated or a euphemism of the common juxtaposed pain and pleasure narrative. Sontag illustrates this juxtaposition well as she states, “Like all really successful metaphors, the metaphor of TB was rich enough to provide for two contradictory applications–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).

Juxtaposed with epidemics of the past, bubonic plague especially, which afflicted individuals are apart of an incidence risk group, TB is as a disease that isolates one from the community despite its comparable prevalence to other major diseases in society at the time. Sontag suggests that TB, like cancer today, is a mysterious disease of individualism. The disease individualizes and sets a person in relief against the environment; it was tuberculosis of yesterday, and today it is cancer. Individualization reinforces Sontag’s point of “Health becomes banal, even vulgar”(26). She illustrates the romanticization sounding TB and illness as a whole. A strong cultural paradigm in our society is individualism. It fuels not only our social interactions but our capitalistic endeavors.

Illness individualizes the person, reminds us that we all not only want a narrative but to occupy a narrative space that others cannot or would not want to occupy; to be non-banal and uncommon. It also subconsciously reminds us of our repudiation of “vulgar” communism as TB and other diseases show the differential health outcomes of the economic classes. We need illness as it confirms our bias that reveals self-evident truths of hard work, righteousness, and consequence. Anything else would be vulgar.

When analyzing these various metaphors, overarching themes start to radiate, and one can begin to see where the metaphors overlap and possibly how they became to be. TB is a bacterial infection of the lungs, which Sontag suggests as being “ a disease of the soul” (18), as it attacks the metaphorical “upper, spiritualized body,”(17). It is also a disease that disproportionately afflicted individuals immersed in poverty; “ a disease of poverty and deprivation– of thin garments, thin bodies, unheated rooms, poor hygiene, [and] inadequate food” (15).

With the added nuance of the disease being relatively painless (at least compared to a multitude of other terminal diseases) it is easier to see why individuals romanticize Turburculosis as a rest for the weary. TB thus gives a blueprint for recognizing which diseases are more likely to be romanticized, at least in a similar fashion as TB. Which diseases afflict individuals that are pitied, or deemed faultless; which diseases are relatable to the majority- in the sense that they induce sympathy/empathy due to familiarity, and which diseases are seen as rest for the weary.

The metaphors of illness that most translates into the modern age would be what Sontag describes as insanity or mental illness. In this particular case, major depression and mood disorders in today’s society would best reflect a mirrored nuance that TB held a century ago.

Sontag points to the parallels insanity and TB share, “ With both illnesses, there is confinement. “Sufferers are sent to a ‘sanatorium’ (the common word for a clinic for tuberculars and the most common euphemism for an insane asylum). Once put away, the patient enters a duplicate world with special rules. Like TB, insanity is a kind of exile. The metaphor of the psychic voyage is an extension of the romantic idea of travel that was associated with tuberculosis. To be cured, the patient has to be taken out of his or her daily routine. It is not an accident that the most common metaphor for an extreme psychological experience viewed positively-whether produced by drugs or by becoming psychotic-is a trip” (35-36).

Sontag describes insanity as the translation of TB into the twentieth century, and this idealization continues into the twenty-first century through the form of major depression and in particular manic-depression/ Bipolar disorder. The social implications of TB, such as the sufferer is weak in a certain way, or unable to handle the daily rigors of daily life like the vast majority of the population can, or “ the notion of the sufferer as a hectic, reckless creature of passionate extremes” (36), are all medicalized conditions in Bipolar Disorder. Juxtaposed characteristics of strength and weakness are magnified in manic-depressives as their strengths of increased sensitivity, heightened emotions, and senses, increased drive for pleasure is ultimately their weakness as well.

Manic-depressive individuals were also at one point in time highly likely to be quarantined in unsafe and unsanitary mental health facilities like tuberculars in sanatoriums. Also, the idea of empathy from the majority that surrounds bipolar disorder is fundamental as unlike physical illness, the etiology of what constitutes bipolar disorder is not concrete. This one allows for intrigue surrounding the disorder and further aligns bipolar with TB, as during the height of the TB epidemic the cause was unknown. More importantly is the connection between bipolar disorder and poverty and trauma. Bipolar is more likely to afflict individuals who suffered from these unfortunate events/predicaments, but they also increase the likelihood of poverty and trauma occurring. This phenomenon is critical for empathy/ sympathy from others.

However, the romanticization of bipolar disorder can be debilitating and dangerous. Although the idea of ease of life, and the absolving of responsibility and potentially guilt provides secondary benefit to individuals who are manic-depressive, there is an infantilization effect that is to most a heavy price to pay for the romanticization. Because illnesses such as these afflict the mind, there is a sense among the majority that there is a loss of self-control, which that highly coveted in a society that intermingles independence and self-control. Coupled with the idea of a lack of rational thought in manic-depressives which culminates in a very conditional form of empathy. The secondary benefits that are incurred through diagnosis come with increased surveillance and societal separation.

The critiques of Sontag’s work illuminate the complexity and the difficulty of what she is asking society to achieve.“But how to be morally severe in the late twentieth century? How, when there is so much to be severe about; how, when we have a sense of evil but no longer the religious or philosophical language to talk intelligently about evil? Trying to comprehend “radical” or “absolute” evil, we search for adequate metaphors. But the modern disease metaphors are all cheap shots. The people who have the real diseases are also hardly helped by hearing their disease’s name constantly being dropped as the epitome of evil. Only in the most limited sense is any historical event or problem like an illness. And the cancer metaphor is particularly crass. It is invariably an encouragement to simplify what is complex and an invitation to self-righteousness, if not to fanaticism.”

This excerpt gets to the crux of the major critique of Sontag’s thesis, and by the way, she delves into a spirited and defensive diatribe, she seemed to know what the major critique was. Sontag is keenly aware that metaphors are not only a staple in the English language but highly intertwined and conflated in the American context. Metaphors were a literary warning shot even during the founding of the country, “A prince whose character is thus marked by every act which may define a Tyrant, is unfit to be the ruler of a free people”( Declaration of Independence). Sontag knows she would be argued meticulously sometime in the future, and she was as Lakoff and Johnson would later argue in Metaphors We Live By, notably, that metaphors are omnipresent in language as such, saturating even the most simple and casual utterances.

Although she is not trying to rid the language of all metaphorical nuance, to rid it from medicalized language is difficult as it is pervasive. So much so that Sontag inadvertently utilizes the adjective “virulent” to describe the use of disease-metaphors. However, to harp on every instance of “disease-as-metaphor” is facetious at best. The idea is that to use disease, especially a disease that is not fully understood- like cancer, as metaphorical for or in condemnation of society; for one, helps no one, harms those who are ill, and most importantly is morally irreprehensible.


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Illness as Metaphor Narrative Essay. (2022, Mar 19). Retrieved from https://samploon.com/illness-as-metaphor/

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