'Illness as Metaphor'
by Susan Sontag
Reviewed by DENIS DONOGHUE
The New York Times
Published: July 16, 1978
Illness as Metaphor" first appeared as three long essays in the New York Review of Books last January and February. The essays have been revised in a spirit of discretion. Wilhelm Reich's language is no longer described as having "its own inimitable looniness"; now it has "its own inimitable coherence." Laetrile is a "dangerous nostrum" rather than a "quack cure." John Dean is not reported as calling Watergate "the cancer on the Presidency." The revised version has him explaining Watergate to Nixon: "We have a cancer within -- close to the Presidency -- that's growing." Far-right groups no longer have "a paranoid view of the world"; now they have a "politics of paranoia." All the textual changes I have come across serve the cause of moderation.
But Susan Sontag is still angry. Her book is not about illness, but about the use of illness as a figure or metaphor. She is particularly concerned with the metaphorical sue of tuberculosis in the 19th century and cancer in the 20th. Most of these metaphors are lurid, and they turn each disease into a mythology. Until 1882, when tuberculosis was discovered to be a bacterial infection, the symptoms were regarded as constituting not merely a disease but a stage of being, a mystery of nature. Those who suffered from the disease were thought to embody a special type of humanity. The corresponding typology featured not bodily symptoms but spiritual and moral attributes: nobility of soul, creative fire, the melancholy of Romanticism, desire and its excess. Today, if Miss Sontag's account is accurate, there is a corresponding stereotype of the cancer victim: someone emotionally inert, a loser, slow, bourgeois, someone who has steadily repressed his natural feelings, especially of rage. Such a person is thought to be cancer-prone.
Most of Miss Sontag's evidence for attitudes about tuberculosis is taken from 19th-century novels and operas. Evidence for attitudes about cancer is rarely cited at all, except from wild men like Reich and George Groddeck. At one point Miss Sontag says that "there is peculiarly modern predilection for psychological explanations of disease, as of everything else" and that these explanations are popular because psychology is "a sublimated spiritualism," "a secular, ostensibly scientific way of affirming the primacy of 'spirit' over matter." But she does not produce any respectable evidence for these assertions.
If a doctor gave me a psychological stereotype instead of a cure or an alleviation, I'd demand my money back. If doctors have nothing better to say than that you have cancer because you are the type of person to get cancer, then indeed they should keep quiet. But because they don't know what causes cancer, their offense is venial if they hazard a guess.
Miss Sontag says that the most truthful way for regarding illness is the one most purified of metaphoric thinking. A disease should be regarded as a disease, not as a sign of some terrible law of nature or an otherwise unnamable evil. I agree with her. But anger drives her to the point of asserting that "our views about cancer, and the metaphors we have imposed on it, are so much a vehicle for the large insufficiencies of this culture, for our reckless improvident responses to our real 'problems of growth,' for our inability to construct an advanced industrial society which properly regulates consumption, and for our justified fears of the increasingly violent course of history." Very little evidence is produced that would sustain this list of charges.
The gross mythology of tuberculosis did not persist after the discovery of streptomycin in 1944 and the introduction isoniazid in 1952. I cannot believe that the sinister mythology of cancer will persist after the causes of the disease are known and a successful treatment is produces. It is appalling that the disease retains its secret. So long as it dies, the secret is likely to turn itself into a mystery and to stand for nameless evils of every kind. In the meantime we should be alert to our attitudes and to our words. Miss Sontag's book is bound to help in this respect, even though it is short of evidence. "As long as a particular disease is treated as an evil, invincible predator, not just a disease, most people with cancer will indeed be demoralized by learning what disease they have." I'm sure that's true, though I'm not convinced that many cancer patients are encouraged or forced to think of their disease in that way. What they fear is not an evil, invincible predator, but the terrible probability that their disease will result in death. If the metaphorical use of cancer discouraged doctors from trying to discover its cause and its cure, the situation would indeed be obscene, but there is no evidence that this is the case. Still, we are careless in our language. Miss Sontag is right in that charge.
But she is not innocent in her practice. She confesses that once, in despair over America's war on Vietnam, she wrote that "the white race is the cancer of human history." That is the kind of statement she would now repudiate, not for its political sentiment but for its recourse to the metaphor of cancer. In the last chapter of her book she comments on the fact that the same vocabulary is used in reference to cancer, aerial warfare and science fiction. Cancer cells invade the body, patients are bombarded with toxic rays, chemotherapy is chemical warfare: the enemy is a nameless Other to be conquered and destroyed. Tumors are malignant or benign. And so on. "The use of cancer in political discourse," Miss Sontag maintains, "encourages fatalism and justifies 'severe' measures -- as well as strongly reinforcing the widespread notion that the disease is necessarily fatal."
Miss Sontag is sensitive to this issue partly, I think, because she knows that her own rhetoric has often been guilty. Her victims have mostly been literary critic, so they have not deserved better treatment, but the habit of mind in her sentences has regularly been punitive. In the first pages of "Against Interpretation," for instance, she wrote that "like the fumes of the automobile and of heavy industry which befoul the urban atmosphere, the effusion of interpretations of art today poisons our sensibilities." The works of Beckett, she went on, have "attracted interpreters like leeches." A few pages later she wrote of "the infestation of art by interpretations." "Think of the sheer multiplication of works of art available to every one of us," she continued, "superadded to the conflicting tastes and odors and sights of the urban environment that bombard our senses." And the first sentence of her review of Sartre's "Saint Genet" reports that it is "a cancer of a book, grotesquely verbose, its cargo of brilliant ideas borne aloft by a tone of vicious solemnity and by ghastly repetitiveness." If any other critic were to write that sentence, Miss Sontag would italicize "cancer," "grotesquely" and "ghastly" and accuse him of having an obscene mind.
None of these sentences represents Miss Sontag at her best. At her best she is tough but fair. I have found "Illness as Metaphor" a disturbing book. I have read it three times, and I still find her accusations unproved. But the book has some extraordinarily perceptive things about our attitudes: how we view insanity, for instance, of heart disease. Nearly everything she writes demands to be qualified, but that demand is rarely met: she silences it before it has a chance to utter itself. I think her mind is powerful rather than subtle; it is impatient with nuances that ask to be heard, with minute discriminations that, if entertained, would impede the march of her argument. She is happiest when attacking a prejudice or a superstition or whatever she deems to be such, some force at large in the world that doesn't deserve the qualification that a more scrupulous mind would feel obliged to propose. She had the mind of a person who wants results and wants them now. So the elective affinity between her mind and its object is explained by the fact that each is present in the world as a form of power.
To Miss Sontag, writing is combat. If I wanted to see a fine discrimination made, with precisely the right degree of allowance for and against, I wouldn't ask Miss Sontag to supply it. She would be bored by the request. But if I badly wanted to win, at nearly any cost, I would do anything to have Miss Sontag on my side. As in "Against Interpretation," "Styles of Radical Will," "Trip to Hanoi" and now "Illness as Metaphor," she would use lurid metaphors to fight lurid metaphors, believing that a good end justifies any means, any language, any style.
It is my impression that "Illness as Metaphor" is a deeply personal book pretending for the sake of decency to be a thesis. As an argument, it seems to me strident, unconvincing as it stands, a prosecutor's brief that admits nothing in defense or mitigation. The brief is too brief to be just. So the reader is left with a case not fully made but points acutely established; enough, at any rate, to make him feel not only that he must in future watch his language but, with the same vigilance, watch his attitudes, prejudices, spontaneities.
Denis Donoghue is professor of Modern English and American Literature at University College, Dublin. His most recent book is "The Sovereign Ghost." He will teach at the Graduate Center in the City University of New York next fall.