Written in 1978, Sontag’s long form essay ‘Illness as Metaphor’ is poignant for its historical study of illnesses and the metaphors that are used to describe them. These metaphors, most often, have a punitive and mystified connotation. Sontag takes us through the journey of metaphors attached with tuberculosis and, more recently, cancer. Essentially, she advocates for an explanatory language that is based on medical truths rather than on the disposition of the afflicted.
As a proponent of critical theory, it might seem like Sontag is handing over an illness to the field that it belongs to- the medical. However, she presents the tendency of philosophers and the general populace to shroud an illness, about which very little is known, in colorful and distasteful figurative language. This can be seen when Sontag writes, “And it is diseases thought to be multi-determined (that is, mysterious) that have the wildest possibilities as metaphors for what is felt to be socially or morally wrong.” In the course of the text, Sontag maintains that the mystification of diseases reduces as and when the scientific causes for a disease are determined.
The aim of this book review, in current times, is to look at the connections and predictions it makes about the trajectory of a disease and its imaginings in the public as well as medical realm.
Cancer in ‘Illness as Metaphor’
Medicine has seen a tremendous amount of technological and research-based advancement in the last four decades. The book tackled the subject before such revealing hypotheses about cancer were established. I, nevertheless, consideration of concepts and theses Sontag posits, despite this case. The concepts are still relevant to the way cancer shows up in our public parlance and imagination.
The book was written some years after President Nixon announced a war to vanquish cancer, even as the Vietnam war was being fought. The ready understanding of cancer as being invasive and spreading is widespread in cancer literature. The antibiotics and other forms of treatment are seen as ammunition against cancer, which takes over a body that rightfully belongs to the otherwise healthy patient.
Sontag brings attention to the fact that medicine has had (and perhaps still does have) a dominant narrative of being curative. It has been the claim of medicine that diseases can and must be cured so that the body can return to the land of the healthy. It is interesting that recent literature, like Atul Gawande’s ‘Being Mortal: Medicine and What Matters in the End,’ and schools of thought, such as narrative medicine, look at more than conventional curative modes of treatment.
Cancer: In the Public Realm
In ‘Welcome to Cancerland’, Barbara Ehrenreich illustrates, among many pertinent issues, the omniscient presence of cancer in everyday life, but also the ignorant optimism that it wouldn’t choose you as its ‘victim’ or ‘enemy’. It might happen to somebody else but not to ‘me’. Therefore, when one is diagnosed with cancer, the shock is overwhelming and denial is the initial response. This can be seen when patients list of the things they did right- the stringent exercise regime, their careful diet, lack of dependence on substance, etc. Ehrenreich, a patient of breast cancer, also looks at cancer as a metaphor for moral decay(like Sontag’s analysis decades earlier). She also looks at the way these metaphors pit her against her illness and her cancered body. She looks at treatments (mostly onerous) being addressed as fights, where only the morally strong emerge victorious.
Even when one is to look at a publicly sourced group of essays on cancer, the abundance of comparisons between war and cancer are countless. This begins with the statistical information that the number of ‘casualties’ due to cancer far exceed the number of casualties by war.
In conclusion, it is important to reflect on the impactful lines penned by Lisa Bonchek Adams, a ‘victim’ of metastatic breast cancer, in 2012. She is insistent that it is important not to look at her as a ‘fallen’ victim of the cancer. She notes that grief will also be best dealt with, in the case of her ‘passing’, when the truth is said as it is, and not in layers of abstraction.
While the ideas in Susan Sontag’s book might not be technically relevant in this day and age, her proposition to look at a medical disease in all its terrible truth is still appropriate. The novella, therefore, is a valuable read for physicians.