29 pages • 58 minutes read
Illness As Metaphor
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Chapters 4-6Chapter Summaries & Analyses
Chapter 4 Summary
Chapter 4 opens with an extended quotation from Oliver Goldsmith’s 1773’s play She Stoops to Conquer. In it, a wife and husband are speaking about the wife’s child by a previous marriage. The boy has a terrible cough and is generally weak. The wife, Mrs. Hardcastle, begins by blaming herself for the boy’s perpetual sickly state and wonders if shielding him from the world is the cause of his illness. Sontag uses this exchange to show the received ideas about TB (who is to blame, sources of shame, etc.) already at work in the 18th-century English culture.
With the advent of social mobility in the late 18th and early 19th century, TB became a marker of one’s appearance. The poet Byron Shelley, a tubercular, noted that the sickness colored his outward appearance. Oddly, in the 19th century, it became uncouth to eat heartily or act in a libertine manner, as more and more people aspired to a sickly, wan appearance that was brought on by sicknesses like TB. The co-opting of the look of TB victims by artists and aristocrats led to the look becoming something aspirational and of “a mark of distinction” (29). Sontag even relates the 20th-century look of high-fashion (thinness) with the last vestiges of a romanticization of the TB look.
This aestheticization became divided along gender lines, as women were idolized for retaining the look of a tubercular in the 19th century while men, during the growth of the industrial revolution, were idolized for their rapacious and power-hungry attitudes, which translated into size and girth. Ultimately, the aestheticization and romanticization of the outward appearances of TB led to a valorization of the affectations associated with its sufferers: melancholy, poetic, tragic, intelligent. It led to an association that still exists, that of tuberculosis being the disease of those with endless depth of feeling; as Shelley wrote to Keats, “this consumption is a disease particularly fond of people who write such good verses as you have done...” (32).
Lastly, Sontag makes comparisons between TB and insanity. Both require trips to the sanitorium, both are seen as a kind of exile, and both require the patient to leave society in order to heal. When TB is mostly cured through medical advances, some of its metaphors are given to those diagnosed with insanity—hecticness, recklessness, the romanticization of “madness”—and some move to cancer: “the agonies that can't be romanticized” (36).
Chapter 5 Summary
By pointing to two examples from Thomas Mann’s writings Death in Venice (1912) and The Magic Mountain (1924), Sontag notes that contracting TB isolates one from the community and, by extension, makes them singular and unique. TB and cancer both strike the individual, not like other sicknesses like the bubonic plague, typhoid, or cholera that targeted the masses. This circumstance prompted both notions of uniqueness on the side of the victim but also questions of “why me?”
In determining the cultural attitude towards TB, Sontag brings up another prominent sickness from the era: syphilis. While TB was seen to effect people on the ends of the spectrum—the passionate and the repressed—a syphilitic person was immediately read as being sexually promiscuous and a social scourge. The mysterious aura, sense of depth, and complexity that was often placed upon the tubercular was not conferred onto someone with syphilis.
All the singular feelings of “why me?” and the social question of why a disease hits a particular area are often parlayed into questions of divine judgment. That is to say, one’s becoming afflicted with a disease prompts both the community and the victim to wonder whether the disease is a moral judgment on someone’s character. This question has transhistorical roots, particularly with the great plague of the 14th century, which prompted Boccaccio to write in the Decameron, one of the era’s most famous literary works, that Florence’s people invited the wrath of the plague as punishment for their debauched behavior. The opposite of this religious judgment is a sort of transcendental revelation, potentially laying bare the falseness of one’s existence and allowing the sufferer to live out his or her remaining time authentically.
Chapter 6 Summary
The association between disease and victim, between disease and punishment, goes back to the origins of both literature (with Homer’s Iliad and Odyssey) and Christianity. However, by the 19th century, a disease diagnosis was seen to be an expression of a person’s character or will—“the presence of disease signifies that the will itself is sick” (43), wrote Arthur Schopenhauer. Through this association, metaphors of illness are reverse engineered. Cancer and disease become an evocative way of discussing and describing something. For example, as Kant writes, “Passions are cancers for pure practical reason and often incurable” (44). From this point, Sontag argues that, rhetorically, diseases are excessiveness and expression. This belief is made manifest insomuch as a disease was thought to reveal something unexpressed or concealed about a victim or the victim’s character.
There has been a shift in society to take a punitive view of disease as something the victim has wrought upon himself or herself, through action or, more likely, a lack of action. This, as Sontag clearly writes, is a dangerous view that manages “to put the onus of the disease on the patient and not only weaken the patient's ability to understand the range of plausible medical treatment but also, implicitly, direct the patient away from such treatment” (47). If a lack of self-regard or self-love is the cause of the disease, then it is unlikely that seeking a cure, which is an act of self-regard or self-love, will be undertaken. What’s worse, as Sontag shows with a diary entry by Katherine Mansfield, is that the diseased often thought they had to heal their flaws of character before they could rid themselves of the disease, instead of seeking medical treatment.
While the myths of both TB and cancer include the idea that the self is to blame, cancer’s associations are far worse and see the victim stricken with vast amounts of shame. The perception of cancer is one of a supreme failure of expression and one that results in contempt. These ideas (of shame, of social ostracization, of failure of expression) are all expressed in W.H. Auden’s poem “Miss Gee.” In the eyes of the public, a cancer diagnosis is seen as one of defeat and prescribed to losers. In the political realm, the cancer diagnoses of Ulysses S. Grant, Robert Taft, Huber Humphrey, and Napoleon were all linked to political loss.
Chapters 4-6 Analysis
Across the middle section of the book, Sontag is primarily concerned with tracking two interrelated ideas. The first is the language used to discuss disease (particularly TB and cancer) and how that language has changed over time. The second is how that language congealed into social perceptions and (mis)conceptions about those diseases and their relation to the victim. Sontag conveys these ideas, methodologically speaking, through constant citations of poems, plays, novels, personal letters, and diaries, and often by notable artists. What this technique accomplishes is two-fold. First, it gives the reader a clear look at the language that was used to describe illness at the time, and secondly, it allows the reader to extrapolate how that language either helped to form or was formed by prevailing notions about sickness.
What Sontag hits upon during these three chapters is the way TB became associated with certain affections of the creative soul (passion, expression, depth of feeling) and the look of the aristocracy (the gauntness of a tubercular influenced fashion in the 19th century and remains a visual pillar today). When the disease is linked with emotions, images, and affects rather than its symptoms or treatments, the primary social association becomes corrupted. That is to say, using metaphors to discuss illness presents a fogged view of the victim while also obscuring the direct line from causation to treatment. The disease’s cause and logic are subsumed by the metaphors—instead of looking to science or medicine for understanding, the notions of who the diseases target are related to literary and religious notions of shame, repression, and punishment.
As society progressed, its understanding and perceptions of disease and victimhood regressed. In place of the poetic soul stricken with TB, now someone who has bottled up their emotions and passions is seen to have brought the disease upon themselves. The cancer victim is, unlike the tubercular, not an image that is co-opted by the fashion community or the aristocracy. Rather, the cancer sufferer is seen to have brought the disease upon themselves either through moral or social failures, a lack of expression, or detached debauchery.
It is the metaphor that has entangled all these misconceptions and misnomers about disease and sickness in Sontag’s view. When the image of sickness is used to describe the passions, repressions, or degenerations of things (think of Kant’s notion that passion is a cancer to logical reason), the perception of cancer becomes unified with its usage as a metaphor. A metaphorical use of cancer, a cancerous idea for example, is a shameful and harmful thing that often kills or metastasizes to other ideas it is associated with. For Sontag, these associations blot out our definitions and ideas about real medical cancer or sickness, often in a way that is harmful to the sufferer, who, because of this false association, often blames their moral failings and thus seeks the wrong treatment for the sickness.
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