The language surrounding cancer is one of extremes: People have to “fight” or “crusade” against the “killer” sickness. The onus is placed on the sick to battle to get well, to fight off the demonic disease. Any disease or sickness whose cause is mysterious and whose cures are not a given is treated with a similar social weight and dread. Due to this murkiness, “the disease itself becomes a metaphor” (58), and thus the use of that metaphor takes on significance beyond its medical domain (e.g., the leper became a symbol for both decay and social ostracization). These diseases then take on added linguistic meanings and become adjectival: Lépreuse is a French word used to describe a decaying façade, and pestilence (from the bubonic plague) shifted to pestilent (a synonym for deadly).

The broadening usage of metaphors of illness has had pernicious effects in numerous ways. One concrete example is the usage of syphilis in anti-Semitic rhetoric in the late 1800s and early 1900s. In 1933, Wilhelm Reich argued that the fear of syphilis was reconfigured and transmuted onto mass feelings of anti-Semitism, a conclusion that Sontag lauds, although she notes that Reich himself used cancer as a metaphor to refer to modern ills. While syphilis became a potent metaphor, the diseases that are more mysterious in their causation and cure (TB at one point, and cancer at the time of the book’s publication) take on wider and thus potentially more harmful metaphors of social and moral ill. Cancer, for example, is associated with abnormal, unwanted, or uncontrolled growth or spread. Cancerous cells spread without inhibition, destroying the healthy cells along with them.

The tubercular was treated as someone with self-destructiveness but ultimately as someone vulnerable. They were given similar treatments as the mental patient: peaceful surroundings, isolation, relaxation, and controlled diet. The cancer patient, in keeping with its language, is prone to brutal treatments, a veritable counterattack against the disease’s initial onslaught—hence, as Sontag parenthetically notes, the famous line about cancer, “The treatment is worse than the disease” (64). The language surrounding the treatment of cancer becomes warfare-like (“invasive,” “colonizing” cells are up against the body’s “defenses”). The cultural discussion, as Sontag evocatively suggests, utilizes these terms in a similar fashion to how one discusses actual wars. Moreover, the language of doctors and reporters reporting on the hopeful cures for cancer is akin to the politicians and reporters predicting the end of a war (like Vietnam) long before it was over.

Sontag’s last argument of the chapter is that TB is a sickness from within, of the self, whereas cancer is the sickness of the Other. A cultural connection for how we understand cancer can be drawn to science fiction, where there are invaders, mutations, and ray guns. This idea, along with many other false ones bandied by different cultural and political factions, understands cancer as a modern disease, one whose cause is related to modern ills and excesses. This is just another misconception that makes extricating the disease from the patient that much more difficult.

Diseases, as Sontag notes, are often used metaphorically to gauge and measure individual and societal health. Illnesses become rhetorical devices for writers to expose the repressions and contradictions in the social lives of different locations. When miasma theory (the idea that atmosphere could help cure the sickness) was used to treat TB, illogical places were proposed for treatment, such as the dessert, the mountains, and islands—any place that was not the city. Many literary works affirm the perception that the city is disease-ridden and the provincial countryside is purer.

Illness’s usage in metaphors was undertaken across the political spectrum. In Italy alone, these metaphors colored the writings of both Antonio Gramsci (the founder of the Italian Communist Party) and Filippo Tommaso Marinetti (an artist who vehemently supported fascism). Given the depth and flexibility of the metaphor, many prominent social and political philosophers have glommed onto the usage of illness metaphors in their writing. Machiavelli suggests that an early diagnosis and foretelling of TB is helpful in its cure and a similar idea should be applied to ills in the body politic. Hobbes used the notion of illness to preach a reasoned response to societal problems, and Lord Shaftesbury used the metaphor to suggest that some tolerance of problematic symptoms must be accepted. For him, no society is 100% healthy.

In the modern era, the imagery of illness took on a more negative, more fatal undertone. For Sontag, this shift aligns with the times of revolution, particularly the American and French revolutions. In these eras, writers viewed social problems and unrest as fatal illnesses that needed to be attacked and excised. While these revolutions were used to pursue more democratic and egalitarian societies, subsequent political movements used the disease imagery to totalitarian ends. Hitler, for example, accused Jewish people of spreading “a racial tuberculosis among nations (83).”

When used in the political realm, metaphors of illness suggest radical and violent treatment. This can mean the removal of something generally agreed to be against the interests of the population (totalitarian regimes or fascist movements), or they can be used by authoritarian regimes as a means of propaganda or social control (a prominent example is with ethnic genocides). The chapter ends on a contemplative note, with Sontag suggesting that the use of disease imagery is inadequate is to articulate the “evils” of life and, worse, transfers a terrible perception onto those who suffer from the disease.