Book: Illness as Metaphor

Overview
Susan Sontag’s 1978 essay interrogates the figurative language that surrounds disease, arguing that metaphorical thinking shapes how illnesses are imagined, blamed, and treated. Opening with the stark observation that "Illness is the night-side of life", she maps the cultural histories of tuberculosis and cancer to show how societies project anxieties and moral judgments onto the sick. By reading literature, journalism, medical writing, and popular culture, she demonstrates how metaphors do conceptual work that can burden patients and distort medical understanding.

Central Thesis
The core claim is that illness should be freed from metaphor. Sontag contends that metaphors assign hidden meanings to disease, converting a biological event into a moral or characterological drama. When illnesses are imagined as punishments, expressions of personality, or signs of decadence, sufferers are stigmatized and care is compromised. She urges a literal, non-moralizing language that treats disease as disease, not as symbol.

Tuberculosis: Romantic Metaphor
Sontag reconstructs the nineteenth-century imagination of tuberculosis, then called consumption. Its symptoms of pallor, thinness, and fever were romanticized as signs of spiritual refinement and heightened sensibility. In novels and operas, Dumas’s La Dame aux Camélias and Verdi’s La Traviata, Puccini’s La Bohème, and the world of sanatoria in Thomas Mann’s The Magic Mountain, consumption confers a melancholy glamour. The disease is figured as a wasting fire, a consumption of the body by inner heat that mirrors passionate, creative life. Even suffering is aestheticized, valorizing a languorous decline. Such imagery validates social fantasies about genius, sensitivity, and class, while masking the mundane causes and the brutal reality of the illness.

Cancer: Modern Metaphor
In the twentieth century, cancer becomes the dominant metaphor, but stripped of romance. It is conceived as secretive, insidious, a hidden growth that invades and metastasizes. Sontag shows how this imagery attaches to notions of repression and emotional coldness: psychoanalytic and popular theories pathologize a certain personality, the so-called Type C, as susceptible to cancer due to self-denial or bottled-up anger. The metaphors are militarized: patients are drafted into battles and wars, therapies are assaults, and the body is a battlefield to be scorched or poisoned. Cancer’s opacity and unpredictability feed fantasies of contamination and conspiracy, inviting social panic and victim-blaming.

Language, Blame, and Power
The essay tracks how illness metaphors migrate into political and moral discourse. Societies diagnose "the cancer of corruption", "social tumors", or "plagues" of crime and immigration, treating social problems as pathological intrusions to be excised. This rhetoric legitimizes aggressive policies and casts opponents as diseased. When the language returns to medicine, it brings with it a punitive, moralizing stance toward patients. Sontag criticizes euphemism and secrecy around cancer, doctors’ reluctance to name it outright, as a symptom of these metaphors, compounding fear and shame.

Prescription
Sontag’s remedy is a disciplined literalism. Metaphors, however inevitable in language, should be kept from directing medical practice and personal response. Casting patients as heroes or cowards, winners or losers, imports moral stakes where they do not belong. The task is to strip disease of meanings that neither explain nor heal, so that treatment can proceed without stigma and the sick can refuse identities imposed by cultural fantasy.

Afterlife
While focused on tuberculosis and cancer, the argument anticipates later crises in which metaphor intensifies fear and blame. The sequel, AIDS and Its Metaphors, extends the critique to epidemic illness. As a cultural intervention, Illness as Metaphor established a paradigm for analyzing how figurative language shapes suffering, pressing readers to reconsider the stories told about disease and those who bear it.