Illness as Metaphor and AIDS and Its Metaphors

by Susan Sontag

In cancer, non-intelligent (“primitive,” “embryonic,” “atavistic”) cells are multiplying, and you are being replaced by the non-you.

Shaftesbury’s point is that it is rational to tolerate a certain amount of irrationality (“superstition,” “enthusiasm”), and that stern repressive measures are likely to aggravate disorder rather than cure it, turning a nuisance into a disaster.

As was said in speeches about “the Jewish problem” throughout the 1930s, to treat a cancer one must cut out much of the healthy tissue around it. The imagery of cancer for the Nazis prescribes “radical” treatment, in contrast to the “soft” treatment thought appropriate for tuberculosis—the difference between sanatoria (that is, exile) and surgery (that is, crematoria). The Jews were also identified with, and became a metaphor for, city life—with Nazi rhetoric echoing all the Romantic clichés about cities as a debilitating, merely cerebral, morally contaminated, unhealthy environment.

To describe a phenomenon as a cancer is an incitement to violence.

The people who have the real disease are also hardly helped by hearing their disease’s name constantly being dropped as the epitome of evil. Only in the most limited sense is any historical event or problem like an illness. And the cancer metaphor is particularly crass. It is invariably an encouragement to simplify what is complex and an invitation to self-righteousness, if not to fanaticism.

Our very notion of the person, of dignity, depends on the separation of face from body,1 on the possibility that the face may be exempt, or exempt itself, from what is happening to the body. And however lethal, illnesses like heart attacks and influenza that do not damage or deform the face never arouse the deepest dread.

Diseases, insofar as they acquired meaning, were collective calamities, and judgments on a community. Only injuries and disabilities, not diseases, were thought of as individually merited.

So remember when a person has sex, they’re not just having it with that partner, they’re having it with everybody that partner had it with for the past ten years,” runs an endearingly gender-vague pronouncement made in 1987 by the Secretary of Health and Human Services, Dr. Otis R. Bowen. AIDS reveals all but long-term monogamous sex as promiscuous (therefore dangerous) and also as deviant, for all heterosexual relations are also homosexual ones, once removed.