Illness as Metaphor and AIDS and Its Metaphors

by Susan Sontag

Sickness was a way of making people “interesting”—which is how “romantic” was originally defined. (Schlegel, in his essay “On the Study of Greek Poetry” [1795], offers “the interesting” as the ideal of modern—that is, romantic—poetry.) “The ideal of perfect health,” Novalis wrote in a fragment from the period 1799–1800, “is only scientifically interesting”; what is really interesting is sickness, “which belongs to individualizing.” This idea—of how interesting the sick are—was given its boldest and most ambivalent formulation by Nietzsche in The Will to Power and other writings, and though Nietzsche rarely mentioned a specific illness, those famous judgments about individual weakness and cultural exhaustion or decadence incorporate and extend many of the clichés about TB.

It is not an accident that the most common metaphor for an extreme psychological experience viewed positively—whether produced by drugs or by becoming psychotic—is a trip.

The speculations of the ancient world made disease most often an instrument of divine wrath. Judgment was meted out either to a community (the plague in Book I of the Iliad that Apollo inflicts on the Achaeans in punishment for Agamemnon’s abduction of Chryses’ daughter; the plague in Oedipus that strikes Thebes because of the polluting presence of the royal sinner) or to a single person (the stinking wound in Philoctetes’ foot). The diseases around which the modern fantasies have gathered—TB, cancer—are viewed as forms of self-judgment, of self-betrayal.

One’s mind betrays one’s body. “My head and lungs have come to an agreement without my knowledge,”

In the pre-modern view of disease, the role of character was confined to one’s behavior after its onset. Like any extreme situation, dreaded illnesses bring out both people’s worst and best. The standard accounts of epidemics, however, are mainly of the devastating effect of disease upon character. The weaker the chronicler’s preconception of disease as a punishment for wickedness, the more likely that the account will stress the moral corruption made manifest by the disease’s spread.

Even if the disease is not thought to be a judgment on the community, it becomes one—retroactively—as it sets in motion an inexorable collapse of morals and manners.

Fatal illness has always been viewed as a test of moral character, but in the nineteenth century there is a great reluctance to let anybody flunk the test. And the virtuous only become more so as they slide toward death.

agony—his cancer being unmentionable to his wife and children—reveal to him the lie of his whole life; when dying, he is, for the first time, in a state of truth.

Ceasing to consider disease as a punishment which fits the objective moral character, making it an expression of the inner self, might seem less moralistic. But this view turns out to be just as, or even more, moralistic and punitive. With the modern diseases (once TB, now cancer), the romantic idea that the disease expresses the character is invariably extended to assert that the character causes the disease—because it has not expressed itself. Passion moves inward, striking and blighting the deepest cellular recesses.

Illness expands by means of two hypotheses. The first is that every form of social deviation can be considered an illness. Thus, if criminal behavior can be considered an illness, then criminals are not to be condemned or punished but to be understood (as a doctor understands), treated, cured.4 The second is that every illness can be considered psychologically. Illness is interpreted as, basically, a psychological event, and people are encouraged to believe that they get sick because they (unconsciously) want to, and that they can cure themselves by the mobilization of will; that they can choose not to die of the disease.

Nazis quickly modernized their rhetoric, and indeed the imagery of cancer was far more apt for their purposes. 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.

Thinking about illness!—To calm the imagination of the invalid, so that at least he should not, as hitherto, have to suffer more from thinking about his illness than from the illness itself—that, I think, would be something! It would be a great deal!

The purpose of my book was to calm the imagination, not to incite it. Not to confer meaning, which is the traditional purpose of literary endeavor, but to deprive something of meaning: to apply that quixotic, highly polemical strategy, “against interpretation,” to the real world this time. To the body. My purpose was, above all, practical.

One feature of the usual script for plague: the disease invariably comes from somewhere else. The names for syphilis, when it began its epidemic sweep through Europe in the last decade of the fifteenth century, are an exemplary illustration of the need to make a dreaded disease foreign.1 It was the “French pox” to the English, morbus Germanicus to the Parisians, the Naples sickness to the Florentines, the Chinese disease to the Japanese. But what may seem like a joke about the inevitability of chauvinism reveals a more important truth: that there is a link between imagining disease and imagining foreignness. It lies perhaps in the very concept of wrong, which is archaically identical with the non-us, the alien. A polluting person is always wrong, as Mary Douglas has observed. The inverse is also true: a person judged to be wrong is regarded as, at least potentially, a source of pollution.

Written on the eve of the Nazi takeover of Czechoslovakia, Čapek’s allegorical play is something of an anomaly—the use of the plague metaphor to convey the menace of what is defined as barbaric by a mainstream European liberal. The play’s mysterious, grisly malady is something like leprosy, a rapid, invariably fatal leprosy that is supposed to have come, of course, from Asia. But Čapek is not interested in identifying political evil with the incursion of the foreign. He scores his didactic points by focusing not on the disease itself but on the management of information about it by scientists, journalists, and politicians. The most famous specialist in the disease harangues a reporter (“The disease of the hour, you might say. A good five million have died of it to date, twenty million have it and at least three times as many are going about their business, blithely unaware of the marble-like, marble-sized spots on their bodies”); chides a fellow doctor for using the popular terms, “the white plague” and “Peking leprosy,” instead of the scientific name, “the Cheng Syndrome”; fantasizes about how his clinic’s work on identifying the new virus and finding a cure (“every clinic in the world has an intensive research program”) will add to the prestige of science and win a Nobel Prize for its discoverer; revels in hyperbole when it is thought a cure has been found (“it was the most dangerous disease in all history, worse than the bubonic plague”); and outlines plans for sending ...

Appetite is supposed to be immoderate. The ideology of capitalism makes us all into connoisseurs of liberty—of the indefinite expansion of possibility. Virtually every kind of advocacy claims to offer first of all or also some increment of freedom. Not every freedom, to be sure.

There is also the need for an apocalyptic scenario that is specific to “Western” society, and perhaps even more so to the United States. (America, as someone has said, is a nation with the soul of a church—an evangelical church prone to announcing radical endings and brand-new beginnings.) The taste for worst-case scenarios reflects the need to master fear of what is felt to be uncontrollable. It also expresses an imaginative complicity with disaster. The sense of cultural distress or failure gives rise to the desire for a clean sweep, a tabula rasa. No one wants a plague, of course. But, yes, it would be a chance to begin again. And beginning again—that is very modern, very American, too.