Illness as Metaphor and AIDS and Its Metaphors

by Susan Sontag

The dying tubercular is pictured as made more beautiful and more soulful; the person dying of cancer is portrayed as robbed of all capacities of self-transcendence, humiliated by fear and agony. * * *

The passive, affectless anti-hero who dominates contemporary American fiction is a creature of regular routines or unfeeling debauch; not self-destructive but prudent; not moody, dashing, cruel, just dissociated. The ideal candidate, according to contemporary mythology, for cancer.

Theories that diseases are caused by mental states and can be cured by will power are always an index of how much is not understood about the physical terrain of a disease.

Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.

Cancer is a metaphor for what is most ferociously energetic; and these energies constitute the ultimate insult to natural order.

When not being explained away as something psychological, buried in the recesses of the self, cancer is being magnified and projected into a metaphor for the biggest enemy, the furthest goal. Thus, Nixon’s bid to match Kennedy’s promise to put Americans on the moon was, appropriately enough, the promise to “conquer” cancer. Both were science-fiction ventures. The equivalent of the legislation establishing the space program was the National Cancer Act of 1971, which did not envisage the near-to-hand decisions that could bring under control the industrial economy that pollutes—only the great destination: the cure.

Modern totalitarian movements, whether of the right or of the left, have been peculiarly—and revealingly—inclined to use disease imagery. The Nazis declared that someone of mixed “racial” origin was like a syphilitic. European Jewry was repeatedly analogized to syphilis, and to a cancer that must be excised. Disease metaphors were a staple of Bolshevik polemics, and Trotsky, the most gifted of all communist polemicists, used them with the greatest profusion—particularly after his banishment from the Soviet Union in 1929. Stalinism was called a cholera, a syphilis, and a cancer.2 To use only fatal diseases for imagery in politics gives the metaphor a much more pointed character. Now, to liken a political event or situation to an illness is to impute guilt, to prescribe punishment.

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.

Apocalypse is now a long-running serial: not “Apocalypse Now” but “Apocalypse From Now On.” Apocalypse has become an event that is happening and not happening. It may be that some of the most feared events, like those involving the irreparable ruin of the environment, have already happened. But we don’t know it yet, because the standards have changed. Or because we do not have the right indices for measuring the catastrophe. Or simply because this is a catastrophe in slow motion. (Or feels as if it is in slow motion, because we know about it, can anticipate it; and now have to wait for it to happen, to catch up with what we think we know.)