Literary Theory: “Illness As Metaphor” (1978) by Susan Sontag

"The Agnew Clinic" (1889), Thomas Eakins.

“The Agnew Clinic” (1889), Thomas Eakins.

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

Susan Sontag started writing on disease metaphors when she underwent surgery and treatment for stage-four breast cancer in the 1970s. Fearing that she would die soon, she wrote Illness As Metaphor (1978) in an almost manic frenzy. In this work, she tried to demystify diseases and the metaphors people use to discuss them.

I want to describe, not what it is really like to emigrate to the kingdom of the ill and live there, but the punitive or sentimental fantasies concocted about that situation: not real geography, but stereotypes of national character.

Sontag argues that the most truthful way of regarding illness (and the healthiest way of being ill) is one most purified of metaphoric thinking. She admits that this is nearly impossible since metaphorical thinking is inevitably part of of how the human brain makes sense of things. However, we should mind the metaphors we decide to use because, as we have learned from the recent post on Metaphors We Live By, these metaphors influence our actions and how we interpret the world around us.

In Illness as Metaphor, Sontag discusses two diseases and their metaphors: tuberculosis and cancer. She shows how, in the nineteenth century, TB patients were seen as delicate, artistic, and superior people with great feeling and passion, and how this glorification of the disease caused people to want to look like they had TB, almost like a fashion trend. People like Lord Byron were convinced that dying from TB was the Romantic way to go (‘I should like to die of consumption. […] Because the ladies would all say, “Look at that poor Byron, how interesting he looks in dying”’). In the case of cancer, the opposite is the case. Sontag argues that according the “mythology of cancer,” the disease is caused by a steady repression of feeling and subsequent frustration. Because of this idea, the disease is seen as something shameful and the metaphors make it so for cancer patients.

Many critics have disagreed with her on this point, but do concur that the metaphors we choose to discuss a certain disease will affect the way patients experience their illness and how they estimate their chances of recovery. Thus, metaphors can be incredibly harmful in a psychological sense. They can influence how a doctor approaches a patient, how research into possible treatments is conducted, and how the patients are treated by their friends and family. Therefore Sontag argues that we should resist the temptation to interpret illnesses and make a disease into something more mysterious than it really is: a medical matter.


Sontag, Susan. AIDS and its Metaphors (1989).

This is an addendum to Illness as Metaphor that Sontag wrote at the height of the HIV/AIDS epidemic in the United States and Europe. Here, she addresses a couple of the criticisms Illness As Metaphor had received and speaks on the HIV/AIDS crisis in relation to epidemics of the past. AIDS and its Metaphors and Illness as Metaphor are often published in a single volume, so if you’re interested in the subject I would suggest buying one of those editions.

Lakoff, George, and Mark Johnson. Metaphors We Live By (1980).

In this book, Lakoff (a linguist) and Johnson (a philosopher) explore how our use of conceptual metaphors in everyday language shapes the way we think and act, down to the most mundane little details. Read my previous post on Metaphors We Live By here!

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