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on 8 February 2011
An overused word but in this case very apt. Susan Sontag has a way of approaching the familar and making you view it from an entirely fresh angle. Academic, yet never wilfully obscure, she gets straight to the heart of the subject and interrogates it so throughly you'll think you never really knew it before. Illness as Metaphor, explores the history of illness, how illness is spoken about,how the ill are treated and placed within society. She draws parrallels between the approaches to incurable illnesses in previous centuries and the present- startling similar inspite of modern medicine. Of fundamental importance to anyone suffering illness, caring for the sick or just interested in attitudes to illness is the notion of blame and personality traits that these uncured diseases accrue. The mythology that attaches to illness is especially cruel in the light of how it dissolves and coallates around a new condition as soon as the cause/cure is discovered. Sontag is a truly original thinker and this book, whilst deeply intellectually inspiring, was also for me a personal liberation from an illness that I have often been encouraged to feel is 'my own fault'. Life changing.
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on 7 October 2012
Sontag's key point is that illness isn't a metaphor, it is illness, but try telling that to writers and even to doctors. In the course of her argument, as she draws out what they said in novels and private letters and medical treatises, you have the feeling that you are holding in your hand a cluster of well polished cultural gems, each facet carefully cut to catch the light. She has collected snippets from writers in a way that now would be heavily propped up by Google searches, that in her case in the 1970s must have meant her asking all her friends for every reference they could think of to cancer and TB and the wider history of disease. This was written when cancer still meant for many a death sentence, when it was common place that the cure was worse than the illness, when attitudes and personality were clung to as a possible way of cheating death, and the inclination was to blame the patient and their `cancer personality'.

Cancer and TB struck individuals selectively and mysteriously, so individuals could seem responsible for their illness. `Why did I get cancer?' the victim asks.

Sontag deconstructs the various accounts of a `cancer personality' and the TB personality, with a kind of mordant, low key humour. `As cancer is now imagined to be the wages of repression, so TB was once explained as the ravages of frustration. ...Keats exclaimed `My dear Brown, I should have had her when I was in health, and I should have remained well.'

It was terribly appropriate to have TB if you were an artist - it meant you were eaten up by passion. It was of course important to quit your routine life - and go elsewhere. It was a `new reason for exile' - to Italy, the South pacific, mountains, deserts.

And preposterously, sadness and TB made one `interesting': "It was glamorous to look sickly. `Chopin was tubercular at a time when good health was not chic,' Camille Saint-Saens wrote in 1913."

The cancer personality type reflects the life of the not so young - in whatever age they are found. In modern times, this personality is: `depressed and unsatisfied with their lives and having suffered loss', `someone with a great tendency for self pity and a remarkably impaired ability to make and maintain meaningful relationships.' As Sontag says, `this is called the human condition', even before the person suffers the trauma of being diagnosed with cancer.

In Victorian times, the human condition was often rather different: `In contrast to contemporary American cancer patients, who invariably report having had feelings of isolation and loneliness since childhood, Victorian cancer patients described overcrowded lives, burdened with work and family obligations, and bereavements... Physicians found the causes of predisposing factors of their patients' cancers in grief, in worry (noted as most acute among businessmen and mothers of large families), in straitened economic circumstances and sudden reversals of fortune, and in overwork - or, if the patients were successful writers or politicians, in grief, rage, intellectual overexertion, the anxiety that accompanies ambition, and the stress of public life." `Always much trouble and hard work', the physician noted.

Sontag comments that it would be strange if cancer were found to have a single cause like the TB bacillus; you look for multiple causes in a disease that is not understood, she suggests. You can quibble with this, since we have now returned to understanding the social contexts in which diseases like TB take hold - including overcrowding and poor hygiene. But it does shine a light through some of what writers and doctors do to impose the cause of the disease back on the patient when it is too difficult for the doctor to explain.

Does metaphor matter? Is it wrong to point to a cancer in society? "To describe a phenomenon as a cancer is an incitement to violence. The use of cancer in political discourse encourages fatalism and justifies `severe' measures - as well as strongly reinforcing the notion that the disease is necessarily fatal." Sontag ends by asking whether the cancer metaphor will become obsolete as the TB one did - she would like to write it out. Instead, she was obliged to write a later book about AIDS.
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on 19 July 2014
Clear and informed analysis- delighted to reread it. It should inform all cancer websites.
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