It supplied an important model of bohemian life, lived with or without the vocation of the artist. The Romantics invented invalidism as a pretext for leisure, and for dismissing bourgeois obligations in order to live only for one’s art. Read honest and unbiased product reviews from our users. It also analyzes reviews to verify trustworthiness. In Stendhal’s Armance, the anxious mother is reassured by the doctor that her son is not, after all, suffering from tuberculosis but only from that “dissatisfied and critical melancholy characteristic of the young men of his generation and position.” Sadness and tuberculosis became synonymous. cit, pp. I found her premise that we tend to demonize illnesses we do not understand. Sontag argues that the metaphors and mythology created around these diseases make them seem evil and mysterious and very much like invincible predators, and hence sometimes prevent people from believing in conventional treatment to … Rich countries have the highest cancer rates and the rising incidence of the disease is seen as resulting, in part, from a diet rich in fat and proteins and from the toxic effluvia of the industrial economy that creates affluence. Peer review. Her books include Against Interpretation, On Photography, Illness as Metaphor, and The Volcano Lover. Such a disease is, by definition, mysterious. Many tuberculars died in terrible pain, while some people die of cancer feeling little or no pain up to the end. Select Your Cookie Preferences. Agony became romantic in a stylized account of the preliminary symptoms of the disease (for example, debility is transformed into languor) and the actual agony was simply suppressed. Being afraid of a disease, be it cancer, AIDS, or whatever else, can be debilitating. Thus, to deal with the metaphors surrounding TB and cancer is to explore the idea of the morbid, in particular its evolution from the nineteenth century (when TB was the most common cause of death) to our own time (where the most dreaded disease is cancer). (John of Trevisa: “Whan the blode is made thynne, soo folowyth consumpcyon and wastyng.”)1 But the pre-modern understanding of cancer also invokes the notion of consumption. Far from proving anything spiritual, it proves that the body is, alas, and all too much, the body. It is not naming as such that is pejorative or damning but the name “cancer.” As long as a particular disease is treated as an evil, invincible predator, not just a disease, most people with cancer will indeed be demoralized by learning what disease they have. 101-102. (What is hinted at by the languid, etherealized belles of Pre-Raphaelite art is made explicit in the emaciated, hollow-eyed, tubercular girls depicted by Edvard Munch.) illness as metaphor review Although one good poet, L. E. Sissman, while dying, wrote some excellent poems about cancer, it seems unimaginable to aestheticize the disease. After the US writer Susan Sontag underwent chemotherapy for breast cancer, however, she took a different approach. But for whatever reason, human beings did attain the ability to think critically about their surroundings, which happened to be a world filled with diseases. It is true that there was a certain reaction against the early-nineteenth-century cult of the disease in the second half of the century. As once TB was thought to come from too much passion, afflicting the reckless and sensual, today people believe that cancer is a disease of insufficient passion, an affliction of those who are sexually repressed, inhibited, unspontaneous, incapable of expressing anger. The look of TB had, inevitably, to be considered attractive once it came to be considered a mark of distinction, of breeding. While TB takes on qualities assigned to the lungs, which are part of the upper, spiritualized body, cancer is notorious for attacking parts of the body (colon, bladder, rectum, breast, cervix, prostate, testicles) that are embarrassing to acknowledge. In a heartbreaking letter of November 1, 1820, from Naples, Keats, forever separated from Fanny Brawne, writes, “If I had any chance of recovery [from tuberculosis], this passion would kill me.” As a character in The Magic Mountain explains: “Symptoms of disease are nothing but a disguised manifestation of the power of love; and all disease is only love transformed.”. I looked up this title intending to buy a copy for a friend and found out that the edition I own is not available anymore. The undernourished nourishing themselves—alas, to no avail. Book in perfect condition, fast shipping- great price! (As in the contemporary updating of this fantasy, the cancer-prone are those who are not sufficiently sensual or in touch with their anger.) I mean by that that what is not fatal is not cancer. The heroine of Erich Segal’s Love Story dies of leukemia—the “white” or TB-like form of the disease, for which no mutilating surgery can be proposed—not of stomach or breast cancer.) This page works best with JavaScript. James Curran, GP locum, Glasgow. “I look pale,” said Byron, looking in the mirror. In her pair of related essays, Illness as a Metaphor and AIDS and its Metaphors, Susan Sontag reveals many of the metaphors surrounding such influential diseases as tuberculosis, cancer, syphilis, and AIDS. Wan, hollow-chested young women and pallid, rachitic young men vied with each other as candidates for this mostly (at that time) incurable, incapacitating, really awful disease. In 1978, Susan Sontag published Illness as Metaphor, a book composed of three long essays which were originally delivered in the distinguished James Lecture Series at the New York Institute for the Humanities, and then published in New York Review of Books before making it to the bookstores as paperback. The very names of such diseases are felt to have a magic power. He stays for the next seven years. In the earlier, more optimistic form of this fantasy, the repressed feelings were sexual; now, in a notable shift, it is the repression of violent feelings that is imagined to cause cancer. Cancer is generally thought an inappropriate disease for a romantic character, in contrast to tuberculosis, perhaps because unromantic depression has supplanted the romantic notion of melancholy. “It was fashionable to be pale and drained; Princess Belgiojoso strolled along the boulevards…pale as death in person.” Saint-Saëns was right to connect an artist, Chopin, with the most celebrated femme fatale of the period, who did a great deal to popularize the tubercular look. Like TB, insanity is a kind of exile. Instead there are cancerphobes like Norman Mailer who recently explained that had he not stabbed his wife (and acted out “a murderous nest of feelings”) he would have gotten cancer and “been dead in a few years himself.”8 It is the same fantasy that was once attached to TB, but in rather a nastier version. I guess Ebola will be the next metaphor for evil. I had just finished a retreat in California that should have been restful but wasn’t. A cancer patient herself when she was writing the book, Sontag shows how the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper treatment. It seems that having TB had already acquired the associations of being romantic by the mid-eighteenth century. Kafka’s letters are a compendium of speculations about the meaning of tuberculosis, as is The Magic Mountain, published in 1924, the year Kafka died. I am not sure that I much care for leprosy as a metaphor for life. The TB sufferer was a dropout, a wanderer in endless search of the healthy place. The question of ‘who’ the wild duck is becomes the subject of the second half of the play, and in the end it seems the wild duck is a … And who of us doesn't know people that are scared to death of cancer, or of AIDS? But no change of surroundings is thought to help the cancer patient. ↩, Nearly a century later, in his edition of Katherine Mansfield’s posthumously published Journal, John Middleton Murray uses similar language to describe Mansfield on the last day of her life. In her two essays published as a single work entitled Illness as Metaphor and AIDS and Its Metaphors in 1990, cultural critic and intellectual Susan Sontag, a cancer survivor herself, aptly presents the varied and convoluted metaphors surrounding illness. It may be, is increasingly thought to be, something in the environment that has caused the cancer. Some features of TB go to insanity: the notion of the sufferer as a hectic, reckless creature of passionate extremes, someone too sensitive to bear the horrors of the vulgar, everyday world. In the nineteenth century it was possible, through fantasies about TB, to aestheticize death. After passing his exams and before taking up his job in a Hamburg ship-building firm, young Hans Castorp makes a three-week visit to his tubercular cousin in the sanatorium at Davos. It was also a way of describing sexual feelings, while removing the onus of libertinism. In Stendhal’s Armance (1827), the hero’s mother refuses to say “tuberculosis” for fear that pronouncing the word will hasten the course of her son’s malady. There was a notion that TB was a wet disease, a disease of humid and dank cities. Sontag writes about how cancer, tuberculosis, AIDS and – hinting at its future increase in metaphorical importance – mental illness are used as potent symbols and definitive statements about those who suffer from them. Susan Sontag's Illness as Metaphor was the first to point out the accusatory side of the metaphors of empowerment that seek to enlist the patient's will to resist disease.It is largely as a result of her work that the how-to health books avoid the blame-ridden term 'cancer personality' and speak more soothingly of 'disease-producing lifestyles' . Cancer patients don’t look at their biopsies. 4. So much for the germ theory of disease. Mrs. H.: I’m actually afraid of his lungs. Illness as Metaphor examines in more general than personal terms how society regards illness and being ill, in particular “the punitive or … It is not uncommon for people to write about their experience of experience. Like all really successful metaphors, the metaphor of TB was rich enough to provide for two contradictory applications. asked his friend Tom Moore, himself a tubercular, who was visiting Byron in Patras in February 1828. © 2008-2021, Amazon.com, Inc. or its affiliates, Illness as Metaphor and AIDS and Its Metaphors, See all details for Illness as Metaphor and AIDS and Its Metaphors. Its principal metaphors refer to topography (cancer “spreads” or “proliferates”; tumors are surgically “excised”) and its most dreaded consequence, short of death, is the mutilation or amputation of part of the body. 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. Cancer phobia, some people say, is worse than cancer. The fantasies inspired by TB in the last century, by cancer now, are first of all responses to a disease thought to be intractable and capricious—that is, a disease not understood—in an era in which medicine’s central premise is that all diseases can be cured. For example, Kenneth Clark, describing Ruskin’s inability to propose to Adele Domecq, says: “His passion brought on a mild attack of tuberculosis” (Ruskin Today, edited by Clark, Penguin Books, 1964, p. 26). Sadness made one “interesting.” It was a mark of refinement, of sensibility, to be sad. And etymology indicates that tuberculosis—from the Latin tuber, meaning bump, swelling—was also once considered a type of abnormal extrusion; the word tuberculosis means a morbid swelling, protuberance, projection, or growth.2 Rudolf Virchow, who founded the science of cellular pathology in the 1850s, thought of the tubercle as a tumor. Mr. H.: Latin for him! Someone who has had a coronary is at least as likely to die of another one within a few years as someone with cancer is likely to die soon from cancer. Then coughs again. It is focused on two "modern" illnesses: tuberculosis and cancer. According to the mythology of cancer, there is generally some steady expression of feeling that causes the disease. Shock and awe. TB is thought to be relatively painless. 5.0 out of 5 starsStill relevant. Read honest and unbiased product reviews from our users. Although there may be periods in which tumor growth is arrested (remissions), cancer produces no contrasts like the oxymorons of behavior—febrile activity, hectic inactivity, passionate resignation—thought to be typical of TB, nothing comparable to TB’s paradoxical symptoms: liveliness that comes from enervation, rosy cheeks that look like a sign of health but come from fever. Nevertheless, TB retained most of its romantic attributes—as the mark of a superior nature, a becoming frailty—through the end of the century and well into ours. Once put away, the patient enters a special world with special rules. Find helpful customer reviews and review ratings for Illness As Metaphor at Amazon.com. During that time I needed to review several scientific papers, arrange for pet sitters, do loads of laundry, and make various last minute preparations. TB is a disease of time, the fever that hastens things. Shelley wrote on July 27, 1820 to Keats, commiserating as one TB sufferer to another, that he has learned “that you continue to wear a consumptive appearance.” This was no mere turn of phrase. TB is understood as a disease of extreme contrasts: white pallor and red flush, vitality alternating with languidness. “La tubercule” was introduced in the sixteenth century by Ambroise Paré from the Latin tuberculum, meaning “petite bosse” (little lump), which comes from the Latin tuber, meaning “truffe” or “excroissance.” In Diderot’s Encyclopédie (1765), the entry on tuberculosis cites the definition given by the English physician Richard Morton in his Phtisiologia (1689): “des petits tumeurs qui paraissent sur la surface du corps.” ↩, As cited in the OED, which gives as an early figurative use of “canker”: “enuie which is the canker of Honour”—Bacon, 1597. Clear and informed analysis- delighted to reread it. The source for much of the current fancy that associates cancer with the repression of passion is Wilhelm Reich, who defines cancer as “a disease following emotional resignation—a bio-energetic shrinking, a giving up of hope.”9 But the same theory can be, and has been, applied to TB. Even with patients informed about their disease, doctors and family were reluctant to talk freely. In America, where—in part because of the doctors’ fear of malpractice suits—there is now much more candor with patients, the country’s largest cancer hospital mails routine communications and bills to out-patients in envelopes that do not reveal the sender, on the assumption that the illness may be a secret from their families. The metaphors attached to TB and to cancer imply living processes of a particularly resonant and horrid kind. Editorial Reviews. It should come as no surprise than that illness and disease, concepts sometimes etiologically and often morally incomprehensible, are often the subject for metaphors; an inevitable consequence of human insight intermingling with mysterious biological forces. 60. Having a tumor generally arouses some feelings of shame but, in the hierarchy of the body’s organs, lung cancer is felt to be less shameful than rectal cancer. A cancer patient herself when she was writing the book, Sontag shows how the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper treatmen First came the use of tubercular metaphors to describe love—the image of “diseased” love, of a passion that “consumes.”6 Eventually the image was inverted, and TB was conceived as a variant of the disease of love. Instead, our system considers things like how recent a review is and if the reviewer bought the item on Amazon. These seemingly opposite diagnoses are actually not so different versions of the same view (and deserve, in my opinion, the same amount of credence). … Cancer, as a disease that can strike anywhere, is a disease of the body. It is toward an elucidation of those metaphors, and a liberation from them, that I dedicate this inquiry. Cancer is something hard: the body tissues degenerating, turning to stone. TB makes the body transparent. Although one good poet, L. E. Sissman, while dying, wrote some excellent poems about cancer, it seems unimaginable to aestheticize the disease. Verified Purchase. After viewing product detail pages, look here to find an easy way to navigate back to pages that interest you. An important concept is discussed in this book: the idea that diseases come with a set of what Sontag calls metaphors, but what I would term associations, that have little if … TB is understood as a disease of one organ, the lungs, while cancer is understood as a system-wide disease. Cancer has only true symptoms. Cancer is thought to be, invariably, excruciatingly painful. TB is thought to provide an easy death, while cancer is the spectacularly awful one. I want to describe not what it’s really like to emigrate to the kingdom of the ill and to live there, but the punitive or sentimental fantasies concocted about that situation; not real geography but stereotypes of national character. p. 20: “He was very unhappily married. Sufferers are put into a “sanatorium” (the common word for a clinic for tuberculars and the most common euphemism for an insane asylum). Even if we hadn't evolved the ability to think sensibly about the world around us, disease would have continued to be a major factor in Homo sapien debilitation and mortality. “I should like to die of a consumption.” Why? disease in which death and life are so strangely blended, that death takes the glow and hue of life, and life the gaunt and grisly form of death; disease which medicine never cured, wealth never warded off, or poverty could boast exemption from…. Love is now lethal. Only with the microscope was it possible to grasp the distinctiveness of cancer, as a type of cellular activity, and to understand that the disease did not always take the form of an external or even palpable tumor. Keats was advised by his doctors to move to Rome; Chopin tried the islands of the western Mediterranean; Robert Louis Stevenson chose a Pacific exile; D. H. Lawrence wandered over half the globe. In TB, the person is “consumed,” burned up. In 1978 Susan Sontag wrote Illness as Metaphor, a classic work described by Newsweek as "one of the most liberating books of its time." Reviewed in the United Kingdom on June 3, 2018. (A leading French oncologist has told me that fewer than a tenth of his patients know they have cancer.) Indeed, the romanticizing of TB is the first widespread example of that distinctively modern activity, promoting the self as an image. It is with TB that the idea of individual illness is articulated, and in the images surrounding the disease we can see emerging a modern idea of individuality that has taken in the twentieth century more affirmative, if no less narcissistic, forms. When, not so many decades ago, learning that one had TB was tantamount to hearing a sentence of death—as today, in the popular imagination, cancer equals death—a tremendous fear surrounded TB, and it was common to conceal the identity of their disease from tuberculars and, after their death, from their children. Thus a surprisingly large number of people with cancer find themselves being shunned by relatives and friends and are the object of practices of decontamination by members of their household, as if cancer, like TB, were an infectious disease. © 1963-2021 NYREV, Inc. All rights reserved. To die of TB was still mysterious and (often) edifying, and remained so until practically nobody in Western Europe and North America died of it anymore. The X-rays which are the standard diagnostic tool permit one, often for the first time, to see one’s insides—to become transparent to oneself. But she had lost her life to save it.” More of the reality of Mansfield’s suffering is to be found in her own journal entries. In Nicholas Nickleby, Dickens apostrophized TB as the. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Cancer is thought to be de-sexualizing. Just before Hans “goes down,” the doctor diagnoses a spot on his lungs. Conversely, if conscious beings had been born to a world free of disease, they would have still tried to find out how their universe functioned, and they probably would have employed the metaphor as an aid for conceptualizing notions not well understood. The inside of the body became damp (“moisture in the lungs” was a favored locution) and had to be dried out. The passage continues: “…because desire increases during the illness, because the guilt of the ever-repeated symbolic dissipation of semen in the sputum is continually growing greater,…because the It allows pulmonary disease to bring beauty to the eyes and cheek, alluring poisons!” ↩, Reich, op. He sickens with longing and frustration, gets TB and dies. The patient has an opaque body that must be taken to a specialist to find out if it contains cancer. Illness as Metaphor, Chapter 7. No, no, the alehouse and the stable are the only schools he’ll ever go to. The fear surrounding cancer being even more acute, so is the concealment. Best of The New York Review, plus books, events, and other items of interest. Written in 1978, Sontag’s long form essay ‘ Illness as Metaphor ’ is poignant for its historical study of illnesses and the metaphors that are used to describe them. With this scenario, today Michel would have to get cancer. You can never be too thin,” the Duchess of Windsor once said.). However I got sent a book with a different cover than the one pictured. All these notions are recapitulated by Mann in The Magic Mountain and in his short story “Tristan.”. When a wild duck is wounded, it swims to the bottom of the lake, bites down on some pond weed and holds itself down there until it drowns. Indeed, twentieth-century women’s fashions (with their cult of thinness) are the last stronghold of the metaphors associated with the romanticizing of TB in the late eighteenth and early nineteenth centuries. Part of the regimen for patients in The Magic Mountain is a second breakfast, eaten with gusto. Reviewed in the United Kingdom on February 23, 2018, Reviewed in the United Kingdom on July 19, 2014. The TB patient is thought to be helped—maybe even cured—by a change in environment. Illness is the night-side of life, a more onerous citizenship. Get immediate access to the current issue and over 20,000 articles from the archives, plus the NYR App. Illness as Metaphor.” The treatment for my current flare began as expected, with a rapid-fire attempt to dominate the body with a high dosage of steroids and organ transplant drugs. I own the original print of ILLNESS AS METAPHOR; by that I mean, the print that contains only the essay on Tuberculosis and Cancer and not the one on AIDS. Any disease that is treated as a mystery and acutely enough feared will be felt to be morally, if not literally, contagious. If my view of cancer is correct, you just give up, you resign—and, then, you shrink.”11 Tolstoy’s “The Death of Ivan Ilyich” is often cited as a case history of the link between cancer and characterological resignation. This is how those two famously tough-minded observers, the Goncourt brothers, explain the TB of their friend Murger (the author of the book from which La Bohème was drawn): he is dying “for want of vitality with which to withstand suffering.” TB is celebrated as the disease of born victims, of sensitive, passive people who are not quite life-loving enough to survive. It described the death of someone (like a child) thought to be too “good” to be sexual, the assertion of an angelic psychology. The most striking similarity between the myths of TB and of cancer is that both are, or were, understood as diseases of passion. In 1978 Susan Sontag wrote Illness as Metaphor, a classic work described by Newsweek as "one of the most liberating books of its time." It is not an accident that the most common metaphor for an extreme psychological experience viewed positively—whether it is produced by drugs or by becoming psychotic—is a trip. And cancer was described as a process, like TB, in which the body was consumed. Best of The New York Review, plus books, events, and other items of interest. The Oxford English Dictionary records “consumption” in use as a synonym for pulmonary tuberculosis as early as 1398. The sufferer is wracked by coughs, then sinks back, recovers breath, breathes normally. A cancer patient herself when she was writing the book, Sontag shows how the metaphors and myths surrounding certain illnesses, especially cancer, add greatly to the suffering of patients and often inhibit them from seeking proper treatment. And with the desire the lungs die away,…the body dies away….”10. There are no modern Insarovs. There were special places thought to be good for tuberculars: in the early nineteenth century, Italy; then islands in the Mediterranean or the South Pacific; in the twentieth century, the mountains, the desert—all landscapes that had themselves been successively romanticized. My point is that illness is not a metaphor, and that the most truthful way of regarding illness—and the healthiest way of being ill—is one most purified of, most resistant to, metaphoric thinking. The cancer patient “shrivels” (Alice James’s word) or “shrinks” (Wilhelm Reich’s word). (Among the earliest figurative uses of cancer are as a metaphor for “ennuie” and for “sloth.”)3 Metaphorically, cancer is not so much a disease of time as a disease or pathology of space. Though the course of both diseases is generally marked by a loss of weight, getting thin from TB is understood very differently from getting thin from cancer. It was a way of retiring from the world without having to take responsibility for the decision—the story of The Magic Mountain. Mr. H.: And truly so am I; for he sometimes whoops like a speaking trumpet—(TONY halooing behind the Scenes)—O, there he goes—A very consumptive figure, truly. Reviewed in the United States on February 18, 2018. The poverty may not be as literal as Mimi’s garret in La Bohème; the tubercular Marguerite Gautier in La Dame aux camélias lives in luxury, but inside she is a waif. Reich illustrates his influential theory with Freud’s cancer, which, he said, began when Freud, a naturally passionate man, “had to give up, as a person. The TB-influenced idea of the body was a new model for aristocratic looks—at a moment when aristocracy stops being a matter of power, and starts being mainly a matter of image. Mr. H.: Ay, if growing too fat be one of the symptoms. 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