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. Focusing on tuberculosis, syphilis, cancer, and later AIDS, Sontag wishes to demystify these diseases. Speaking from diverse perspectives, including academic research, nonacademic observation, and personal experience, she strives to dismantle such myths which exert profoundly damaging consequences for those troubled by disease. Moreover, Sontag contends that the latter two illnesses are popularly viewed as an individual and/or even as a societal blight or punishment. In turn, she reduces illness to what it is at its most essential level—nothing more than a disease—in the case of cancer, a malignant tumor caused by the abnormal multiplication of cells, and, in the case of AIDS, the retrovirus HIV which destroys white blood cells and debilitates the immune system.
However, such a task is far from simple. Illness and disease are particularly stupefying phenomena, especially with regard to their causation and moral implications. In order to better understand the unknown, it appears that humans employ metaphor, which allows them to critically examine their surroundings and make some sort of sense out of them. Metaphor is created from more than just history, but also from the imagination. In light of this, Sontag posits, "Of course, one cannot think without metaphors. But that does not mean there aren't some metaphors we might well abstain from or try to retire."
Sontag ultimately wants to shift the focus from transmission of disease, the vector of disease, and other aspects of the process of acquiring disease to the illness itself; one must comprehend the reality of disease. Sontag stresses, however, that these diseases are carried by people. These victims of illness do not necessarily fit into particular "risk groups" or any other bureaucratically assigned label. Sontag laments, "AIDS, in which people are understood as ill before they are ill...brings to many a social death that precedes the physical one." Unfortunately, in our given society, there is a tendency to dehumanize, if not completely ostracize, patients of cancer and AIDS alike. Sontag suggests that disease and illness should not fundamentally define one's identity nor should it ascribe an inner sense of guilt or shame, as it often did in the past with cancer patients and currently does now in the case of AIDS patients. In the face of such prejudice, society's understanding and each individual's understanding of these diseases and others like them can indeed combat such metaphors of blame and fear.
In an attempt to contextualize her argument regarding the present metaphors surrounding cancer, and more recently AIDS, Sontag devotes a significant portion of her essays to the history of disease. In intricate detail, she traces the development of diseases and their psychological conceptions, whether they prove to be true or false. For example, tuberculosis was often viewed as a positive enrichment of one's character. Likewise, the dementia caused by syphilis was often romanticized as a source of creativity. On the other hand, only negative metaphors and connotations have been ascribed to cancer and AIDS. It is the AIDS patient who faces the worst fate, as he is viewed not as a victim, but rather a pariah. Sontag contends that this not only creates a stigma, but also materially hinders people from seeking the necessary treatment. Sontag states, "The metaphors and myths, I was convinced, kill."
However, the metaphors do not stop here. Sontag demonstrates the wide scope which these metaphors inhabit. The conception of illness shifts from being a metaphor, with the implementation of such language as "invasion" to describe cancer and AIDS and "pollution" to characterize syphilis and AIDS, to being used as a metaphor. Furthermore, metaphors concerning illness and disease function to be directed at either the individual or the society as a whole. For instance, the term "plague" is the primary metaphor by which the AIDS epidemic is conceived. Epidemics are commonly thought of as plagues and plagues are thought of as epidemics. So which term fuels the other? Regardless, they are both irrevocably bound to the idea of AIDS, which has, by consequence, banalized cancer to a certain extent. While a medical approach tends to target the individual as the focus of disease, historical accounts illuminate the importance of population dynamics on illness. Sontag forces the reader to think critically about prejudice and metaphor in relation to illness and disease, to the point where the reader finds himself questioning his own moral judgments. Sontag decidedly concludes, "We are not being invaded. The body is not a battlefield. The ill are neither unavoidable casualties nor the enemy."
Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors. New York: Picador, 2001.