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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 8; 335(7618): 517.
PMCID: PMC1971179
Medical Classics

Illness as Metaphor; AIDS and its Metaphors

James Curran, GP locum, Glasgow

It is not uncommon for people to write about their experience of experience. After the US writer Susan Sontag underwent chemotherapy for breast cancer, however, she took a different approach. Illness as Metaphor examines in more general than personal terms how society regards illness and being ill, in particular “the punitive or sentimental fantasies concocted about that situation.”

In a sense she still writes from her experience in focusing on descriptions of cancer (with some comparisons with tuberculosis, the disease that killed her father), though drawing examples mainly from Western literature. The result is an important and influential essay that exposes some common and detrimental myths about illness.

Sontag cites example after example from novels, essays, poems, and medical writings to show how cancer has traditionally been associated with repression and defeat. It is seen as a shameful disease and always as inevitably fatal, even in the late 20th century, by which time treatments had improved. Such metaphors combine to create the effect that “much of the very reputation of the illness added to suffering of those who had it”—a situation not helped by the use of the word “cancer” in common parlance to mean “the epitome of evil.”

Fallacies about the emotional basis of cancer even gained some credence in medical literature, with the theory that certain personality types were prone to the disease. The militaristic language associated with cancer also riles Sontag (and many cancer patients)—from descriptions of the biological process (an invasion through the body's defences) to treatment (“a war on cancer”). Such a view of cancer burdens patients: not only do they seem to have to shoulder some responsibility, they also have to shoulder arms against it.

Many of the myths concerning cancer arose from ignorance about its causes, an aspect Sontag discusses in her companion essay, AIDS and its Metaphors. This piece, written at the beginning of the AIDS epidemic, examines in terms similar to those used in the earlier work how the disease was being described at the time, when there was much talk of contamination, plagues, and punishment.

In both pieces Sontag writes forcefully but with wit. Her writing is always lively and provocative. There can be flaws, as with anything written in such a polemical style. Sometimes points are repeated or contradicted a few pages later. There are passages where her arguments may be weak, but even these make the reader think. For this reason—and because these two essays challenge us to question how we think and talk about illness and the effect our language has on patients—these works are a valuable read for all doctors.


Illness as Metaphor; AIDS and its Metaphors

By Susan Sontag

First published 1978 and 1988 respectively

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