On Illness as Metaphor

Note: I wrote the following earlier this year and for obscure reasons didn’t want to share it then. Now, with the publication of my cancer related poems, the time is right.


A quick scan of the reviews of Susan Sontag’s Illness as Metaphor on Goodreads reveals that younger readers, many of whom are reading the essay for a class, are often perplexed by it, so far removed are we from the metaphors on cancer that Sontag was attacking in 1978. They see virtually no trace of them today. I admit I have trouble remembering a time when some of them were active, but then until recently I had the luxury of not having to think about cancer. As a friend said, “welcome to a whole new world you didn’t want to know anything about.” I’m willing to grant that Sontag, a cancer patient, really encountered them. I do however question Sontag’s claim that Wilhelm Reich, “did more than anyone else to disseminate the psychological theory of cancer”—that certain characteristics can lead to cancer, that it’s the victim’s fault. I doubt Reich’s influence was ever that great on popular culture. It seems to me Woody Allen’s Sleeper is most indicative of Reich’s presence in 1970’s popular culture. And everyone knows how little influence Reich has had on science.

Ten years later, in AIDS and its Metaphors, Sontag noted that the cancer myths had abated somewhat, overshadowed by the horror of AIDS. But she still maintained their presence, and now we know that with the dying of the AIDS panic cancer has reemerged as disease enemy # 1. Its crown had only been temporarily removed. She had also declared herself cured of cancer but sadly it turned out that she was in remission. Her claim of being cured, it seems to me, goes straight to the heart of her mission in both essays: not to allow language—specifically the discourses of others, apart, of course, from science—to determine her own thinking about cancer. But when we know that the body produces billions of cells every day, and that it takes one, but one cancer cell to start the disease up all over again, and that cancer treatment today is a cat-and-mouse game just as it’s been for decades—knowing all this, we might be forgiven in still shivering in horror at a disease that can seem to disappear, for years even, then just as suddenly come back more vicious than before. We might be forgiven in choosing to call it Monster.

Many reviews point out the repetitions, the sloppiness really, of Sontag’s essay. She approached an admission of this, again in the first paragraphs of AIDS and its Metaphors: she wrote the prior essay quickly, seeing it as an urgent task. Time is of the essence when one is told they have cancer. I understand and can overlook this fault. It’s more difficult to sort out the value of her mission from the zeal with which she carried it out. It’s impossible to think without metaphors, a simple fact she admits in the opening of AIDS and its Metaphors. She should have mentioned it, along with caveats or explanations, in Illness as Metaphor. But what one finds in the earlier essay is a single-minded determination, without nuance or counterpoint, to blast away the unwanted metaphors—ironic, given that one of them is ‘cancer treatment as warfare’. Never mind chemo drugs are in fact poisons, that they do in fact kill cells. Sontag writes, “Treatment aims to “kill” cancer cells….” She puts the word kill within quotations. But these are not metaphors. Cytoxan, a derivative of nitrogen mustard, kills cells. That’s all it does, that’s all it’s for. I personally heard an oncologist use the phrase “scorched earth”. She said that since the tumor in question was so deadly and aggressive we had to be just as aggressive to fight it. Such metaphors are, well, they’re like a double-edged sword. For what is the “scorched earth” here, but the poor patient’s body? Was that really the best choice of words? Then again, look what happens during an aggressive course of chemotherapy followed by radiation: the patient is literally struck down, wounded, stripped of cells and sapped of strength. There could be long-term side effects, some of which could be deadly. It happens and it’s real. The patient should know this going in. Picking through available metaphors to construct a concise statement for a course of treatment can be like walking through a minefield. It’s tricky for both doctor and patient. If this isn’t like battle then I don’t know what it’s like.

The thing is to watch one’s metaphors, temper them, see that they don’t gain the upper hand, that they don’t determine the course of discourse. Such a lesson may be implicit in Sontag’s essay, but she never says it outright. On the contrary, her project results in distortions of fact and fiction. Take her criticism of the process of cancer to a “science-fiction scenario: an invasion of “alien” or “mutant” cells, stronger than normal cells….” It’s unclear why she has a problem with this language. More importantly, her placing the word mutant in quotation marks distorts the fact that cancer is caused by mutations in cells. This is not literary metaphor, it’s science.

Sontag’s apparent intent—to not allow the discourses of others to determine her own thinking—is something I can champion. Unfortunately she went about it almost as if metaphor itself were the enemy.

My favorite part of Illness as Metaphor is its final paragraph:

But at that time perhaps nobody will want any longer to compare anything awful to cancer, since the interest of the metaphor is precisely that it refers to a disease so overlaid with mystification, so charged with the fantasy of inescapable fatality. Our views about cancer, and the metaphors we have imposed on it, are so much a vehicle for the large insufficiencies of this culture: for our shallow attitude toward death, for our anxieties about feeling, for our reckless improvident responses to our real “problems of growth,” for our inability to construct an advanced industrial society that properly regulates consumption, and for our justified fears of the increasingly violent course of history. The cancer metaphor will be made obsolete, I would predict, long before the problems it has reflected so vividly will be resolved.

One will notice she has flipped the focus: not how metaphor has distorted the fact of cancer, but how cancer as metaphor reflects—vividly, she writes—issues, problems, “insufficiencies of [our] culture”. Only upon reflection can we see that the cancer metaphor does this. And one sees why this essay is discussed in the classroom. It raises innumerable questions about how we see and say ourselves.

I wish now to comment on two of these questions.

The first is personal but I can name it and sketch it out. From the point of view of a poet, I want to know how I can process cancer. I’ll use everything and anything, from the science of cancer to firsthand accounts to novels and poems to essays like Sontag’s and more. One is visited by disease like a punch to the face. That’s a terrible metaphor. It’s far worse than that. But the point is, the average person is unprepared. Why give one moment’s thought to cancer if you don’t have to? When it arrives it takes over all at once and right away. Life or death decisions must be made quickly. You barely have time to learn the science, much less join a support group. There are a hundred things to do right now to save your life. There’s no time to sort through metaphors when you’re just trying to catch your breath. In the beginning you grope like a child. Cancer is bigger than life, a monster that rages into your village, takes a piece of you, kills someone you love, just as quickly leaves and you don’t know when it will be back. St. George, Beowulf, Atossa, you grasp through primal fears at primal images. From a literary point of view, you think in clichés. The pamphlets the doctors give you to process the information are written as if for children: cartoon language to digest the basic facts. It’s all you can do. With time you can begin to arrange your thoughts, pick out some words…. Sontag wrote in 1978 that, “Cancer is a rare and still scandalous subject for poetry; and it seems unimaginable to aestheticize the disease.” I realized that I knew a lot about TB from a literary point of view, almost nothing about cancer. Which leads me to the second question:

Cancer is heterogeneous, everyone’s cancer is their cancer, and so it stands to reason that everyone’s path is also their path. While some of the myths Sontag did battle with in the 1970’s no longer exist, others have emerged. The culture of breast cancer, for example, is rife with pink sugared bows and princess crowns and talk of survivor-warriors kicking cancer’s ass. And while I’m aware of potential damage such metaphors can do, I’m not interested in writing a new version of Illness as Metaphor. If it helps someone with the disease to paint a crown on her bald head I’m all for it. Any woman doing battle with breast cancer is a princess as far as I’m concerned. Also a warrior. But that doesn’t mean I’m going to invest in a pink balloon factory. I have too much respect for those with the disease and, yes, for the disease itself to ever use the phrase, “kicked cancer’s ass”. If I say of someone in remission they “kicked cancer’s ass” then what does that imply about those who have relapsed? It’s your fault. You were too weak. You couldn’t kick cancer’s ass. So go ahead and wear your pink ribbon if it makes you feel better. I won’t judge you. But neither will I go there. I never will. Even though real men love pink. Seriously. I have to find my own way.

This entry was posted in personal essay, Prayers and Curses and tagged , , , . Bookmark the permalink.

2 Responses to On Illness as Metaphor

  1. angela says:

    Thought provoking write, Mark. Cancer seems to be coming up a lot in my circles, actually, it has not left since I lost a dear friend, who was just 34 when he passed, fourteen years ago. I agree with you – it is a personal story ever single time. I also agree that there is no “kicking cancer’s ass” – it is more akin to a relationship where one hopes to stay in harmony with their body.

    • I had the good fortune not to think about cancer before last December. Now it’s everywhere. But really, the statistics are frightening. I hope you’re getting regular checkups. Please do, and tell all your friends to.

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