Illness As Metaphor

The history of understanding illnesses metaphorically spans back to antiquity: Greek and Latin words for cancer (used for growths or lumps) stem from the word for crab because tumor veins resembled the legs of a crab. TB and cancer were thought and spoken of in similar terms until 1882 when, with the use of medical advancements, the former was finally understood as a bacterial infection. From then, the terms separated. TB was thought of as having visible symptoms (coughing spasms, emaciation, fever), while cancer was invisible. Sontag spends the rest of the chapter outlining the ways these two differ in their social and medical understandings. The two most important are cancer’s association with spatial terms—“cancer ‘spreads’ or ‘proliferates’ or is ‘diffuse’"; tumors are surgically ‘excised’” (15)—and TB’s association with poverty and lack—“thin garments, thin bodies, unheated rooms, poor hygiene, inadequate food” (15).)

Sontag continues to look at works of fiction and the writings of famous authors to ascertain a cultural relationship to tuberculosis in the 19th and early 20th century. She quotes Charles Dickens in Nicholas Nickleby and Franz Kafka’s letters (the latter author died of TB), both of whom make a clear association between tuberculosis and near-certain death. Finally, a progression is created from TB (the most common cause of death in the 19th century) to cancer (the most feared killer in the 20th century). Sontag attributes the general misconception that cancer equals death to the famous German doctor and writer Georg Groddeck, who implied as much in his 1923 book, The Book of It. The differences in how TB and cancer attack their victims, however, also reflect how they are discussed and written about. 

The linkage between disease, both TB and cancer, with passion has long been utilized by writers, thinkers, and the layperson. Again, TB and cancer find themselves on opposite sides of the same coin, where TB was once assumed to arise from too much passion and cancer from a lack of passion or sexual repression. This representation, for Sontag, binds them around ideas of sexual activity. Sex was thought to prevent cancer, whereas sex was sometimes prescribed in the treatment of TB. These treatments were not esoteric or last-ditch efforts. The poet John Keats, who died of TB, wrote in a letter that if he had ascribed to passion when he was well, he would not have contracted the sickness. The Austrian doctor and psychoanalyst Wilhelm Reich called cancer "a disease following emotional resignation—a bio-energetic shrinking, a giving up of hope” (23), and he wrote of his mentor Sigmund Freud that Freud’s cancer stemmed from resignation because of an unhappy marriage. Georg Groddeck also made a strong connection between disease and the desires of the victim to be sick, calling tuberculosis “the pining to die away” (23).

In the dialogue around cancer, the primary language is one of repression. For example, people who are sexually repressed are supposedly prone to cancer, or, worse, people believe that repressing any feeling can be cancerous. Tuberculosis and cancer share another element in how they are understood: Resignation is often seen as the cause of the disease, a giving-in to life and a renunciation of passion. A tubercular is someone who is, according to Robert Louis Stevenson, “tenderly weaned from the passion of life” (24). It was not far off to have this resignation be seen as a sort of suicide or a lack of a will to live.

The complex and successful metaphor of tuberculosis served two ends. One, “it described the death of someone (like a child) thought to be too ‘good’ to be sexual” (25), and two, it gave a way to describe sexual feelings divorced from decadence or debauchery. In a culture that used metaphors of illness to describe and understand both passion and repression, sex and prudishness, life and death, the mere idea of health became, in Sontag’s words, “banal, even vulgar” (26).