Susan Sontag

Illness as Metaphor and AIDS and Its Metaphors

Marion

Illness is the night-side of life, a more onerous citizenship.

Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.

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.

I want to describe, not what it is really like to emigrate to the kingdom of the ill and live there, but the punitive or sentimental fantasies concocted about that situation: not real geography, but stereotypes of national character.

My subject is not physical illness itself but the uses of illness as a figure or metaphor. 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.

Yet it is hardly possible to take up one's residence in the kingdom of the ill unprejudiced by the lurid metaphors with which it has been landscaped. It is toward an elucidation of those metaphors, and a liberation from them, that I dedicate this inquiry.

A large part of the popularity and persuasiveness of chology comes from its being a sublimated spiritualism: a secular, ostensibly scientific way of affirming the primacy of spirit' over matter. That ineluctably material reality, disease, can be given a psychological explanation. Death itself can be considered, ultimately, a psychological phenomenon.

A 'physical' illness becomes in a way less real - but, in compensation, more interesting - so far as it can be considered a 'mental' one. Speculation throughout the modern period has tended steadily to enlarge the category of mental illness. Indeed, part of the denial of death in this culture is a vast expansion of the category of illness as such.

Illness is interpreted as, basically, a psychological event, and people are encouraged to believe that they get sick because they (unconsciously) want to, and that they can cure themselves by the mobilization of will; that they can choose not to die of the disease. These two hypotheses are complementary. As the first seems to relieve guilt, the second reinstates it.

Psychological theories of illness are a powerful means of placing the blame on the ill. Patients who are instructed that they have, unwittingly, caused their disease are also being made to feel that they have deserved it.

Virtually every kind of advocacy claims to offer first of all or also some increment of freedom. Not every freedom, to be sure. In rich countries, freedom has come to be identified more and more with 'personal fulfillment' - a freedom enjoyed or practiced alone (or as alone). Hence much of recent discourse about the body, reimagined as the instrument with which to enact, increasingly, various programs of self-improvement, of the heightening of powers. Given the imperatives about consumption and the virtually unquestioned value attached to the expression of self, how could sexuality not have come to be, for some, a consumer option: an exercise of liberty, of increased mobility, of the pushing back of limits. Hardly an invention of the male homosexual subculture, recreational, risk-free sexuality is an inevitable reinvention of the culture of capitalism, and was guaranteed by medicine as well. The advent of AIDS seems to have changed all that, irrevocably.

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