The following version of this book was used to create the guide: Sontag, Susan. Illness as Metaphor. Farrar, Straus and Giroux, 1978.

“Illness as Metaphor” is an extended essay which describes and critiques the metaphors that have historically been used to describe disease. The Prologue states the goal of the book – to explain and attack metaphors related to illness. In Chapter One, the author, Susan Sontag, narrows her focus to cancer and tuberculosis. She does this because she believes that these diseases have been the most highly stigmatized throughout modern history and are most often discussed in western literature. She explains that cancer patients often suffer from shame, stigma, and secrecy; people tend to avoid those suffering from cancer rather than provide support. The following chapters provide Sontag's explanation for why this is the case.

In Chapter Two, Sontag emphasizes the distinctions between the ways tuberculosis and cancer have been culturally perceived. In general, tuberculosis was seen as causing a person to become shriveled, ‘refined’, weak, and romantic. Cancer was seen as rampantly overcoming or 'invading' a person with non-self cells in an excruciatingly painful process. As a result, cancer has been more stigmatized than tuberculosis, due to the popular perception that it destroys a person like an enemy in war, while tuberculosis makes a person more spiritual and pure. Building on these core distinctions, Chapter Three claims that tuberculosis was associated with passion, heartbreak, and emotional exhaustion, while cancer has been associated with rage, repression, and lack of emotion.

Chapter Four further explores the ironic romanticization of tuberculosis. Tuberculosis was seen as making its sufferers interesting, glamorous, and attractive, even though it drained them and made them weak. Additionally, tuberculosis provided a justification for traveling and escaping the world, because travel to a healthy climate was seen as a potential cure. This theme is expanded on in Chapter Five, which compares tuberculosis to cholera. While tuberculosis was seen as making the sufferer refined and unique, cholera seemed to erase the sufferer’s identity by making them just another anonymous victim of a mass plague. The divergence between these two characterizations, Sontag argues, extends to ancient times. Plague and illness were once seen as punishment from God, and brought the community together in its collective perception of divine punishment. In contrast, in modern times disease is seen as punishing the specific individual rather than society more broadly.

Chapter Six zooms out from the focus on tuberculosis and examines historical change over time, tracing the depiction of disease from Greek times to the nineteenth century. The overarching argument here is that disease metaphors have become more specific and more negative over time. While authors used to utilize disease or plague in general as a metaphor for social problems, eventually more specific metaphors developed around tuberculosis and cancer. Disease used to be viewed as a religious punishment, but in modern times (the nineteenth and twentieth centuries), it was viewed as a psychological problem – the sufferer subconsciously willed themselves to get sick. Building on this argument that disease is now attributed to psychological issues, Chapter Seven attacks twentieth-century studies that attempted to establish links between being diagnosed with cancer and experiencing past emotional trauma. Sontag states that history has been misused in these attempts to tie cancer to emotion – for example, authors cite the Greek physician Galen, who claimed that cancer was linked with ‘melancholia.’ However, the Greek ‘melancholia’ was a physiological condition rather than the mental condition we now call ‘melancholy.’

Chapter Eight introduces three new metaphors that have been linked to both tuberculosis and cancer. First, both diseases have been used in political attacks to describe society as suffering from social decay. Second, both were used in metaphors about the economy by describing the body as using up its inner ‘resources’ or ‘savings’ in battling disease. Third, curing cancer has been described as a ‘war’ in which sufferers and scientists have to ‘crush’ or ‘battle’ cancer. Finally, Chapter Nine focuses on how political theorists from the nineteenth century to today have capitalized on the negative associations with tuberculosis and cancer described in the previous chapters. Politicians use disease metaphors, particularly those regarding cancer, to attack critics and inspire fear over the topic being described. Sontag also compares cancer to gangrene and decides that cancer has been more heavily stigmatized. She concludes by optimistically speculating that cancer will no longer be rhetorically attacked once its cause and cure have been discovered.