Infirmary Blues

Illness as Metaphor

by Susan Sontag
Farrar, Straus and Giroux, 88 pp., $5.95

The ideas behind this inflammatory broadside (it is only eighty-eight pages) are stated plainly on an introductory page:

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.

This is the Puritan view—the view that got such a clouting from Ibsen in The Wild Duck. But here is Dickens expressing perfectly what happens to illness when it is used as “a figure or a metaphor.” Young Smike, of Nicholas Nickleby, is dying of TB. This is admittedly a “dread disease,” but it “refines” death’s “grosser aspect” in that “the struggle between soul and body is so gradual, quiet, and solemn, and the result so sure, that day by day, and grain by grain, the mortal part wastes and withers away, so that the spirit grows light and sanguine with its lightening load….”

Miss Sontag has made a fine collection of such repellent passages of metaphorical nonsense. They were used by the Victorians, she explains, to prettify the great killer of the nineteenth century, and there were two reasons why metaphor was particularly suited to it: first, the doctors didn’t know what it was, and so laid it open to the whims of fantasy; second, it did marvelous things (as the Dickens passage shows) to the physical crudities of man. TB is “a disease of extreme contrasts: white pallor and red flush, hyperactivity alternating with languidness,” and it gave the dying person a far more “beautiful and more soulful” appearance than he had enjoyed in his robuster days. From there, it was only a step to regarding it as “romantic,” and once established as romantic, it couldn’t fail to grow fashionable. “I could not have accepted as a lyrical poet anyone weighing more than ninety-nine pounds,” said Gautier (a novelist who was allowed to be heavier, Miss Sontag presumes). Saint-Saëns, who is also quoted, remarked Chopin’s good fortune in being “tubercular at a time when good health was not chic.” Needless to add, this “really awful disease” was good for both religion and society: it helped Little Eva, on her deathbed, to beg her father to free his slaves. Its mysterious nature left ample room for comforting illusions: Shelley was able to assure Keats that it always made a beeline for the very best poets, and even Byron, already renowned for his pallor, said that a little TB might provide added interest.

This way of seeing TB went right on into the middle of our own century, long after Koch had found that a bug was at the bottom of it. Middleton Murry found his wife, Katherine Mansfield, more beautiful on the day before her death than she had ever looked before: he wrote of her on that day in the sort of words …

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