COVID-19 is an infectious disease of the respiratory tract. Its typical incubation period is around five days. When symptoms develop, they are unremarkable: fever, fatigue, a dry cough. Around 20 percent of those who develop symptoms become seriously unwell. Its mortality rate is hard to assess, but the World Health Organization estimates that around 3 percent of those with symptoms go on to die.
So much for the facts. Within months of its entry into our lexicon, COVID-19 has become the stuff of metaphor. Like many diseases, COVID-19 has been cast as the enemy in a difficult war. This time, though, the enemy is a vengeful nature, the lex talionis due for wet markets and pangolin meat. The disease is a spotlight: with Trump, inequality and global supply chains all caught in its unforgiving beam. It’s an X-ray too, a harsh medicament trained on society’s ills; it yields a shadowed picture of its hidden, broken parts. And COVID-19, writes Arundhati Roy, is a “portal”: by inducing mass migration, economic devastation and authoritarian surveillance, it gives us a vision of the future.
COVID-19 may be new; metaphors of illness are not. In 1978, Susan Sontag published three essays in the New York Review of Books; six months later, they appeared, lightly edited, as a book: Illness as Metaphor. Sontag’s focus is wider than the name might suggest: “metaphor” acts as a metonymic placeholder for a range of symbolic figurations. In Illness, Sontag traces both the imprint left by tuberculosis on the literary imagination of the long nineteenth century and the fantasies imposed on cancer by the twentieth. The book’s twin ideals are truth and health; metaphor is their joint enemy. To purge oneself of metaphoric thinking, Sontag writes, is both the most truthful way of regarding illness and the healthiest way to suffer it.
Although tuberculosis is contagious, its symbolic career was not like that of other epidemic diseases. By becoming rhetorically figured as a disease that refined the sensibility, tuberculosis served to articulate a romantic ideal of selfhood. Cholera, typhoid and bubonic plague infected individuals as members of infected communities; tuberculosis, by contrast, was understood as a disease of isolation and exile. This was no accident. As the nineteenth century saw the emergence of sanatoria and travel—to Rome, to the mountains, to the Pacific—as tuberculosis treatments, a diagnosis often meant being prized from one’s home and community. Material isolation of the sick body, so suggestive of cloistering, was understood as the physical expression of an interior difference.
Understood as a mode of individuation, disease could be folded into this expressive structure and read backwards, as the visible sign of an inner essence. This understanding was codified in the fiction of a “susceptible personality”: someone whose inner nature and passions made them into a tubercular. A process that began with the material realities of disease shaping its symbolic potencies ended with the sick body being overwritten by its imaginary counterpart. The breath of a consumptive has “the odor of rotting flesh,” but this unpleasant reality was merely a palimpsest for its romantic image. To be a tubercular was to be made sensitive, interesting, spiritual.
That image remained entrenched well into the twentieth century. Sylvia Plath’s The Bell Jar—a depiction of TB that Sontag never mentions—plays a sly game with TB’s representation. Esther Greenwood goes to visit her jock boyfriend, Buddy, who is spending the summer in a sanatorium. “I wasn’t sure what I expected,” Esther muses. “I think I expected a kind of wooden chalet perched up on top of a small mountain, with rosy-cheeked young men and women, all very attractive but with hectic glittering eyes.” As for Buddy himself, she imagines him gaunt, “shadows carving themselves under his cheekbones.” Instead, everything in the sanatorium is the color of liver, and Buddy has become fat. Worse, he has written a poem, about seashells and palm trees.
Disease becomes symbolically fecund, in Sontag’s view, when its etiology is mysterious and its treatment difficult. Tuberculosis lost its charge with the discovery of antibiotics. As the twentieth century progressed and treatment became (in the West, at least) straightforward, its symbolic inheritance was split in two. “Madness” displaced TB as the disease of the artistic temperament, while the unaesthetic remainder was taken over by a disease that could not be made poetic: cancer.
Cancer’s symbolic inheritance was complex. Where the grammar of tuberculosis was temporal, cancer’s is topographic: TB “progresses,” cancer “grows.” Tuberculosis was a disease of the lungs; cancer can afflict any part of the body, and often it afflicts those marked by sex or shit. But the fantasy of a susceptible personality remained intact. Where TB was read as the effluence of a passionate nature, cancer was cast as the price of repressed emotion.
Metaphors of illness come in two varieties. We may give an illness a name that is not its own—“cancer is an invasion.” Or we may use the names of illnesses to talk about something else—“Stalinism is a cancer.” In the first case, Sontag says, “the disease itself becomes a metaphor”; in the second, the disease’s “horror is imposed on other things.” Sontag takes both to distort the patient’s experience of illness by overlaying it with meanings it does not deserve. But the two deserve separate treatments. “Stalinism is a cancer” exploits illness; it uses sickness to cast light on something else. It presupposes that cancer is more straightforward, more readily comprehensible than Stalinism—otherwise, why try to understand the latter in terms of the former? It obscures cancer precisely by presenting it as readily comprehensible. “Cancer is an invasion” is something else entirely, something far more likely to be used by someone seeking to make sense of their own sickness. Audre Lorde reaches for the image repeatedly in her memoir. “I am not only a casualty,” she writes in The Cancer Journals. “I have been to war, and still am. … I refuse to be reduced in my own eyes … from warrior to mere victim.”
Lorde and Sontag were both diagnosed with cancer in their forties. Both had breasts removed; Sontag lost muscles from her chest and part of her armpit too. Both are concerned with living truthfully in and after illness. Where Sontag focuses on cancer’s discursive creation, Lorde examines the marks its treatment leaves on the body. To wear a prosthetic breast, writes Lorde, encourages her to see her mastectomy as a cosmetic occurrence. This cosmetic guise, in turn, blots out a reckoning with death. The image of the warrior, for Lorde, is a memento mori.
Sontag’s ethic is one of truth: we are to see illness as it really is. But what is the truth about illness? Sontag is sometimes accused of a form of positivism, of assuming that the truth about disease can only be spoken in the cool, impersonal language of the lab and clinic. Where Lorde’s writing about cancer is confessional, Sontag refuses the collapse of analysis into autobiography. (Women’s essays, though, are always read as personal—Denis Donoghue calls Illness “a deeply personal book pretending for the sake of decency to be a thesis.”) Illness may have been written after her recovery from cancer, but it is not a memoir—as Anne Boyer observes in The Undying, her own account of breast cancer and chemo, Sontag never writes “I” and “cancer” in the same sentence.
Sontag pits her opacity against the romantic tradition that made the body a loquacious authority. To live in the world at all is to find oneself read—interpreted—by others. Sociability is always a kind of toggling, whether playful or nervous, between disclosure and withdrawal; we make ourselves, in part, by deciding what to keep private. Illness disrupts this dynamic. Part of what illness does is to unsettle both the sense of ourselves that emerges from our patterned and effortless doings, and our capacity to project this sense outwards, into the social world. In illness, the body as it is processed and experienced by others takes over and wholly penetrates the lived-in body, the body as it feels “from the inside.” Boyer’s memoir dramatizes this process. “Life … breaks open under the alien terminology of oncology,” she writes:
Patients become information … The nurses ask questions about my experience of my body. They enter the sensations I describe into a computer, clicking on symptoms that have long been given a category and a name and an insurance code. … I have informaticized my own sensation. It is the doctors who read me—or rather, read what my body has become.
For both Sontag and Boyer, cancer is the muffling experience of having the public body speak for and over them. But whereas for Sontag, the body was made to speak by the moralizing fiction written onto cancer, for Boyer, the speaking is done by the colorless lexicon of bureaucratized medicine. Metaphors of illness, in Sontag’s analysis, rendered her socially legible in ways she rightly found distasteful.
But metaphors are also used by those who, like Lorde, seek to remake the lived-in body after sickness has threatened to swallow it. What should Sontag make of illness metaphors so used? It’s hard to say: while Sontag tells us a lot about how not to talk about illness, she is relatively silent on how we ought to do so. There are some scattered clues: in her later book AIDS and Its Metaphors, she gives Daniel Defoe’s Journal of the Plague Year as an example of “good” illness writing. The Journal, published in 1722, gives a firsthand account of the 1665 outbreak of bubonic plague in London. It is, of course, a realist novel: Defoe tabulates the dead and disavows plot; he is studiedly dull but utterly engrossing. He presents his novel as a clear pane of glass through which we can look to see the plague pits and the shut-up houses, just as they were, quite uninterpreted. Sontag approves of it because it does not “further any understanding of the plague as punishment or … transforming experience.”
Sontag is here in obvious tension with her past self. In a 1965 essay, On Style, she writes, “All representation is incarnated in a given style … there is, therefore, strictly speaking, no such thing as realism, except as, itself, a special stylistic convention.” Writing that is expository, impersonal and flat is just as selective as any other form of writing, just as much a projection of sensibility as the ornate, the hermetic or the beautiful. We dream of a representation that we can stare right through to the thing itself, but this dream of a “style-less, transparent” representation is only a tenacious fantasy. By the time Sontag writes Illness, she can seem to have fallen for just this fantasy: the language of medicine, some have taken her to say, offers just such a prospect. The closer writing comes to a bare record of epidemiology, the closer it comes to this longed-for transparency.
It can start to sound like Sontag takes the language of medicine to offer the sick a privileged mode in which to represent their sickness: a perfectly neutral, perspective-free language with which to describe disease. Read thus—and Sontag has been read this way—the vision is hardly appealing. After all, the lab and the clinic are not nowhere. Illness is always a human event, always in someone’s “here” as well as their “out there.” Read this way, Lorde and Boyer stand as rebukes to Sontag, showing how her case against metaphor depends on her neglect of the ways in which illness is always a personal event, and not only a medical one.
But Sontag deserves a more careful reading. Her suspicion of metaphor is not a demand for a language stripped of the personal and the perspectival. Rather, she is suspicious of fantasy. Our language of illness should, she thinks, act as a guard against fantasy rather than induce it. Metaphors fail this test. Their contents are plastic, open-ended and difficult to pin down. When a metaphor “seems right,” it is often hard to say why; it reconfigures our thinking in subtle, untraceable ways.
Illness is not an uncritical medic’s manifesto, nor is it an instruction to speak only impersonally. Metaphor may well be used as a tool to reconstruct the lived-in body, but when it is so used, this reconstruction risks being built on a fantastic foundation. The really difficult question is whether there is some alternative. Or is the will to survive always entangled in some form of fantasy?
Sontag’s own life suggests an answer. When Sontag was first diagnosed with breast cancer in 1975, her doctors were pessimistic. They told her she had only months to live. Furious, she left America for France, to try an aggressive regime of chemotherapy not available in the United States. She survived to be diagnosed with cancer twice more. At the age of seventy, she received her third and final diagnosis: leukemia. She died a year later, in 2004.
In 2008, her son published an account of her final years. “My mother,” he writes, “had always thought of herself as someone whose hunger for truth was absolute. After her diagnosis, the hunger remained, but it was life and not truth that she was hungry for.” Her hunger for life, her son records, took the form of a forced and bullying optimism about her treatment. “In order for her to believe that she would be cured, my mother needed to believe that her loved ones were convinced of this as well.” Sontag’s life shows the limits of an ethic of truth. A life stripped of fantasy may not be a livable one, and in the face of death, the blandest language can become its vehicle. A final lesson is hardest to learn: the line between fantasy and truth can blur. Had Sontag died in 1975 as her doctors predicted, she might have seemed like a fantasist from the start.
When I first read Sontag, in 2013, I suffered from severe hypochondria. Terror about my health began in my early twenties and lasted for almost a decade. I thought mostly about cancer. I imagined, with something close to passion, tumors growing in my breasts, in my bowels and gut. Reading Sontag did not, of course, cure my hypochondria (if only), but it did help me understand my own illness better. Sontag was concerned with those who suffered because their disease was made to mean too much. I had been suffering because I failed to grasp that my fixation on disease might really be fixation on something the disease had come to stand for. Sontag was against the interpretation of illness, but interpretation was just what I needed: only once I saw that diseases had meaning could I understand that I might not really be sick.
In March this year, as the pandemic took hold in the U.K., my hypochondria returned. But this time, I wasn’t alone: everyone was just as obsessed as me with the thought that they might have COVID-19.
Key to the fantasy life of both cancer and TB is the fact that neither is nor ever was a collective experience. COVID-19 is different. Not all of us have or will get the disease, but the pandemic is communal. The fantasies it invites, then, are not personal—the susceptible personality—but world-historical, and often overtly political.
As Sontag details in her concluding essay, political uses of illness have typically involved analogizing civil disorder with disease, or casting dissenters as sick parts of the body politic. The emerging corona-imaginaries are different. For the political right, coronavirus is an overhyped elite conspiracy, one more force to be struggled with in the name of freedom. For the political center, coronavirus is suggestive not of civil disorder, but rather of a shared trial that we all must undergo; the virus promises to bind us into newly solidary nations, states and cities. In leftist rhetoric, by contrast, the pandemic makes for a politics of rupture. Coronavirus, it is suggested, lays bare the pathologies of capitalism. It shows us that our “normal” was always a kind of nightmare; we cannot and should not go back.
But it may be the pleasures of apocalypse porn, rather than metaphors, that offer us the best guide to the emergent corona-fantasies. Part of the pleasure of the disaster movie lies in its epistemology of vindication: a staple of the cinematic apocalypse is that someone sees it coming, but when they try to warn others, they are dismissed as neurotic and unhinged. A crisis, like an apocalypse, is often construed as an alethic event: it makes manifest the hidden truths of what came before: for the left, the contradictions and hypocrisies of capitalism; for the center, the importance of group solidarity unsplintered by identity politics. Corona-fantasies borrow the vindicatory epistemology of the disaster movie: Whatever I thought was wrong with the world before, well, this proves it. In its most bellicose forms, the fantasy has it that the crisis should and must persuade others of our rightness too. The apocalypse, it turns out, has an upside: it means not having to argue any more.
What should we make of these fantasies of vindication? The easy answer would be: resist and expose; do for these illusions what Sontag did for the metaphors of illness. This easy answer may well be right. But a harder answer returns to the Sontag who, in the face of death, was forced, finally, into an illness fantasy of her own: I will survive this cancer too. Living makes for a strange discipline: it comes with a guarantee of death, but it is hard, for most of us, to live at all well—to steer between nihilism and naïveté—without some kind of fight against this guarantee.
Democratic politics has a similar structure: it requires an argument that will never be over, never be fully won. But for most of us it is hard to argue well, or at all, without cleaving to the fantasy that if we just argue well enough, we can cheat not death, but disagreement. We need to believe our arguments will work, that our opponent will—or at the very least could—succumb to the unforced force of our words. To endure arguing at all, we need the fantasy that the arguing will, one day, be over.