Illness as Metaphor was published by Farrar, Straus and Giroux in 1978. Sontag wrote it during and immediately after her treatment for stage IV breast cancer — a diagnosis she was told was almost certainly fatal. She survived (through aggressive experimental treatment she sought out herself), and the essay is both a work of scholarship and an act of self-defense: an argument against the cultural narratives that surround disease and transform biological misfortune into moral judgment.
The essay’s central argument is that illness acquires metaphorical meanings that harm patients. Tuberculosis, in the nineteenth century, was romanticized as the disease of sensitive souls — of artists, of the spiritually refined, of those too delicate for the coarse world. Cancer, in the twentieth century, acquired opposite metaphors: it was the disease of repression, of unexpressed emotion, of people who failed to “fight” — implying that the patient’s personality caused the disease and that recovery required moral transformation rather than medical treatment.
Sontag traces these metaphors through literature (Keats, Mann, Kafka, Solzhenitsyn), through popular psychology (the notion of a “cancer personality”), and through political language (cancer as metaphor for social ills, nations described as “sick”). Her argument is not that metaphor is avoidable — language is metaphorical by nature — but that metaphors of illness are uniquely cruel because they add moral responsibility to physical suffering: the patient is blamed for being ill.
The companion volume, AIDS and Its Metaphors (1989), extended the analysis to the HIV/AIDS epidemic, examining how the disease acquired metaphors of plague, contamination, and moral punishment that were deployed as weapons against gay men and the developing world.
First edition (Farrar, Straus and Giroux, New York, 1978): Cloth binding, dust jacket.
Market values:
- First edition in dust jacket: $40–$100
- Signed first edition: $100–$300
- Without jacket: $10–$25
- Combined edition with AIDS and Its Metaphors (1990): $15–$40
Sontag’s most personally urgent work. Values track with continued relevance in medical humanities, disability studies, and public health discourse.