In her well-known 1978 book Illness as Metaphor, Susan Sontag says, “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” (3). Illness affects all human beings in some way, whether it is a simple bout of the flu, a chronic painful condition, a disability, or a life-threatening disease. Because all readers, even if we have not ourselves been severely ill, can relate to the idea of Sontag’s two kingdoms, illness is a frequent and powerful theme in literature. When we are sick, we have a feeling of not being part of the mainstream; we can concentrate only on the sickness, the pain, and the discomfort, and in doing so, we remove ourselves from life for a while. The sick, then, are deviant; they are not normal. Literature has a history of using illness to highlight deviations from what is normal, both positive deviations and negative ones. Sociologists and medical professionals have several different ways of explaining why illness has such a powerful hold over our imaginations. Echoing Sontag’s metaphor, the physician Michael Stein says in The Lonely Patient that illness is a kind of travel into a “foreign kingdom” or an “unrecognized neighborhood” (10). The sick person is confused and anxious, asking many unanswerable questions about how to act, what to say, and how long the stay in this “foreign kingdom” will be. Illness, then, can symbolize a journey, albeit a frightening, disorienting one.
The writer and physician Oliver Sacks notes that the word we use to describe that journey—sickening— has no counterpart: There is no “healthening.” We usually use the word recovery, which indicates we are retrieving our lost health from somewhere, but it is the “sickening” that provides the powerful metaphor (quoted in Stein 96). This metaphor is so powerful, claims David B. Morris in Illness and Culture in the Postmodern Age, that “almost every era seems marked by a distinctive illness that defines or deeply influences it” (50). In the Middle Ages, the bubonic plague changed the face of Europe, killing millions of people, approximately one fourth of the population. Not only did millions die, but millions more lived in constant fear of contracting the dreaded plague. In the Renaissance, what was known at the time as “melancholy,” but what today we would call depression, pervaded. In the late 17th and 18th centuries, sometimes referred to as the Enlightenment, gout, a kind of arthritis, and syphilis, a deadly venereal disease, held sway. Doctors attributed both of these diseases to the loosening morals of the upper classes, as gout was mostly diagnosed among the wealthier citizens who could afford treatment, and syphilis was the product both of aristocratic promiscuity and the urban poverty of the prostitutes they frequented. In the 19th century, tuberculosis was the dominant illness. With its victims weak, pale, and bedridden, the disease seemed to indicate that the suffering it brought purified those whom it struck, or at least returned them to a natural state. Many artists and writers of the 19th century died from tuberculosis, including the writers John Keats, Emily Brontë, and Robert Louis Stevenson and the composer Frédéric Chopin, leading to the assumption that those of artistic temperament were especially susceptible. In the 20th century, cancer took over as the defining illness.
Cancer is a brutal, seemingly indestructible enemy that can attack out of nowhere and that often must be fought by further brutalizing the body with surgery, chemotherapy, and radiation. It dehumanizes the patient. As such, it is an appropriate metaphor for the 20th century and the rise of technology. Many authors have harnessed the power of illness— its anxiety, its dread, its ability to drive people apart and to bring them closer together—to tell their stories. In Louisa May Alcott’s Little Women, for instance, Beth, the sweetest of the March sisters, contracts scarlet fever while nursing a poor family. Although she recovers, she lives life in a weakened state and eventually succumbs. Her death reminds the March sisters, especially Jo and Amy, of the importance of family unity despite disagreement. In Charles Dickens’s A Christmas Carol, Dickens uses the sickly, disabled figure of Tiny Tim to illuminate the joy of Christmas. If this poor creature can be happy, Dickens seems to say, then so should we all be. A 20th-century take on illness can be found in Don DeLillo’s White Noise. Jack and his family have come simultaneously to fear illness and to see it as inevitable. They take pills for reasons they do not understand and receive vague diagnoses that only serve to frighten them. In addition to serving as a useful vehicle around which to tell a powerful tale, illness has also functioned as a more specific metaphor. For example, illness can also represent failure.
The noted American sociologist Talcott Parsons has described health as a “gatekeeper” to success. A healthy body and mind is the basic condition, he says, for functioning in a democracy and “too low a general level of health is dysfunctional” (quoted in Gerhardt 7). When illness stands as a metaphor for failure, it symbolizes deviancy. The sick person has failed to keep well, failed to keep personal commitments, and failed to adequately garner support and admiration from others (Gerhardt 22). The ill in this scenario are necessarily passive, helpless, and detached from reality. Therefore, they lack the characteristics to succeed in the modern world. In Eugene O’Neill’s play Long Day’s Journey into Night, half of the Tyrone family suffers from chronic illness. At the play’s start, Edmund has just learned he suffers from tuberculosis. His many attempts to find his place in the world have failed and now, O’Neill seems to be suggesting, he will find his true calling in death. His mother, Mary, suffers from a debilitating morphine addiction; she has failed to face the problems in her real life, so she uses morphine to dull the emotional pain this gives her. The morphine, in effect, paralyzes her, highlighting the metaphorical paralysis in which the whole family is trapped. While the idea that illness represents a kind of failure is common in discussions of physical illness, in discussions of mental illness it is practically normative.
Mental illness, as the literary historian Shoshana Felman has theorized, is like a kind of blindness, a literally inability to see what is actually happening. As such, those who are mentally ill are often shunned because they are incapable of acting in a way we consider reasonable. In Sylvia Plath’s The Bell Jar, the protagonist, Esther Greenwood, loses her ability to function in the real world as the novel progresses. She cannot “see” who she really is—a young woman with talent and intelligence. She feels trapped, not only by her skewed view of the world but also by the assumptions of those around her that she could just “decide” to be all right. That those who, like Esther, are sick because they want to be or because they deserve it is another common portrayal of illness in literature. Disease has long been seen as a form of divine punishment—a curse well deserved by those who have fallen sick. Susan Sontag explains that the ancient Greeks believed illness sprung from supernatural punishment or demonic possession and that the accursed must have done something to warrant this affliction.
Early Christians, she writes, had more moralized notions of disease. Disease was still viewed as a divine punishment, but now the specific disease was thought to express the deviant character of the patient. This view of disease can be seen well into the 20th century. Tuberculosis, for instance, was long believed to result from too much passion, while cancer was thought to result from the suppression of passion (Sontag 21). AIDS, with its most common methods of transmission involving behavior considered deviant by most (homosexual intercourse, the use of intravenous drugs), has been referred to as a “punishment from God” by ignorant, fearful critics. In Tony Kushner’s Angels in America, Roy Cohn, the closeted homosexual lawyer diagnosed with AIDS, certainly feels this way. He is ashamed of his disease and does everything he can to hide it.
Prior Walter, on the other hand, also diagnosed with AIDS, gains confidence as he embraces his past and his present, being visited by an angel and dead relatives and being declared a prophet. In the end, perhaps Cohn is being punished—not for being gay, but for hiding his true identity. Although there are many different methods by which authors deal with illness in their texts, it is such an important, unavoidable part of real life that it always serves as a powerful device. Depictions of illness can carry hope, despair, and grief; they can illuminate difference and similarity; and they can most powerfully display the experience of being human.
See also Capote, Truman: In Cold Blood; Cather, Willa: O Pioneers!; Hawthorne, Nathaniel: House of the Seven Gables, The; Ibsen, Henrik: Doll ’s House, A; Lessing, Doris: Golden Notebook, The; Poe, Edgar Allan: “Fall of the House of Usher, The”; “Tell-Tale Heart, The”; Fitzgerald, F. Scott: Tender Is the Night; Gilman, Charlotte Perkins: Yellow Wall paper, The; Rhys, Jean: Wide Sargasso Sea; Silko, Leslie Marmon: Ceremony; Sinclair, Upton: Jungl e, The; Turgenev, Ivan: Fathers and Sons; Steinbeck, John: Of Mice and Men.