Illness as a Metaphor: Susan Sontag Reads the Constitution

April 16, 2020

It is now well-known that Republican-controlled state governments moved less quickly than their Democratic Party counterparts to implement the – draconian but essential – public health measures required to stem the assault of the coronavirus. Long after other state governments had taken decisive action to limit public gatherings, for instance, deference to local authorities prevailed in Texas, Florida, Georgia, Mississippi, Alabama, and Iowa. Republican governors in these states voiced reluctance to encroach on the authority of municipal officials and private organizations to take the lead on decisions involving public health at the local level. Among the 10 states that displayed the most significant levels of social distancing in the early weeks of the crisis, all voted for Hillary Clinton in the 2016 election; among those 10 states with the lowest levels of social distancing, 9 voted for Donald Trump in 2016.

While one can parse a variety of non-political, non-partisan explanations for these different state-level responses, it is striking the extent to which these patterns also manifest themselves nationally. For example, compared to other nations such as China, South Korea, and Germany that have more effectively imposed the difficult measures needed to limit and control the spread of the virus, the Trump Administration has floundered. Trump and his team have delivered mixed messages, confused politics with policy, and evinced a propensity to kick decision-making back to the states on key matters such as requisitioning supplies, tests, machines, and medicines needed to handle an unprecedented influx of patients.


Today, we consider and are mightily perplexed by the fragmented, often dissonant responses of our federal system of government to the coronavirus pandemic. We consider them alongside similarly halting responses to other recent natural disasters such as Hurricanes Katrina and Sandy and wonder why we cannot respond with the dispatch and efficiency of other nations. How can we account for these disparate responses? Can partisanship and media silos alone explain disparities and confusion surrounding how, when, under what pretext, and under whose authority to manage the worst public health crisis the nation has faced in more than a century?

We can look to the current political landscape for answers. But the current political landscape will only tell us so much, and its lessons may mislead, because the political reality shaping this response was embedded in the system of governance planned out and bequeathed to us more than 225 years ago by the nation’s founders. From its nascency, the Constitution reflected metaphorical and moral perspectives on illness that have since both deeply informed and handicapped the capacities of our governing institutions to respond to and manage pathogenic invasions, even as scientific understanding of these natural forces has advanced.

The proximate cause of the American federalist system enshrined by the Constitution was always the management of human conflict via the parcelization and subdivision of power and influence (with nature itself for the most part merely a static backdrop to the human tableau). However, the systems that have allowed the government to manage human conflict are precisely those that make it difficult for the nation to deliver coherent, unified governance responses to natural disasters, including pandemics.


Susan Sontag’s “Illness as Metaphor,” one of the great essays of the 20th century, offers us a window into perspectives on the relationship between nature and humanity of our nation’s founders. First published in the New York Review of Books in 1978, the essay explored the many ways in which humans have tried to reduce the sweeping, scythe-like power of illness to being merely a signifier, reflecting, we can presume, a profound and imperiled need to imagine nature as a mirror of humanity.

In her essay, Sontag reminds us how for centuries epidemic diseases figuratively summoned the essential, plague-like nature of social disorder. As early as the first half of the 16th century, “pestilent” signified “injurious to religion, morals, or public peace,” while “pestilential” meant “morally baneful or pernicious.” We first project “feelings about evil” onto a disease, she tells us. And then the disease, “(so enriched with meanings), is projected onto the world.”

Yet more profoundly, Sontag traces the evolution this notion of “moral pollution,” from the medieval world into the modern, and its interplay with conceptions of the scapegoat, a means to externalize and purge evil that threatens a community. She recalls that “massacres of Jews in unprecedented numbers took place in plague-stricken Europe of 1347-48, then stopped as soon as the plague receded.” Since the Reformation, however, with the emergence of the individual soul as the centerpiece of moral drama, “the scapegoat is not so easily separated from the patient.”


References to "disease" run rampant throughout The Federalist, appearing in no fewer than ten of the papers, often alongside references to "contagion," "pox," "epidemical," and other metaphorically rich language to frame relationships and contests of power.

Of course, Madison sets the tone (in 10, 14, and 37) with his references to the “violence of faction,” this “dangerous vice,” this “mortal disease” from which popular governments “have everywhere perished,” of which “alarming symptoms have been betrayed by our own” and for which the Constitution alone can provide a “proper cure.” Indeed, Madison writes, the Constitutional convention itself “must have enjoyed, in a very singular degree, an exemption from the pestilential influence of party animosities, the disease most incident to deliberative bodies, and most apt to contaminate their proceedings.”

Madison establishes that curbing the disease of factions is the primary role of a properly constituted and enduring (a major concern of the founders) government. But his pestilential political imagination pales next to Alexander Hamilton’s (in 15, 16, 21, 28, 61, 63, and 73) )for whom Shays Rebellion in western Massachusetts liberated an instinctual appreciation for the “extent and malignity of the disease” that lays bare the dark heart of the Articles of Confederation.

Hamilton begins where Madison ends, with the concern that political factions that will invariably strive to “erect a tyranny on the ruins of order and law.” But while Madison settles for checks and balances as the machine-like design premise of the Constitution, Hamilton’s “epidemical” imagination leads him to directly to the conclusion that only a powerful (and, if necessary, overweening) executive authority could secure the union from the “sophistries” of informal and weak political alliances among sovereign nations. Hamilton uses the language of pestilence, inflammation, and metastasis – “infection,” “contagion,” “tumors and eruptions from the natural body” – to capture his fear of the assaults and invasions that would consume and destroy any government with an insufficiently unitary and sovereign center.


What is striking about the use of these tropes of microbial aggression and subterfuge to marshal support for the Constitution is the extent to which “nature” as itself, as a real thing outside and inside of the human species, otherwise disappears entirely from the Constitutional debate. The Constitution is a document about governing affairs between humans, with essentially no regard for the incursions of nature into human affairs. Instead, nature appears as an imagined thing, invoked nearly 100 times throughout The Federalist, often to refer to “human nature,” but only once to reference itself, the natural world, here from the gentle Madison when he considers “those numerous canals with which the beneficence of nature has intersected our country.”

And so when considering the inconsistency and ineptitude that has characterized the management of a very devastating and very real public health crisis, the language that impairs our nation’s response to COVID-19 has been the metaphorical language of illness and disease. The evaporation from the Constitution (and from the conversations preceding its ratification) of “nature” itself, as the real and immediate context of our existence, liberates this metaphorical and moralistic linguistic proxy for “real nature” to infuse and concretize this document’s mission statement – which is really (and, perhaps more to the point, solely) to preserve the union, at all costs, from the violent passions, rages, and diseases of human beings.

More than four decades since the publication of “Illness as Metaphor,” the language that impairs America’s response to COVID-19 has continued to be the metaphorical and judgmental language of illness and disease, as when New York Times columnist David Brooks referred to “the moral meaning of the plague” and White House faith adviser Ralph Drollinger invoked the coronavirus to illustrate how God punishes those who engage in homosexual acts or environmental activism.

To a great extent, then, our focus on nature as an endlessly fertile symbolic playfield, and not as the foundation and context for everything we do, has deprived us of a vision of governance that can act realistically and “naturally” when those whom the Constitution exists to protect are grievously afflicted by forces beyond our ken.