Coronavirus as Metaphor

In her 1978 extended essay, Illness as Metaphor, Susan Sontag contrasted the cultural role of tuberculosis and cancer. Just as Walter Benjamin defined Paris as the capital of the nineteenth century, so Sontag saw tuberculosis as the emblematic disease of that epoch, associated with the artistic and romantic and famously represented in the Paris-set operas La Boheme and La Traviata. But Sontag's real subject is cancer, from which she herself was suffering at the time she wrote the essay, and which she characterises as the emblematic disease of the twentieth century (you may also assume that she would similarly consider New York as the capital of her own era). If TB was thought to be a product of an excess of feeling, or the sublimation of disappointment, particularly in love, then cancer was seen as the malign product of repression and depression, an internal rot caused by inadequately expressed emotion or the failure to adjust to everyday life. The parallels with Romanticism and Modernism are obvious.

While TB was thought of as a complete mode of life - a delayed death sentence that restricted living and required changes in behaviour and situation - cancer was thought of more as a project, with clearly defined pathological stages and an emphasis on how the sufferer could minimise disruption to their lives, or at least prepare responsibly for death. The one was an excursion, often in the literal sense of a move to high or dry places for their assumed health benefits, the other a deviation that could be bracketed and potentially overcome. If TB was artistic, cancer was scientific, despite the continuing mystery of its etiology. Indeed, it was this mystery that Sontag saw as the factor common to both: "The fantasises inspired by TB in the last century, by cancer now, are responses to a disease thought to be intractable and capricious - that is, a disease not understood - in an era in which medicine's central premise is that all diseases can be cured." That last remark must be seen as the product of the years immediately before the discovery of AIDS, a subject on which Sontag subsequently wrote, and its explosion in popular consciousness as an incurable "plague".

Cancer gradually lost its role as the paradigmatic disease of the twentieth century from the 1980s onwards. This was not so much because it was supplanted by AIDS, which affected relatively few people and had well-known transmission routes, or because of improvements in treatment and survival, but because it was increasingly seen as a product of the environment rather than a reflection of the personality. Sufferers became victims. All diseases are seen as judgements upon the person, regardless of how arbitrary they may be, but cancer has increasingly been seen as a judgement on industrial society and in particular its callous disregard for public safety. In popular culture, this is the trajectory from Dark Victory (1939) to Erin Brockovich (2000). No longer seen as the outward manifestation of personal maladjustment or a lack of virtue, cancer was now a societal failing. One consequence of this was that cancer as a metaphor came to be promiscuously applied to all sorts of social ills, from inflation to football hooliganism.


Cancer was also a metaphor for existential dread during an era of imminent nuclear annihilation. While TB was associated with cities and its treatment was thought to be aided by particular climates (mountain sanitoria and arid deserts), cancer was truly global: there was no safe-zone, no bolt-hole. It was pervasive, implacable and could strike at a moment's notice. In recent decades, as medical science has advanced, the public health approach to cancer has been geared to screening in order to improve "early warning". Many of the metaphors associated with disease are military - battle, advance, retreat - but in the case of cancer this went beyond analogy to the practical deployment of radiotherapy, applying the science of selective mass destruction on the body's cells. That this metaphorical dimension "went into remission" after 1989 is not entirely coincidental. Cancer is now increasingly seen as a manageable disease and has lost its central role as a judgement on character to "diseases of affluence" like diabetes, obesity and clinical depression. It has also lost its metaphorically apocalyptic role to climate change.

As yet there is no leading candidate for the disease of the twenty-first century. Ebola and SARS, with their high death-rates, revived the anxiety of infection, but the difficulty of contagion hasn't shifted them out of the same category as AIDS. The great fear is of a new disease that is easy to catch and near-fatal, but such diseases tend not to become pandemics because they kill their hosts too quickly. A truly effective pandemic needs to have a long enough incubation period to aid its spread, as well as being easy to catch and difficult to treat (i.e. infection outpaces fatality). The early signs are that Covid-19 corresponds with this profile but that its fatality rate will probably be lower than the advertised 3-4%, perhaps around 1%, though this is significantly more than seasonal flu (0.1%). As a result, its metaphorical role is currently oscillating between the traditional view of a character judgement (the obsession with personal hygiene) and the more modern view of an environmental hazard (the speculation about the origin of the virus in dubious Chinese food practices and the focus on transport and tourism as vectors).

As cancer overtook tuberculosis as the paradigmatic disease, the traditional concern with virtue shifted from the patient's culpability to her response: a lack of "fight" or a lapse into fatalism being seen as a failure of character ahead of the failure of the body. In the case of Covid-19, the search for virtue has largely been societal, from the criticism of the state's initial response to the lauding of unflappable experts. The suggestion that the lack of a free press in China has worsened the situation, like the belief that the Johnson administration cannot be anywhere near ready because it certainly isn't ready for a no-deal Brexit, is obviously ideological. The lockdown of Hubei province will probably prove more efficacious than free copies of the Daily Mail. The UK government's strategy for Covid-19 - containment, delay, research and mitigation - is metaphorically a mix of the military and the technocratic: an appeal both to robustness and expertise. But the reality has been mostly dither and delay.


Containment has already failed and research cannot be accelerated further. Mitigation will be patchy, a lottery dependent on employment status and care responsibilities. The core strategy is delay. There are parallels here with climate change: the inadequacy of flood defences and continued building on flood-plains; the constant pressure to relax decarbonisation targets or seek market solutions such as offsetting; the foot-dragging on responding to research; the bias of mitigation strategies to gestural greenwashing or the scientific never-never. What underlies this commonality is the association with the economy. Covid-19 won't be an emblematic (or "idealised") disease in the way that TB was until the 1940s or cancer until the 1990s, not just because it isn't likely to be around for more than a couple of years but because it is seen not as a personal misfortune, whether as the result of a lack of virtue or social externalities, but as a symptom of a globalised economic model that is decidedly under the weather. Seasonal flu is not an inappropriate metaphor for secular stagnation, but it will never have the psychological power of TB or cancer.

The metaphors of the economy are often medical, essentially because we see it in corporeal and organic terms (much as we do the "nation"). We take the economy's temperature, we worry about it catching a cold, we equate consumption with healthy growth (rather than, as with TB, the body turning on itself). But the metaphors we apply to the economy are noticeably antiquated in their language - depressed spirits, sclerosis, equilibrium - reflecting the origins of political economy in the 17th and 18th centuries. The metaphorical impact of psychoanalysis on the vocabulary of the economy has been slight, despite the best efforts of Keynes and behavioural economics, while the impact of genetics is limited to waffle about corporate DNA. Marxian economics remains current in part because its language of systems and contradictions is recognisably modern, the vocabulary of cybernetics and engineering as well as critical theory. This antiquated language partly explains why the association of Covid-19 and the economy has tended towards another round of Enlightenment-worship, rather than the more useful task of "turning hysterical misery into common unhappiness".

The chief metaphorical value of the coronavirus is that it allows us to articulate anxieties about the economy, not just in the overt sense of concerns about demand and supply shocks but in the more generalised fear that modern society is fragile: that a small disruption could bring the economy crashing down - a concern that has been lurking in the background since 2008. Will Hutton has directly equated the response to Covid-19 to the Gordon Brown-organised response to the banking crisis: "Now, one form of unregulated, free-market globalisation with its propensity for crises and pandemics is certainly dying. But another form that recognises interdependence and the primacy of evidence-based collective action is being born." The claim that "Coronavirus won’t end globalisation, but change it hugely for the better" reminds me of the joke about the patient who asks the doctor if he will be able to play the violin after his operation, "because I couldn't play it before".