Remembering Susan Sontag

[W]hen you are acquitted in this fashion the charge is lifted from your shoulders for the time being, but it continues to hover above you and can, as soon as an order comes from on high, be laid upon you again. . . . [B]ut again it is possible, just as before, to secure an ostensible acquittal. One must again apply all one's energies to the case and never give in.

Franz Kafka, The Trial

Franz Kafka was one of Susan Sontag's intellectual heroes. I cannot read these famous words of his without remembering her with sadness and admiration. In this passage the "painter" is explaining to K., the perennial defendant, that freedom is always temporary and provisional. The best one can hope for is an "ostensible acquittal"; "final acquittals" almost never occur. The medical equivalent of an "ostensible acquittal" is "remission." In its original meaning, remission meant release from the penalty of sin. We now use remission to mean release from the burden of illness, usually incurable, chronic illnesses like cancer. Good health, like freedom, is at best temporary and provisional.

Good health eluded Susan Sontag throughout much of her life. As a child she suffered from severe asthma. In 1976, at age forty-three, she was hospitalized with stage IV breast cancer with thirty-one positive lymph nodes and told she had a 10 percent chance of living two more years. After aggressive treatment she had her first remission. In 1999 she again received chemotherapy for uterine sarcoma. Sadly, on December 28, 2004, she died of complications of preleukemia at age seventy-one. Yet, unlike Kafka's K., who was a perennial defendant, Sontag was not a perennial patient. She wrote two classic monographs on illness and literature; she also wrote four novels, four plays, two films, dozens of celebrated essays, and she was an active human-rights advocate. Although she considered her own life story "banal," her cultural significance is in part due to the exemplary way she conducted her life.¹ Despite her famous formulation that illnesses like cancer and AIDS are "meaningless," she showed that illness can be a positive event that one can live with rather than being defined or limited by it.² Resisting the temptation to become defined as a cancer survivor, she used her illness as a platform for moral self-transformation and refused to let illness become her ongoing identity.

Sontag wrote prolifically on the arts, but she left only two slim monographs that specifically deal with medicine and literature. These two essays are informed by an intention that is in some ways opposed to that of her aesthetic criticism. While she believed that art could transfigure our sensual lives, could "incite" our imaginations, she wrote Illness as Metaphor to "calm the imagination."³ Quoting Nietzsche, Sontag argued that people invest illness with punitive meaning; she intended to deprive illness of this stigma. She described her intention as "practical": to help patients, their families, and their caregivers deal more effectively with cancer.⁴

One of Sontag's major intellectual concerns was the tension between morality and art. She was not the first to address this issue. Max Weber wrote in 1915 that "the refusal of modern men to assume responsibility for moral judgments tends to transform judgments of moral intent into judgments of taste. . . . This shift from the moral to the esthetic evaluation of conduct is a common characteristic of intellectualist epochs."⁵ In the scientific world, this tension between morality and art has its parallel in the confusion between morality and technology (the medical treatment of post-traumatic stress disorder is a case in point). The transformation of moral issues into technical problems has a larger cultural context, one that Sontag's work has frequently addressed. While there is a large volume of literature on the relationships between morality, art, and illness, no one has attacked this subject with the passion and the range of Sontag.

I had the opportunity to meet Susan Sontag in the fall of 2003 when she led a seminar on literature and medicine as writer-in-residence at Columbia University. The reading list included...