The implication of the illness metaphors of *In America*: Mitigating negative effects of metaphors through illness narratives in the postpandemic era of COVID-19

The paper examines how illness metaphors pervade everyday and medical language and the harms that can arise when such metaphors are used inappropriately. Building on Susan Sontag’s critique that illness has been romanticized and stigmatized—especially via militaristic framings—the authors pose the central question of how illness metaphors can traumatize at personal, social, and national levels, and how their negative effects might be mitigated. Using Sontag’s novel In America as a lens, and drawing parallels with the COVID-19 pandemic, the paper argues that although metaphors are indispensable to human cognition and medical communication, their appropriateness depends on context. The study’s purpose is to illuminate the detrimental impacts of metaphor misuse and to propose illness narratives as a constructive means to reduce harm, particularly in the postpandemic era.

The authors review theoretical and empirical work on metaphors in medicine and society. They discuss Sontag’s arguments in Illness as Metaphor and AIDS and its Metaphors about romanticization (e.g., tuberculosis as beauty/creativity) and stigmatization (illness as immorality/pollution/punishment), and her call to retire militaristic metaphors. They juxtapose Sontag with cognitive metaphor theory (Lakoff & Johnson) emphasizing the pervasiveness and functional selectivity of metaphor, and with scholars who note both benefits and harms of metaphors (e.g., Semino et al. on Violence/Journey metaphors; Gibbs on metaphor’s role in coping; Hui et al. on metaphors in serious-illness conversations). Kleinman’s distinction between illness experience and cultural context frames how social, cultural, and religious factors shape metaphor effects. The review also traces the historical entrenchment of war metaphors in biomedicine (Sydenham, Pasteur, military-industrial complex) and surveys COVID-19-era scholarship on stigmatization, militarized discourse, and media narratives that racialized or nationalized the disease. Collectively, the literature supports a context-sensitive view: metaphors can empower or harm depending on usage, audience, and setting.

This is a qualitative, conceptual analysis grounded in literary and medical humanities approaches. The authors conduct close textual analysis of Susan Sontag’s novel In America to identify and interpret illness metaphors and their consequences as experienced by key characters (Maryna and Ryszard). They apply conceptual metaphor theory (source–target mapping) to categorize metaphor types (e.g., illness as beauty/creativity; illness as immorality/pollution/punishment; illness as war) and relate these to personal, social, and national traumas depicted in the narrative. In parallel, they perform a narrative synthesis of secondary literature on COVID-19 metaphors, stigma, and militarization, drawing on public health, sociology, and media studies to illustrate contemporary parallels. The methodological stance rejects the feasibility of eliminating metaphors, instead interrogating appropriateness within context and exploring illness narratives as a mitigation strategy.

- In America illustrates how illness metaphors can inflict trauma at three levels: personal (internalized stigma and pressure to perform “absolute health” in Maryna’s case), social (class-based stigmatization around syphilis impacting lower-class passengers), and national (Poland framed as socially “ill” with poverty/backwardness, legitimizing partition within a militarized metaphorical logic). - Romanticization (e.g., tuberculosis as beauty/creativity) and stigmatization (illness as immorality/pollution/punishment) persist as harmful cultural scripts that compound patients’ physical suffering with shame and social exclusion. - Militaristic metaphors are pervasive and double-edged: they can motivate action but may dehumanize patients, entrench hierarchies, and justify power asymmetries when extended from bodies to societies and nations. - COVID-19 recapitulates these dynamics: stigmatization affected patients, families, health workers, and residents of outbreak regions; for example, 16% of Hubei residents reported being stigmatized during the outbreak’s peak. Militarized language (front lines, enemies, ammunition) became dominant in politics and media, contributing to fear, blame, racialization, and international tensions. - Because metaphor use is inescapable and context-dependent, mitigation—not eradication—is the practical goal. Illness narratives can cultivate empathy, inform patient-centered care, and help recalibrate metaphor use to patients’ contexts and preferences.

The analysis demonstrates that inappropriate illness metaphors can shape reality in harmful ways by channeling attention, legitimizing stigma, and empowering dominant groups to frame diseases and affected populations as threats or moral failings. Applying these insights to COVID-19 shows that the harms are not merely literary or historical but ongoing and societally consequential. Recognizing the impossibility of removing metaphors from thought and language, the authors argue for context-aware, patient-sensitive use. Illness narratives enable clinicians and the public to apprehend patients’ experiences, reducing emotional distance, and supporting more appropriate metaphor choices in clinical communication and public discourse. Additional strategies—medical knowledge dissemination, responsible media practices, and psychological support—can further counteract stigma and its public health repercussions (e.g., concealment and reduced help-seeking).

The paper contends that while metaphors are integral to cognition and medical communication, their inappropriate use has tangible harms at personal, social, and national scales—vividly illustrated in Sontag’s In America and re-enacted during COVID-19. Sontag’s call to eliminate metaphors is impractical, but her warning is prescient: context determines whether metaphors help or harm. The authors propose illness narratives as a practical pathway to mitigate negative effects by fostering empathy, improving patient-centered communication, and recalibrating metaphor use. They urge attention to context, improved public and media literacy about disease, and supportive psychosocial interventions. Future work should empirically evaluate how illness narratives influence metaphor reception and outcomes across diverse populations and settings.

The study is based on textual and conceptual analysis without face-to-face patient interviews or empirical testing, limiting causal inferences. Diverse social, cultural, and religious backgrounds mean that the same metaphor can have different effects, precluding a single prescriptive context for “appropriate” use. The absence of demographic data further constrains generalizability about how illness narratives mitigate harms across populations.