“Cancer,” Susan Sontag observed in Illness as Metaphor, “is a rare and still scandalous subject for poetry; and it seems unimaginable to aestheticize the disease.” Though she wrote this in the late 1970s, her point still stands. When it comes to descriptions of cancer, in real life or in books, many people struggle to stretch beyond the limited range of accepted, often military metaphors. You’re supposed to “battle” cancer, not prettify it. To veer away from this register runs the risk of sounding flippant, even cruel.

But the French writer Annie Ernaux has never been afraid of breaking taboos. Over the course of her 50-year career, Ernaux—the winner of the 2022 Nobel Prize in literature—has portrayed an illegal abortion (Happening), the complexities of working-class life (A Man’s Place; A Woman’s Story), and the highs and humiliations of sexual obsession (Simple Passion). The Use of Photography, published in 2005 and newly translated into English by Alison L. Strayer, approaches Ernaux’s experience of breast cancer in the early 2000s with a similar fearlessness, emphasizing sensuality in the face of death. It is a radical gesture to treat the sick body, a body threatened by its own demise, as one that is also capable of performing that most generative of acts: sexual intercourse. In doing so, Ernaux takes control of, and breathes life into, the narrative of illness and death.

The Use of Photography is a collaboration, in which Ernaux’s writing alternates with that of the book’s co-author, the photographer and journalist Marc Marie. The book also includes 14 photos taken by them both, each of which features piles of discarded clothing scattered by Ernaux and Marie across the floors of various rooms over the course of their brief love affair. Looking at each image, it is easy to imagine these garments—the tangled straps of a lace bra procured specially for the occasion, the creased leather of a man’s boots—to still be warm from their owners’ skin. But as the text reveals, Ernaux was undergoing chemotherapy when these photos were being taken. In this context, the shapeless clothes take on a mournful air, the appearance of a funeral shroud.

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Sex and death, Eros and Thanatos, have been paired in the popular imagination since Freud theorized about their relationship in his 1920 essay “Beyond the Pleasure Principle.” In Ernaux’s book, the frenetic, self-destructive drive and heated sexual passion of her earlier work has subsided into something more elegiac. This is a cold book: It is winter in many of the most memorable photos, even Christmas morning in two of them (“I have no memories of happy Christmases,” writes Marie). The first time they sleep together is on a January evening. When contemplating death, Ernaux briefly imagines “the physical form of a corpse, its icy cold and silence.” The book is slim, its pages filled with white space, and the photos themselves take on the feeling of a mausoleum’s statuary. The clothes, pictured without living bodies inside them, are beautiful and unmoving.

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But even amid this chill, Ernaux’s precise rendering of both sex and cancer animates the book. “There is something extraordinary about the first appearance of the other’s sex,” she writes near the beginning, detailing the night she and Marie first slept together. She later likens the viewing of his penis as a counterpart to Courbet’s fixation on a woman’s vulva in The Origin of the World. Later, the “catheter like a growth protruding from my chest” becomes a “supernumerary bone”; the plastic tubing running into the bag holding her medication makes Ernaux look “like an extraterrestrial.”

Cancer depersonalizes the body, turning it foreign. As it undergoes chemotherapy, Ernaux’s takes on an otherworldliness. Her face, without eyebrows or eyelashes, offers “the eerie gaze of a wax-faced doll,” while her limbs, similarly hairless, are turned under Marie’s watchful eyes into those of a “mermaid-woman.” Her physical form now unfamiliar, Ernaux views her treatment from a remove, observing it as if it were a performance: “For months,” she writes, “my body was a theater of violent operations … I performed my task of cancer patient with diligence and viewed as an experience everything that happened to my body.” The notion that being a patient involves acting out one’s assigned role appears in other accounts of breast cancer, too. In her semi-autobiographical 1992 novel, Mourning a Breast, the Hong Kong writer Xi Xi likens the radiation unit to “a film set,” each patient quietly playing their respective parts.

Photograph by Annie Ernaux and Marc Marie

Certain qualities have traditionally been expected from the sick person, especially if she is a woman. There exists a long history of the dying muse, beautiful, feverish, and doomed: In 1852, the artist’s model Elizabeth Siddal posed as Hamlet’s Ophelia for the pre-Raphaelites, her languid sickliness attributed to tuberculosis by her peers. It was indeed that disease that solidified this archetype, and Ernaux thinks to herself at one point that cancer “should become as romantic a disease as tuberculosis used to be.” In the 19th and early 20th centuries, tuberculosis appeared in or inspired works as wide-ranging as Keats’s “La Belle Dame sans Merci,” Puccini’s La Boheme, and Thomas Mann’s The Magic Mountain. Cancer, conversely, is far less glamorized. For the healthy Marie, though, Ernaux’s body, even as it undergoes chemotherapy, is still sexual; at one point, Marie incorrectly assumes that the cancer is in Ernaux’s left breast—the one less swollen. “He could probably not imagine,” Ernaux writes, “that the prettier of the two was the one with cancer.”

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Though Marie’s sections are, unsurprisingly, less interesting than Ernaux’s (it’s tough to go head-to-head with a Nobel laureate), their appearance in the book—unmarked, without a chapter heading or a visual symbol to differentiate them—creates an egalitarian dynamic. Both Ernaux and Marie assume the roles of creator and muse. A fundamentally different power structure is at play here than the one of vital artist and feeble subject that dominated the tubercular age: Though cancer saps Ernaux of her life force, it is also for her an unexpected source of inspiration.

For Ernaux, this dynamic is political. At the time of her writing, she notes, 11 percent of French women “have had, or currently suffer from breast cancer.” Recording her own experiences publicly identifies her as one of them, her cancerous breast as one of “three million … stitched, scanned, marked with red-and-blue drawings … hidden under blouses and T-shirts, invisible.” She writes that “we must dare to show them one day. (Writing about mine is part of this unveiling.)” Appearing as it does in an organ so closely identified with female sexuality, breast cancer is unique; it is both a focal point of cancer awareness (at one point, Ernaux remarks dryly that, upon reading in an issue of Marie Claire that it is Breast Cancer Awareness Month, “I was keeping up with fashion”) and also a disease that has been hidden away, its disfigurements commonly concealed by cosmetic surgery. There is an echo, in Ernaux’s “unveiling,” of Audre Lorde’s rallying cry on the first page of The Cancer Journals, her 1980 account of her own experience of breast cancer and subsequent mastectomy: “I am a post-mastectomy woman who believes our feelings need voice in order to be recognized, respected, and of use.”

In this lineage of women writing about breast cancer, Ernaux’s focus on eroticism reminds the reader that the cancer patient still has wants and desires; that is, she is still a human being. Discussing cancer will always reveal the paucity of language—what it can and cannot say for the person suspended between life and death. By the book’s end, Ernaux has reached her own conclusion: “I can no longer abide novels or films,” she writes, “with fictional characters suffering from cancer … how do they dare to invent these kinds of stories? Everything about them seems fake.” With its aim to transmit into words and images what is so often left unsaid about breast cancer, The Use of Photography is the opposite: the real thing.

A classic bildungsroman follows the growth and development of a young person, who typically matures from a dreamer into a rational being. Jane Austen was a master of the genre: In her posthumously published novel Northanger Abbey, she satirizes the overly imaginative Catherine Morland, a voracious reader who perceives her life as a Gothic story. Catherine finds intrigue and plot everywhere she looks: A cabinet in her room might hold morbid secrets; a laundry bill might be a clue to a dark scheme. Her salacious imagination gets her into trouble, but like a good heroine, she eventually sees things as they really are. She becomes an adult, a person of reason, and learns to live in the real world.

The Nobel laureate Olga Tokarczuk’s latest novel, The Empusium: A Health Resort Horror Story, is also a bildungsroman, following the education of a young man. But in contrast with Northanger Abbey, The Empusium charts the opposite trajectory: What if a person could instead be taught to see the world as an unreasonable place, dominated by the supernatural or mystical? Pulling from folktales, mythology, art, and literature, Tokarczuk’s novel spins a story that feels eerily familiar and yet totally new. The book challenges the supremacy of the “rational” that has held sway since the Enlightenment, painting a picture of a world that is illogical, fantastical, and often simply unexplainable.

The Empusium, which has been translated from Polish by Antonia Lloyd-Jones, opens at a train station, where “the view is obscured by clouds of steam from the locomotive that trails along the platform. To see everything we must look beneath them, let ourselves be momentarily blinded by the gray haze, until the vision that emerges after this trial run is sharp, incisive, and all-seeing.” Like a camera panning across a set, the collective first-person narration slowly scans across the train platform, where a left shoe appears, then a right one: a new arrival. This is “our” protagonist, to adopt the novel’s language, a young Mieczysław Wojnicz, who has arrived at Görbersdorf, a sanatorium in the Prussian province of Silesia, now part of Poland. Wojnicz is here, as many other gentlemen would have been in September 1913, to pursue a rest cure for tuberculosis.

The novel’s opening signals that Tokarczuk is returning to hallowed literary ground: Thomas Mann’s The Magic Mountain, on its 100th anniversary. The older novel follows a young man’s lengthy stay at Davos, a Swiss sanatorium. Like Mann’s protagonist, Hans Castorp, Wojnicz has studied to be an engineer, and like Castorp, he mostly passes the time in the sanatorium by listening to debates among other, older guests. But unlike Castorp, who lived at Davos for seven years, Wojnicz finds himself a spot at a discounted inn, the Guesthouse for Gentlemen in Görbersdorf, while waiting for a vacancy at the main resort, the Kurhaus.

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In The Magic Mountain, Castorp learns a great deal from his fellow guests. The resort acts as a microcosm of the intellectual climate in Europe before World War I: Over the course of the novel, the guests represent and dissect ideas put forth by Nietzsche, Marx, Hegel, and Freud, among other thinkers. In contrast, Wojnicz has a front seat to what reads hilariously as a cut-rate, drunken version down the street. The debates in the guesthouse never soar to the intellectual heights reached in Mann’s book, or even come to a definitive conclusion, instead petering out as the local liquor takes hold. By parodying Mann’s discourse, The Empusium seems designed to take The Magic Mountain down a peg or two.

Though Wojnicz is a keen observer of the social dynamics that unfurl around him, he prefers to listen to the debates and rarely weighs in. He is naive, “an odd creature, so completely unaware, so innocent.” He spends his long afternoon rest cures reflecting on his past: his childhood after his mother’s early death, his strict education in Lwów and then Dresden, his torment by a father determined to toughen a sensitive son. Wojnicz is clearly at Görbersdorf at the insistence of his father, who believes that it will make him into more of a man. “To be a man,” Wojnicz reflects sadly, “means learning to ignore whatever causes trouble. That’s the whole mystery.”

Yet as the novel progresses, Wojnicz is unable to disregard disturbing events. The guesthouse proprietor’s wife hangs herself the day after his arrival, and sensitive Wojnicz is alarmed that no one, including her husband, Willi Opitz, appears to care. Wojnicz registers other oddities as September turns into October, then November. The attic emits cooing noises at night. The town’s residents claim that witches live in the forest. The liquor that the guesthouse gentlemen imbibe at night, Schwärmerei (German for “excessive sentiment”), seems to have hallucinogenic properties. On a hike in the woods, Wojnicz is horrified to come across earthen sculptures called Tuntschi—objects that, according to his companions, are used as sex toys by the local coal burners. The nearby cemetery is full of tombstones for young men who recently died; the previous year, a young man had been found ripped apart in the forest. Is all this mere coincidence, as Dr. Semperweiss, a psychoanalyst who works at the main sanatorium, suggests? Or is there something sinister, maybe even supernatural, in the woods beyond Görbersdorf?

The answer to these questions might be a matter of perspective. Wojnicz’s only friend in the guesthouse, a young landscape painter named Thilo von Hahn, encourages him to pay attention to these odd events. On his own, Wojnicz doesn’t notice anything interesting about the tombstones; it’s not until Thilo presses him to look more closely that Wojnicz realizes that a young man seems to die each November. Together they look at Thilo’s prized possession, a painting by the Flemish artist Herri met de Bles called Landscape With the Offering of Isaac. The canvas looks normal to Wojnicz until he moves in closer: “Once the viewer’s attention was well and truly put to sleep, a new sight loomed out of the picture, the old contours arranged themselves into something completely different that had not seemed to be there before.” Wojnicz is horrified by what emerges—something “alive,” a grotesque face or body. Thilo then tells Wojnicz that once a year in Görbersdorf, the land “takes its sacrifice and kills a man.” Wojnicz thinks that his friend might be delusional from fever, but the eerie sense of being “watched by the local landscape” persists. Everything visible might be mirrored by a shadowy world.

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Yet for all the creepiness of Görbersdorf, one of the most disturbing parts of The Empusium is Tokarczuk’s depiction of the everyday misogyny of the time. No matter the topic at hand, each debate among the men at the guesthouse seems to come back to the problem of women. Do they have souls? Are they merely minor men? What social purpose do they serve? “We cannot regard the act of a woman as entirely conscious,” one character opines. “Female psychology has proved that a woman is at once a subject and object, and so her choices can only be partly conscious.” Not long after the death of his wife, Willi Opitz concludes that “motherhood is the one and only thing that justifies the existence of this troublesome sex.” In a note at the end of the novel, Tokarczuk explains that these conversations are paraphrased from more than 30 male authors, ranging from Ovid to Saint Augustine, Henry Fielding to William Butler Yeats. Underneath their discussions about democracy, rationalism, and religion lies one consensus: Women are subordinate and subhuman. If the narrative of the 20th century is one of male greatness and genius, a pantheon of figures such as Nietzsche and Freud, Tokarczuk insists that this history obscures a world of shameful sexism.

Female inferiority is perhaps the only topic on which the gentlemen of the guesthouse can agree. In one scene, a character proffers that the “surest sign” of brilliant literature “is that women do not like it.” Puffing on a cigar, he contends that women writers “often yield to the attraction of all manner of oddities: ghosts, dreams and nightmares, but also coincidences and other chance circumstances, with which they try to conceal their lack of talent in sustaining a consistent plot.” It’s easy to picture Tokarczuk writing this line with a kind of satirical glee, perhaps because her own work has consistently incorporated supernatural elements, through characters such as the Jewish mystic Jacob Frank in The Books of Jacob and the devoted astrologer Janina Duszejko in Drive Your Plow Over the Bones of the Dead. Her oeuvre is marked by a dedication to the strange and the unbelievable.

For Tokarczuk, telling odd and sometimes incredible stories seems to be a political choice, a way of challenging the official histories that get passed down. She wants her reader to recognize that the history of modern, rational thought that has been so prized since the Enlightenment—the kind of thinking memorialized in The Magic Mountain—is simply one side of the story. Tokarczuk’s work points to an alternative world where humans may not be the only actors and reason is not the end of knowledge, an alternative history that finds its roots in the kinds of stories that go unrecorded.

The Empusium is a masterful novel, with a breadth of possible readings. I won’t spoil the twists and turns of its deft story—“sustaining a consistent plot” is just one of Tokarczuk’s many gifts—but I will say that the novel defied my expectations, turning me into Wojnicz confronted with the de Bles landscape. It’s fitting, then, that The Empusium’s title comes from a creature from Greek mythology: Empusa, a shape-shifting female who feeds on young men. Just when you think you have this novel in your sight, it shimmers into something else entirely.