DISEASE IS WAR - the narrative of illness


At a Duane Reade Pharmacy in Brooklyn. Taken on 4/8/19


is one of the most established conceptual metaphors out there.

A conceptual metaphor is basically the language of the mind, a bridge we build between the vast, incommensurable universe of our thoughts and the more limited scope of our words. We take a hard-to-grasp/describe concept (DISEASE) and liken it to another that is rooted both in our physical experience, and in our tangible and common understanding of the world (WAR).

Stemming from this conceptual metaphor, then, “real language” arises and shows up in our everyday discourse. This is the case for the language we use to talk about illness and disease and how it refers to all things WAR. But this is not a new or modern approach: Avicenna (980-1037), the father of early modern medicine, described the constant plagues and infections of his time as INVASIONS, and throughout history, medical discourse and warfare have gone hand in hand.

So what does this look like?

Consider the first image on this post, from an advertisement in LIFE Magazine from 1944, as World War II was still raging all over Europe. The ad talks about the literal “thunderous battles of this war”, but then switches the topic WITHOUT switching the language and refers to penicillin as “the most potent weapon ever developed against many of the deadliest infections known to man”. A year later, in the June 1955 issue, the magazine features a piece on “The war on virus diseases.”

The American Cancer Society, already in 1928, created their logo as a sword with intertwined serpents (symbolizing medicine) at the handle, and branded their medical staff and volunteers as CRUSADERS against cancer. Even today, their homepage encourages visitors to “see how we’re attacking cancer from every angle.”

In 2014, CNN took language one step further and called the Ebola virus “the ISIS of infectious agents”, asking whether it needed “to be treated with [a terror approach to] strategy , likening the disease to terrorism, the viruses to its agents and the prevention measures to war strategy. In the clip, one of the contributors talks about “a national security issue” and recommends the US “attack the problem overseas” and “protects the American public.”

An in the arts, the Museum of the City of New York is currently hosting an exhibition called Germ City: Microbes and the Metropolis, which “explores the complex story of New York’s long battle against infectious disease—a fight involving government, urban planners, medical professionals, businesses, and activists.” This exhibit is part of a larger, international, multimodal and multi-city project called Contagious Cities, which takes conversations on global preparedness for epidemics to the local level.

Language, then, is plagued by the conceptual metaphor is DISEASE IS WAR and we find examples in everyday expressions: a disease can destroy the immune system; our body must build defenses against illness; humans are at war with disease; how in autoimmune diseases the body turns against itself…

This narrative of war, however, is a double-edged sword and like all things violence, can have devastating effects on targets.

Research shows that two thirds of the conversations that oncologists have with patients actively use metaphors. And quantitative corpus research finds that the conceptual metaphor of ILLNESS IS WAR is one of the most used, also by healthcare professionals, caretakers, and even family members of the patients. But these linguistic metaphors of war, when applied to people with cancer, pit the person against NOT ONLY the illness, but their own bodies as well. Being construed in terms of winners and losers can make a person feel like, in addition to dealing with the illness, they also have to be triumphant heroes or losing failures. In a war, there must necessarily be both, and people whose lives have been changed by cancer may not be in a mental or emotional position to endure the expectations that warriors, battles, and fighting inevitably carry, especially when the war wages inside the person her/himself and the battlefield is not a fair one.

Cancer survivors are hailed as heroes… but what about those who do not survive the illness? Must we think of them as losers? As the defeated? And those who live with cancer, must they always be in a fighting spirit? Ready to battle (beautifully or not, as the image on the margin suggests) at all costs against the unseen enemy within? How could they not feel guilty and disempowered on the hard days, responsible for not improving or not trying hard enough?

The emotional state and well-being of the person are paramount when creating and building the medical and care-taking narrative for patients. There is no perfect metaphor, or only one way to figuratively talk about cancer and other illnesses, but keeping in mind that there are other metaphors available can enormously aid in the crafting of social and public discourse around it.

Considering the ILLNESS AS A JOURNEY, or the ILLNESS AS AN UNWANTED GUEST AT HOME are other possible options. The LIFE IS A JOURNEY conceptual metaphor is already a pervasive one in our cultural mindset (we travel through the road of life, go on adventures, follow a path, journey with companions…) and has an easy transfer to the discourse surrounding illness. Moreover, a journey always offers the choice of sharing the experience, of being open to new paths, or of being in the company of those chosen to come along. And it gives the person agency in how they choose to travel.

Ultimately, our discourse should be crafted from giving the patients their own voice and allowing them to choose how they want to frame their experience, and we should never choose for them. Whether we fight, endure a terrible roommate, or journey down a path and explore options is, after all, a choice.

Social narratives on illness must consider all options and be aware of what the language of each conveys.

The cognitive and corpus linguist Elena Semino has written and researched extensively on this topic: you can find more on her work from her Twitter account.

Mariam Ghani is the artist-in-residence for the Contagious Cities Project. Her film Dis-ease, which explores the linguistic and visual metaphors related to illness over time, has been recently presented at CUNY’s Graduate Center in New York City.

Reyes Llopis-García