When discussing death, the words we choose can speak volumes.
In the 1970s and 1980s, Susan Sontag wrote about the metaphors that surround TB, AIDS and cancer, arguing that their use can add to the suffering of patients, stigmatising them and encouraging victim-blaming.
More recently, much has been written, often by people with cancer or other diseases, protesting against warfare metaphors. On a BBC World Service radio programme, writer and presenter Andrew Graystone says: “I had to try and love these cancer cells because I didn’t want to declare a civil war in my own body, I didn’t want to be a battleground.” Rob A Ruff, head of chaplaincy services at a Minnesota hospital, writes: “We rarely leave room in the warfare metaphor for the realization that some battles cannot be won despite everyone’s best effort.”
While some patient groups, charities and government bodies are removing references to fighting and battles from their documents, making way for discussions of journeys and pathways, others are still embracing these metaphors. Graystone writes: “the advertising agency that designed Cancer Research UK’s recent Race for Life campaign wanted to turn their traditional sponsored runners into ‘an army who run, dance and sing all up in cancer’s stupid stupid face with the new line of Cancer We’re Coming To Get You’.”
Professor Elena Semino and colleagues at Lancaster University have been studying how metaphors are used in communication about the end of life. Based in the Department of Linguistics and English Language, they have assembled a set of over 1.5 million words, collected from interviews and from online forums where patients, carers or healthcare professionals meet to talk with their peers. They used the words as a dataset to investigate how and when people in these groups use particular types of metaphors – whether related to sport, violence or any other theme.
This work has shown that, despite the backlash, violence metaphors are still used by people with cancer, in a variety of ways and to describe different situations. One of the most striking things for Semino is how often patients use them, and how often they’re empowering. “They use them to encourage each other,” she says. “‘You’re such a trooper!’, ‘keep up the fight!’”
One of the areas in which patients use these metaphors is when they’re talking about going into hospital or preparing to meet health professionals, especially consultants. Patients also describe the effects of the disease with violence metaphors (cancer attacking, invading or strangling them) as well as their response to it (being a fighter, sharpening weapons). They also use them to describe their treatment, their relationship with family and friends and even their own mental state (“I am destroying myself with my mind right now, torturing myself”).
“Metaphors are resources and tools for making sense of our experiences and expressing our emotions and our feelings,” says Semino. “Different metaphors are more or less appropriate for different people at different times – or even for the same person at different times.”
Semino and colleagues are now working on a ‘metaphor menu’ to help people with cancer talk about their disease, and are looking for feedback on the project.
“Hopefully by sharing our data we can help doctors know what to listen out for and react in a slightly more nuanced way – if something seems to be helpful, accept it or even use it.”