Military Metaphors and Disease: St. Michael’s Army

The language we use about disease is loaded: we “fight” illnesses, and if we “beat” them we are “survivors”. In fact, military metaphors are so entrenched in our discussions of disease that you might not notice them until they’re pointed out, and it can be challenging to come up with alternative phrasing. While there is some truth to the idea that a pathogen is an invading force, it is not especially accurate. If simply entering the body is an invasion, the same could be said of many other biological processes, like conception (SPERM WAR!), but we generally restrict our use of martial language to disease.

Language is a powerful tool, but at times we lack the words to describe a situation outright. That’s where metaphor comes in. Metaphors explain the world around us, from love to landscapes, using comparison. These metaphoric descriptions have a profound impact on our understanding of reality and help shape our values3, creating a feedback loop where metaphor supports belief, and belief reinforces metaphor. Disease is no exception, and framing illness in combat terms shapes our relationship to it as a society.

History of the metaphor

Illness and war are deeply interconnected (for more on this topic, see my posts from March), and a metaphoric fusion between soldiers and the sick took place centuries ago. In fact, the patron saint of military forces, St. Michael the Archangel, revered for casting Satan out of heaven, is also the patron of the ill and the dying6. Despite the longstanding association between disease and combat, military metaphors for disease did not become popular until the 19th century. Until then, disease was discussed primarily in agrarian terms: disease was thought of as a seed growing in the soil of the body4.

military metaphors
He’s got your back.

Two events contributed to the establishment of a martial context for disease in the 1800s: the Civil War and germ theory (the idea that disease is caused by microorganisms)4. The brutality of the Civil War linked war and disease in the imagination of the American populus4, and germ theory both supported and was supported by the metaphor. A militaristic understanding of disease cast the newly discovered germs as enemy combatants and gave the medical community purpose, while germ theory afforded the metaphor a biological foundation. Martial language had taken root by the 1880s4, and was pervasive in medical literature by the beginning of the 20th century3. Its popularity has continued to increase3, and it is ubiquitous in modern discussions of disease.

The uses and abuses of metaphor

Military metaphors impart drama to their subject, and grant it greater importance. Placing disease in a martial framework encourages action, which can be a boon for the ill. Combat language galvanizes the public5, aids fundraising efforts4, and grants a sense of purpose and promotes psychic peace to those involved5. However, war is an ethical quagmire, and results in the abandonment of normal morality. Associating disease with conflict can justify the use of extreme political action and containment measures, such as home quarantine, immigration restrictions, and daily personal health assessments, and reduces public resistance to them3. Presenting medicine as war can grant a dire situation an appropriate sense of urgency (those containment measures might be necessary to curtail disease spread), but it can also cause collateral damage by negatively effecting the general population, medical professionals, and the sick.

A martial understanding of illness can cast medical professionals as the main actors in the conflict and place patients in a passive role, more akin to the battlefield rather than soldiers. This in turn glorifies medical action and intervention, and can encourage overly aggressive treatment, overprescription, and the intense working conditions that are common in hospitals, such as long hours and rigid hierarchies2. Although military metaphors can empower the ill, they can also lead to social exclusion, which causes a fear of diagnosis5. Combat language can also incorporate and encourage stereotypes, employing biases in advertising campaigns and contributing to social segregation4.

Any other name

Can we relate to disease without metaphor? In her seminal work, Illness as Metaphor, Susan Sontag advocates for the abandonment of metaphor in our understanding of disease, arguing that the negative impacts outweigh the positive7. There is modern precedent for a non-metaphoric view of disease; although military metaphors are pervasive, they are not used uniformly. Some diseases, such as heart disease, remain free of metaphor, despite being quite common8. But stripping illness of metaphor doesn’t seem to be a trend. In fact, metaphors for disease continue to evolve and incorporate modern technologies and concerns, like Pac-Man and pollution8.

The link between disease and death gives illness immense social importance, and may make it impossible to sever sickness from metaphor1. Martial language offers a suite of images for disease that are widely appealing and have become deeply embedded in our imagination of illness. Altering this viewpoint would require a radical shift in perspective, which seems unlikely in the near future. For now we are all soldiers in St. Michael’s army.

References

1. Brandt, AM. 1988. AIDS and metaphor: toward the social meaning of epidemic disease. Social Research, 55(3):413-432.

2. Hodgkin, P. 1985. Medicine is war: and other medical metaphors. British Medical Journal, 291(6511):1820-1821.

3. Ibrahim, Y. 2007. SARS and the rhetoric of war in Singapore. Crossroads: An Interdisciplinary Journal of Southeast Asian Studies, 18(2):90-119.

4. Keiger, D. Why metaphors matter. Johns Hopkins Magazine. February 1998. Web. 24 May 2014. http://pages.jh.edu/~jhumag/0298web/metaphor.html

5. Ross, JW. 1989. The militarization of disease: do we really want a war on AIDS? Soundings: An Interdisciplinary Journal, 72(1):39-58.

6. “St. Michael the Archangel”. Catholic Online. Web. 2 June 2014. http://www.catholic.org/saints/saint.php?saint_id=308

7. Sontag, S. Illness as Metaphor. New York: Vintage Books, 1978. Print.

8. Weiss, M. 1997. Signifying the pandemics: metaphors of AIDS, cancer, and heart disease. Medical Anthropology Quarterly, 11(4):456-476.

Image source: Guido Reni’s Michael, http://en.wikipedia.org/wiki/File:Guido_Reni_031.jpg

Tuberculosis: Sick Chic

Aliases: tuberculosis, TB, consumption

At first glance, tuberculosis (TB) seems an odd choice for May’s theme, language, but in fact, the disease has a distinguished literary lineage. As early as the mid-1700s, TB gained a reputation as a romantic disease. Socially the illness was understood as a disease of passion, an idea that the Romantics (Byron, Shelley, and their compatriots) enthusiastically built upon, coopting TB into a sort of nineteenth century emo cliché: a disease afflicting the sensitive and soulful. This linked TB and creativity, contributing to the literary concept of “romantic agony”, and providing an early example of the tortured artist stereotype that (tragically) still persists.

The portrayal of TB as a relatively painless death that elevated the dying, connecting them to the sublime and granting them an aura of grace became widespread and pervaded the literature of the 1800s. Writers from Dickens to Brontë used TB’s spiritual significance to craft beatific ends for their characters, especially the young, and poignant demise by TB remained a literary mainstay for over a century.

The fictional accounts of TB reflected contemporary fashion. In the 1800s, it was in vogue to appear tubercular, meaning thin, pale and delicate. The disease was associated with gentility and vulnerability, and was considered particularly attractive in women. The impact of this inversion of illness as beauty continues to be felt in modern culture and is evidenced in trends like the “heroin chic” look of the 1990s and the societal fixation with female thinness2.

tuberculosis
How emo can you go?

Cause: TB is caused by Mycobacterium tuberculosis, a bacteria that generally infects the lungs, but can affect all parts of the body. The bacteria are transmitted when a naïve (not previously exposed) person breathes in the bacteria released by an infected person when s/he coughs, sneezes, speaks, or sings. Although TB is quite infectious, it is possible to have close contact with someone who is sick without contracting the disease; the CDC states that TB is not transmitted by shaking hands, kissing, sharing food, drink, or toothbrushes (WHY WOULD YOU SHARE A TOOTHBRUSH? IS THERE NO DECENCY LEFT IN THE WORLD?). If exposed, you’re more likely to develop TB if you have an impaired immune system1.

Consequence: There are two types of TB: latent infection and disease. Most instances of TB infection result in latent TB infection, which is asymptomatic (has no symptoms) and noninfectious (it can’t be transmitted). However, if the infected person’s immune systems stops suppressing the growth of the offending bacteria, the infection may become active disease (where the bacteria multiply unchecked). TB disease results in both general and respiratory symptoms, including chest pain, a cough that lasts 3 or more weeks, coughing up blood, weight loss, chills, fever, night sweats, weakness, and fatigue1.

Cure: There are two tests used to determine TB infection status: a skin test and a blood test. If TB is detected, further tests are done to determine if it is latent infection or active disease. Latent TB infections may be treated, if they are deemed at high risk of progressing into an active infection. Treatment for both latent infection and TB disease depend on a cocktail of antimycobacterial drugs; treatment of latent TB is usually short, while TB disease requires a 6-9 month course of medication1.

Finally, a PSA: if you are interested in the topics covered in this post and have not read Susan Sontag’s book, Illness as Metaphor, get out there and get a copy. It is fantastic.

References

1. Division of Tuberculosis Elimination. “Tuberculosis (TB)”. Centers for Disease Control and Prevention. 13 March 2012. Web. 14 May 2014. http://www.cdc.gov/tb/topic/basics/default.htm

2. Sontag, S. Illness as Metaphor. New York: Vintage Books, 1978. Print.

Image source: Portrait of Lord Byron by Thomas Phillips, http://en.wikipedia.org/wiki/Lord_Byron