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.
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.
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