Military metaphors and friendly fire – Pub Med PMC article
Phrases such as “fight against disease, the “clinical armamentarium” and “doctor’s orders” are common in daily language and medical discourse. These military metaphors are not new, but have appeared in medical discourse since the 17th century, well before the advent of Pasteur.
As a result, physicians, patients and medical students have internalized the “medicine is war” construct as a natural way of describing how we deal with illness.
I find such militaristic thinking inappropriate and ill-suited for dealing with chronic pain, yet I see these metaphors repeated everywhere: “Fight the Pain”, “Beat Pain”, “Pain Killers”, even “War against Pain”, urging me to “Fight” so that I could “Win”.
Well, I lost that war a very long time ago.
Now, if I foolishly attempt to “battle” my pain, I will inevitably be defeated. Never underestimate the impervious persistence of chronic pain.
Although some practitioners praise this genre of figurative language for its potential to restore a sense of agency to patients, it is becoming increasingly clear that there are pernicious consequences.
Military metaphors reframe clinical interactions, replacing the doctor–patient relationship with a doctor–disease interaction.
Instead of being empowered, patients are relegated to the status of “battlefield” and become bystanders to their own care. Many feel uncomfortable with being told they have to “fight” in order to survive. Moreover, military metaphors are “inherently masculine, power-based, paternalistic and violent.”
Many sources suggest that patients do not consider the war metaphor to be an appropriate approach to their care … patients conceive of illness in their own ways
When medicine is seen as war, patients may believe that becoming healthy is only a matter of “fighting” hard enough. But, who loses when disease “triumphs”?
Too often, physicians add insult to injury by making patients responsible when treatments fail.
when physicians use metaphors to explain concepts to patients, the latter are “at the mercy of the metaphor” as it “dominates completely the thought of the recipient”
The military metaphor is conceptually weak and often fails to provide a meaningful or useful description of the patient’s reality.
Characterizing disease as the enemy can be fraught with contradictions.
For example, what is the “target” to be “fought against” or “eradicated” in mental illness?
This is the crux of the problem: we cannot separate the “fighter” from what’s being fought against. The pain is internal, generated by our own bodies, and has become an integral part of us; it is part of who we are and who we will become.
More importantly, such language interferes with a reflective approach to decision-making
A recent oncology article underscores the importance of figurative language in medicine: “metaphors don’t merely describe similarities; they create them.” This notion that language shapes behaviour is an old idea in linguistics12 and has important implications in the clinical setting
Considering how pervasive and undermining military metaphors are, it behooves any practitioner interested in forming a healing relationship with a patient to think carefully about the power of words