- Stress effects on physical structures provide a useful and generally harmless metaphor for human stress.
- But metaphoric meanings associated with cancer and HIV/AIDS have had a deleterious impact on patients.
- Viewing hypertension as a physical manifestation of psychological "pressure" may undermine its treatment.
- Dropping the language of "war" to describe how we cope with disease may be advisable.
A metaphor is a figure of speech in which a word or phrase refers to something for which it is not literally applicable—like describing someone as having a “sunny” disposition or being a “wet blanket.”
A metaphor can capture a concept in a vivid and memorable manner, attracting attention and interest. In research, it can organize ideas about the features and dimensions of a concept, and generate hypotheses about how it functions.
On the other hand, metaphors can imbue concepts with meanings that are inaccurate and harmful. They can reflect and promote unwarranted associations with unfortunate connotations that color the concepts and the individuals to whom they attach.
“Stress” by Any Other Name
For better and for worse, metaphors are linked to many concepts involving health, disease, and their psychological ramifications.
For example, the meaning of “stress” in psychology has roots in its use in physical sciences in the 1800s. Derived from a Latin word for tightness or compression, "stress" came to refer to changes in a structure like a bridge or building, created when an external force, or “load,” impinges on it, causing damage referred to as “strain.”
Based on this usage, the term “stress” commended itself for use by Hans Selye, who popularized the concept of stress among psychologists. It also has shaped how scientists and laypersons alike think about stress. This has had heuristic value, generating ideas, hypotheses, and research, even if it is ultimately an imperfect model for human stress.
The Big “C”
By contrast, metaphoric meanings of “cancer” arguably have had a negative impact. “Cancer” has origins in the Greek word for crab, which is attributed to the perceived similarity between the crustacean and the appearance of external tumors surrounded by leg-like blood vessels. Figuratively, the word “cancer” implies invasiveness, destructiveness, and decay.
Some of “cancer’s” negative connotations may have rubbed off from its namesake. It moves stealthily through the body like a crab through sand, and causes pain as can the crab’s pincers.
Susan Sontag compared the connotations of “cancer” to those of “tuberculosis,” to which threatening meanings were also attached until it was found to reflect a bacterial infection. Sontag suggested that this discovery demystified tuberculosis, removing much of its threat value, and negative connotations along with it.
Sontag expressed concern about the negative impact of cancer’s metaphoric meanings on cancer patients. She argued that it can lead to fear, blame, and avoidance, exacerbating the emotional impact of a cancer diagnosis and dampening hope.
Favorable incidence and survival trends since the 1990s may have reduced cancer stigma. In its place, individuals with HIV/AIDS have been a target of avoidance and blame. Sontag and others have also discussed the role of metaphoric thinking about HIV/AIDS in this development.
Hearts and Minds
Heart disease offers an interesting comparison. “Heart” has a plethora of figurative meanings, including passion, compassion, and courage. But when it comes to heart disease, that the literal heart is a pump seems to have promoted the use of mechanical metaphors, as in “ticker trouble.” And with many of its problems stemming from arterial blockages, there is the phrase and image of “clogged pipes.”
Heart patients are at times stigmatized by their condition. They can be blamed for it when it is attributed to dietary overindulgence or an angry temperament—but not to the degree that patients were affected decades ago when the word “cancer” was sometimes left unspoken and they might not even be informed of their diagnosis, nor in the way in which individuals with HIV/AIDS have been stigmatized.
However, metaphors of the heart may have deleterious consequences in ways unrelated to stigma. The notion of “stress” as a physical force, combined with an image of the heart as a pump, apparently reinforces the view that the figurative pressure of psychological stress is responsible for raising the actual pressure with which blood circulates in individuals with essential hypertension.
Certainly, psychological stress can temporarily raise blood pressure, and may have some involvement in the development of sustained high blood pressure. But over-emphasis on the role of stress may lead hypertensives to neglect the importance of diet or to take their medication only when they feel they have been under stress, rather than daily, as prescribed.
To Cope with Disease is to Cope with its Metaphors
The word “cope” has origins in an old French word meaning “to strike a blow.” It is now closely linked to the stress concept, referring to ways people deal with stress and its effects. This by itself may seem both fitting and harmless.
However, Sontag and others have expressed concern about a prescriptive stereotype in which cancer patients are expected to take an aggressive stance against their condition. Labels such as “fighting spirit” unnecessarily invoke the imagery of military combat, whereas the concepts of approach versus avoidance, engaged coping, and self-efficacy would lend themselves equally well as descriptors and are associated with more convincing theory and methodology.
Disease-related metaphors may just be a just a drop in the bucket when one considers that medical patients can be mistreated for many other reasons, including racial/ethnic, and gender- and age-related stereotypes and prejudice. And even when the disease is the focus, rather than social demographic categories, factors other than metaphor can be at play. For example, a former editor of the New England Journal of Medicine raised the concern that research on the health effects of positive attitudes and emotions may lead patients to engage in self-blame when their condition worsens.
A War of Words about Words of War
Recently, objections have been raised against the metaphoric "war" to eradicate the coronavirus, following its usage regarding other major health threats and social problems, as in Nixon's "War on Cancer" declared a half-century ago. Concerns include the idea that this language raises fears, promotes authoritarianism, and can have a stigmatizing effect on those affected.
It is incumbent on the researcher, healthcare professional, news outlets, and public figures to be careful not to confuse metaphors with literal meanings, as well as to be aware of other sources of inappropriate and potentially counterproductive language and behavior in their interactions with and characterizations of patients. For the lay public, it is a matter to be addressed along with other forms of health illiteracy.
Bottom line: Sometimes a metaphor is only a metaphor. Literally.
Copyright 2023 Richard J. Contrada
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