Two years ago, she committed suicide.

She was a close family friend diagnosed with primary central nervous system (CNS) lymphoma that affected multiple regions in her brain. After months of battling the disease with the best weapons in the hospital’s arsenal and bombarding the tumor cells with high doses of radiation, doctors seemed hopeful as she entered a period of remission. Remission, unfortunately, did not last long as a relapse spread to her right eye. With a prognosis with months to live, she was losing the battle. Doctors claimed there was little that could be done as curative approaches to her illness have failed.

Shortly after, we were notified of her loss; she died by suicide. 

At her eulogy, one line in particular stuck with me: “She was at war. She was in a battle with cancer and a battle with mind.” To this day, I find this statement so compelling. On one hand, I couldn’t help but be drawn to the militarization of medicine: the language of warfare so naturally interwoven with the language of healing. But on the other hand, this statement ingeniously introduces the idea that the cancer (her physical health) and her mental health are not mutually exclusive. They are two battles encompassed within a much larger war: the “war of her life” and a “war for survival.” As I reflect upon that day and the events that transpired, I can’t help but wonder whether the ways in which the doctors presented their prognosis influenced her ways of thinking about her own quality of life. Did she, on some level, feel as though her body “failed” her and her family when the cancer relapsed? By using language of warfare in her treatment, doctors ascribe notions of victory and defeat, which when doing so runs the risk of devaluing human life. As curative approaches no longer worked, could the doctor’s defeatist language have devalued her life when she was told she was losing her battle against cancer? While thinking about disease as an “enemy” contextualizes illness and provides accessible language during complex times, Lorenzo Servitje, assistant professor of literature and medicine at Lehigh University, communicates how militarized metaphors have disparaging implications for physician-patient communication and skews public understanding of disease. “By only having [the war metaphor], especially with doctors having this as the only way to describe it, it’s very delimiting,” Servitje explains, “It doesn’t allow for other options. Palliative care doesn’t make sense under the logic of medicine and war, does it? I mean, it’s surrender.” Thus, did she really have a choice to “continue living” within this war metaphor? 

Similar ideas continue to permeate my mind as I go through my own journey of recovery with depression. While we often conflate military metaphors with physical health and illnesses, we forget about the ways in which we describe the journeys taken by people undergoing mental health crises. In the same vain, mental illnesses are also described to be sites of war and violence. When I am told to “overcome” my past traumas and to “conquer” anxiety before it “consumes” me, I am confronted with violent language that brings into question my strength, my willingness to live, and survival. It presumes that if I succumb to emotion, I am weak: a continuation of the victory and defeat dichotomy. A parallel to physically-ill patients, such verbiage positions me into a role of “the fighter.” Like physical illnesses, the language choices used here to describe mental health and psychological illnesses have powerful effects on how we, as a society, conceptualize mental health and the people living with mental health conditions. 

American writer (and “cancer survivor”) Susan Sontag’s work, in particular, examines the implications of adopting metaphors of illness culturally and socially into modern Eurocentric medicine. Focusing on human immunodeficiency viruses, she explores the process of stigmatization. As illness metaphors are institutionalized, there is a shift from the patient room setting to the social milieu (i.e. everyday language). When this happens, “military metaphors overmobilize, they overdescribe, and they powerfully contribute to the excommunicating and stigmatizing of the ill” (1990, 182). Due to these ongoing misunderstandings of illness, there is considerable stigma that surrounds mentally ill patients in comparison to other illnesses. Violence of the illness is compounded by violence exerted from society. Patients with psychological disorders are thus significantly devalued.

We, as a society, have been complicit in weaponizing military metaphors against ill persons. Complicity in this framework involves the usage of adjectival and pejoratives that involve illness metaphors in everyday language. Using leprosy as an example, Sontag explains the process by which illness metaphors become adjectival:

“First the subjects of deepest dread (corruption, decay, pollution anomie, weakness) are identified with the disease. The disease itself becomes a metaphor. Then in the name of the disease the horror is imposed on other things. The disease becomes adjectival. Something is said to be disease-like, meaning that it is disgusting or ugly. In French, a mouldering stone façade is still lepreuse” (1990, 60)

While lepreuse is not as commonly utilized in our everyday speech, many mental health terms have permeated into our everyday language. One study, from 2007, identified that schizophrenia was more likely to be “metaphorized” than cancer in press in both the United Kingdom and the United States (2007). Metaphorical usage was not limited to a particular topic, but it was most apparent when talking about eccentric new fashion: “...red hair, freckly skin and green eyes. I also have a bit of a schizophrenic style’ in the Daily Mail (03 February 2005). A celebrity described Armani as being ‘... versatile and flexible enough to adjust to my sometimes schizophrenic personality.’ (The Times, 22 January 2005).” 

Our cultural vocabulary is quite dramatic in this way. By utilizing mental health terminology in non-literal speech, we utilize mental health terminology as adjectivals in trivializing and pejorative ways. The term “crazy” for example is one of the most culturally and socially accepted terms in today’s society. Historically a derogatory term used to regard mentally-ill patients as an oddity or criminal, crazy has been well integrated into the most basic of words in our colloquial lexicon. Crazy, when used in conversation, also mirrors the overall disposition of America on mental illness: comical and trivial. 



Likewise, Obsessive compulsive disorder (OCD) itself has also become adjectival. To this day, I hear my peers using the terms “OCD” and “perfectionist” interchangeably—almost to a point of great hubris. Rather than the socially accepted culture of OCD being associated to being hygienic or neatness, OCD, in reality, is a mental health disorder characterized by obsessions that lead to compulsive behaviors. Such behaviors result in patients “living a life feeling apart, abnormal even.” This cultural demeaning of the mental condition (in speech) trivializes the experiences of actual patients that live with OCD, who by no means receive the same recognition as students who boast about their “perfectionist” mindsets. Examples like these emphasize just how much mental health metaphors and their adjectivals contribute to the overall misunderstanding and stigmatization of mental health. What is the role of social media in complicitly perpetuating the trivialization of mental health and misinformation? What are the ways in which we can change the narratives surrounding modern medicine to more accurately depict the severity of mental and physical illnesses? What are the ways in which we can accurately contextualize such illnesses? Are metaphors really the best way to describe illness? 

In her work, Sontag argued that the most accurate way to portray illness is to strip it of its metaphors. While this idea may work for mental health illnesses where the best way for patients to talk about their embodied experiences is through explanation of thoughts and feelings, I wonder about the practicality such a proposition would have for patients dealing with physical illnesses. Physical illness encompasses sociocultural and personal ideals of “pain” and pain tolerance which is challenging to contextualize for physician-patient interactions. I hope that by the end of this semester, I may be able to better understand the nuances of Sontag’s novel proposal. 

 

Works Cited

Chopra, Arun K, and Gillian A Doody. “Schizophrenia, an Illness and a Metaphor: Analysis of the Use of the Term 'Schizophrenia' in the UK National Newspapers.” Journal of the Royal Society of Medicine, The Royal Society of Medicine, Sept. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC1963407/. 

“Lorenzo Servitje: A War (of Words) on Disease.” Lehigh University, Lehigh News, 12 Nov. 2018, www2.lehigh.edu/news/lorenzo-servitje-a-war-of-words-on-disease.

Sontag, Susan. Illness as Metaphor, AIDS and Its Metaphors. Farrar, Straus and Giroux, 1990.