Dr Heather Lane is a PhD Candidate at the Centre for Palliative Care, St Vincent’s Hospital and Consultant Geriatrician, Eastern Health, Melbourne, Australia.
I have noticed expressions such as ‘fighting’ or ’battling’ dementia increasingly being used, not only in the popular media, but also in the medical literature. These sort of military metaphors have long been used in medicine, particularly when referring to cancer. I work in a palliative care unit as well as in geriatric medicine and doing so has given me some opportunity to reflect on the importance of such terminology. In a recent Age and Ageing article I considered what we have learned about the use of such metaphors from palliative care and oncology and what effect they have on how we manage and support patients with dementia.
Palliative care physicians often experience discomfort when they hear talk of ‘fighting’ or ‘battling’ cancer. When caring for a person who is focused on ‘battling’ their advanced cancer it can be challenging to shift the conversation towards matters such as how they wish to spend their remaining time, whilst recognising that for some individuals this fighting attitude is a means of approaching and coping with their illness. Reports of people dying after ‘a long battle’ with cancer seem to suggest that they have somehow ‘lost’ or ‘failed’ in their ‘fight’, implying some personal control of their disease course.
Whilst some may consider metaphors simply a descriptive figure of speech, Lakoff and Johnson1 suggest metaphors can shape the way we conceptualise our world, highlighting some aspects of a concept over others. For example, talk of ‘fighting’ dementia may focus attention on ‘attacking’ the disease with medical treatments and potentially divert attention from planning for the future and supporting carers.
We need to be mindful of the language we use as it has the potential to impact on how we and our patients conceptualise illness. Whilst military metaphors help in raising the profile of dementia and fundraising for research and care provision, these metaphors are also part of the message the general public, including people with dementia and their carers, hear.
1. Lakoff G, Johnson M. Metaphors we live by. Chicago: University of Chicago Press; 2003.