Diabetes and Metaphors

Here at this site, the URL encourages visitors to 'Battle Diabetes' but how appropriate is the war metaphor among people with this disease?

A metaphor is a rhetorical device designed to mediate the gap between the unfamiliar and the familiar. We use them extensively when talking about human illness, because often, disease pathology is so confusing that an effective metaphor can help us to understand what's really going on.

The war metaphor is very, very common, perhaps because illness is perceived as a direct threat to continued existence and facing such drastic circumstances metaphors involving ballerinas or unicorns just won't fly.

Cancer Metaphors

Nowhere is the war metaphor on greater display than in cancer. You can go back to 1971 and find President Nixon declaring war on cancer ... or you can go all the way back to 1937 and the establishment of the National Cancer Institute and the Washington Post headline, "'Conquer Cancer' Adopted as Battle Cry of Public Health Service."

Combat rhetoric dominated cancer in the 20th century, maybe because a pair of World Wars that collectively claimed the lives of 60 million people impacted the century as well, although good luck finding a century in human history free of warfare.

Still, we're drawn to compare anything similar to this to a fight. Combat. Kill or be killed. Receiving a cancer diagnosis is equivalent to forced conscription into the anti-cancer army, which does not wear the usual fatigues but is instead outfitted in pink, or purple, or blue, or whichever color one's cancer subtype has co-opted for the purposes of fundraising.

The problem is that for many, this metaphor is ill-fitting. In cancer this is especially true since the life of a cancer patient is so far removed from that of a soldier. Fighting requires taking active offensives, but the reality is that the actual fight is between one's health care team and one's disease and the battleground is one's own body, and the patient is largely a passive spectator. Contrary to conspiracy theory sites that say that doing X or Y will cure one's cancer, the truth is there's not much that patient can do except show up-- show up for treatments, for scans, for lab tests, and hope for the best. Sure, they can change their diet, their lifestyle, but these steps do nothing to ameliorate the internal disease; at best they appease the external host.

Diabetes and Metaphors

In type 1 diabetes, the patient can exert a measure of control over the disease through better day-to-day blood sugar management or through more appropriate dietary choices. But does the decision to eat a healthy salad instead of getting sh*t-faced drunk feel like an offensive, like a 'fight' against diabetes? If so, it is a battle victory in a long and protracted war, and the sense is that it's not unlike the impact of grades on one's GPA: Getting an A doesn't help one's GPA nearly as much as getting a D destroys it.

We know that mismanagement of diabetes has several potential consequences, from cardiovascular disease to loss of limbs to death. But patients must do more than simply 'show up' to confront their disease; their active participation is crucial, a true sine qua non if there ever was one in medicine.

In that respect, war metaphors seem more appropriate. The problem is that contrary to human history, not everyone particularly likes war.

The use of rhetorical devices can tell you a lot about a writer or a speaker; they go directly to that person's chosen means of self-expression. They are far more important than we imagine, because, if passively adopted and not chosen, they can define one's experience in terms that the patient personally finds distasteful, repugnant, or simply ill-fitting.

If the goal in type 1 is management, and the goal in type 2 is reversal, then an aggressive metaphor seems better suited to the latter. It's one thing to be told you have a disease and the cure is there but only if you get yer boots on and fight, soldier; quite another to be told you have a disease and there is no ostensible cure but get yer boots on anyway and wage this war until you tumble into your grave from exhaustion. Diabetes burnout is common, and maybe one minor contributor is the insistence that the patient view their disease in these combative terms.

In cancer, there has been a move towards re-framing the metaphor into a journey, which some say helps them cope better with the many highs and lows. It really doesn't matter in what manner each person views their disease; the important thing is that the broader metaphor fits the patient's personality and preference, and not the other way around.

Diseases are as heterogeneous as the individuals afflicted by them; so too should the language be that each person uses to better understand them.