MED Magazine - Issue 15 - January 2004

What we talk about when we talk about illness
by Diane Nicholls

Next in the series of articles on metaphor


A dictionary is far more than just a list of words in the language with their definitions and details of their accompanying grammatical behaviour. It is a vast repository of information about the culture and attitudes in the countries where that language is spoken. It is a snapshot of the way we see things and feel about things, of the images and metaphors which we use, consciously or unconsciously, when we talk about any subject in our lives. Examining and understanding, en masse, the body of vocabulary and phrases which relates to any given subject is a useful way to discover the ideas and attitudes embedded in the words we use. It is also an interesting and efficient way to expand and enrich one's vocabulary.

Unlike idioms, which generally allow very little freedom for variation or invention, metaphors can be adapted, built upon and played with, so long as the central idea remains intact. Once we have grasped the core ideas relating to a topic in English, we can start to use these to create our own metaphors using synonyms to make our language more fluent, inventive, poetic, or even amusing. These novel uses may even catch on and find their way into future editions of the dictionary.

This month we look at illness. What do we talk about when we talk about illness?

Illness is down and health is up

The first thing we notice when we look at the vocabulary of illness is that the ill exist metaphorically on a lower plane than the healthy. When we become ill we fall ill, come or go down with something, and are laid low, or even prostrated as a result. We collapse or keel over and the illness is said to strike or cut us down. We describe people who contract an illness as going down/falling/dropping like flies or ninepins. Even when we succumb to an illness we are, etymologically speaking, lying down underneath it, as this word comes via Old French from the Latin verb succumbere, which combines 'sub-', meaning 'under', and 'cumbere', meaning 'to lie'. When we are afflicted or have an affliction, we are metaphorically 'thrown down' by an illness as afflict comes from the Latin verb affligere 'to throw down'. As a result of our illness, we feel low, run down or under the weather. The patient whose condition is getting worse is said to be sinking fast.

The 'down' metaphor for illness is not surprising, of course, since we generally do end up being more or less horizontal when ill. The well person, on the other hand, is metaphorically 'up'. When we recover from an illness, we bounce back and, instead of being on our last legs, we get back on our feet. We throw the illness off like a duvet, or, like a defeated enemy.

This brings us to the next illness metaphor.

Illness is an enemy attacker

When we talk about illnesses, we use the same vocabulary we use when talking about attackers. We talk about a heart attack or an attack of flu, for example. The first meaning of the verb fight off in the dictionary is 'to stop someone who is trying to attack you'. The definition given for the second, more figurative, meaning states: 'if your body fights off an illness, it prevents the illness from making you ill'. In this metaphor, illness is an attacker and the body is the attacked.

The thousands of example sentences in the dictionary provide clear evidence of how deeply entrenched in our language this metaphor is. We talk about illness, infection and germs as we would talk about an invading army: 'The infected cells can invade the healthy tissue'; 'An invasion of cancer cells'; 'Invasive bladder cancer'. The body is vulnerable to such attacks: 'The virus attacks the body's red blood cells'; 'The wound is vulnerable to infection' and the body has to fight to defend itself from illness: 'New drugs that work by strengthening the body's own defences', and must put up resistance, like an occupied country: 'Vitamin A helps build resistance to infection'; 'Antibodies help us resist infection'.

Doctors and nurses are described in the same terms we use to describe soldiers fighting a war: 'Surgeons battled to save the man's life'; 'These people are on the front line of health care'. Medicines are spoken of as if they are weapons or ammunition. Magic bullets, for example, which are defined as, 'a medicine designed to cure an illness quickly and completely'.

Illness is war

Once the body's natural lines of defence are breached, the illness that follows is portrayed as a battle between the patient him/herself and the illness. We talk about an outbreak of food poisoning as we talk about the outbreak of war, or about a flare-up of an illness as we do a flare-up of hostilities. The 'fight' metaphor is also seen in the use of bout (e.g. a bout of flu) which is of uncertain origin but which we also use to describe a boxing or wrestling match. The noun fit, as in 'a violent coughing fit' is believed to come from the Old English word fitt, meaning 'conflict'.

Now the whole patient is doing battle, engaged in a struggle, or fighting: 'She has lost her battle against breast cancer'; 'Her struggle with the disease lasted ten years'; 'She died yesterday after a long fight against cancer'. The person with a serious illness has to fight for their life. And those who win the battle are said to have beaten it, fought it off, or conquered it: 'Women who have beaten breast cancer'. When medical tests prove that the patient has returned to health, they are given the all clear, which calls to mind the end of an air raid in a war. The deeply ingrained metaphor of the ill person fighting a battle which can be won or lost is one of the features of the way we talk about illness challenged by Susan Sontag in her book Illness as Metaphor and AIDS and Its Metaphors.

The ill person is a victim

Another metaphor of illness, which depicts the ill person as a victim, has also been challenged by people who believe that such metaphors in our language can create a negative mental attitude to illness which can hinder recovery. The dictionary gives a number of examples of this metaphor in use: 'The meningitis outbreak claimed a third victim today'; 'She fell victim to a rare disease'.

Illness is an unnatural state

There is an underlying image of illness as unnatural; something that takes us out of our natural state. It could be argued that illness is in fact a very natural phenomenon since it is the body's natural response to bacteria, infection and other factors in daily life. When you are ill, people say you are a shadow/ghost of your former self, or you are not yourself: 'Take a rest - you're not quite yourself today'. You might describe yourself as out of sorts. When you have recovered from an illness, you are described as being your old self: 'Once you're better you'll soon be back to your old self again'.

Illness is monochrome; Health is colourful

There is, naturally, a strong link between the notions of colour and of health and it is not surprising to find this reflected in the language we use to describe the healthy and the sick. As well as being described in terms of their insipid colour — the spectrum ranges from white, to ashen, grey, and green — which often tends to be more or less literal, ill people are said to be off-colour, washed out, discoloured. If their situation gets worse, they are said to be fading, or to fade away. Healthy people, on the other hand, are described as blooming, glowing, in the pink.

The language we use to talk about illness is a logical expression of the way we feel about and experience illness. That illness is described as 'down' is not surprising when we consider that 'down' metaphors are used for many other things in our lives which are universally considered to be bad, like poverty (down and out), unhappiness (down in the dumps), and failure (go down like a lead balloon). All of these metaphors can be seen as subsets of an overarching 'bad is down' metaphor which exists in English and many other languages. The remaining metaphors of illness discussed this month reflect the way that we generally feel about illness — that it is an attack, then a struggle, and that it changes us from our usual selves into pallid victims.

The metaphors and expressions listed above are all taken from the Macmillan English Dictionary and are not intended as a comprehensive list. We would be pleased to hear from any reader who can suggest any other illness metaphors in English which are not covered here.

Further reading

The Language of Metaphors, Andrew Goatly (Routledge, 1997)
Metaphors We Live By, G. Lakoff and M. Johnson (University of Chicago Press, 1980)
Illness as Metaphor and AIDS and Its Metaphors, Susan Sontag (Anchor, 1990)

Next in the series

Next month, we will take a look at what we talk about when we talk about failure and success.

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