The War Against Dementia

Are We Battle Weary Yet?

Heather Patricia Lane; SueAnne McLachlan; Jennifer Philip

Disclosures

Age Ageing. 2013;42(3):281-283. 

In This Article

Negative Aspects of Military Metaphors

A metaphor in itself is not harmful. However, military metaphors can become pervasive, with a 'fighting attitude' expected. For some aggressive metaphors are unhelpful, even distressing.[22] The pressure to maintain a fighting attitude, rather than discuss the real emotions they are experiencing, may become a burden, leaving the person isolated from family and friends.[27]

Military metaphors have been criticised for focusing attention on disease as 'the enemy', while the patient as an individual with their own physical, psychological and social needs is forgotten.[22,23] Such metaphors have also been criticised for perpetuating hierarchy in the doctor–patient relationship, with Fuks writing: 'the battle cannot be won without following doctor's orders'.[23] In a military context, the defiance of orders is deemed 'insubordinate'. This may limit a patient's ability to exercise judgement or question treatment options.

Military metaphors may inhibit conversations about alternative treatment options or prognosis. The focus on 'battling' encourages 'taking action', and discussion is centred on treatment. The desire to 'do everything possible' could encourage doctors and patients to adopt burdensome therapies which hold a very small chance of benefit.[22] Other conversations, such as planning for the future, may be impeded. This may result in people with a limited prognosis, having insufficient time to accomplish other important tasks of life.

When military metaphors predominate, the outcome of an illness becomes one of victory or defeat. If someone does not 'win their battle' with illness, have they failed? The implication is that perhaps a person who is dying did not fight hard enough. This could leave those with progressive disease, feeling a sense of inadequacy or self-blame. Some people will favour a 'fighting' approach, but perhaps physicians can be complicit in the ongoing use of military metaphors, when promoting alternative metaphors or encouraging other ways of viewing the situation might be useful.

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