Some things I have learnt while using corpus methods to study health communication

On a dark winter afternoon in December 2011 (before CASS existed), an email from the Economic and Social Research Council informed me that they would fund the project ‘Metaphor in End of Life Care’, which I had put forward with several colleagues from Lancaster. The project involved a combination of manual analysis and corpus methods to study the metaphors used in a 1.5-million-word corpus consisting of interviews and online forum posts by people with advanced cancer, family carers and healthcare professionals. Even in the elation following that announcement, I could not remotely foresee how important that project would become in my (professional) life, and how much interest it would attract from healthcare professionals, charities, the media and the general public. That interest, I now realise, is due to two main factors. First, the topic of communication about cancer and end-of-life is important and intrinsically interesting. In particular, most people have strong feelings about the metaphors used for cancer, such as the ubiquitous but much hated ‘battle against cancer’ that is ‘lost’ by people who die of the disease. The second factor in the success of the project is even simpler: corpus methods actually make sense to people.

At the beginning of the project, I expected that it would be difficult to get audiences outside (corpus) linguistics to understand and appreciate our methods. I was wrong. I have consistently found that people generally, and healthcare professionals in particular, quickly become interested in corpus methods and appreciative of what can be learnt from them. After all, healthcare professionals are used to large-scale quantitative studies and statistical analyses, and therefore do not find corpus-based research at all alien. The dissemination of our findings has therefore been much better received than I would ever have imagined.

A paper we published in BMJ Supportive and Palliative Care has been the most read in that journal from February 2015 to January 2016. In that paper we provide evidence from our patient data of the potential negative, disempowering effects of Violence metaphors (e.g. when a patient says: ‘I feel such a failure for not winning this battle’). However, we also show that those same metaphors are motivating and empowering for some people, who proudly embrace the identity of ‘fighters’ (e.g. when another patient says: ‘cancer and the fighting of it is something to be proud of’). Our paper shows a similar pattern for Journey metaphors, which are used in preference to Violence metaphors in policy documents and guidelines on cancer and end-of-life in the UK’s National Health System (e.g. ‘my cancer journey’). In our patient data, Journey metaphors are used in positive and empowering ways by some people, and in negative and disempowering ways by others. From a healthcare professional’s point of view, this means that there is no easy one-size-fits-all approach to communication about cancer. Rather, it is essential to be sensitive to the language used by individual patients, and to adapt one’s own responses accordingly. The fact that this message has attracted so much interest is due in large part to the nature and amount of evidence that we have been able to provide by using corpus linguistic methods. In retrospect, I shouldn’t have been surprised.