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.

Workshop on ‘Metaphor in end of life care’ at St Joseph’s Hospice, London

On 26th September 2014, three members of the CASS-affiliated ‘Metaphor in end of life care’ project team were invited to run a workshop at St Joseph’s Hospice in London. The workshop was attended by 27 participants, including clinical staff, non-clinical staff and volunteers.

Veronika Koller (Lancaster University) introduced the project, including its background, rationale, research questions, data and use of corpus methods in combination with qualitative analysis. Zsófia Demjén (The Open University) and Elena Semino (Lancaster University) presented the findings from the project that are particularly relevant to communication between healthcare professionals and patients nearing the end of their lives. These findings include: how patients diagnosed with terminal cancer use Violence and Journey metaphors to talk about their experiences of illness and treatment; and how patients and healthcare professionals use a variety of metaphors to talk about their mutual relationships. The project team pointed out the different ‘framings’ provided by different uses of metaphor, particularly in terms of the empowerment and disempowerment of patients. They provided evidence that no metaphor is inherently good or bad for all patients, but rather suggested that different metaphors work differently for different people, or even for the same person at different times. In the final session, Veronika Koller introduced the ‘Metaphor Menu’ – a collection of metaphors used by cancer sufferers, which the team are planning to pilot as a resource for newly-diagnosed patients.

A lively discussion followed each presentation, with many members of the audience asking questions and contributing their personal and professional experiences. The workshop received very positive evaluations in anonymous feedback questionnaires: 83% of participants rated the session at 4 or 5 on a 5-point scale (where 1 corresponds to ‘Very poor’ and 5 to ‘Excellent’). Comments included: Very interesting research & resonated with my experience. Food for thought!’ and ‘Will help with my area of care, will help me understand and think about what my patients and relatives are actually telling me. Will make me reflect and respond more appropriately’.

Corpus linguistics MOOC: Second run beginning soon

We are running the corpus MOOC again – and we are really looking forward to it. In the first run of the course we taught social scientists and other researchers from across the globe about how to use corpus linguistics to study language. We looked at a range of topics of contemporary social relevance in doing so – including how we talk about disability and how newspapers write about refugees. We also looked at key areas where corpus linguistics has contributed greatly, notably the areas of dictionary construction and language teaching.

The result, I must say, exceeded our expectations – which were pretty high. People really seemed to like the course and get a lot from it. Even though the approach was entirely new to most students, a very large number worked through all eight weeks of the course. The feedback on our training has been exceptionally strong – a look at the #corpusMOOC hashtag on Twitter will give a good idea of the overwhelmingly positive response to that course. The following quote, from a Chinese notice board on which our MOOC was discussed, gives a strong sense of how the course succeeded both in training students and in showing them that corpora have a key role to play in exploring social science questions (thanks to Richard Xiao for the translation):

“CorpusMOOC, with its assembly of the best corpus linguists and rich content, cannot be praised enough … The greatest benefit for me has been that the course has widened my vision: corpus linguistics and the applications of corpus technologies have gone far beyond what I had imagined – more resembling big data in the field of social science research instead of being confined to linguistics… I think the significance of this course lies not merely in teaching a large number of corpus techniques but more, rather, in introducing corpora and demonstrating what corpora can be used for, thus making us aware of them and helping us understand their importance … the corpus-based approach is the unavoidable approach to language in future.”

The first run of the MOOC had a great impact – the course was taken mainly by women (70.44% of students), and drew participants from all continents and a wide range of countries – including places as far flung as the British Antarctic Territory! The areas in which course participants were working and researching were heavily oriented to the social sciences, with students drawn from areas such as business consulting and management, health and social care and media and publishing. The greatest contribution of the course, however, seems to have come from providing training to teachers/lecturers in the UK and beyond. Given that the great majority of students were taking the course for career development (78.59%), the course was likely not only to have had a strong effect on this group but also, by extension, on the students who are exposed to the ideas in the course by the teachers/lecturers who took it.

Having read this, you can probably understand why we were keen to run the course again. Through it we have been able to get a good understanding of corpus linguistics across to thousands of people around the globe. We have made a few changes to the course based on the feedback we received – all designed to make a good course better! This includes new lectures (for example on the language used in cancer treatment) and new in conversation pieces with corpus linguists (such as Douglas Biber).

If this run of the course proves as popular as the first, which we think it should, we plan to run the course every September. Who knows when we will stop!

For a limited time, registration is still open. Book your place on ‘Corpus linguistics: method, analysis, interpretation’ now. 

Reflections from the Front Line: Sarah Russell on MELC and Twitter

Sarah Russell (Director of Education and Research, Peace Hospice Care and the Hospice of St Francis) attended this month’s Language in End-of Life-Care event, where an audience of approximately 40 healthcare professionals and researchers specialising in palliative and end-of-life care gathered to share their perspectives.

In a new blog post on eHospice, she reflects on this experience, as well as sharing some insight into a tweet chat with @WeNurses, where 128 participants came together to discuss individual experiences, symptom control, communication, recognising dying, family and patient needs, caring, and denial as a coping mechanism.

Read more to learn about Sarah’s experience, and to hear her challenge for everyone (including researchers and health care professionals) by visiting eHospice now.

‘Language in End-of-Life Care’: A user engagement event

On 8th May 2014, the main findings of the CASS-affiliated project ‘Metaphor in End-of-Life Care’ were presented to potential users of the research at the Work Foundation in central London. The event, entitled ‘Language in End-of-Life Care’ attracted an audience of approximately forty participants, consisting primarily of healthcare professionals and researchers specialising in palliative and end-of-life care. Although most participants are based in the UK, international guests joined us from Germany, the Netherlands, Spain and the US.

melc1Professor Sheila Payne (Co-Investigator on the project and Co-Director of Lancaster’s International Observatory on End-of-Life Care), opened proceedings and acted as chair for the day’s activities. Two high-profile invited speakers shared their perspectives on communication in end-of-life care. Professor Lukas Radbruch (Chair of Palliative Medicine, University of Bonn) gave a presentation entitled ‘The search for a final sense of meaning in end-of-life discourses’. Among other things, he emphasized the influence of language and culture on perceptions and attitudes towards end of life and end-of-life care. Professor Dame Barbara Monroe (Chief Executive of St Christopher’s Hospice, London) discussed the main current challenges in hospice care in a talk entitled ‘Listening to patient and professional voices in end-of-life care’. These challenges, she argued, include those posed by a variety of linguistic and communicative barriers.

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The methods, data and findings of the ‘Metaphor in End-of-Life Care’ project were introduced by four members of the team: Professor Elena Semino (Principal Investigator), Dr Veronika Koller (Co-Investigator), Dr Jane Demmen (Research Associate) and Dr Zsófia Demjén (former Research Associate, currently at the Open University). The project involves a combination of ‘manual’ and corpus-based methods to investigate the metaphors used to talk about end-of-life care in a 1.5-million-word corpus consisting of interviews with and online forum posts by terminally ill patients, family carers and health professionals. The team introduced the findings from the analysis that are particularly relevant to practitioners in end-of-life care, namely: the use of ‘violence’ and ‘journey’ metaphors by terminally ill patients, and the narratives of ‘good’ and ‘bad’ deaths told by hospice managers in semi-structured interviews. The implications of these findings for end-of-life care were suggested by the team and discussed with the audience. Participants were also invited to discuss selected uses of metaphors from the health professionals’ data, and to consider the potential value of some creative, alternative metaphors for cancer in particular.

melc3The richness of the interactions on the day and the liveliness of the event’s hashtag on Twitter (#melc14) suggest that the event was a success. In the words of a hospice director: ‘everybody at the conference was truly inspired by the potential for change in practice and training!’ Although the funded phase of the project is coming to an end, the contacts made on the day are likely to lead to further collaborative research between the Lancaster team and healthcare professionals in the UK and beyond.

Elena Semino appears on BBC World Service ‘Healthcheck’

CASS project affiliate (and head of department of Linguistics and English Language at Lancaster University) Elena Semino was interviewed about the findings of the ESRC-funded project ‘Metaphor in End-of-Life Care’ on the BBC World Service’s programme ‘Healthcheck’, presented by Claudia Hammond. The programme will air four times between 7th and 11th May 2014; the first 15 minutes of the programme focus on metaphors and cancer.

 

‘Fight’ metaphors for cancer revisited: Are they always bad?

By the ‘Metaphor in End-of-Life Care’ project team, funded by the UK’s Economic and Social Research Funding Council (ESRC):

Elena Semino, Veronika Koller, Jane Demmen, Andrew Hardie, Paul Rayson, Sheila Payne (Lancaster University) and Zsófia Demjén (Open University)

Recent media controversy over the use of social media by people with terminal illness has sparked a new debate on ‘fight’ metaphors for cancer. Writing in the New York Times on 12th January 2014 about Lisa Bonchek Adams’s blogging and tweeting, Bill Keller describes her as having spent the last seven years in a fierce and very public cage fight with death’. On the one hand, Keller acknowledges that Bonchek Adams’s ‘decision to treat her terminal disease as a military campaign has worked for her’. On the other hand, he favourably compares his own father-in-law’s ‘calm death’ with what he describes as Bonchek-Adams’s choice to be ‘constantly engaged in battlefield strategy with her medical team’.

As part of the ESRC-funded project ‘Metaphor in End-of-Life Care’ at Lancaster University, we are studying the use of ‘fight’ metaphors by cancer patients in a large collection of interviews and online fora. We have found plenty of evidence of the negative sides of these metaphors, which have been criticised by many patients and commentators before Keller, and most famously by Susan Sontag in Illness as Metaphor (1979). Seeing illness as a fight can make people feel inadequate and responsible if they do not get better, as when a patient in our data writes: I feel such a failure that I am not winning this battle’. Military metaphors can also express distressing ways of perceiving oneself, such as when some patients describe themselves as ‘time bombs’ during periods of remission.

On the other hand, we are finding that, for some patients, ‘fight’ metaphors do seem to provide meaning, purpose and a positive sense of self. For example, writing in an online forum, a cancer sufferer proudly comments: ‘my consultants recognised that I was a born fighter’. Another patient says in an interview: ‘I don’t intend to give up; I don’t intend to give in. No I want to fight it. I don’t want it to beat me, I want to beat it. Because I don’t think we should give up trying.’ ‘Fight’ metaphors are also used to give and receive encouragement and solidarity. For example, a patient writes ‘let me hear you scream the battle cry to spur us on to win this war’, while another ends an online forum post with the words ‘Soldier on everybody’.

We would not go as far as to argue that ‘fight’ metaphors should be rehabilitated: they can do real harm, and nobody should ever feel under pressure to see themselves as fighters. However, as with most metaphors, the implications of ‘fight’ metaphors change depending on who uses them, why, where and how. Our data suggest that they can be helpful enough to be recognised and accepted as one of many possible ways of approaching illness, including its terminal phase.


The Economic and Social Research Council (ESRC) is the UK’s largest organisation for funding research on economic and social issues. It supports independent, high quality research which has an impact on business, the public sector and the third sector. The ESRC’s total budget for 2013/14 is £212 million. At any one time the ESRC supports over 4,000 researchers and postgraduate students in academic institutions and independent research institutes.

Originally posted on eHospice. Visit their page for more palliative care news from around the world.

More about the Metaphor in End of Life Care project at Lancaster University

MELCcoverThe CASS-affiliated Metaphor in End of Life Care project has just released a free resource containing information of interest to many of our readers. Download the document now to learn more about the project, from basic concepts (what is metaphor, and how are they used in everyday life?) to more specific details (why study metaphor in end-of-life care?). Some interesting initial findings are also included. For instance, “Family carers often say that their emotions can only be safely ‘released’ when talking to people who are ‘in the same boat’.” Read on to learn more about the project.

Elena Semino, Veronika Koller, and Zsófia Demjén investigating ‘good’ and ‘bad’ deaths in interviews with hospice managers

What is a ‘good’ or a ‘bad’ death from the point of view of health professionals who work in hospices? As part of the CASS affiliated project ‘Metaphor in End of Life Care’ at Lancaster University  (funded by the Economic & Social Research Council), we tried to find out. We conducted interviews with 15 hospice managers based in the UK. Amongst other things, each interviewee was asked: ‘How would you describe a good and a bad death?’

Almost all interviewees stressed that different people will have different ideas about what is ‘good’ or ‘bad’ in the experience of death. As a consequence, their own job involves finding out and fulfilling the wishes of patients and their families. The difference between good and bad deaths is partly expressed via contrasting metaphors.

To find out what they said, read the full post on the European Association for Palliative Care website. For more information on the project, visit the MELC website, http://ucrel.lancs.ac.uk/melc/.