Tag Archives: metaphor

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

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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.

New CASS Briefing now available — A ‘battle’ or a ‘journey’? Metaphors and cancer

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CASSbriefings-melcA ‘battle’ or a ‘journey’? Metaphors and cancer. Metaphors matter because they ‘frame’ topics in different ways, which can affect our perception of ourselves and our experiences. The ‘battle’ metaphor for cancer has become controversial because of the framing it may impose on the patient’s experience; the ‘journey’ metaphor frames the cancer experience very differently. We were particularly concerned with whether and how different metaphors may place the patient in an ‘empowered’ or a ‘disempowered’ position, and with the resulting emotional associations.

New resources are being added regularly to the new CASS: Briefings tab above, so check back soon.

A three-parent baby or a change of battery? Language in the ethical debate on mitochondrial donation

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On 22nd October 2014, the House of Commons Science and Technology committee will hold a one-off evidence session on a new human fertilisation technique variously known as mitochondrial donation, mitochondrial transfer or mitochondrial replacement. This technique is intended to help women who carry serious genetic diseases that are passed to the embryo through the mitochondria – the outer layer of the egg (e.g. muscular dystrophy). In such cases, the cell’s mitochondria would be replaced with mitochondria from a healthy donated egg immediately before or after fertilisation, thus eliminating the possibility that the child will inherit the genetic disease.

The first embryo with donated mitochondria was successfully created at Newcastle University in 2010. In 2012, the Nuffield Council on Bioethics approved the procedure. However, the technique has not yet been legally approved in the UK. Two public consultations have found that the majority of people are in favour of introducing the technique, but have also revealed some opposition. Previous parliamentary discussions have primarily focussed on the safety of the procedure. However, concerns have been expressed both in Parliament and in the media about the ethics of manipulating the genetic make-up of human embryos.

As far as the ethical issues are concerned, the language used to describe the procedure is crucial, especially in media reporting. In order to study this language systematically, we constructed a dataset (corpus) including all relevant news reports published in the UK press between April 2010 (when the Newcastle team announced the success of the technique), and September 2014. The corpus contains a total of 119 news articles, amounting to 64,804 words. We have found that, in our data, the words used to express the case for or against approval frame the issue in opposite and irreconcilable ways. This, we suggest, reduces the chances of a reasoned debate, and makes it difficult to see the merits of the case.

The case in favour: changing a faulty battery

In April 2010, Newcastle University issued a press release in which one of the directors of the research, Professor Doug Turnbull, explains the new procedure as follows:

‘Every cell in our body needs energy to function. This energy is provided by mitochondria, often referred to as the cells’ ‘batteries’. Mitochondria are found in every cell, along with the cell nucleus, which contains the genes that determine our individual characteristics. The information required to create these ‘batteries’ – the mitochondrial DNA – is passed down the maternal line, from mother to child.

[…]

“What we’ve done is like changing the battery on a laptop. The energy supply now works properly, but none of the information on the hard drive has been changed,” […] “A child born using this method would have correctly functioning mitochondria, but in every other respect would get all their genetic information from their father and mother.”

The ‘battery metaphor’ is one of the main rhetorical strategies used in our data to suggest that the procedure poses no ethical issues, and should thus be approved on medical grounds: most people can relate to how changing the battery in an appliance does not affect its essential characteristics. The noun battery occurs 38 times in the data, including both the singular and plural forms. We used a new software tool to find the top ‘collocates’ of the singular form battery, i.e. the words that are strongly associated with this word in our corpus. This tool displays collocates as a network with the search word in the centre (see figure 1).

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Figure 1 – Collocation network for battery

Battery is closely linked with the technical term mitochondria on the one hand, and, on the other hand, with a small set of words that belong to the ‘battery’ metaphorical scenario: pack, faulty, replacing and changing. The extracts below are instances of the pattern displayed in figure 2:

About one in 6,500 children are born with defects in their mitochondria – the “batteries“ that power each cell.

The new techniques would see defects in a cell’s battery pack, the mitochondria, replaced by a healthy version supplied by a woman donor

[Mitochondria] are like batteries in a camera or a laptop – you can change them without changing anything else. The child’s identity will come from its two parents, who determine the nuclear DNA.

In these extracts, the focus is on the way in which serious medical problems can be avoided by means of an intervention at the level of cells.

The case against: three-parent babies

The case against approval focuses on the babies who would be born as a result of the procedure, and particularly on their kinship relationships with the people whose cells would be involved in the creation of the embryo: the woman who carries the genetic disease, the woman who donates the healthy mitochondria, and the man whose sperm is used to fertilise the egg.

The word baby as a singular noun occurs 99 times in the corpus, and the plural form babies occurs 268 times. Figure 2 shows the network of words that centres around the plural form babies in our corpus.

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Figure 2 – Collocation network for babies

As figure 2 shows, the collocates of babies include:

  • Words that relate to the debate, and to the issue of official approval: approve, legalise, draft, sanction, permit, backing, comment, ministers.
  • Words that relate to the procedure itself and its outcome: create, created, creation, order, genetically, modified, GM, designer, eugenics, three, three-parent.

The second group in particular reveals the main argument against approval of the procedure, namely that it involves the creation of genetically modified babies with three biological parents. This, it is argued, would pave the way to a future where prospective parents can choose the characteristics of their children, such as eye colour. The following extracts express this position:

Three-parent babies may never know their ‘second’ mother

Government accused of dishonesty over GM babies

Dr David King, of watchdog Human Genetics Alert, said: “This will eventually lead to a designer baby market. […]”

Done differently, it could lead to the creation of designer babies , made to order by hair colour or eye colour.

More specifically, the corpus contains 40 instances of three-parent baby/babies, 33 instances of designer baby/babies and 12 instances of GM babies. In some articles, these phrases are used to place mitochondrial donation alongside other ethically controversial issues:

Issues ranging from fracking to three-parent babies and genetically modified crops are all difficult […].

The problem with the two alternative linguistic framings

The cases for and against approval or mitochondrial donation are expressed in the press in ways that polarise the issue in an extreme, and arguably unhelpful, fashion. In the case against, the creation of a human baby from the genetic material of three people results in a genetically modified, designer human being, and in an abnormal kinship relationship involving two mothers and three parents. In the case in favour, the use of mitochondria from a donated egg is a mechanical process that has negligible genetic implications and no abnormal kinship implications at all. More generally, the case against focuses on the people involved in the process and their relationships, while the case in favour focuses on what scientists do in a lab in order to prevent serious incurable conditions. As figures 1 and 2 show, the two networks centering on babies and battery do not meet: they have no words in common. For example, the verb form associated with the battery network is replace, whereas for babies it is create.

In this context, it is difficult for non-experts to make sense of the complex scientific issue that underlies the ethical questions, namely the function of mitochondria and their role in the genetic make-up of human beings. Those who adopt the ‘battery metaphor’ tend to point out that mitochondria only provide 0.1% of a human being’s genetic material, none of which influences the characteristics that we associate with identity and uniqueness. Those who adopt the ‘three-parent’ view implicitly suggest that two women are equally involved in the creation of the embryo, presumably because the provision of any amount of genetic material would constitute biological parenting.

The language used in the media to represent both sides over-simplifies and polarises the issue, and therefore makes it difficult to understand the basis of the disagreement. It would be desirable to have a debate that enables the public to appreciate the nature and complexity of the scientific issues, so that they can form a reasoned view of the implications of the introduction of the procedure. To achieve that, both sides have to abandon the current linguistic framings, and find a common linguistic ground from which to argue their respective cases.

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

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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’.

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

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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

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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’

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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?

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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

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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.

Introducing Challenge Panel Member: Alice Deignan

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Our latest Challenge Panel introduction comes from Professor Alice Deignan via the University of Leeds. Read her brief autobiography below.

deignan

I am Professor of Applied Linguistics in the School of Education, University of Leeds, UK. I come from a language teaching background and many of my current students are language teachers. My interest in corpora dates back to my days as an MA student at Birmingham University where I was introduced to the Cobuild project in corpus lexicography. I was fascinated by the possibilities that corpus work opened up, and when I finished my MA, I joined the project as a lexicographer. I later worked for the project as a consultant on pragmatics and then as an author. Around the same time, I also became very interested in metaphors and other kinds of figurative language, partly because of the difficulties that my students had with this kind of expression.

I studied part time for a PhD, in which I used the Bank of English at Cobuild to explore the predictions that Conceptual Metaphor Theory makes for language patterns. I saw that the corpus could be cherry-picked to select examples that were completely consistent with the theory. However as a lexicographer I’d been trained to analyse entire concordances, or very large random samples of them, and to account for all the data. I was a huge fan of Conceptual Metaphor Theory so I was surprised to find that this rigorous analysis turned up patterns in the corpus that were not predicted by the theory, and needed other explanations. I later wrote up my findings as a book ‘Metaphor and Corpus Linguistics’ (Benjamins 2005).

More recently, I have become very interested in variations in figurative language across different genres and registers, and together with Jeannette Littlemore and Elena Semino wrote ‘Figurative Language, Genre and Register’ (Cambridge University Press, 2013). One of my studies for the book compared figurative language use in science research articles with their popularisations. This has led me to a broader interest in the language of science, especially as experienced by young people, an issue that has societal importance well beyond theories of language use. I am currently exploring this area with colleagues who work with secondary school pupils. I am also exploring the connections between collocation and different kinds of and degrees of metaphoricity.

Did you miss our previous introductions? Click through to the Challenge Panel page to see profiles, and check back soon for updates.