The opening lines of Susan Sontag’s oft-quoted pre-AIDS essay for The New York Review of Books in 1978, Illness as metaphor, are perhaps necessarily harsh, although ultimately fair metaphor themselves.
“Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”
The article, published just two days before the start of my teenage years, showing both its time and its timelessness, focuses predominately on the language around tuberculosis and cancer. The author, who coincidentally was a ‘victim’ of cancer herself before she died in 2004, was expressing her angst against the contemporary medical establishment that appeared to conspire to conceal the reality of cancer from patients by wrapping up diagnosis and communications in language and secrecy to protect them. Obviously, a lot has moved on, thank goodness.
TB was, on the other hand, seen to be almost desirable. Artistic types – the Romantics – sought the characteristics of the disease as this helped them become more appealing, vulnerable, attractive even. “So well established was the cliché which connected TB and creativity that at the end of the [19th] century one critic suggested that it was the progressive disappearance of TB which accounted for the current decline of literature and the arts,” she writes.
Dr Abraham Fuks, a fellow Canadian, recently wrote a paper, ‘The military metaphors of modern medicine’. In it he suggests that the militarisation of language around medicine introduces a barrier between the patient and the clinician. Like Sontag, he highlights the use of language, popularised from the 1880s onwards, to “fight disease”, “stage war on cancer”, “agents of disease”, “doctor’s orders” and “silver bullets” in fact undermines “the ability of physicians and society to deal with the burgeoning burden of chronic illness”.
This all comes to mind since a couple of days ago saw the launch of Action on Stroke month from Stroke Association, which we have rebranded, the brand launching on the same day. In helping the charity reposition itself, to get the attention and recognition it and stroke needs and deserves, we helped them describe a brand model that captured all the good stuff going on in the charity, but not being effectively communicated. Just as cancer became the new TB, so must stroke be in the consciousness of people so that they can take action. The desire is to build and lead a stroke movement, preventing stroke and supporting those who survive stroke.
Someone told me once that, ‘It looks different, because it is different’. I have never forgotten this. I also passionately believe that brands should serve business and not the other way round. Stroke Association was so much more than its external brand wrapper told. Stroke Association also wants to do yet more. 150,000 people in the UK have a stroke every year. One-third of those will recover, another third will live with severe disabilities (stroke is the largest cause of disability in the UK) and the rest will die. That’s 50,000 people who will have a stroke and die that could probably have been prevented and they could be living. And another 100,000 and their families who wouldn’t have to be living with the devastating effects of stroke every day.
Knowing that gets you quite angry. You start talking about fighting, about putting you head above the parapet and come out all guns blazing. The charity’s strategic plan, the way that it intends going about its business, is to help the other 50% of people who have a stroke and survive, but they don’t help at the moment, to get the funding to do the research to find a cure and demand that services at adequate and accessible. It’s incredibly challenging. I met lots of people, mostly volunteers for the charity, who had had a stroke. Many of them told me that every day was a fight. Frontline staff are fighting to improve services, extend them, or keep them open. And in such a noisy world, the charity needs to fight to get its messages across and get the attention of fundraisers and donors.
I agree with Dr Fuks. Making the disease the thing you fight is not necessarily helpful if it means that the disease is “displacing the patient as the interlocutor in the doctor-patient relationship”. But the language is completely appropriate when it is attached to the cause, the leadership of a movement and a call to action.
We know that such fighting talk doesn’t necessarily sit well with everyone, particularly those in the caring professions. But no one can deny the power of language if used it the right way. Stroke Association’s brand promise is ‘to be your ally in stroke’ – another military metaphor – something that not one of the people I met could deny.