When I was in medical school, my classmates came from diverse backgrounds. Some came from wealthy families and some were poor. The majority were of European-American descent, but many came from minority backgrounds, including African-American and Latino-American. Slightly more than half the class was female. Some of the students grew up with physician parents and had always been interested in clinical work; others had worked in health care as nurses or therapists and were seeking further training. A few were musicians or actors who were changing careers. Several—including me—were primarily interested in science but wanted to apply research skills to human health. Despite our differences, however, over time we became more similar. For instance, we all grew increasingly fascinated by the human body.
It might be impossible to make it through medical training without growing awed by the body’s staggering complexity and elegance. In my program, the first year focused almost entirely on normal structures and functions, and I suspect every one of the beginning students felt privileged to be learning so much about the human organism.
But after that first year the emphasis changed; from then on we studied abnormalities. It proved hard to avoid feeling terrified as we learned the myriad ways bodily functions can falter: every major organ system can succumb to a startling variety of illnesses. Like many of my classmates, I began to visit the student health service, seeking reassurance.
I believe this tension between the beauty of the healthy body and the threat of an ailing one explains a lot about modern medical care. Notice how the focus on healthy function lasted only a year. The bulk of the remaining nine years of my training was designed to prepare me to manage illness.
Granted, medical education has improved since the 1980’s, and some fields (like primary care) spend more time on preventative health than others. But the focus on disease is unavoidable. What’s more, it comes with an implicit charge to battle illness at all cost. Although we now understand that at end of life the focus must shift to palliative care, the entire system is built to resist the transition from fighting illness to supporting a person as they succumb to it.
This may be the best way to deliver effective health care; it may be what the public wants. However, the focus on disease, when combined with time and resource limitations, places physicians in opposition to most of the bodies they see. Patients in good health are briefly reassured and given pamphlets. Only when treating illness do most physicians truly perk up and apply themselves.
The result is a gradual lack of body appreciation. The doctor doesn’t scan for signs of vigor, but for signs of deterioration. Healthy patients are seen briefly; most of the hard work is directed toward ailing ones. The necessity to spot disease, the rapid pace and high stress of clinical practice, and the emotional impact of dealing with suffering, make it hard for doctors to avoid feeling like gladiators. They step into the arena and wrestle ill bodies back into health.
The idea of medicine fighting a war against illness is so widespread many don’t realize we could choose different metaphors. We don’t think twice when we read of a celebrity ‘battling against’ breast cancer, but we’d take notice if the headline read she was ‘working with’ it. The way doctors and the general public use military metaphors in reference to disease was the subject of a 2014 Atlantic Monthly article. The piece detailed the history and implications of this metaphor but didn’t devote too much attention to possible alternatives.
What are some other ways we could view disease? We could see it as an important challenge (like a mountain to climb), or an opportunity to spend time on the body (like a visit to the gym). We could use a gardening metaphor, so that we would work to pull weeds and encourage flowers, while fertilizing and watering the soil of our being.
The point is, we don’t have to be at war with ourselves. We could treat the body with more kindness and gentleness.
This might seem dangerous. Wouldn’t it be giving in to cancer to use less violent language? Would survival times diminish if we spoke of gardening rather than battling? It is possible that for some people, or at some stages, a martial metaphor makes sense. But as a policy, as a general stance toward the body and its vulnerabilities, it seems to me that a more nurturing stance would lead to more effective healing.
And it’s worth considering that strong resistance seldom serves us. In politics, hardline, angry positions lead to gridlock. Could medicine’s aggressiveness actually worsen prospects in the same way? It’s worth considering.
The illness as enemy metaphor is especially problematic for those, like me, with chronic diseases. Coping with ongoing pain and limitation is hard enough; aggressive resistance (the natural effect of military language) only increases tension and, inevitably, suffering.
The fact is, as a body ages it begins to deteriorate. Discomfort rises; capability falls. If we view this natural process, which often starts early in life (e.g, my neck pain was already constant by age thirty), as a foe, we reject much of what is simple reality: systems wear out with time and usage. Wouldn’t it be better to support the body as it works with limitations. After all, the healing we hope for must come from the body itself. Rather than seeing our minds as the riders of a rebellious horse that needs to be whipped into submission, couldn’t we adopt a friendlier attitude? Couldn’t we look at the mind’s relationship with body as a partnership? Perhaps rather than seeing ourselves as riders atop horses, we could take a page from the notebook of Siamese twins, who seamlessly interact with and care for one another.
Metaphor is ultimately a personal choice. We each must decide what works for us. A good friend of mine went through treatment for a serious cancer shortly after I underwent surgery for a vascular problem. His illness was more dangerous than mine, and the treatments required were more grueling. When I referred to his process as a ‘healing journey,’ he felt alarmed. A producer of martial arts championships, he was using a tournament metaphor. He was fighting his illness and working his way through the treatment round by round.
But while it is important to allow patients to choose their own metaphors, it is also important not to unconsciously influence them with our own preferences or those of the culture at large. In medicine, aggressive, militaristic language is so widespread we hardly notice it. But it has many effects. It would be healthier, I believe, to use a greater variety of metaphors.
In particular, the idea of ‘battling’ should be balanced with an ethic of ‘tending.’ We can imagine pulling weeds while calm and peaceful, but we can’t fight a battle unless we’re angry and on guard.