Is laughter the greatest medicine for cancer patients?

People can use humorous metaphors (figures of speech) to empower themselves by undermining the illness, mocking it and distancing themselves from it.

In 'Metaphor, Cancer and the End of Life', Elena Semino, Andrew Hardie, Sheila Payne and Paul Rayson, from Lancaster University, and Zsófia Demjén from University College London, present the methodology, findings and implications of a large-scale corpus-based study of the metaphors used to talk about cancer and the end of life (including care at the end of life) in the UK.

"We studied an online forum for people with cancer and found that some contributors regularly joke about what is happening to them," says Professor Elena Semino, who led the research team.

"For example, the cancer is referred to as 'Mr C', a colostomy bag as 'Baggy' and an oncologist as 'the Wizard of Onc'."

Co-author Dr Zsófia Demjén adds: "Making fun of cancer helps some people on the online forum cope with serious, threatening and unpredictable circumstances, and to bond with one another."

The whole study presents what is the largest-scale study to date of metaphor in the experience of cancer and (care at) the end of life.

It focuses on metaphor as a central linguistic and cognitive tool frequently used to talk and think about sensitive and subjective experiences, such as illness, emotions, death, and dying. It can both help and hinder communication and well-being, depending on how it is used.

The study examines particularly the metaphorical language used by members of three different groups in healthcare:

· People diagnosed with advanced cancer

· Unpaid family carers looking after someone who has cancer

· Healthcare professionals

The team adopted corpus linguistics -- a branch of linguistics that uses computer-aided methods to study a variety of linguistic phenomena in large digital collections of texts known as 'corpora' (singular, 'corpus'), to examine the metaphors used by the three groups to talk about cancer and the end of life.

The team built a 1.5-million-word corpus consisting of interviews with and online forum posts by people from each of the three groups.

They then used a combination of qualitative analysis and corpus linguistic methods to present a range of findings that have implications for: metaphor theory and analysis; corpus linguistic and computational approaches to metaphor; and training and practice in cancer care and hospice, palliative and end-of-life care.

The study shows the metaphors most commonly used by members of the three participant groups, and points out both differences and similarities across the groups.

It reveals the possible effects and functions of different patterns of metaphor use, such as, to engender a sense of community amongst cancer patients communicating in a peer-to-peer online forum.

It argues that there are no inherently 'good' or 'bad' metaphors in communication about illness, but that different uses of metaphor may be more or less (dis)empowering, depending on how they are used at different points in time and how they reflect and reinforce different emotions, self-perceptions and degrees of agency and control.

The study has implications for how healthcare professionals can engage with the metaphors used by patients and family carers in clinical contexts, and generally for how to employ metaphors sensitively and effectively in healthcare communications.

Professor Elena Semino: "By exploring systematically the metaphors used by patients, family carers and healthcare professionals in the context of cancer and the end of life, we hope to increase healthcare professionals' awareness of their own and others' uses of language, so that they can adopt more sensitive and effective communication strategies with patients and their families.

Top ten metaphors revealed in the study

Animals: Used primarily by patients and carers writing online. Both groups describe cancer negatively as a 'beast'. Animal metaphors are also used by both patients and carers to describe themselves in self-deprecatory terms, usually because of attitudes or behaviours that are part of the experience of illness. Several patients use 'chicken' metaphorically to suggest that they perceive themselves as the opposite of the conventional notion of the 'brave' cancer patient, and are like a scared animal in car headlights.

Sports and Games: Both patients and healthcare professionals used the opposition between a 'sprint' and a 'marathon' metaphorically to suggest that, like a marathon, cancer requires sustained effort, determination and resilience over a long period of time. A doctor writing online suggests the 'marathon vs. sprint' metaphor is a good way to prepare someone to care for a person with a terminal illness. There are references to 'winners' and 'gold medallists'.

Religion and the Supernatural: Metaphors drawing from religion and the supernatural are more frequent in online forum contributions by patients than by the two other participant groups. Both patients and carers online describe distressing situations as being in 'hell' and situations of uncertainty and lack of activity (e.g. waiting for appointments or results) as being in 'limbo'. Others talk about the 'green eyed monster' and tumours as 'dragons'.

Restraint: Both patients and carers talk about the consequences of cancer in their lives in terms of being physically restrained in a particular location. This applies particularly to the inability to leave their homes so the house becomes a 'trap' or they are 'trapped' in a nightmare

Openness: The members of all three groups use Openness metaphors to describe the ability and willingness to talk honestly and explicitly about emotions, a cancer diagnosis, and/or the imminence of death

Obstacles: The member of all three groups talk -- quite conventionally -- about different kinds of difficulties as 'obstacles' and 'hurdles'.

Wholeness: Metaphors to do with wholeness, and particularly loss of wholeness, are primarily used by patients and carers writing online to talk about the consequences of illness or bereavement for their own mental states, self-perceptions and sense of identity.

Machines: These include a number of highly conventional metaphorical expressions for people's mental lives, such as 'coping mechanism' or 'switching off' from worries. 'Roller coaster' and 'treadmill' are common.

Violence and Journey: The project team previously identified that Violence and Journey metaphors were the most commonly used in the data. While there is evidence that violence metaphors can be harmful for patients, the study showed that both violence and journey metaphors can be empowering or disempowering, depending on how they are used.