Military Metaphor and Covid

Quid est Veritas? · Nov 26, 2020

Biden Thanksgiving speech: We're at war with the virus, not each other

I see this kind of rhetoric quite frequently nowadays. That we are fighting a war, or that the virus is our enemy. This is called the military metaphor, and is fairly common in Medicine. However, it is actually discouraged, since there is evidence that it is harmful. When utilising the military metaphor, it worsens pain scores and psychological well-being - because if the condition deteriorates, it is seen as losing the fight or being defeated, in all likelihood. Similarly, it discourages palliation in extreme cases, as well as wait-and-see approaches, which are sometimes called for. Those are conceptualised as doing nothing in the face of the enemy, or not fighting hard enough - when often, non-intervention might have been the best option.

All in all, it is actually counterproductive to frame our efforts in this light. It is understandable, especially in the light of the politician wanting to look like he is doing something, but we are not opposing a malevolent force here. These are merely viruses, bits of RNA; and while public health measures are required, they need to be considered and measured ones. The military metaphor merely lends itself to hysteria and rushed action, while we chase an imaginary enemy we see hiding in numbers and incidence graphs. After all, we aren't going to 'defeat' this virus, but will just have to learn to get on with it. The only time we actually managed to win our 'war' was with Smallpox (and maybe Polio someday), but Covid will not be another of those, and good evidence suggests we should not be girding our loins for battle, but treating an infection.

RDKirk · Nov 26, 2020

Quid est Veritas? said:
Biden Thanksgiving speech: We're at war with the virus, not each other

I see this kind of rhetoric quite frequently nowadays. That we are fighting a war, or that the virus is our enemy. This is called the military metaphor, and is fairly common in Medicine. However, it is actually discouraged, since there is evidence that it is harmful. When utilising the military metaphor, it worsens pain scores and psychological well-being - because if the condition deteriorates, it is seen as losing the fight or being defeated, in all likelihood. Similarly, it discourages palliation in extreme cases, as well as wait-and-see approaches, which are sometimes called for. Those are conceptualised as doing nothing in the face of the enemy, or not fighting hard enough - when often, non-intervention might have been the best option.

All in all, it is actually counterproductive to frame our efforts in this light. It is understandable, especially in the light of the politician wanting to look like he is doing something, but we are not opposing a malevolent force here. These are merely viruses, bits of RNA; and while public health measures are required, they need to be considered and measured ones. The military metaphor merely lends itself to hysteria and rushed action, while we chase an imaginary enemy we see hiding in numbers and incidence graphs. After all, we aren't going to 'defeat' this virus, but will just have to learn to get on with it. The only time we actually managed to win our 'war' was with Smallpox (and maybe Polio someday), but Covid will not be another of those, and good evidence suggests we should not be girding our loins for battle, but treating an infection.

I don't agree with your concept of the military. A force at war frequently does "wait and see." Stalemates are common. Sometimes it's a victory just to "hold the fort" and survive until the cavalry arrives. Even strategic retreats sometimes happen.

Materially, military logistical concepts are certainly needed to mobilize and manage resources...and that's been a huge failure so far.

Arc F1 · Nov 26, 2020

Quid est Veritas? said:
Biden Thanksgiving speech: We're at war with the virus, not each other

I see this kind of rhetoric quite frequently nowadays. That we are fighting a war, or that the virus is our enemy. This is called the military metaphor, and is fairly common in Medicine. However, it is actually discouraged, since there is evidence that it is harmful. When utilising the military metaphor, it worsens pain scores and psychological well-being - because if the condition deteriorates, it is seen as losing the fight or being defeated, in all likelihood. Similarly, it discourages palliation in extreme cases, as well as wait-and-see approaches, which are sometimes called for. Those are conceptualised as doing nothing in the face of the enemy, or not fighting hard enough - when often, non-intervention might have been the best option.

All in all, it is actually counterproductive to frame our efforts in this light. It is understandable, especially in the light of the politician wanting to look like he is doing something, but we are not opposing a malevolent force here. These are merely viruses, bits of RNA; and while public health measures are required, they need to be considered and measured ones. The military metaphor merely lends itself to hysteria and rushed action, while we chase an imaginary enemy we see hiding in numbers and incidence graphs. After all, we aren't going to 'defeat' this virus, but will just have to learn to get on with it. The only time we actually managed to win our 'war' was with Smallpox (and maybe Polio someday), but Covid will not be another of those, and good evidence suggests we should not be girding our loins for battle, but treating an infection.

"steel our spines". That's a new one for me, first time I've ever heard it.

Quid est Veritas? · Nov 26, 2020

RDKirk said:
I don't agree with your concept of the military. A force at war frequently does "wait and see." Stalemates are common. Sometimes it's a victory just to "hold the fort" and survive until the cavalry arrives. Even strategic retreats sometimes happen.

Materially, military logistical concepts are certainly needed to mobilize and manage resources...and that's been a huge failure so far.

Yes, but that is not the common opinion of the military. When reading a military history, most time will be spent on battles, not the period inbetween. Regardless if that interpretation is really valid, that is what the metaphor implies. If I say we are going to fight something, few think that means just seeing what will happen.

RDKirk · Nov 26, 2020

Quid est Veritas? said:
Yes, but that is not the common opinion of the military. When reading a military history, most time will be spent on battles, not the period inbetween. Regardless if that interpretation is really valid, that is what the metaphor implies. If I say we are going to fight something, few think that means just seeing what will happen.

What you say of the military can be said by atheists of Christianity.

What is the common opinion of those outside Christianity of Christianity? "Onward Christian soldiers, marching as to war!"

It all amounts to not knowing enough about the subject one is protesting.

Quid est Veritas? · Nov 26, 2020

RDKirk said:
What you say of the military can be said by atheists of Christianity.

What is the common opinion of those outside Christianity of Christianity? "Onward Christian soldiers, marching as to war!"

It all amounts to not knowing enough about the subject one is protesting.

I am not really saying anything about the military, but about the common implications of using the metaphor. It has been extensively studied in Medicine, and its use actually results in poorer outcomes. It is not a good way to frame disease prevention or public health.

In Christianity it is more apt, I feel, as there really is a defeat or a victory there, as well as opposing forces.

sesquiterpene · Nov 26, 2020

Quid est Veritas? said:
Biden Thanksgiving speech: We're at war with the virus, not each other
I see this kind of rhetoric quite frequently nowadays.

I believe you're not from the US, but I think it's the last part of the message (which I've bolded) that is important here. Thanksgiving is a holiday dedicated in part to cooperation and peace - something that has been missing in our nation to a large degree. If Biden can make the nation more unified in a "fight" against Covid, good for him, completely irrelevant to it's effects in clinical medicine.

I also wonder if you have studies that are really relevant in the context of a massive vaccination campaign in the face of fairly widespread opposition to the new vaccines. If militaristic rhetoric can persuade an extra 10% of the population to vaccinate, that might make the difference between eradication and continued endemic transmission. If so, I'd suggest you stand back and salute

Ophiolite · Nov 26, 2020

Quid est Veritas? said:
I am not really saying anything about the military, but about the common implications of using the metaphor.

There goes the bathwater. And there goes the baby.

You chose to make your argument about the universal application of the military analogy to covid.

@RDKirk has pointed out its aptness for the logistical effort required to deal with covid. I've seen it remarked that armchair generals argue about bayonet strength and weapons technology, while real generals debate logistics. Battling Covid is a good military analogy.
@sesquiterpene has pointed out why the military analogy is politically important at a time when America is seriously divided.

So, while I can appreciate that talking to a frantic relative, whose father or daughter are intubated, about fighting Covid may be ill advised, I do not accept your universal rejection of the analogy.

Quid est Veritas? · Nov 26, 2020

Ophiolite said:
There goes the bathwater. And there goes the baby.

You chose to make your argument about the universal application of the military analogy to covid.

@RDKirk has pointed out its aptness for the logistical effort required to deal with covid. I've seen it remarked that armchair generals argue about bayonet strength and weapons technology, while real generals debate logistics. Battling Covid is a good military analogy.

@sesquiterpene has pointed out why the military analogy is politically important at a time when America is seriously divided.

So, while I can appreciate that talking to a frantic relative, whose father or daughter are intubated, about fighting Covid may be ill advised, I do not accept your universal rejection of the analogy.

Well, I respectfully disagree.

On the logistical side, that is not the tenor the metaphor usually carries. It is as if I call someone a 'ray of sunshine' - I don't mean thereby that that person is running a temperature, and no one would take it as such.

sesquiterpene said:
I also wonder if you have studies that are really relevant in the context of a massive vaccination campaign in the face of fairly widespread opposition to the new vaccines. If militaristic rhetoric can persuade an extra 10% of the population to vaccinate, that might make the difference between eradication and continued endemic transmission. If so, I'd suggest you stand back and salute

Further, on this point, I would also disagree. Simply put, military metaphors are known to worsen pain scores and subjective reported symptoms. Now the new covid vaccines are probably not very good on their side-effect profiles. The Pfizer one certainly, and maybe Oxford, would require repeat doses, and if we have flu-like side-effects that seem likely, this would discourage the use of the booster. Of course, I have no studies on the military metaphor on large-scale rushed vaccination drives, as we have never done them before - but allowing the use of induction here, a bit of a sin in Evidence-Based Medicine, it is not clear to me that this argument holds water. I would think it would result in a less effective vaccination programme, based on the known outcomes that the military metaphor usually results in. People tend to avoid things that make them feel ill, and this effect would likely be accentuated by the metaphorical use, if not convince people of their dangers or inefficacy. These vaccines are a bit rough after all, seeing that they are hopelessly rushed by economic and political pressures. I don't think militaristic rhetoric is at all called for here, and certainly runs in the face of much evidence.

Ophiolite · Nov 26, 2020

Quid est Veritas? said:
Well, I respectfully disagree.

On the logistical side, that is not the tenor the metaphor usually carries. It is as if I call someone a 'ray of sunshine' - I don't mean thereby that that person is running a temperature, and no one would take it as such.

Further, on this point, I would also disagree. Simply put, military metaphors are known to worsen pain scores and subjective reported symptoms. Now the new covid vaccines are probably not very good on their side-effect profiles. The Pfizer one certainly, and maybe Oxford, would require repeat doses, and if we have flu-like side-effects that seem likely, this would discourage the use of the booster. Of course, I have no studies on the military metaphor on large-scale rushed vaccination drives, as we have never done them before - but allowing the use of induction here, a bit of a sin in Evidence-Based Medicine, it is not clear to me that this argument holds water. I would think it would result in a less effective vaccination programme, based on the known outcomes that the military metaphor usually results in. People tend to avoid things that make them feel ill, and this effect would likely be accentuated by the metaphorical use, if not convince people of their dangers or inefficacy. These vaccines are a bit rough after all, seeing that they are hopelessly rushed by economic and political pressures. I don't think militaristic rhetoric is at all called for here, and certainly runs in the face of much evidence.

Your entire argument appears to be taken exclusively from the impact that such a metaphor may have upon the acceptance of man in the street to the need for vaccination, or how those suffering, or close to those suffering, may be influenced by it.

You mentioned that, with respect, you disagreed. With respect, if that respect was genuine you would have thought about what I and others had written and not interpreted it soley in the light of your specific, limited perspective. To remind you:

@sesquiterpene's point related to the need to address the divisiveness in the USA, arguing that may well be more important than the downsides of the metaphor you have exclusively emphasised.
The point about logistics is its value in reminding/persuading the decision makers how vital a military style approach to dealing with the pandemic is importatn. i.e. it is directed to a discrete sub-set of society not us rank and file.

Quid est Veritas? · Nov 26, 2020

Ophiolite said:
@sesquiterpene's point related to the need to address the divisiveness in the USA, arguing that may well be more important than the downsides of the metaphor you have exclusively emphasised

I mentioned in the OP that it might be politically useful, but medically it is counterproductive.

Besides, Trump used the same rhetoric and certainly this did not help division.
The (In)Appropriateness of the WAR Metaphor in Response to SARS-CoV-2: A Rapid Analysis of Donald J. Trump's Rhetoric

Ophiolite said:
The point about logistics is its value in reminding/persuading the decision makers how vital a military style approach to dealing with the pandemic is importatn. i.e. it is directed to a discrete sub-set of society not us rank and file.

The Honestiores and the Humiliores are both English speakers using a shared metaphorical idiom. So the 'military style' within the metaphorical use likely remains the same.

Ophiolite said:
Your entire argument appears to be taken exclusively from the impact that such a metaphor may have upon the acceptance of man in the street to the need for vaccination, or how those suffering, or close to those suffering, may be influenced by it.

Well no, my argument is based on the evidence that the military metaphor worsens measurable outcomes in disease. All the counter arguments are not based on any evidence as such, but on speculative opinion.

jayem · Nov 27, 2020

Quid est Veritas? said:
After all, we aren't going to 'defeat' this virus, but will just have to learn to get on with it. The only time we actually managed to win our 'war' was with Smallpox (and maybe Polio someday), but Covid will not be another of those, and good evidence suggests we should not be girding our loins for battle, but treating an infection.

But at the level of an individual patient, an infection is a battle of sorts. When I say I'm fighting off a cold, there's an element of truth. If rhinovirus gets into my airway epithelium, it stimulates the secretion of inflammatory cytokines, such as various interleukins and interferons. Which also attract and activate T-cells. All of which act in concert to inhibit viral replication. So from my perspective, there is fight going on. My body was invaded and my immune system is taking measures to contain, and ultimately destroy the viral attacker. Infection with SARS-CoV-2 is much the same. Though it appears that the sickest patients with the highest mortality mount an excessive immune response. The defenders here have gone rogue and are laying waste to home territory. But in any case, the military metaphor is not an altogether inappropriate description of what's happening to a specific patient.

Quid est Veritas? · Nov 27, 2020

jayem said:
But at the level of an individual patient, an infection is a battle of sorts. When I say I'm fighting off a cold, there's an element of truth. If rhinovirus gets into my airway epithelium, it stimulates the secretion of inflammatory cytokines, such as various interleukins and interferons. Which also attract and activate T-cells. All of which act in concert to inhibit viral replication. So from my perspective, there is fight going on. My body was invaded and my immune system is taking measures to contain, and ultimately destroy the viral attacker. Infection with SARS-CoV-2 is much the same. Though it appears that the sickest patients with the highest mortality mount an excessive immune response. The defenders here have gone rogue and are laying waste to home territory. But in any case, the military metaphor is not an altogether inappropriate description of what's happening to a specific patient.

Yes, it seems apt, hence its popularity. But at heart, it is just a metaphor, not a real relation. Are macrophages soldiers? Are T cells spotters or majors? Of course not. It is a description in which we frame an unlike situation, so that we can understand it in more anthropomorphic or quotidian ways. In like manner, the brain isn't really a computer, the heart not a pump, Anaesthesia isn't sleep, etc.

Now we have evidence this specific metaphor is associated with poorer outcomes. Why continue to use it then? It isn't a bad fit as a metaphor, but it isn't one that seems appropriate to use, perhaps. It isn't expressing an actuality but a framing device for understanding. To use an analogy, if I call a well-run Chinese city an anthill, the metaphor isn't wholely deficient, but could have negative connotations or effects that someone could also deduce. Better avoid it then, if we have other metaphors we could draw on.

A metaphorical relation has a vehicle and a tenor; the former being the thing that appears similar, and the latter the meaning you are trying to express thereby. Often a metaphorical relation may be taken too far, and the tenor adopting more from the other than is really justified. A good example here is the brain, which we initially used to explain a computer, but then started reversing the metaphor until people essentially equate the organ and the machine. The military metaphor is another example thereof, where we may be helping to understand physiology, but end up with all kinds of ideas of defeat and victory and so, as well.

Healing Without Waging War: Beyond Military Metaphors in Medicine and HIV Cure Research

sesquiterpene · Nov 27, 2020

Quid est Veritas? said:
Besides, Trump used the same rhetoric and certainly this did not help division.
The (In)Appropriateness of the WAR Metaphor in Response to SARS-CoV-2: A Rapid Analysis of Donald J. Trump's Rhetoric

This is a post-modern textual analysis of Trump's rhetoric. It isn't about medical outcomes.

Quid est Veritas? said:
Healing Without Waging War: Beyond Military Metaphors in Medicine and HIV Cure Research

This is a post-modern textual analysis. It isn't about medical outcomes, or even about Covid.

Seriously, are you pranking us here? There are many possible discussions about all the myriad problems in handling this pandemic, but a discussion about whether a metaphor might be slightly off-kilter seems like a bizarre distraction. Can you provide data that this a real problem in this particular situation, and what the real outcomes here might be?

Quid est Veritas? · Nov 28, 2020

sesquiterpene said:
This is a post-modern textual analysis of Trump's rhetoric. It isn't about medical outcomes.

The context of that post was the claim that the military metaphor was required to heal division, so that was posted as an easy summary of Trump's extensive use thereof, and thus showing that it is no balm for divisiveness.

sesquiterpene said:
This is a post-modern textual analysis. It isn't about medical outcomes, or even about Covid.

The context here was in response to a defense of the appropriateness of the metaphor to describe physiology, so this is to highlight that other metaphors may also be applied.

sesquiterpene said:
Seriously, are you pranking us here? There are many possible discussions about all the myriad problems in handling this pandemic, but a discussion about whether a metaphor might be slightly off-kilter seems like a bizarre distraction. Can you provide data that this a real problem in this particular situation, and what the real outcomes here might be?

Obviously we don't have data for the use of the metaphor in a pandemic, since obviously it isn't that common to have pandemics and when we do, inevitably the politicians would employ this one due to its political expediency.

However, extrapolating from general medical studies, the pain scores and psychological outcomes are poorer. Mostly this was done in arthritis and carcinoma, but even in infective diseases this holds true. I have added a few studies below, but you can do your own literature study if you are interested.

https://www.researchgate.net/publication/280867057_Pain_as_metaphor_Metaphor_and_medicine
Patients' experience of cancer: evidence of the role of 'fighting' in collusive clinical communication - PubMed
Ascribed meaning: a critical factor in coping and pain attenuation in patients with cancer-related pain - PubMed
Coping strategies and individual meanings of illness - PubMed
https://www.researchgate.net/public...eases_and_War_How_to_Use_it_and_not_to_Use_it

FrumiousBandersnatch · Dec 1, 2020

I think the metaphor was less about the virus and more about an appeal for national unity in a time of extreme polarisation - if the virus hadn't been around, he would have found some other perceived national problem as a focus for unification.

I have my doubts how effective it will be or whether there will be any of the suggested negative effects in the medical sphere... but I think it was an attempt at unifying rhetoric, the kind of thing Biden thinks necessary and statesman-like in times of national divisiveness.

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