ObjectiveTo compare the frequencies with which patients with cancer and health professionals use Violence and Journey metaphors when writing online; and to investigate the use of these metaphors by patients with cancer, in view of critiques of war-related metaphors for cancer and the adoption of the notion of the ‘cancer journey’ in UK policy documents.DesignComputer-assisted quantitative and qualitative study of two data sets totalling 753 302 words.SettingA UK-based online forum for patients with cancer (500 134 words) and a UK-based website for health professionals (253 168 words).Participants56 patients with cancer writing online between 2007 and 2012; and 307 health professionals writing online between 2008 and 2013.ResultsPatients with cancer use both Violence metaphors and Journey metaphors approximately 1.5 times per 1000 words to describe their illness experience. In similar online writing, health professionals use each type of metaphor significantly less frequently. Patients’ Violence metaphors can express and reinforce negative feelings, but they can also be used in empowering ways. Journey metaphors can express and reinforce positive feelings, but can also be used in disempowering ways.ConclusionsViolence metaphors are not by default negative and Journey metaphors are not by default a positive means of conceptualising cancer. A blanket rejection of Violence metaphors and an uncritical promotion of Journey metaphors would deprive patients of the positive functions of the former and ignore the potential pitfalls of the latter. Instead, greater awareness of the function (empowering or disempowering) of patients’ metaphor use can lead to more effective communication about the experience of cancer.

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When faced with hardship, how do we emotionally appraise the situation? Although many factors contribute to our reasoning about hardships, in this article we focus on the role of linguistic metaphor in shaping how we cope. In five experiments, we find that framing a person's cancer situation as a "battle" encourages people to believe that that person is more likely to feel guilty if they do not recover than framing the same situation as a "journey" does. Conversely, the "journey" frame is more likely to encourage the inference that the person can make peace with their situation than the "battle" frame. We rule out lexical priming as an explanation for this effect and examine the generalizability of these findings to individual differences across participants and to a different type of hardship-namely, an experience with depression. Finally, we examine the language participants produced after encountering one of these metaphors, and we find tendencies to repeat and extend the metaphors encountered. Together, these experiments shed light on the influential role of linguistic metaphor in the way we emotionally appraise hardship situations.

This study combines quantitative semi-automated corpus methods with manual qualitative analysis to investigate the use of Violence metaphors for cancer and end of life in a 1,500,000-word corpus of data from three stakeholder groups in healthcare: patients, family carers and healthcare professionals. Violence metaphors in general, especially military metaphors, are conventionally used to talk about illness, particularly cancer. However, they have also been criticized for their potentially negative implications. The use of innovative methodology enables us to undertake a more rigorous and systematic investigation of Violence metaphors than has previously been possible. Our findings show that patients, carers and professionals use a much wider set of Violence-related metaphors than noted in previous studies, and that metaphor use varies between interview and online forum genres and amongst different stakeholder groups. Our study has implications for the computer-assisted study of metaphor, metaphor theory and analysis more generally, and communication in healthcare settings.