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    What It Means When Epidemic Prevention Becomes a ‘War’

    Treating illness like a battle can help mobilize popular support, but what about the long-term risks?

    In her book “Illness as Metaphor,” Susan Sontag explores the various ways society has sought to understand diseases through metaphoric expressions, and how those metaphors are translated into a politics that governs the lives of the ill. One of the most common metaphors she analyzes has been all but inescapable during the current pandemic: illness prevention and treatment as a kind of “warfare.”

    This language isn’t limited to COVID-19. As Sontag found after being diagnosed with breast cancer, the spread of cancerous cells through the body is often likened to a process of “invasion” and “colonization”; the purpose of treatment is to “kill” the invasive pathogens or tumors. “When a patient’s body is considered to be under attack, the only treatment is counterattack,” she writes.

    The widespread use of these metaphors can be traced to the popularization of germ theory in the late 19th century. At the time, scientists understood their work as identifying “evil” pathogens that invade the body and cause illness. Their job was to “defend” the body, “counterattack,” and “destroy” the intruder.

    Warfare as a metaphor for illness long predates the 19th century, however. In traditional Chinese medicine, illness is frequently likened to a kind of assault. “The Inner Canon of the Yellow Emperor,” compiled more than 2,000 years ago, states that diseases are caused by a series of invasions by “external evil.” Over the centuries, military metaphors became entrenched in TCM theory and practice, often expressed through binary opposites like “internal righteousness” and external evil.

    In the first half of the 20th century, the gradual influx of Western medical knowledge introduced new military metaphors for disease to China, where they gradually combined with their TCM counterparts to create an attitude of militant hostility toward illness. Medical workers became frontline “soldiers,” the immune system was seen a kind of fortification, and drugs were humanity’s weapons in the fight against disease.

    After the founding of the People’s Republic in 1949, military metaphors were almost de rigueur in Chinese mainstream media coverage of illness, especially during times of political turmoil or epidemics. In an analysis of articles on disease published in the People’s Daily between 1946 and 2019, I found the use of military metaphors peaked during both the Cultural Revolution and the 2002-2003 SARS outbreak. I also found that the use of aggressive language, such as calls to “eliminate” or “battle” a disease, were more common than expressions like “build lines of defense” or “resist the epidemic.” Military metaphors of all kinds were accompanied by collective subjects — “we,” “everyone,” and “all the people” — that emphasized the masses over the individual.

    This tendency has carried over into the current pandemic. Facing an outbreak of unprecedented scale, China has relied on militarized language to mobilize public opinion and secure people’s cooperation in epidemic prevention work. In COVID-19 articles published on the official Weibo social media account of the People’s Daily, military metaphors were second in importance only to terms directly describing COVID-19 itself. The purpose of these metaphors is clear: uniting the Chinese people and improving national morale in the “battle” against the coronavirus.

    But the overuse of military metaphors can also bring about social problems. As Sontag notes in a later essay, “AIDS and Its Metaphors”, “Military metaphors contribute to the stigmatizing of certain illnesses and, by extension, of those who are ill.” The excessive use of military metaphors can lead people to see patients, as well as diseases and pathogens, as enemies who need to be isolated and “eliminated.” It can also lead to unnecessary levels of stress in society, as people grapple with the pressure of a protracted “war” against an illness or pathogen. This may negatively impact pandemic prevention work in the long term.

    Translator: David Ball; editors: Cai Yiwen and Kilian O’Donnell; portrait artist: Wang Zhenhao.

    (Header image: An automated loudspeaker in a residential community in Xi’an, Shaanxi province, 2021. VCG)