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6 Case Study – The Media, Metaphors and Alzheimer’s Disease

6 Case Study – The Media, Metaphors and Alzheimer’s Disease

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16.6



Case Study – The Media, Metaphors and Alzheimer’s Disease



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they offer a collective voice for otherwise marginalized people, they provide understanding of particular conditions and suffering and a framework and language for

articulating experience, needs and claims.

Much of what is known about the social situations of people with dementia and

their families is due to the work of advocacy organizations. Media coverage of

dementia usually includes comment from advocacy organizations and the increase

in media coverage in many countries is paralleled by the growth of advocacy organizations. However while media depictions of dementia can increase the visibility of

people with Alzheimer’s disease, an unintended consequence is that they may inadvertently increase the stigma encountered by people with the disease and their families and carers. In 2012 Alzheimer’s Disease International revealed that nearly one

in four people surveyed with dementia concealed their diagnosis citing stigma as the

main reason. The stigma of dementia can be amplified by media depictions which

focus on people with dementia in the late stages of their illness, when they are often

unable to communicate verbally and attend to their daily hygiene, grooming and

nutritional needs. Because the media focus largely on the late stages of dementia,

people may wrongly assume that as soon as the diagnosis is made, the person can no

longer make decisions or care for themselves (Batsch and Mittleman 2012).

On the other hand positively biased portrayals of people with dementia can also

have negative consequences if they lead to an underestimation of the challenges of

living with dementia. Kessler and Schwender (2012: 268) make the point that overly

positive portrayals may “leave people unprepared (psychologically, financially and

otherwise) to deal with the inherent losses that accompany the dementia process”.

They also suggest that the idealised world of news magazine photography may lead

policy makers and members of society to think that less effort is required to increase

the quality of life for people living with dementia.

At its most severe, the stigma associated with dementia has been equated with

‘social death’. The concept of ‘social death’ has a long history in sociology (Goffman

1963; Glaser and Strauss 1965; Sudnow 1967) and refers to the way certain people

are treated as ‘non-people’, that is, they are viewed as socially ‘dead’ even though

their bodies are still biologically alive. The use of the concept in relation to dementia commenced in the 1990s when Sweeting and Gilhooley (1997) proposed that

individuals with late stage, dementing illness are likely to be regarded as socially

dead. These authors identified three conditions which attract ambiguous and negative interpretations and are likely to result in social death: protracted and progressive illness, extreme old age and illness that strips personhood. All three conditions

are present in Alzheimer’s disease thus multiplying the likelihood of those diagnosed being regarded as socially dead or, at the very least, no longer a well-defined

person (Sweeting and Gilhooley 1997).

Clarke (2006: 269) identified “the absence of a person with a disease as a person

with a voice, with needs and desires” as one of the most notable findings in her

study of the coverage of Alzheimer’s disease in Canadian mass print magazines.

The way language is used by the media is crucial to the discursive construction of

the cultural meanings of dementia. George (2010: 586) writes in The Lancet that

“the everyday language we use to describe dementia shapes our perceptions of brain



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Health and the Mass Media



aging and even contributes to the “social death” of those most severely affected”. He

is critical of the military metaphors used to describe Alzheimer’s disease where

people with dementia are portrayed as ‘victims’ waging a battle against the

disease.

There is a dilemma for Alzheimer’s disease organizations that advocate on behalf

of people with dementia in that their aim is to support and reassure people with

dementia and their families, while at the same time, as voluntary organizations they

need to raise funds to support this activity. In the past, the most effective way of

achieving public support has entailed employing “horror” stories about people with

dementia (Taylor 2010 cited in O’Donovan et al. 2013: 317). These stories often

make reference to ‘burden’ either at an individual level when reference is made to

‘carer burden’ or at societal level in terms of the burden imposed by the aging population. In both cases the very use of the word ‘burden’ is evidence of the negative

connotations of Alzheimer’s disease.

Ensuring that people with dementia speak for advocacy organizations is one way

of reducing stigma as it shows people with dementia taking an active role in an

organization, however Beard (2004) notes that advocacy organizations have been

slow in identifying and using public spokespersons. In part, this is due to the origins

of the movement as carers’ support organizations and not initiated by, or originally

intended for the person with the condition. More recently O’Donovan and colleagues (2013: 317) noted that these organizations now “publicly identify as carers’

and patients’ organizations, reflecting a process of hybridization of their cause”. In

their examination of the Alzheimer’s Disease Society in Britain and the Alzheimer’s

Disease Society in Ireland they show two phases in the history of both these organizations. In the first phase the organizational focus was on supporting carers of people with dementia and in the second phase the focus is on people with dementia and

their carers. This shift has increased the visibility of people with dementia and

expanded the role of the organization.

However despite the negative stereotypes in media reporting, some improvements have occurred. Doyle and colleagues (2011) assert in a study of Australian

media reports from 2000/2001 to 2006/2007 that both the quantity and quality of

reporting had increased over this time period. Another study which identified

improvements in reporting in German weekly news magazines between the years

2000 and 2009 suggested that “the increasing frequency of appearance of the PWD

(person with dementia) makes living with dementia less of a taboo” (Kessler and

Schwender 2012: 268).

The influence of the media is not all in the direction of the lay public or health

consumer. Popular books, newspapers and magazines may also influence both lay

and professional providers of care. The initial visibility of people with dementia

originated from those people in public positions who have spoken out about their

own experience of having the disease. In the past these people have included film

and television personalities like Charlton Heston, public figures like Hazel Hawke,

the wife of the Australian Prime Minister Bob Hawke, and writers like Terry

Pratchett. Paralleling these personal accounts have been the biographical and

fictional works from Iris: A Memoir of Iris Murdoch (Bayley 2002) to Still Alice



16.7



Fictional Medicine: The Portrayal of Doctors and Nurses in Television



241



(Genova 2009), both adapted into films and starring well-known celebrity actresses

Judi Dench and Julianne Moore.

The narratives of those caring for a person with dementia are gendered with more

of the narratives from women caring for men than from men caring for women.

Alzheimer’s disease organizations in countries like New Zealand are also gendered

workplaces with women making up most of the field workers (Kirkman 2011). This

is not unusual as many of these workers have a background in nursing and nursing

remains a female dominated occupation. However it does mean that when a representative from Alzheimers New Zealand is asked to provide an informed comment

to the media it is the voices of women that appear. Sociolinguists (e.g. Holmes

2006) have shown how the way women speak is judged to be different than that of

men, with gender stereotypes being brought into play. Men’s narratives may be

viewed as more authoritative and this has implications for how the messages that

advocacy organizations want to disseminate to the wider population are received.



16.7



Fictional Medicine: The Portrayal of Doctors

and Nurses in Television



A multitude of fictional doctors and nurses have passed over television screens since

the inception of television. In Britain there was Emergency Ward 10 (ITV 1957–

1967) and Dr Finlay’s Casebook (BBC 1962–1971) and in North America there

was Dr Kildare (MGM 1961–1966) and Dr Casey (ABC 1961–1966). These programmes also featured in other English speaking countries like Australia, New

Zealand and Canada. By the 1980s we had St Elsewhere’s and in Australia The

Young Doctors became a long running programme, as did Shortland Street in New

Zealand. Medical dramas continue to be popular, including Casualty (BBC 1986-),

Holby City (BBC 1999-), ER (NBC 1994–2009), Doc Martin (ITV 2004–2013),

House MD (Fox 2004–2012) and Grey’s Anatomy (2005-). Medical dramas are

often screened on prime-time television which means they attract a wide audience

(Harris and Willoughby 2009).

These programmes illustrate changing gender roles with the early programs featuring predominantly male doctors and female nurses. When the occasional female

doctor appeared on screen they were usually there as a foil to the male doctor and

often for romantic interest. By the 1980s at least one woman doctor was de rigueur

in medical dramas, reflecting in part the great increase in numbers of women entering medicine. By the 1990s some of these women doctors were occasionally, and

for a few episodes only, lesbian. However despite the increase in women doctors

their male colleagues continue to dominate the show. The portrayal of nurses has

been less complicated, with the good nurse, the bad nurse, and the ‘sexy’ nurse

(Bradby et al. 1995). These media stereotypes have had consequences for the way

in which nurses have been viewed more generally.



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As well as the portrayal of health practitioners television dramas portray medical

techniques such as cardiopulmonary resuscitation (CPR). Diem and her colleagues

(1996) found in their study of resuscitation attempts on the television programmes

ER and Chicago Hope (CBS 1994–2000) that the portrayal of CPR on television

may lead the viewing public to have an unrealistic impression of CPR and its

chances of success. Similarly, Van den Bulck (2002) found that the consumption of

medical television drama is related to overestimating survival chances after inhospital resuscitation by physicians and nurses following cardiopulmonary arrest.

Harris and Willoughby (2009) suggest that the lay public largely base their perceptions of CPR on their experience of the portrayal of CPR in the media. In their study

of CPR coverage in Casualty, Holby City, Grey’s Anatomy and ER they found that

while the immediate success rate of resuscitation of television is comparable to reality, the age distribution, difference in outcome by age and lack of intermediate and

long term outcomes have the potential to be misleading to the lay person. However,

it is not just CPR that is portrayed by medical dramas but also a whole range of

health information storylines, including contraception and sexual health (Brodie

et al. 2001), and therefore the impact of these television dramas should not be

underestimated.



16.8



Conclusion



This chapter has discussed how the media provides information about health and

health services. It is also relevant to note here in concluding that ‘health’ and ‘illness’ have also been used by the media as metaphors for the condition of society. To

write about the health of the economy and the health of society is making reference

to something greater than the health of the individuals within that society. As discussed earlier Susan Sontag (1978) first wrote of cancer as a metaphor for loss of

control, for proliferation and uncontrolled growth. She observes that both tuberculosis (TB) and cancer have been seen in the past as diseases of passion – TB as

caused by too much, and cancer as a result of too little. As passion is a threat to

economic and social stability, so cancer is a metaphor for all the real and imagined

disorders of civilisation; civilisation out of control is cancerous. And the treatment

of cancer as a disease abounds with the use of military metaphors – the tumour is

bombarded with rays, which will kill the cancer cells, the tumour may be described

as invasive, and survival is seen to depend on marshalling all the body’s defences.

The use of military metaphors have also been illustrated in the media coverage of

dementia with some commentators asking for a change in this usage. However

given the power of the media in the use of metaphors that invoke health and illness

this elimination of battle imagery is unlikely in the immediate future.

This chapter commenced with an examination of how medical events are a daily

feature of news reporting. But as we have shown health and illness are not only the

staple topics of news reporting, but also feature in magazines, film and television.

As well as providing us with factual information about health and illness, the media



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