Article Text

Download PDFPDF

The online use of Violence and Journey metaphors by patients with cancer, as compared with health professionals: a mixed methods study
  1. Elena Semino1,
  2. Zsófia Demjén2,
  3. Jane Demmen3,
  4. Veronika Koller1,
  5. Sheila Payne4,
  6. Andrew Hardie1 and
  7. Paul Rayson5
  1. 1Department of Linguistics and English Language, Lancaster University, Lancaster, UK
  2. 2Department of Applied Linguistics and English Language, The Open University, Milton Keynes, UK
  3. 3Department of Linguistics and Modern Languages, University of Huddersfield, Huddersfield, UK
  4. 4International Observatory on End of Life Care, Lancaster University, Lancaster, UK
  5. 5School of Computing and Communications, Lancaster University, Lancaster, UK
  1. Correspondence to Professor Elena Semino, Department of Linguistics and English Language, Lancaster University, Lancaster, LA1 4YL, UK; e.semino{at}


Objective To 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.

Design Computer-assisted quantitative and qualitative study of two data sets totalling 753 302 words.

Setting A UK-based online forum for patients with cancer (500 134 words) and a UK-based website for health professionals (253 168 words).

Participants 56 patients with cancer writing online between 2007 and 2012; and 307 health professionals writing online between 2008 and 2013.

Results Patients 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.

Conclusions Violence 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.

  • Cancer
  • Communication

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter Follow Elena Semino at @elenasemino

  • Contributors ES co-planned and co-conducted the research, and took charge of writing the paper. She is responsible for the content as guarantor. ZD and JD co-conducted the research and contributed to the writing of the paper. VK co-planned and co-conducted the research, and contributed to the writing of the paper. SP co-planned the research and contributed to the writing of the paper. AH and PR co-planned the research, conducted the data collection and commented on the paper.

  • Funding Economic and Social Research Council; grant numbers: ES/J007927/1; ES/K002155/1).

  • Competing interests None.

  • Ethics approval All data analysed in the study were obtained from publicly accessible online fora. The organisation in charge of the patient online forum was informed of our data collection process. Research ethics approval for the study was obtained from Lancaster University, Lancaster, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.