Discourse, medical metaphor and the East Asian medicine approach to conflict resolution

Abstract

This article analyses how threats and dangers have been understood through biomedical metaphors in international relations (IR) and US security discourse, suggesting an alternative to such understandings based on an East Asian medicine (EAM) approach to world politics. By conducting a genealogical study of US security discourse, I argue that medical and disease metaphors, such as communism as a disease in the Cold War era and terrorism as a cancer in the post-Cold War period, were broadly utilised by US policymaking elites in the discursive formation of foreign and security policies. This delineated how the specific issues should be understood by ordinary people; it also suggested measures, such as containment, targeted killings, and surgical strikes, to tackle security threats. As real-world policy practices have demonstrated, the Westphalian understanding of security and conflict resolution, characterised by the utilisation of medical analogies and the necessity of coercive responses, may be inherently flawed. To address the security threats and maintain stability in a specific region, the EAM approach to world politics and conflict resolution is proposed, which is defined by non-coercive actions (wuwei); furthermore, transformability should be operated from within, and the yin–yang theory of harmonious relations could contribute to long-term peace.

Keywords:

• Discourse
• medical metaphors
• disease metaphors
• East Asian medicine (EAM)
• conflict resolution

Introduction

Metaphors and metaphorical thoughts have been utilised by individuals and societies throughout human history. However, the concept of metaphor has traditionally been studied as a poetic device and as a rhetorical flourish by scholars of literature and language.¹ Nevertheless, in recent decades, the significance of discourse, language and words has begun to be discussed by international relations (IR) scholars, especially after the post-positivist approach to international politics was introduced to IR scholarship in the late 1980s.² Discourse- or rhetoric-oriented researchers argue that discourse, narratives and metaphors are essential in our world; they not only help individuals frame and understand the situations they face, but also co-constitute the social world.³ To further study the function of metaphors, IR scholars tend to concentrate on metaphors’ heuristic, interactional and persuasive roles. The heuristic role indicates that, via strategic use of metaphors, the target audience can easily understand a complex or remote situation.⁴ The interactional role refers to a specific rhetorical skill that highlights the use of analogies as a means of discursive expression and knowledge production.⁵ Finally, in terms of the persuasive role, relevant research particularly focuses on the analysis of how politicians and policymaking elites use metaphors to conceptualise a specific subject or event and further rationalise and justify the initiatives conducted by government authorities.⁶

In addition to these conceptual and instrumental roles, prior research has explored how social reality and truth are discursively and metaphorically constructed, and how discourses function to produce subjects, objects and their relations.⁷ George Lakoff and Mark Johnson argue that metaphors not only create realities, but also guide future actions; they also emphasise that metaphors can be self-fulfilling prophecies.⁸ Specifically, by defining a particular event as a war (ie the utilisation of a war metaphor), an external, foreign and hostile enemy is discursively and metaphorically constructed; and importantly, the specific interpretation per se implies and suggests a series of war plans together with certain political and economic actions, such as intelligence gathering, sanctions and military deployment. In addition, Roxanne Lynn Doty, by employing a discursive practices approach, denaturalises the world order dominated by two superpowers, and illustrates how US Cold War foreign relations were constructed and constituted due to the production of discursive spaces within which a hierarchical structure was created based on subjects’ identities and their positions vis-à-vis one another.⁹ Identifying itself as ‘an initiator of action’, ‘a formulator of policy’, ‘an assessor of situations’ and ‘a definer of problems’ over the past several decades, the United States consistently perceived itself as a unique nation that had the obligation to transform the world and fight against the threats that might challenge the free world and Western civilisation; other countries, especially the countries in the Third World, were forced to accept the guidance and protection of the United States.¹⁰

By adopting a post-positivist approach to IR, this paper provides a metaphor-based analysis of US security discourse, and suggests an alternative understanding of threat and danger identified by decision- and policymaking elites. Given the United States’ record in shaping and dominating international politics, the way it understands and engages with the world is worthy of further examination. Using a genealogical study of US security discourse, the present research illustrates that, since World War II, US administrations have continually utilised medical or disease metaphors to frame and conceptualise the particular threats that the US has faced, such as communism, terrorism and the so-called rogue states. The specific expression of threats and dangers based on biomedical thinking not only has affected the ways in which these subjects – that is, communism, terrorism and rogue states – should be comprehended, but also has suggested particular measures for dealing with them. Accordingly, US political elites have widely adopted the containment and coercion approach to conflicts and conflict resolution. However, real-world policy practices have demonstrated that the understanding of (in)security and conflict resolution may be inherently flawed and not as efficient as the security apparatuses initially expected. The genealogical study of US security discourse not only contributes to a comprehension of US foreign policy practices, but also provides a critical reflection on the contingent and ad hoc nature of particular events and things. If biomedicine-informed security policy thinking emphasises the significance of using lethal force, the worldview of East Asian medicine (EAM) is characterised by the notions of non-intrusive actions (wuwei), the yin–yang theory of harmonisation and the belief that transformation operates from within.¹¹ Although biomedicine and EAM differ in their understanding of disease (or symptom) identification and medical treatment, it should be particularly noted that the discussion of EAM in this research does not aim at reproducing an East/West binary opposition. Instead, this research stresses the concept of yin–yang dialectics and illustrates how this specific concept could contribute to an alternative understanding of conflict and conflict resolution.

Following the introduction, this article comprises five major sections. The first section introduces the use of metaphors and metaphorical thoughts in IR scholarship and the political sphere. The second section provides a genealogical study of contemporary US security discourse, illustrating that the decision- and policymaking elites in Washington, DC have consciously utilised medical and disease metaphors to conceptualise the identified threats and dangers and that the discursive origins of these metaphors can be traced back to the 1940s. The third section problematises the medical expression of threats and dangers and reveals the consequences of the biomedical approach to conflict and conflict resolution. The fourth section sketches out the EAM worldview and explains how the EAM approach could provide an alternative understanding of conflict and conflict resolution, and ultimately contribute to sustainable peace. Finally, a conclusion is provided.

Metaphorical thoughts in IR scholarship and the political sphere

The study of metaphors and metaphorical thoughts has attracted increasing attention and generated wide discussion in the field of IR, especially after constructivist and other post-positivist approaches to IR emerged in the late 1980s. According to Nicholas Onuf, the discussion of metaphorical thoughts can be traced back to ancient Greece.¹² In Rhetoric, Aristotle mentions that metaphors ‘should help us “get hold of something fresh”, and they “must not be far-fetched”, or they will be difficult to grasp, nor obvious, or they will have no effect’.¹³ In his Poetics, Aristotle indicates that ‘metaphor consists in giving [a] thing a name that belongs to something else’.¹⁴ Aristotle’s arguments thus illustrate the conceptual and analogical roles of metaphors. By utilising metaphorical thoughts and expressions, speakers and interpreters can easily introduce a specific subject and explain a complicated concept or idea to their target audience.

In IR scholarship or, more broadly, the political sphere, scholars, theorists and political professionals have frequently adopted metaphors and metaphorical thoughts to conceptualise theories and elaborate on particular situations that the world or certain countries have experienced.¹⁵ Post-war US policymaking elites adopted metaphorical concepts such as ‘malignant parasite’, ‘domino theory’ and ‘iron curtain’ to illustrate the communist threats and express the particular situations that several specific countries faced. Moreover, at the height of the Cold War, leaders in the United States and Soviet Union adopted the policy of nuclear deterrence to prevent their competitors from using nuclear arms. Scholars also introduced specific concepts such as ‘the prisoner’s dilemma’, ‘game theory’ and ‘the chicken game theory’ to interpret the relations between the two superpowers.¹⁶ In so-called game theory, the US and the Soviet Union were perceived as two rational players; ‘chicken’ is metaphorically understood as an analogy for nuclear deterrence.¹⁷ Given that the consequences of nuclear warfare are catastrophic, both the United States and the Soviet Union attempted to prevent a pre-emptive military strike.¹⁸ The chicken game theory is seen as a classic example of metaphorical thought.

Since the 1970s, metaphorical thoughts have been broadly utilised in IR theorising. In IR scholarship, metaphors have been employed not only to conceptualise individuals’ understanding of world affairs, but also as a way to analyse international politics. The mainstream IR theories – realism, liberalism and constructivism – share the same theoretical assumption in which states are the main actors of international politics, although the roles of non-state actors are also highlighted in liberalism and constructivism. States, as they are interpreted in mainstream IR theories, are metaphorically conceptualised as independent individuals, acting based on the principle of rationality and making efforts to secure their interests.¹⁹ Related to this, the realist interpretation of IR is characterised by the contextual metaphors of ‘anarchy’, ‘system’ and ‘structure’; these contextual metaphors ontologically shape the nature of IR and establish the setting in which IR takes place.²⁰ Realists also argue that interactions among states are determined by the distribution of power. Although ‘power’ is an abstract concept that does not exist ontologically, the realists’ definition of the term implies that power can be measured, quantified, and distributed.²¹

Like realists, constructivists have employed metaphorical concepts to build their theory. Constructivists argue that the world is socially constructed and constituted; thus, living in an ‘international society’, state actors’ identities, roles and behaviours are shaped, regulated and constrained by intersubjective norms and rules.²² For constructivists, although norms – defined as standards or patterns of social behaviours – may not always be found, they profoundly affect how actors should behave in international society.²³ To further explain the concept of norms, constructivists use the ‘life circle’ metaphor to elucidate the origins and internationalisation of norms.²⁴ Scholars frequently seem to use the ‘state-as-person’ and ‘human beings’ metaphors to frame and construct their IR theories.

Other metaphorical concepts contribute to the knowledge production of IR. For instance, ‘container’ and ‘equilibrium’ metaphors are often used in discussions about the European Union and EU integration.²⁵ The different understandings of the EU suggest different ways to study European politics – that is, supranational versus intergovernmental approaches. By interpreting the EU as a ‘container’, the EU is comprehended as a ‘fixed unit’ that acts independently as a sovereign state.²⁶ Therefore, issues related to federalism, comparative politics and European constitutionalism are discussed and elaborated upon.²⁷ However, the ‘equilibrium’ metaphor conceptualises the EU as a supranational institution constructed and constituted by various member states.²⁸ Accordingly, the accounts of liberal intergovernmentalism, international law, diplomacy and balance of power are of particular concern in this framework.²⁹

Regarding the implication of metaphors and real-world policy practices, scholars have empirically studied these topics and demonstrated that policymakers have purposefully adopted metaphorical thoughts to frame their foreign and security policies. As Chilton and Lakoff indicate, ‘metaphors are among our most important tools for comprehending the world. They are necessary tools for understanding the nature of world politics and for formulating policy’.³⁰ Research on the US-led War on Terror campaign has also illustrated that metaphors are not mere rhetoric; rather, they can guide policy practices and have a political effect. Since the 1980s, US administrations have tended to use the ‘war’ metaphor to conceptualise terrorist attacks targeted at US citizens and respond militarily to those attacks.³¹ By interpreting a terrorist attack as an act of war, the US Department of Defense and the National Security Council plot the subsequent war plans. Consequently, the move towards the war against terrorism is regarded as inexorable; other, non-coercive measures, such as criminal investigation and law enforcement, are seen as impracticable.

Recent research has demonstrated that the Obama administration broadly utilised metaphors in its foreign policy formulation and how particular metaphors shaped US foreign relations. In 2012, to respond to Syria’s civil war and address the possibility of US intervention, President Obama famously warned Syria’s ruling regime that it would cross a ‘red line’ if it used chemical weapons against civilians and rebel forces. By using the ‘red line’ metaphor, the US administration sent a particular political message to its Syrian counterpart and implied a potential military action drafted by the US.³² Moreover, the Obama administration claimed that its counterterrorism strategy would be guided by the so-called ‘light footprint’ principle. That specific principle indicated that, in contrast to the large-scale military surge implemented by the George W. Bush administration, the Obama administration would continue to lead a war against terrorism and violent extremism while sharing its burdens with US allies. Thus, the size of the US army in the Middle East was reduced, and the Obama administration’s counterterrorism initiatives were characterised by the wider use of special military forces and unmanned aerial vehicles (UAVs). In addition, President Obama’s ‘pivot’ to Asia policy and his expectation about US–Russian relations, denoted by the phrase ‘pushing the reset button’, reveal that metaphors and metaphorical thoughts are constantly utilised in the political sphere, and importantly, they have a political impact.³³

A genealogy of medical metaphors in US security discourse

Since the onset of the Cold War, US policymaking elites have widely used medical metaphors to frame and structure their security discourse. Successive US administrations have adopted metaphorical terms, such as disease, malignant parasite, germ, scourge, cancer, tumour, cell and toothache, to interpret the particular threats that the United States has faced, such as communism in the Cold War period and terrorism, terrorists and rogue states in the post–Cold War era. The specific interpretation of threat, danger and crisis not only shapes the understanding of a particular security issue shared by security apparatuses and ordinary people, but also stresses the significance of utilising military forces to tackle the threats identified by government authorities.

The use of a pathology metaphor in the contemporary US political arena can be traced to the 1940s.³⁴ The most notable examples are the discursive formation of the Truman Doctrine and George Kennan’s ‘long telegram’ from Moscow. To protect Greece and Turkey from the so-called Soviet threat, Dean Acheson, then the US Under Secretary of State, met with several key influential senators on Capitol Hill, to discuss the urgency of US financial assistance.³⁵ Adopting the pathology metaphor, Acheson explicitly indicated:

No time was left for measured appraisal. In the past eighteen months, I said, Soviet pressure on the Straits, on Iran, and on northern Greece had brought the Balkans to the point where a highly possible Soviet breakthrough might open three continents to Soviet penetration. Like apples in a barrel infected by one rotten one, the corruption of Greece would infect Iran and all the east. It would also carry infection to Africa through Asia Minor and Egypt, and to Europe through Italy and France, already threatened by the strongest domestic Communist parties in Western Europe. (emphasis added)³⁶

Echoing Acheson’s interpretation of the communist threat as a disease that could infect countries in the Middle East, Africa and Europe, President Truman urged US nationals to support the anti-Soviet policies prompted by his administration, arguing, ‘If Greece should fall under the control of an armed minority, the effect upon its neighbor, Turkey, would be immediate and serious’.³⁷ Truman claimed that ‘confusion and disorder might well spread throughout the entire Middle East’, and the collapse of Greece would cause ‘a profound effect upon those countries in Europe’.³⁸ By employing a specific linguistic device, President Truman and his political advisors metaphorically constructed communism and communist ideology as a disease. Moreover, in the US Cold War discourse, many key US allies were portrayed as cell-like countries that could be infected by the specific disease spread by the Soviet Union. To protect Central and Eastern Europe from ‘Sovietization’, US Congress consequently passed relevant acts that aimed at building up Turkey’s and Greece’s military and economy.³⁹

In addition to the Truman Doctrine, Kennan’s expression of the Soviet threat and his introduction of the containment strategy similarly utilised a disease and medical metaphor. On 22 February 1946, the former US ambassador to the Soviet Union wrote a lengthy analysis of Soviet policy in Moscow. In this document, the Soviet threat was conceptualised as a ‘malignant parasite’ and a ‘creeping disease’ that spread ‘germs’ to the whole world; therefore, it threatened freedom and Western democratic institutions.⁴⁰ To tackle the dangerous threat posed by the ‘neurotic’ Soviets, Kennan stated that the US should act as a ‘doctor’ and conduct a medical examination for any ‘unruly and unreasonable individual’.⁴¹ Importantly, as Kennan argued, the ‘health and vigor of [American] society’ would be the solid foundation of US anti-communism initiatives.⁴²

Kennan’s firm attitude towards Soviet communism can also be found in his Foreign Affairs article titled ‘The Sources of Soviet Conduct’. He argued that the Soviet Union is an ‘impotent’ and ‘sterile’ nation, and the threats posed by Moscow should be carefully controlled through a delicate strategy of containment. Kennan argued, ‘the main element of any United States policy toward the Soviet Union must be that of a long-term, patient but firm and vigilant containment of Russian expansive tendencies’.⁴³ For Kennan, the communist threat was not irremediable; instead, it could be ‘contained by the adroit and vigilant application of counter-force’ at ‘a series of constantly shifting geographical and political points’.⁴⁴ Kennan’s interpretation of the Soviet threat was widely shared by US policymaking elites during the Cold War; his containment strategy directed US anti-communism initiatives, such as financial support for Greece, Turkey and other European countries, and the construction of the North Atlantic Treaty Organization and the Central Treaty Organization.

Like the discursive formation of the communist threat, US political elites employed medical and disease metaphors to conceptualise the world and the country’s rivals that it engaged with during the Cold War era. After the collapse of the Soviet Union, terrorism, terrorists and the so-called rogue states replaced communism and communists as the major threats to the United States – although the issue of terrorism had been noted by the Reagan administration in the 1980s. During Reagan’s terms as president, terrorism and terrorists were discursively constructed as the antithesis of democracy, and US policymaking elites identified them as a particular issue that was directly connected to broader US anti-Soviet policies.⁴⁵ Then-Secretary of State Alexander Haig criticised the Soviet Union’s policy of ‘training, funding, and equipping’ international terrorists.⁴⁶ President Reagan also argued that the emergence of state-sponsored terrorism could be traced back to ‘increased Soviet support for terrorism, insurgency, and aggression coupled with the perception of weakening US power and resolve’.⁴⁷ Additionally, in the official lexicon, terrorism was depicted as a ‘cancer’ and a ‘plague’ that created chaos and destabilised Western civilisation. The Reagan administration claimed that ‘the plague of terrorism’ would ‘spread like a cancer, eating away at civilized societies and sowing fear and chaos everywhere’.⁴⁸ By adopting a medical metaphor, terrorism was portrayed as a disease that could strike anyone and anywhere. It is important to note that the specific interpretation of a terrorist threat also implied that there was, in fact, no cure for this disease, as there was no effective treatment for cancer. Thus, terrorism and terrorists were described as highly dangerous.

The Reagan administration’s discursive invention of terrorism and terrorist threats is arguably the rhetorical foundation of the metaphors used by his successors.⁴⁹ The Clinton and George W. Bush administrations employed disease and medical metaphors to structure their political discourses on terrorism and counterterrorism. For example, John Deutch, Director of the Central Intelligence Agency (CIA) under President Clinton, argued that ‘terrorism, like the plague in the Middle Ages, frightens leaders and citizens. It is a disease that is spreading; its cure is unknown’.⁵⁰ President Bush’s Secretary of State Colin Powell and Secretary of Defense Donald Rumsfeld adopted the same theme to conceptualise the specific threat identified by the US administration. The former referred to the ‘scourge of terrorism’ when he justified the US-led War on Terror after the terrorist attacks that occurred on 11 September 2001; the latter claimed that ‘terrorism is a cancer on the human condition and we intend to oppose it’.⁵¹ Furthermore, President Obama adopted the medical analogy in relation to the threat of terrorism when he expressed the severe threats posed by violent extremism and the Islamic State in Iraq and Levant (ISIL). With that threat, he argued and illustrated that the ‘cancer’ of ‘violent extremism … has ravaged so many parts of the Muslim world’,⁵² and it will take time to ‘eradicate a cancer like ISIL’.⁵³ In line with his predecessors, President Obama referred to the ‘scourge of violent extremism and terrorism’,⁵⁴ emphasising that, if left unchecked, this ‘scourge’ could pose a threat beyond the Middle East.⁵⁵ Since the Reagan administration, terrorism and terrorists have been metaphorically expressed as a disease and a borderless threat that severely threatens the US and the entire world. Additionally, a military and coercive approach aimed at eliminating the threats has been stressed and adopted by various US administrations.

In the 1990s, US administrations used the pathologised metaphor to interpret the so-called rogue states or backlash states. Anthony Lake, National Security Advisor to President Clinton, had argued that even without a major threat from the Soviet Union, the world order was still challenged by several recalcitrant, outlaw and backlash states, such as Cuba, North Korea, Iran, Iraq and Libya.⁵⁶ Lake also mentioned that these countries are ‘more likely to sponsor terrorism and traffic in weapons of mass destruction and ballistic missile technologies’.⁵⁷ To tackle the identified threats, Lake further indicated that the US administration must diplomatically, militarily, economically and technologically isolate these ‘rogue states’.⁵⁸ Notably, while discussing the specific policy towards Saddam Hussein’s Iraqi regime and when considering Iraq’s geopolitics significance in deterring the Iranian threat, the US administration metaphorically referred to Iraq as a ‘toothache’ that could be treated through the so-called dual-containment strategy aimed at surveilling and controlling the behaviour of Saddam’s regime.⁵⁹ For the Clinton administration, although the Saddam Hussein regime posed threats to the US and its key allies in the critical region, it did not constitute an urgent threat that had to be immediately overthrown. However, after the tragedy of 11 September 2001, the toothache metaphor was dropped by the Bush administration, and the Saddam Hussein regime was militarily overthrown because President Bush and his national security team perceived the Saddam Hussein regime as a greater threat for hosting the terrorist network that launched the 11 September terrorist attacks.⁶⁰

Problematising the pathologised security discourse

In addition to the roles of meaning making and policy persuasion, metaphorical concepts profoundly affect real-world policy practices – both discursively and materially. As Lakoff and Shimko indicated, metaphors and metaphorical concepts play significant roles in foreign policy decision-making and their use is ‘commonplace and inescapable’.⁶¹ Indeed, metaphorical expressions do not merely suggest particular approaches to tackling the threats identified by government authorities, but they also limit and constrain the options that can be adopted by decision- and policymaking elites. By interpreting communism and terrorism as a disease or cancer, containment and other coercive approaches to counterterrorism are viewed as the most sensible way to address the threats; other non-coercive approaches are seen as inefficient and excluded. Given that tumour-excision treatment is understood as the most common measure to treat cancer, US decision makers perceive surgical strikes and targeted killings as the most reasonable way to eliminate terrorism and terrorists. However, real-world policy practices illustrate that the military precision of tumour-excision techniques – drone strikes and smart bomb deployments – conducted by US and Western military forces may not bring about the effects decision makers expected, and that the application of violence would be highly likely to provoke retaliation, anger and resistance. To date, terrorism and violent extremism remain among the major perceived threats to the United States and to many Western democracies. Moreover, US military professionals are still fighting a war against terrorists and extremists in the greater Middle East.

As illustrated above, US officials have constantly utilised medical and disease metaphors to interpret the threats that the US and international societies face – namely, communism, terrorism and rogue states. Similar metaphorical expressions have been employed to depict so-called terrorists (or extremists). In US security discourse, terrorists or violent extremists are frequently interpreted as distinct individuals with psychological issues. Moreover, the US security apparatus and officials widely use related terms, such as psycho, twisted, hatred, madness, senseless, perverse, irrational, fanatical, loathsome, bloodshed and brutal, to erroneously focus on mental health problems in the description of perpetrators of political violence.⁶² This is not to say that all perpetrators of terrorist attacks are truly innocent and should not take full responsibility for the acts they committed. Rather, the aforementioned interpretation leads to specific political consequences and fulfils certain political purposes. For instance, it functions to depoliticise terrorism and dehumanise terrorists and extremists, and it fails to reflect on the fundamental causes of violence. Importantly, the proposed counterterrorism initiatives that use lethal force are eloquently justified and seen as indispensable because of this.

Critical terrorism studies scholars have argued and demonstrated that terrorism and extremism should not simply be attributed to religion and other ideologies.⁶³ Instead, many terrorist organisations and their affiliates use violent means to achieve certain political aims. Using brutal approaches, Osama bin Laden and al Qaida expressed antipathy towards foreign interventions, which were mainly conducted by the US and Western countries, and the Western military presence in the Middle East; moreover, they were highly dissatisfied with how Western countries addressed the Israeli–Palestinian conflicts.⁶⁴ Even ISIL, a highly notorious extremist group that emerged in Iraq and Syria in 2014, sought to build a caliphate-governed state in its territories.⁶⁵ However, the causes of political violence stated above are rarely mentioned by government authorities. In official US interpretations, terrorism is often portrayed as religious zealotry; terrorists are said to act violently because of their hatred of Western civilisation and values. Because they are psychotic, senseless and fanatical, they are irrational, insane and brutal; accordingly, they cannot be negotiated with. This principle of granting no concessions is clearly articulated in various official US documents, such as the ‘National Security Strategy’, the ‘National Counterterrorism Strategy’ and the ‘Patterns of Global Terrorism’, and most countries’ counterterrorism practitioners follow them.

To tackle the threats posed by terrorists and extremists, US administrations have viewed the military-oriented approach as the most suitable. The use of US military forces has been adopted by every president since President George W. Bush declared the War on Terror. In addition to conventional military operations, special military forces and the CIA-led targeted killing programmes have been the core components of US counterterrorism initiatives.⁶⁶ The Bush, Obama and Trump administrations continually used weapons-equipped drones, killing specific targets identified by the US security apparatus. However, although Osama bin Laden and Abu Bakr al Baghdadi were killed in 2011 and 2019, respectively, it cannot be concluded that al Qaida and ISIL have been eliminated. To date, al Qaida, ISIL and other Islamic extremist groups still threaten the United States and its allies. According to a recent survey conducted by the Pew Research Centre, after two decades of the War on Terror, more than 70% of American citizens still think terrorism is a major threat to the United States.⁶⁷ Fighting against jihadist terrorists remains, at the time of writing, one of the core national security issues of the Trump administration.⁶⁸ Regarding the political situations in Afghanistan and Iraq, the newly established democracies in both countries cannot be sustained without the deployment of US military professionals; to end the prolonged war in Afghanistan, the US administration led by President Trump has started to meet and negotiate with its Taliban counterparts.⁶⁹

It is also worth noting that metaphorical concepts and medical therapies are explicitly articulated in the US counterinsurgency manual. According to The US Army and Marine Corps Counterinsurgency Field Manual, a US counterinsurgency operation can be categorised into the three following stages: the ‘stop-the-bleeding’ stage, the ‘inpatient care’ stage and the ‘outpatient care’ stage.⁷⁰ Each counterinsurgency mission comprises a cast of characters including physicians, the illness and patients. To cure the disease, front-line counterinsurgents implement medical interventions using coercive and non-coercive methods. In the initial stage, a counterinsurgency operation is comprehended as ‘emergency first aid’ for the patient (ie the population of a targeted country).⁷¹ By breaking the insurgents’ initiative and momentum, the US goal of counterinsurgency aims to protect the local population and determine conditions for further engagement. The second stage consists of creating and establishing stability in a targeted area, usually through ‘long-term recovery’ or the ‘restoration of health’.⁷² Specific plans for post-conflict construction, such as establishing legitimated governments and restoring economic activities and development, are prompted and perceived as indispensable.⁷³ The last stage aims to expand stability operations across contested regions, gradually transitioning the responsibility to the host country.⁷⁴ The articulation of US counterinsurgency implies and actually creates an asymmetric physician–patient relationship (or discursive space, in Doty’s words) within which the US physicians have the superior authority and knowledge to determine therapies and necessary measures for the local populace. The populace, with assistance from the US counterinsurgents, is expected to have self-sufficient capabilities to govern its territories.

Like the United States, the medical allegory is embedded in Canadian counterinsurgency policies also. The Canadian government defines an insurgency as a ‘communicable disease’ that can be restricted through changes in behaviour and the environment, as well as the removal of some risk factors.⁷⁵ In addition, the infected insurgents must be physically and cognitively separated from the normal and healthy populace. Regarding the concrete counterinsurgency operations, inoculation and information warfare, which aim to prevent the wider populace from being exposed to the ‘ideological infection’, are seen as indispensable. Finally, to cure the disease, both coercive and non-coercive measures are necessary therapies for the insurgency. Significantly, for insurgents who cannot be peacefully persuaded, it is justifiable to use other extraordinary measures, such as arrest, capture and targeted killing.⁷⁶ However, the real-world counterinsurgency practices have demonstrated that the use of lethal force does not make the societies subject to the intervention safer, and the use of violence often causes collateral damage, human suffering and increased spread of hatred. Hence, the pathologised security discourse is questionable and necessitates a broader debate.

EAM as an alternative approach to conflict and conflict resolution

The previous sections have demonstrated that the biomedical thinking about threats and dangers, which highlights the significance of identifying the disease and using lethal force as targeted therapies, often leads to counterproductive consequences to both the societies subject to the intervention and the United States. This is why the EAM-inspired approach, defined by the notions that transformability should be operated within and the yin–yang theory of harmonious relations, is worthy of exploration. The EAM approach could provide critical reflections on US- and foreign-led interventions and contribute to an alternative understanding of conflict and conflict resolution. Significantly, EAM could facilitate a discursive shift in both academia and the political sphere so that other, non-coercive measures could be considered and employed in conflict resolution.⁷⁷

The theoretical foundation of the EAM approach to conflict resolution is based on the ancient Chinese philosophy of Daoism.⁷⁸ Daoism advocates non-coercive action (wuwei) and holds that a natural order of change operates from within.⁷⁹ For Daoists, the emergence of a new regime can be attributed to a particular process of transformation, within which the illness of an old regime is naturally and organically redressed by the new one.⁸⁰ Thus, a forceful revolution with support from external agencies contradicts Daoist philosophy. Moreover, Daoism tends to understand all things, especially polarities, as the product of the ongoing processes of mutuality; the process of change can be understood as the generative unity of polarities. However, notably, polarities may be oppositional or complementary.⁸¹ The Daoist elaboration of ‘relativity and mutual transformability’ can be further explained by its well-known symbol of yin–yang. This is marked by a combination of crucial elements, which are as follows: two S-shaped curves (one white, one black) – which represent yang and yin – comprising the whole (a large circle), with each half retaining within it a small dot of the other (one black, one white).⁸² Although it is traditionally understood that yin and yang are mutually incompatible, yin and yang are mutually identified and interpenetrated.⁸³ Significantly, when yin–yang equilibrium is achieved, a harmonious (or stable) relationship can be expected.

Establishing a diagnosis based on the Daoist philosophy, EAM’s treatment emphasises the concept of qi. Although in EAM qi can be conceived of as an essential vitality, energy or force that constitutes and affects a being’s life,⁸⁴ it also refers to the state of being of any phenomenon. Thus, qi is comprehended as the cause, process and outcome of all activity.⁸⁵ According to EAM, sickness can be attributed to the imbalance of qi and the disharmonious conditions in the patient’s body. Hence, EAM physicians believe that when qi is stimulated and released, sickness can be cured.⁸⁶ EAM also asserts that to maintain health and happiness, individuals must resonate harmoniously – both physically and spiritually. In line with yin–yang theory, an EAM prescription stresses that good health requires balancing the spiritual with the physical so that the whole body can operate naturally and organically. Moreover, what distinguishes biomedicine and EAM is that the former tends to focus on identifying the agents of disease and tries to control, isolate and eliminate the agents, while the latter concentrates on identifying a pattern of disharmony and tries to address the imbalance in a patient’s body. The biomedical approach tends to view the body as a collection of distinct parts – such as organs, tissues and cells – that can be separated and considered in isolation; thus, a symptom-based problem-solving treatment is frequently adopted. EAM, in contrast, contends that there is no single cause of disease; rather, it is the result of the interaction of numerous factors in the patient’s life. The differences in the diagnostic methods used by physicians in EAM and biomedicine also affect the treatments they adopt. Specifically, invasive treatments, such as tumour-excision surgery and targeted therapies, are often utilised in biomedicine; however, EAM physicians often suggest non-invasive measures, such as medication, dietary remedies or lifestyle changes.

The EAM approach to disease and medication can be utilised to rethink contemporary conflicts and conflict resolution. As the real-world policy practices presented thus far have demonstrated, the biomedical way of thinking has profoundly affected how Western countries (and beyond) have dealt with identified foreign policy threats. The United States and its allies are cast as the physicians whose tasks include identifying the disease or symptom (ie threat) and suggesting options for medical treatment; they also decide whether ‘emergency care’, ‘inpatient care’ or ‘outpatient care’ should be implemented in the targeted countries. Over the past several decades, Western countries have constantly utilised tumour-excision techniques in their counterterrorism and counterinsurgency initiatives. However, academic research has demonstrated that states with powerful militaries do not win wars more often than do states (or non-state actors) with less powerful militaries, that the utilisation of special military forces and drones cannot effectively stop terrorism and political violence, and that using violence to suppress anti-government resistance or protest is, in fact, largely ineffective.⁸⁷ Moreover, the US-led War on Terror and the US regime-change plans in Afghanistan and Iraq also reveal that violence does not work when the aim is to achieve sustainable peace and implement a new democratic culture. The EAM approach to conflict resolution, which advocates the value of yin–yang dialectics and non-coercive actions, would reject a forceful regime-change plan based on the idea of military superiority and foreign intervention. Rather, it would advocate for peaceful political change (or transformability) that operates from within. Hence, non-coercive conflict-resolution measures, such as negotiation, mediation, political persuasion, non-official diplomacy and civilian-based peacekeeping, would be considered and prioritised by an EAM-minded US administration. As the prolonged US war in the greater Middle East has revealed, democracies based on foreign interventions are fragile, and it is highly likely that political chaos will return.

Additionally, the physician–patient relationship and the method of diagnosis in EAM are worth further exploration. Biomedicine is characterised by a more asymmetric physician–patient relationship, in terms of how diseases or symptoms are identified and prescriptions are given; in EAM, in contrast, the physician–patient relationship is more patient-centred as opposed to physician-centred. EAM physicians emphasise the significance of face-to-face observation and direct interactions with patients; they consider that no single symptom or body part can be understood except within the context of the whole patient. Thus, the EAM-inspired approach to conflict resolution would encourage decision makers and policy practitioners to think about and respond to the perceived threat within its specific social and political contexts so that the fundamental causes of conflict and political violence could be cautiously examined and addressed.

Furthermore, to understand the real causes of violence, a conflict-resolution plan would advocate a wider cooperation among all parties in conflicts and seek an acceptable solution based on the value of mutual respect and collective insights. That is to say, in the EAM way of thinking, the relationships between and among states (or non-state actors) may not necessarily be hierarchical and conflictual, as EAM proposes that yin and yang are mutually identified and penetrated, where a harmonious relationship (ie yin–yang equilibrium) can be expected and achieved. Specifically, an EAM-minded US administration would not discursively dehumanise its enemies and metaphorically identify them as incurable diseases that have to be erased and killed. Also, EAM-minded officials would believe that through a series of negotiations and political dialogues based on the principle of mutual understanding and trust, the United States and its enemies could indeed seek a harmonious relationship with their political counterparts and pursue a stable world order.

Lastly, although EAM geographically originated from East Asia, it has been widely adopted in Western hospitals and medical centres. Thus, there is no straightforward or logical reason why it cannot inform metaphorical thinking in IR outside East Asia. In fact, in light of the theoretical flaws of the orthodox approach to conflict resolution, which stresses the significance and necessity of utilising military forces, a non-violent or pacificist approach to conflict resolution has been recently introduced and discussed in IR scholarship, in particular in the field of peace and conflict studies.⁸⁸ EAM actually resonates with the alternative approach prompted by peace activists and scholars and has the possibility to create more synergy between these approaches. Establishing arguments on the real-world practices of conflict resolution and various empirical cases, advocates of non-violence and pacificism indicate that in addition to the coercive approach which concentrates on the absence of physical or direct violence, other, non-violent or pacificist approaches, such as political communication and negotiation, civil resistance and disobedience, unarmed peacekeeping, and the promotion of new forms of politics based on the promise of non-violence and pacifism, could contribute to a long-term and sustainable global peace, and therefore are worthy of being particularly considered and employed by activists, decision makers and policy practitioners.⁸⁹

Notably, the ideals of non-violence and pacifism have already been practiced in many parts of the world. For example, Nonviolent Peaceforce and Peace Brigades International, the two largest international nongovernmental organisations, are notable for their unarmed civil peacekeeping or protection projects; both demonstrate that the presence and work of unarmed civilians could change armed actors’ behaviour and reduce the level of violence and threats.⁹⁰ Furthermore, cases in Colombia, Somalia and Syria illustrate that forms of non-violent community action could be employed to resist violent inclusions organised by armed groups.⁹¹ The promotion and real-world practices of non-violence and pacifism illustrate the necessity for critical reflection on the traditional approach to conflict resolution and international intervention. As an alternative approach to conflict and conflict resolution, EAM and EAM-inspired approaches could contribute to a discursive shift in scholarship and the political sphere.

Conclusion

An examination of the US political discourse illustrates that political elites consistently use metaphors and metaphorical thoughts to frame and structure their foreign and security discourses. Furthermore, over the past few decades, medical and disease metaphors have functioned to graphically conceptualise the particular security issues identified by policymakers – that is, threats posed by communists, terrorists and rogue states. However, biomedical thinking has suggested and constrained the options that could be utilised to deal with these menaces. The metaphorical expression that frames a threat as a disease or plague literally implies the necessity of using an invasive treatment to fight the agents of disease. By interpreting communism, terrorism and rogue states as a disease, containment, surgical strikes and regime-change plans are invented and introduced as the most reliable measures to address threats and dangers. However, as real-world policy practices and academic research have demonstrated, the coercive or military-oriented approach to conflict and conflict resolution may not be as effective as what government authorities have claimed and expected. Furthermore, the use of lethal force often causes collateral damage, human suffering and the spread of hatred; thus, it is detrimental to long-term global peace. To pursue a long-term and sustainable peace, a critical reflection on the orthodox approach to conflict resolution is necessary to facilitate a discursive shift in both academia and the political sphere.

The EAM approach to conflict resolution can inspire scholars and practitioners to think about security issues in a broader social and political context and to identify the underlying causes of conflict and political violence. It also discourages the use of coercive actions to solve disputes between and among states or non-state actors, because the application of violence contradicts the essentials of the EAM way of thinking – ie non-coercive actions (wuwei) and the yin–yang equilibrium. Additionally, the EAM philosophy of medical treatment and doctor–patient relations could change the hierarchical and asymmetric relations between parties in conflicts and conflict resolution. Notably, an EAM-minded US or foreign administration would not always cast itself as a doctor who has superior knowledge and seeks an external patient to fix. Rather, it would respect the diversity of culture and history, and pursue a harmonious relationship constituted by parties in conflicts and conflict resolution. And, importantly, a diagnosis or treatment plan – if that is necessary – would be given by way of direct observation, frequent interaction and joint discussion, so that local opinions could be valued and stressed. The recent study of non-violence and pacifism and the real-world practices of non-coercive conflict resolution illustrate that EAM can join forces with, and contribute to, these non-coercive approaches. The EAM approach to conflict resolution has the potential to promote short-term peace – that is, the absence of visible and direct violence – as well as long-term, sustainable global harmony.

Acknowledgements

I am grateful to Dr Ching-Chang Chen and Dr Jooyoun Lee for helpful comments and feedback on an earlier draft of the article. I also appreciate two anonymous reviewers and the editors of this special issue for their constructive comments and suggestions which have improved the article a great deal. All remaining errors are solely my own.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Chin-Kuei Tsui

Chin-Kuei Tsui is Assistant Professor at the Graduate Institute of International Politics, National Chung Hsing University, Taiwan, the Republic of China (ROC). His research interests are in US foreign and security policies, critical terrorism studies, peace and conflict studies, and constructivist approaches to IR. He is the author of Clinton, New Terrorism and the Origins of the War on Terror (Routledge, 2016). His recent research on the Western-led countering of violent extremism was published by Manchester University Press in August 2020.

Notes

1 Lakoff and Johnson, Metaphors We Live By, 3.

2 Milliken, “Study of Discourse in International Relations.”

3 Jorgensen and Phillips, Discourse Analysis as Theory and Method.

4 Chilton and Ilyin, “Metaphor in Political Discourse,” 10.

5 Ibid.

6 Ferrari, “Metaphor at Work in the Analysis of Political Discourse”; Charteris-Black, Politicians and Rhetoric; Lakoff, “Metaphor and War.”

7 Lakoff and Johnson, Metaphors We Live By; Doty, “Foreign Policy as Social Construction”; Lakoff, “Metaphor and War.”

8 Lakoff and Johnson, Metaphors We Live By, 156.

9 Doty, “Foreign Policy as Social Construction.”

10 Ibid., 313–6.

11 Ling, “Worlds beyond Westphalia,” 11–3; Ling, “Border Pathology,” 103–9.

12 Onuf, Making Sense, Making World, 40–1.

13 Ibid., 41.

14 Ibid., 40.

15 Marks, Revisiting Metaphors in International Relations Theory.

16 Ibid., 197–8.

17 Ibid.

18 Ibid.

19 Lakoff, “Metaphor and War,” 25–32.

20 Marks, Revisiting Metaphors in International Relations Theory, 197–8; Masoudi, “Metaphorical Incarnations of the ‘Other,’” 753–4.

21 Marks, Revisiting Metaphors in International Relations Theory, 196–7.

22 Fierke, “Constructivism,” 161–78.

23 Ibid.

24 Finnemore and Sikkink, “International Norm Dynamics and Political Change.”

25 Drulak, “Motion, Container and Equilibrium.”

26 Ibid., 512.

27 Ibid., 512–3.

28 Ibid., 512.

29 Ibid.

30 Chilton and Lakoff, “Foreign Policy by Metaphor,” 59.

31 Lakoff and Frisch, “Five Years After 9/11; Winkler, “Parallels in Preemptive War Rhetoric.”

32 Bentley, “Strategic Taboo.”

33 Campbell, Pivot: The Future of American Statecraft in Asia, 11–3; Chollet, Long Game, 9–10, 159–64.

34 Ivie, “Fire, Flood, and Red Fever,” 570–3.

35 Ibid., 571–2.

36 Ibid., 572.

37 Truman, “Special Message to the Congress on Greece and Turkey.”

38 Ibid.

39 Siracusa and Warren, Presidential Doctrines, 94–5.

40 Kennan, “February 22, 1946.”

41 Ibid.

42 Ibid.

43 X, “The Sources of Soviet Conduct,” 575.

44 Ibid., 576.

45 Winkler, In the Name of Terrorism, 84–5.

46 Stampnotzky, Disciplining Terror, 109.

47 Reagan, “Remarks at the National Leadership.”

48 Leeman, Rhetoric of Terrorism and Counterterrorism, 130.

49 Jackson, “Genealogy, Ideology, and Counter-Terrorism.”

50 Deutch, “Terrorism,” 10.

51 Jackson, Writing the War on Terrorism, 73.

52 Obama, “Remarks to the United Nations General.”

53 Obama, “Address to the Nation on United States Strategy.”

54 Obama, “Remarks at the White House Summit.”

55 Obama, “President’s Weekly Address.”

56 Lake, “Confronting Backlash States.”

57 Lake, “From Containment to Enlargement.”

58 Ibid.

59 Indyk, Innocent Abroad, 38.

60 Bush, “Address to the Nation on Iraq from Cincinnati, Ohio.”

61 Shimko, “Metaphors and Foreign Policy Decision Making;” Lakoff, “Metaphor and War,” 25.

62 Jackson, Writing the War on Terrorism; Tsui, Clinton, New Terrorism and the Origins of the War on Terror.

63 Ibid.

64 Pape and Feldman, Cutting the Fuse.

65 Byman, “Understanding the Islamic State – A Review Essay.”

66 Shaw, “Predator Empire,” 546; Calhoun, We Kill Because We Can.

67 Poushter and Fagan, “Americans See Spread of Disease.”

68 “National Security Strategy of the United States of America.”

69 Pompeo, “Next Steps toward a US Agreement with the Taliban.”

70 Petraeus et al., US Army and Marine Corps Counterinsurgency Field Manual, 152–4.

71 Ibid., 153.

72 Ibid.

73 Ibid.

74 Ibid., 154.

75 National Defence Canada, Canadian Land Force Counter-Insurgency Operations Manual, 2-21, 2-22.

76 Ibid., 2-22.

77 Notably, testing a specific foreign policy case is not the aim of this particular research. In fact, any foreign policy case associated with the practices of EAM deserves a single and further research – as other contributors have discussed and demonstrated in this special issue. This research illustrates that EAM can facilitate a discursive shift in both academia and the political sphere, and that US administrations could have employed alternative metaphors and with different political effects.

78 Ling, “Border Pathology,” 103–6.

79 Ling, “Worlds beyond Westphalia,” 559.

80 Ibid.

81 Ibid.

82 Ling, “Border Pathology,” 104–5.

83 Ling, “Worlds beyond Westphalia,” 561.

84 Ling, “Border Pathology,” 104.

85 Kaptchuk, Chinese Medicine, 44.

86 Ling, “Border Pathology,” 106–7.

87 Jackson, “Pacifism: The Anatomy of a Subjugated Knowledge”; Stephan and Chenoweth, “Why Civil Resistance Works.”

88 Jackson et al., “Introduction: The Return of Pacifism to IR”; Ford, “A Pacifist Approach to Countering Extremism”; Moses, “Why Humanitarianism Needs a Pacifist Ethos”; Wallace, “Wrestling with Another Human Being.”

89 Jackson, “CTS, Counterterrorism and Non-Violence”; Ford, “A Peace Studies Approach to Countering Extremism”; Julian “The Transformative Impact of Unarmed Civilian Peacekeeping.”

90 Julian, “Transformative Impact of Unarmed Civilian Peacekeeping”; Julian and Schweitzer, “Origins and Development of Unarmed Civilian Peacekeeping.”

91 Jackson, “CTS, Counterterrorism and Non-Violence”; Stephan, “Civil Resistance vs. ISIS”; Jimenez, Power of Staying Put; Kemp and Fry, Keeping the Peace.