“Our biggest killer”: multimodal discourse representations of dementia in the British press

ABSTRACT

A recent (2016) Office for National Statistics report stated that dementia is now “the leading cause of death” in England and Wales. Ever fixated with the syndrome (an unfailingly newsworthy topic), the British press was quick to respond to the bulletin, consistently headlining that dementia was the nation’s “biggest killer,” while (re)formulating other aspects of the report in distorting and emotive metaphorical terms. In this paper we examine how the media, through use of a recurring set of linguistic and visual semiotic tropes, portrayed dementia as an agentive entity, a “killer,” which remorselessly attacks its “victims.” Such a broadly loaded and sensationalist representation, we argue, not only construed dementia as a direful and pernicious disease, but also, crucially, obscured the personal and social contexts in which the syndrome is understood and experienced (not least by people with dementia themselves). This intensely lurid type of representation not only fails to address the ageist misinformation and common misunderstandings that all too commonly surround dementia, but is also likely to exacerbate the stress and depression frequently experienced by people with dementia and their families.

KEYWORDS:

• Dementia
• Alzheimer’s disease
• media
• Office for National Statistics
• multimodal critical discourse analysis
• photography
• neuroimaging

Acknowledgement

We would like to thank Krysia Ellis for providing the illustrations used in this article.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes on contributors

Gavin Brookes is a Research Fellow in the Centre for Research in Applied Linguistics (CRAL) in the School of English, University of Nottingham, UK. His research interests include corpus linguistics, discourse analysis and multimodality.

Kevin Harvey is a lecturer in the School of English, University of Nottingham, UK. His research interests are in the area of discourse-based health communication, which includes corpus linguistic and critical multimodal approaches to health-related discourse.

Neil Chadborn is a public health researcher with an interest in gerontology and dementia research. He is carrying out an Alzheimer's Society Knowledge Exchange fellowship exploring coordination of services for people with dementia and dementia-friendly communities. Public communication of dementia, and tackling stigma are key issues within dementia-friendly communities.

Tom Dening is Professor of Dementia Research at the University of Nottingham, UK, and Honorary Consultant in Old Age Psychiatry at Nottinghamshire Healthcare NHS Foundation Trust. His research interests include dementia and technology, the Arts and dementia, and services for people living with dementia.

ORCID

Gavin Brookes http://orcid.org/0000-0003-0726-2559

Neil Chadborn http://orcid.org/0000-0003-1368-7983

Tom Dening http://orcid.org/0000-0003-3387-4241

Notes

1. It is worth noting here that “nobody survives” a diagnosis of a whole host of other long-term conditions (e.g. diabetes, osteoarthritis) but, unlike dementia, they do not seem to generate quite the same kind of media hysteria.

2. Given the risk of people seeing through the images, it is hardly surprising that the text producers fail to make it clear to reader-viewers that the participants appearing in these set-up photographs are actors rather than actual people with dementia, since that would, of course, spoil the illusion the press is trying to maintain, calling attention to the synthetic nature of its representations and hence compromising the dramatic impact of the dementia story.

3. At the same time, the gesture of head-holding also makes these participants appear as though they are experiencing a severe headache or migraine, although these complaints are not especially symptoms of dementia.

4. With respect to Alzheimer’s disease – although this does not apply to all types of dementia, all of which have their own unique aetiologies and manifestations – one of its hallmarks is the build-up of proteins in the brain that form structures known as “plaques” and “tangles.” The appearance and effect of these structures leads to the loss of connectivity between cells in the brain, “and eventually to the death of nerve cells and loss of brain tissue” (Alzheimer’s Society 2014b).

5. Apart from their visual pungency, what also makes pictorial metaphors so vividly persuasive (perhaps more so than their textually realised counterparts) is that they permit the blending of target (dementia) and source domains (fire) into a “single hybrid entity” (Semino 2008, 169). Such a visual conflation prevents text producers from having to spell out the metaphor (e.g. Dementia is Fire/Brain on Fire), where doing so, though still retaining its arresting potential, would most likely draw attention to the outlandish nature of the trope.

6. It is unlikely, we argue, that most readers would be able to identify the biomarkers of Alzheimer’s disease in Figure 6. What is “abnormal” about the brain in this image is the enlargement of the five ventricles, the bottom two of which appear almost kidney-shaped. In a “healthy” brain, the ventricles would appear more like slits. Ventricular enlargement is a consequence of loss of brain tissue, which is associated with dementia. Also the fluid-filled spaces around the outside of the brain are more prominent, indicating that there is a degree of atrophy of the cerebral cortex (loss of brain tissue). This is more noticeable at the top and sides of the image (or, to put it more technically, the frontal and temporal lobes of the brain). How much of this readers would be able to ascertain for themselves is open to question.

7. Although neuroimaging is able to reveal cellular damage in the brain, as well as other hallmarks of dementia, it is still not a straightforward process, even during autopsy, to determine the extent of brain damage required for a diagnosis of dementia (Woods 2011, 208). As Woods elaborates, “some older people show dementia during life, with no obvious brain pathology at post-term, while others have significant pathology, but have been apparently unimpaired during life” (2011, 208). Thus despite the apparently incontrovertible evidence provided by neuroimaging, the line between the normal and pathological remains a fuzzy one (George, Whitehouse, and Whitehouse 2016, 23).