The cultural construction of illness

There are two realities to any illness. One is a medically observed event that happens to the human body, the other a mass of culturally relative assumptions that affect how we make sense of that event. On the one hand, for example, is the metastasising of cells and the various treatments used to halt cancer, on the other the stories of bravery and the status of ‘survivor’ that our culture readily attaches to people recovering from the condition.

These latter stories are culturally and historically constructed, although we frequently mistake them for being natural or ‘just the way things are’. For example, in the 21st century TB is seen exclusively as an appalling condition linked with poverty, whereas in the early 19th century, fashionable metropolitans tried to cultivate a pleasingly pale and ‘consumptive’ appearance, driven by the perception of a link between tuberculosis and creativity.

We may think that we’re too smart to fall for this kind of thing today, but in fact it’s hard for anyone to avoid interpreting illness according to the norms of their culture. Those norms are different today than they were in the 19th century, but can obscure the experience of having or treating many kinds of illness just the same.

Why is this important? Put simply, not seeing beyond the dominant constructions can prevent us from developing messaging that is sufficiently credible, salient and distinctive. Here’s a characteristic example of how this can work.

Cultural bias cannot be avoided

Some years ago, we were asked to advise on marketing a cure for migraines in the UK. As we analysed communications by brands in the sector, it was remarkable how consistently migraines was represented as something which overtook women, rendering them helpless, even hysterical, until brought back into normative living by whatever treatment was being promoted. Perhaps unsurprisingly, the treatments themselves were represented as sober, male and commanding.

Two things became clear. Firstly, that most brands in the category were - probably unconsciously - conforming to the cultural idea of migraines as a woman’s problem and to an increasingly outmoded understanding of what that might mean. In this world, migraines were associated with ideas of the overly sensitive, or even hysterical woman, requiring rational male intervention to bring her back to her senses. There was even a sense that migraines weren’t a particularly serious condition - its role in popular comedy as an excuse given for refusing sex and its roots as a term used to describe a whim or a fancy (‘megrim’) all contributed to this.

Secondly, it was clear there was an opportunity for a brand to construct a different understanding of migraines, based on more self-determining ideas of womanhood, while representing the misery of the condition more respectfully. The brand communications developed as a result of these recommendations were highly successful and helped to evolve the way in which the condition is now marketed.

This was a case of a category unable to see beyond a certain cultural construction of the condition it was in the business of treating, something it took for granted that many of our clients weren’t even aware of.

Pharma is stuck in a rut

Although this project happened a few years ago, it’s telling that as we continue to work with pharmaceutical brands, many stories and ideas of illness recur across conditions. Some of these can be positive and lead to very effective communications, but many are habits that marketers can fall into and that prevent new and compelling ways of communicating from being developed.

Here are some examples:

We can be heroes

It’s an obvious option to portray people with a serious condition as heroes confronting a formidable enemy; serious illness tends to be experienced as a catastrophe and we see plenty of messaging that plays on this using imagery of warfare (‘my battle against…’, ‘overcoming the challenge of…’, ‘I won’t give up fighting…’). It also presents the person with the condition as having individual agency and independence, all of which are highly valued by our culture.

This can be impactful - particularly for younger people - but it’s interesting how much this taps into a general cultural narrative of heroism which doesn’t have that much to do with illness. The result can be dramatic or even exciting, but also disconnected from the reality of illness as experienced by patients, carers and medical professionals.

In our work we’ve observed that, just as our culture is increasingly sceptical about medical products having heroic properties, so it’s starting to question the representation of people facing serious illness as heroes.

How does this account for the day-to-day experience of having a disease? Doesn’t it place an unrealistic expectation on the person with the condition?

To really connect with patients and professionals, brands need to find ways of avoiding both the negative associations of the victim and the overly positive associations of the hero.

Health always means harmony

Because illness is so strongly associated with disharmony in our culture, there’s a tendency to construct the return to health as always harmonious and calm. While this might be what many people aspire to, it can also inhibit strong depictions of how pharma products work to return people to health.

We’ve lost count of the times we’ve seen ‘recovery’ depicted as someone doing yoga on a beach or as the metaphor of a butterfly or a flower. These are clichés of course, but they also represent the deep-rooted cultural need to see the return to health as a kind of calm resolution.

It’s interesting to see the success you can have when you break these cultural conventions. Health can also be credibly constructed as messy and chaotic, joyful and engaged or even angry and defiant.

We once worked with a team marketing a product for people with HIV. Their advertising was failing to cut through and it became clear to us that one of the reasons for this was its depiction of happy, calm people living with HIV, but always depicted on their own. When the advertising was evolved to depict these people spontaneously playing with their children in messy, realistic homes or at the heart of social occasions, the uplift was substantial.

Moving away from the idea of the calm and settled individual as the signifier of health was the breakthrough here - finding an alternative but equally salient cultural construction helped move the brand on.

The necessity of taboos

We live in a culture that increasingly prides itself on being liberal and not squeamish when it comes to describing the workings of the body. It’s surprising, then, how we still use the constructions of taboos and euphemisms to represent certain conditions that are viewed as particularly sensitive or shaming.

Of course, it’s essential to show respect, sensitivity and compassion in marketing communications - but it’s also true that openness and black humour can create common currency between pharmaceutical brands and those purchasing them, just as it unites many people in patient support groups.

Work we conducted on COPD (Chronic obstructive pulmonary disease) in the US demonstrated this. There was an assumption among many people working in the category that the nature of COPD needed to be played down. It was too unpleasant and, since it tended to be linked to lifestyle, there was a perceived element of guilt and shame.

Through analysis of the language used by people with the condition when discussing it online, or by celebrities who lived with it, another picture emerged. Black comic imagery of ‘the elephant that jumps on my chest’ and a ‘you only live once, no regrets’ approach to past lifestyle choices were common. When this kind of language was incorporated carefully into advertising, the response was very positive from those with the condition and physicians alike.

The sense that the experience of having the condition was being more authentically portrayed was seen as empowering. The previous assumption that it needed to be talked about in terms of euphemism and that realistically representing it was too much, possibly reflected the cultural assumptions of the marketers more than the patients.

Embedding in culture to empower

Understanding how particular illnesses are culturally constructed is essential work for anyone in pharmaceutical marketing. It both reveals some of the assumptions getting in the way of developing better messaging and helps create better, more humane constructions that in turn can drive more effective campaigns that can help consumers cope more easily with their illnesses.

Those pharmaceutical marketers that frame communications around particular drugs and illnesses when selling to healthcare professionals can do more than improve sales of their drugs. Indeed, if done properly, this approach helps pharma companies to demonstrate their commitment to transforming people’s lives. Talking in terms of cultural constructs helps pharma reps educate healthcare professionals on the best way to talk to patients, their families and the wider public. In turn, this helps consumers to better understand how to deal with their condition and use the available drugs more effectively, which can significantly improve the length and quality of their lives which, ultimately, is what every pharma company is aiming for.