Try talking about cancer without using a war metaphor. You’ll likely stumble. We rarely say someone is living with cancer. People “fight” cancer or “battle” it. They demonstrate they are “warriors” and hopefully one-day “survivors.” Chemotherapy is a “weapon.” The goal is to win “the war.”
Patients, practitioners, and loved ones frequently use fighting metaphors to characterize cancer. The competing metaphor, which is much less commonly used, describes cancer as a “journey.” Many people living with cancer find fighting metaphors empowering. They can be helpful for loved ones trying to make sense of the abstractions of living with such an illness, who grasp for simple ways to talk about complex experiences.
But other cancer patients say fighting rhetoric doesn’t resonate with them and can actually contribute to feelings of stress and inadequacy as they navigate fear, fatigue, and the frustrating ambiguity that typifies so many of their diagnoses.
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Experts who study metaphors in health say there ought to be greater awareness of how language contributes to people’s understanding of disease and primarily how they fuel misconceptions about them.
“We’ve been using this language for so long, it’s so conventional that we’re just beginning to uncover what it’s exposing about how we think about disease,” said David Hauser, an assistant professor of social/personality psychology at Queen’s University in Ontario whose research includes how metaphors guide understanding of the disease. “A lot of cancer patients find this survivorship language to be an incredibly inept description of their experience.”
How metaphors help people understand the illness
Psychologists and linguists say metaphors allow us to think about one thing in terms of another and help talk about abstract concepts such as bodies and disease.
“Metaphors are deeply entrenched in our everyday language and in our everyday thought. And they give us a useful tool to think about new domains, challenging domains, to connect with other people,” said Teenie Matlock, a professor at the University of California Merced who studies psycholinguistics and metaphor.
Hauser said “conceptual metaphor theory” suggests when humans try to understand abstract concepts – things that don’t take a physical form, are complex, or that most people don’t have experiences with – they are aided by metaphors.
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Time, for example, is an abstract concept, so people relate it to something more concrete. People think about time as if it’s money – we spend time, waste time, and exchange time. The disease is an abstract concept, so we relate it to war – the condition is the enemy, patients are warriors, therapies are our weapons.
President Richard Nixon signed the National Cancer Act of 1971, which the National Institutes of Health says “represented the U.S. commitment to what President Nixon described as the ‘war on cancer.'”
The rhetoric has persisted. During Breast Cancer Awareness Month in October 2008, former President Barack Obama released a statement that read, “Now is the time to commit ourselves to wage war against cancer as aggressive as the war cancer wages against us.”
For some cancer patients, fighting rhetoric can be empowering
A 2010 survey found oncologists used metaphors in two-thirds of their conversations with patients, and patients said physicians who used them were easier to understand.
Research shows many cancer patients find fighting metaphors empowering. When a person is first diagnosed, Matlock said, it can be helpful to think about the team they’re putting together to help them fight and the arsenal of tools available to help them overcome the obstacle. These metaphors can also be helpful to patients who receive a grim prognosis.
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“If you’re stage four and your outlook isn’t excellent, and you have doctors, nurses, friends, family, loved ones telling you, ‘We’re your soldiers. You be a warrior, and we’ll be here with you. We’re all going to fight this battle,’ that’s empowering,” she said.
A 2017 study on the use of violence and journey metaphors concluded: “some patients find meaning, purpose and a sense of pride and identity in approaching the illness experience as a fight.”
In a 2018 paper Matlock co-authored, researchers argue war metaphors are omnipresent because they are effective, and “they reliably express an urgent, negatively valenced emotional tone that captures attention and motivates action.” But they also cited research showing war metaphors can sometimes oversimplify issues and suggested they be used cautiously.