By Gwen Darien and Musa Mayer

Loaded Language

Weighing in on war and other cancer metaphors

By Gwen Darien and Musa Mayer

Not surprisingly, the specific power of the military metaphor in cancer has been the subject of much scholarly scrutiny, and has been criticized for fostering denial and encouraging overly aggressive treatment as well as unnecessarily frightening perceptions of cancer therapies. It has also been accused of promoting a focus on the disease rather than the patient, who is often portrayed as a sort of battlefield. To further compound the blame, when a war is lost, armies are defeated on the battlefield. By implication, those who retreat from the battle or refuse to fight become cowards and losers. Can a soldier ever leave the front lines and surrender without shame? Of course, cancer patients don't deserve these judgments should their cancers progress, or if they choose to stop treatment or if they die of their disease. Yet, while certainly unintentional, the metaphors of war imply all these things and may exert subtle and not-so-subtle effects.

"Whether you call it battle, fight, struggle or whatever, my parents weren't in a competition and they didn't lose anything; they died of cancer," says Richard Stephens, who was diagnosed with stage III Hodgkin's lymphoma.

"It makes it sound as if those whom one has lost were cowards/uneducated, while those who have had successful treatment are brave and clever," says Marie Harris, who was treated for cervical cancer 15 years ago. Of course, the patient's bravery and cleverness have nothing to do with whether his cancer progresses. 

And, just as we should move away from implying cowardice, or weakness, so should we question the triumphalism of survivorship. "Cancer is invariably perceived as a ‘fight to the finish,' " writes Rosetta Manaszewicz, who was diagnosed with stage II breast cancer in 1998. "The survivor is the one who by sheer luck, strength of will, courage, fortitude or whatever, has managed to defeat the foe. The credit implicitly resides with the individual. Often they assume almost mythic status—superheroes who have fought the good fight and won! But what of those who have ‘succumbed'—who were not ‘successful'? Are they failures to be scorned because they lacked the necessary ‘will to fight' or were too weak?"

And, what about the optimistic cancer patient? "I've known so many with positive attitudes who have died nevertheless, simply because their cancer was physically impossible to cure, more often than not, too late diagnosed," says another woman who was diagnosed with cancer. "This kind of language seems to indicate that maybe their death is due to their own inability to fight. How awful is that?"

Many others we interviewed echoed similar concerns, finding one phrase in particular objectionable. "‘Lost her battle with cancer' is one I hate—simply because I do not want to be called a loser at my funeral!" says Kim Pawlik, who lives with metastatic breast cancer.

"It irks me every time I read of someone ‘losing their battle' with cancer," echoes Sara McKenna, a stage I breast cancer survivor and advocate. "It is usually a ‘battle' with a non-specific cancer that has been ‘lost,' too. What is wrong with saying simply that they died of a specific type of cancer?"

"Maybe I'm too blunt, but I would prefer my obituary to read: ‘died of cancer after 5, 8, 10 years,' " says Deanne Curtis, who was diagnosed with stage IIIC ovarian cancer seven years ago. "I think that naming the type of cancer is important as well. People may seek more information about that cancer, or make a donation toward research for the type of cancer." The inherent tension between hard reality and the softening power of euphemism seems inextricably linked to metaphor.

There are other metaphors that evoke a thoughtful, more nuanced response to a cancer diagnosis and all that follows. A common metaphor is that of cancer as a journey or passage. "I slowly began to soften the metaphor from that of battlefield to a never-ending roller-coaster ride," says Lindley. "The ride began at diagnosis and the twists, turns, dips and dives became the many challenges that I encountered along the way. With a terminal diagnosis on hand, I started to relish the straight and narrow portions as they represented stability of the disease. For as long as the ride rolls forward, so, too, does life."

"I have used the idea of a journey through a natural setting in my own life with cancer for a long time," says Kate Murphy, who has been diagnosed with breast, ovarian and colon cancer. "Stumbling stones, detours, bramble bushes, restful places in the sun or near a pool of water, a treat of blackberries." It is perhaps no accident that Murphy is also a poet, conscious of words and the power of language.

In an act of deliberate reconciliation, the authors of Speak the Language of Healing: Living with Breast Cancer Without Going to War abandon their battles. Discussing the need to embrace the experience of having cancer as a spiritual process, they offer a bouquet of other metaphors: "It is there that we find maps for the journey, light for the darkness and nourishment for the soul."

"Metaphor was one of my symptoms," wrote Anatole Broyard. With a writer's evident delight, Broyard went on to play with metaphors and humor, creating his own evocative and witty imagery from his cancer experience.

"I saw my illness as a visit to a disturbed country, rather like contemporary China," he wrote. "I imagined it as a love affair with a demented woman who demanded things I had never done before. I thought of it as a lecture I was about to give to an immense audience on a subject that had not been specified."