Cancer as a path

Straight Talk About Cancer

Metaphors are common in our everyday conversation. We use them as a communication short cut. They help us turn complex and abstract ideas into concrete and easy-to-understand ones. Or, by relating something that may be unknown to something familiar, they help clarify and shape assumptions. 

But different metaphors frame a topic in different ways, emphasizing some aspects and obscuring others. For example, “feeling blue” and “drowning in grief” are both metaphors for sadness. Each phrase evokes a clear and specific image that helps us express a more complex thought. But, “feeling blue” conveys a passing mood, while “drowning in grief” implies helplessness and permanence. 

When the conversation is cancer, choosing the right metaphor really matters. It shapes our emotional response to the disease. And it influences how we think about ourselves as patients, how we deal with treatment, and how we view our lives. 

One of the most common metaphors used in talking about cancer is “fighting a battle.” Since President Nixon signed the National Cancer Act in 1971, we’ve been hearing about the “war on cancer.” Originally meant to describe an all-out effort to discover a cure for the disease, this war metaphor has become the dominant way of talking about the disease at the personal level too — physicians and patients frequently talk of “battling the disease.”

The Heroic Fight

For some, the battle image works. It gives them the courage they need to endure the treatments, and a structure to know how to think about it. They understand they are going to be knocked out by a round of chemo, and have to get right back into the fight to go another round. It gives them a clear enemy to fight. And, it provides the incentive to strive for a heroic victory. It’s motivating and empowering. 

As Kriss said when she heard her breast cancer diagnosis, “I knew that it was going to be a battle that I was going to fight. I understood that my body was going to fight physically, and that mentally, I needed to be 100% positive. I never had any doubt that I was going to win.”

But for others, the fight metaphor sets up the possibility of losing. They feel helpless against such a powerful enemy. And, they associate the persistence of disease with personal failure and defeat. For them, the battle mentality is demotivating. As Truus, a news producer familiar with the trauma of war, said of her diagnosis, “I was under attack from my own body, which made me more aware of my mortality and vulnerability, more than working in a war zone.”

Upside Down Language

One of the biggest issues with the battle metaphor is the assignment or acceptance of blame when cancer prevails. When cancer recurs or remains unresponsive, it is not that the patient failed treatment, but rather that the treatment failed the patient. Of course, it is not actually the responsibility of the individual patient to win the war against cancer. That is the responsibility of the medical community. It is the job of researchers and physicians to find cures, to improve detection, to provide more palatable treatments and to deliver care. The patient’s responsibility is to avail herself of the best treatment she can find, to comply with the recommended protocol, to support her medical care with healthy habits. Unfortunately, the loss is still felt by patients and their loved ones regardless of semantics. And the metaphor still predominates.

Some patients have found other metaphors work better for them. Jillian talks about her cancer as a journey. That metaphor conveys a sense of purpose and an explanation for enduring the hardships in the attainment of a goal. For Ann, it was a project that needed to be managed, and she knew she was good at managing projects. Framing cancer this way allowed her to expect success. Michael thought of it as another learning experience, and knowing that life lessons often come with hard work, set himself up for the challenge ahead. All can be constructive metaphors. 

But, a journey you don’t want to take can feel like a forced march. A project can be an overwhelming assignment when one hasn’t volunteered for it. Life lessons can come at a price. When doctors or caregivers thrust an unwanted metaphor on you, it creates expectations that can be hard to meet.

What We Talk About When We Talk About Cancer

So, what is the right way to talk about cancer? As a patient, you get to decide. Maybe you want to use direct language. I am being treated for cancer. I finished treatment for cancer. I am living with cancer. I have no evidence of disease. These are declarative statements that help diffuse the emotional power of cancer. And they are the terms we would use when talking about other illnesses, like the flu or heart disease. 

Or maybe you have your own metaphor. The gift that keeps on giving. My own private hell. The club I never wanted to join. A marathon. A slog through the swamp. An interruption. A chapter in your life. It’s your choice. How do you want to think about your disease and your experience?

And as a caregiver, unless a patient begins to talk about her “battle” or her “journey,” until a former patient declares himself a “survivor,” it might be best to use neutral language. Using a metaphor imposes values on a cancer patient at a time when life has already thrust so many other burdens on her. Don’t assume that your metaphor will make the cancer patient you love feel empowered or even content with the treatment and prognosis ahead.

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