The military metaphor dominates our culture’s dialogue about cancer (Penson et al 2004:712). Although metaphors do not factually explain an illness, they can “add clarity and depth of meaning” (Penson et al 2004:713).
This is crucial in medicine, since a large information gap usually exists between the doctor and patient. Most patients cannot understand the medical jargon of cancer; metaphors can help bridge this gap and provide ways to conceptualize an otherwise cripplingly mysterious affliction (Penson et al 2004:713).
The military metaphor initially appears apt: “there is an enemy (the cancer), a commander (the physician), a combatant (the patient), allies (the healthcare team), and formidable weaponry (including chemical, biological, and nuclear weapons)” (Reisfield and Wilson 2004:4025).
Benefits of the Military Metaphor
War is associated with passion and aggression, which may reassure patients that their condition is being taken seriously. And a war metaphor may prove motivating for patients who want to fight.
Actual historical comparisons can also prove useful; for example, one doctor cited George Gay, a pilot in the Battle of Midway who was shot down and helplessly watched from the water, to empathize with a patient about his sense of being swept up helplessly (Penson et al 2004:710).
The military metaphor, then, can help restore patient autonomy and eliminate some stigma and mystery surrounding cancer.
Drawbacks to the Military Metaphor
There are significant drawbacks to the military metaphor. In her 1978 Illness as Metaphor, Susan Sontag famously argued against the use of metaphor for illnesses, arguing that metaphors add to the stigma and fear an illness inspires.
For example, military-themed ACS propaganda dramatically claimed, “No one is safe from cancer” and “cancer is the greatest and cruelest killer of American women between the ages of 35 and 55” (Lerner 2001:65), portraying cancer as a terrifying social menace.
In addition, the dichotomy of victory and defeat does not correspond well to the complex array of treatment results. It is inevitable that treatment sometimes fails; within the framework of the military metaphor, however, this can be perceived as the patient’s failure.
The desire not to lose or surrender implicitly discourages options such as palliative care or hospice care, and selecting these options may leave patients feeling guilty or defeated (Reisfield and Wilson 2004:4025).
Placing responsibility on the patient as soldier often casts guilt on cancer victims, implicitly or even explicitly. For example, as the ACS launched its campaign, the health magazine Hygeia reported in 1945 that a woman who did not detect or seek treatment for breast cancer in its “early, most curable stage” had “no one to blame for the consequences but herself” (Lerner 2001:60).
In addition, a war metaphor may be uncomfortable for cancer patients who have fought in real wars (Reisfield and Wilson 2004:4025), or for child patients who associate war with death (Penson et al 2004:710).
Moreover, the war metaphor does not correspond exactly to cancer. There is no foreign enemy invader; cancer comes from within the body, and so viewing cancer as an evil enemy implicitly condemns the patient (Reisfield and Wilson 2004:4025).
The cancer cells develop from one’s own body, and so the enemy is not a bacterium or foreign contaminant, but something inside gone awry. Like the ancient view of sickness stemming from inner sin, cancer implies some inner flaw.
History of the Military Metaphor
Infectious diseases were highly fatal for much of the 19th century. In 1882, Robert Koch discovered the bacterium that causes tuberculosis; by the 1910s and 1920s, rates of tuberculosis and other infectious diseases had declined significantly. Physicians redirected their attention to noncommunicable diseases, such as heart disease and cancer.
However, the fear and stigma associated with cancer hindered attempts to raise public awareness; for example, public use of the word “cancer” was relatively rare in the first half of the 20th century, and people afflicted by cancer often concealed their disease from friends and relatives. Cancer was viewed as mysterious, sinister, shameful, and fatal (Lerner 2001:29).
Following World War II, the American Cancer Society (ACS) began a major campaign to discover breast cancers earlier. The ACS employed military metaphors linking the “war on breast cancer” to the recent American military victory, and also used the “rhetoric of fear,” mirroring Cold War tactics (Lerner 2001:41).
Military rhetoric energized public opinion against cancer, maximized public donations, and granted inspiration and optimism to cancer patients and their families (Lerner 2001:45). The use of the military metaphor often stemmed from attempts to escape the stigma and mystery of cancer.
For example, the “Woman’s Field Army” (WFA) was formed in 1936 to promote “trench warfare with a vengeance against a ruthless killer;” they included the “Sword of Hope,” a sword with a hilt formed from a twin serpent caduceus, in their literature (Lerner 2001:43).
TB had recently been “conquered” and it seemed feasible that cancer could be, too. Paradoxically, however, casting cancer as a vile, evil enemy in an effort to energize and motivate has also helped perpetuate the image of cancer as a terrifying menace.
Other Cancer Metaphors
While military metaphors may be motivating to some patients, some patients may prefer to negotiate their illness through other metaphors. These patients may prefer metaphors such as a "journey."
Becoming aware of the metaphors shaping our language can help us understand the impact they have.
Sources:
Lerner, Barron H. 2001 The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America. New York: Oxford University Press.
Penson, Richard T., Lidia Schapira, Kristy J. Daniels, Bruce A. Chabner, and Thomas J. Lynch Jr. 2004 "Cancer as Metaphor." The Oncologist. 9:708-716.
Reisfield, Gary M. and George R. Wilson. 2004 "Use of Metaphor in the Discourse on Cancer." 22(19):4024-4027.
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