Minding our (Cancer) Metaphors by Lois Kieffaber

Some years ago I began thinking about the language we use when we talk about cancer, when I read an article that questioned whether a church with a peace testimony should use militaristic language when speaking about cancer.  Sort of like suddenly becoming aware that songs like “Onward Christian soldiers” or “Am I a Soldier of the Cross”  might not be the best songs for a Quaker worship service.  On the other hand, the Bible uses military metaphors – Paul talks about “putting on the whole armor of God” or says “I have fought the good fight, I have finished the course”.  Oh look, two metaphors in the same sentence, one about fighting, another about running a race.

But sometimes we don’t realize how our language shapes our thinking.

Let me start by saying that I do not now have cancer nor have I ever had that diagnosis, but I did lose a brother to cancer, also a sister-in-law, and two cousins whom I grew up with.  And I know that most of us have this kind of “second-hand” experience with the disease — and some of us in the room today are cancer survivors or are dealing with a cancer diagnosis as we speak.  Secondly, I do not have an answer to the question of what is the right way to talk about such an experience; we are each individuals and might have very different ideas about which metaphors are useful and which are not, in any given situation.

Metaphors permeate our daily language, and we are often unaware of the use or the power of metaphor.  How many times have you heard the phrase “time is money”?  Or “life is just a bowl of cherries” ?  Aristotle described metaphor as “giving something a name that belongs to something else”.  Metaphor is a figure of speech in which a word or phrase literally denoting one kind of object or idea is used in place of another to suggest a likeness or analogy between them.”  Some people “sail through life” while others “carry a heavy load.”  Metaphors reframe complex issues and help to provide meaning.”  We are told in the Old Testament to “put on the garment of praise”.  Jesus said “You must be born again“ and “I am the Bread of Life”.

In our culture the military metaphor has dominated the way we think, and talk, about cancer.  I am asking us to think about whether there might be other metaphors that would be more useful to us.

Even the pacifist and the gentlest of patients think about fighting when they are faced with cancer.  It is almost instinctive.  Our medical language is full of violence metaphors.  Think about the language of immunology for example:  lymphocytes are “deployed” or “mobilized”, we talk about “killer cells”; the images are all about “battles” of supremacy and survival.  We hear about a new “magic bullet”.

One author suggested that this is true because medicine has grown out of a science dominated by men and masculine patterns of thought.  In this environment, emotional restraint and the pursuit of power are rewarded.  The “medicine is war” metaphor has serious implications because it gives a picture of the patient as passive and the physician as active and in control.  So the physician and the disease are the focal point of the battle, not the patient.  The patient often feels “disempowered” because they aren’t given the “right” weapon to fight or that the doctors are “the generals” and they’re just common “foot soldiers”.

The military metaphor was also applied to nursing practices in the late 18th century.  The nursing profession was characterized by loyalty and obedience, the two key qualities that soldiers were expected to demonstrate.  Nursing was organized in a structured and military manner.  Nurses took “orders”, worked at “stations”.  As nurses progressed up the “ranks”, “stripes” were added to their caps and “insignia pins” to their “uniforms”.  Sometimes their “orders” even called for them to give “shots”.

Certainly most cancer patients and survivors have indeed BATTLED the disease.  They have struggled in many cases against long odds.  We have been told how hard it is to deal with a cancer diagnosis and to endure even “mild” cancer treatments. It exhausts the body and plays havoc with relationships and families and just about everything else important to us all.  We would never say that people facing cancer are not brave and courageous and in a real “battle”.

The chief criticism of the military metaphor is that in battles there are winners and losers.  The idea of losing the battle seems to imply that if they had just done SOMETHING else differently, then maybe they might have “won”.  The possibility of losing the battle might be that you didn’t fight hard enough.  It’s your fault that you didn’t do better.  The Christian version of this is “You will be healed if you just have faith in God.”  The obvious corollary is that is you don’t get healed, your faith must not be strong enough.  I watched this happen with Jess Salazar, the husband of Juanita Salazar whom some of you knew, when we were in a small group together.  His family thought of this kind of talk as encouragement to him; in fact, it gave him another heavy burden to bear:  In addition to having cancer, he didn’t have enough faith to be healed.  I think that would be devastating rather than encouraging.

It is also disempowering when the person doesn’t want to fight.  This can also lead to people, specifically at the end of life, who feel that they’re losing “and it’s  their fault.

I think warrior metaphors might prevent a person with cancer from being honest with friends and family.  And the result can be loneliness and isolation.

We should not give cancer this kind of power over us.   What other diseases or condition do we give this kind of power?  My father died of a cerebral aneurism.  Did anyone say that he had “lost his battle to a damaged blood vessel”?  No, he died from an aneurism in his brain.  If someone suffers lifelong hypertension, and eventually dies of a heart attack or stroke, do we ever say that he or she lost his or her battle with high blood pressure?

So why do so many deaths from cancer get reported as “after a long struggle/battle, so-and-so lost his/her battle with cancer?

Kate Granger, a doctor with advanced cancer, warned that she would come back to curse anyone who described her as having “lost her brave fight.”  She wrote:

 I do not want to feel a failure about something beyond my control. I refuse to believe my death will be because I didn’t battle hard enough…After all, cancer has arisen from within my own body, from my own cells.  To fight it would be “waging a war” on myself.”

We all die at some point, life eventually kills us.  Yet, few people are reported to have lost their fight with life. 

The second most common metaphor after “fighting a battle” is the “journey” metaphor.  Life is a journey; marriage is a journey, pregnancy is a journey, parenting is a journey, following Christ is a journey, having cancer is a journey.  The road may be long and hard. It may have bumps in it.   We have companions as we travel this road.  There is a sense of purpose in planning one’s journey one step at a time. The journey metaphor can be empowering if it is used to express a sense of acceptance, purpose and control, or when it is used to suggest companionship and solidarity with family and friends and caregivers, of being “all in it together.”  Journey metaphors do not position the disease as an opponent, and therefore they may appear to cause no harm.

However, things are not quite so simple.  For some patients, the journey is less like an epic adventure and more like the trip from hell.  They feel helplessness and frustration, particularly in the face of “navigating” a journey that they hadn’t chosen to embark on.  They feel like “passengers” on a journey they could not control.  One person says it’s like trying to go uphill in a coach without its back wheels”

But do we have to choose between a journey and a fight?  Each person might find that one metaphor works better than another.  Creative people may be able to come up with their own unique metaphor, but what about those of us who are less creative.  What is needed is a “menu of metaphors” which can be shared with people, and people can pick the ones they want, like you do at a restaurant.

Here are a few others that can be mentioned:  A roller coaster image is a way of conveying good moments and bad moments, highs and lows.  Just when you think you’re in a good place, the bottom drops out and your stomach goes with it.

There is the idea of being on a carousel that you can’t get off of, being dizzy and off-balance and hanging on for dear life.

One pediatric oncologist tends to use the language of “work”.  This is going to be “work”, and it’s going to be hard work.  This is somehow less frightening to children than fighting a battle.  And it is phrased as a joint plan “We are going to do this.” It recognizes the role that the child will play. Sports metaphors are sometimes used, such as “game plan”.

Maybe people use metaphors as a way of avoiding having to talk about the reality of cancer.  It’s getting on with life, because life doesn’t stop even for cancer.  It’s having to still get the shopping done, dinner on the table and children off to school even though you’re in pain and frightened by what the future holds.  Maybe if we talked straight about cancer and what it does to people and their loved ones, we wouldn’t need metaphors.

In closing for people like me who run away from military or violent images, it would do well to remember that the word “fight” has many meanings, not just the military one.  Anatomically speaking, people quite naturally “fight” in their own way, and there are parts of the human anatomy whose job it is to fight illness and infection without us even realizing they are doing it.  So whether we like it or not, our bodies are fighting illnesses and we cannot stop them doing it.  It’s natural.

One of the dictionary meanings of “fight is “to struggle to overcome, eliminate or prevent: to strive to achieve or do something.:  What that means is that some people will use the word fight to describe the ability to get out of bed in the morning, to walk to the local shops, to go to a restaurant for a meal.  Fighting to see a doctor who understands their cancer, fighting for access to the best treatment, fighting when you think someone isn’t listening,

As Christians we have a range of religious images that can help us.  One that would be meaningful to me is to imagine I am resting in God’s hands (sort of like that old All-State commercial) or that I am surrounded by a cloud of God’s love.  Or that Christ is in my boat on a very rough sea.  I’m going to sit down now, and maybe, some of you will want to share metaphors or images that have been helpful to you during bad times.


This message was given by Lois Kieffaber at Spokane Friends Church on July 1, 2018.

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