When talking about cancer, metaphors matter

Cancer is hard to talk about. It’s serious, often frightening, and complicated. So, as with many complex topics, we often turn to metaphor. In discussions of cancer, metaphors are rampant. One in particular — that of a fight — is especially common.

She’s battling cancer
He’s putting up a real fight against his disease
You can beat this

Almost five years ago, someone I’m close to was diagnosed, and I started to realize how inappropriate this language felt — at least for this particular case I was witnessing. There was no fighting. There were bed-bound days, invasive procedures, and sympathy cards. One might say that just showing up to every appointment — especially those where you know you’ll feel terrible afterwards — is fighting, but that’s not how it looked to me. So I started to wonder: how does this pervasive “fight” metaphor affect the way we think about cancer? Are there better alternatives?

I was intrigued to find that I wasn’t the first who had asked these questions, and that there’s actually a substantial field of research on language related to illness. There were also articles in popular media, which would pop up without fail each time a famous person was publicly diagnosed with or died from cancer. People were not only using fight-related language to talk about cancer (e.g., Ruth Bader Ginsburg v. Cancer), but they were also questioning whether that language was appropriate (John McCain did not ‘lose’ his battle with glioblastoma — because cancer is not a war) and offering up alternatives (Cancer is a Journey, not a Battle).

But for all the interesting research and commentaries that were out there, I still wanted empirical evidence. When someone talks about “fighting a battle” with cancer, how does that affect the way we think about the illness? And if “battle” is a harmful metaphor, is “journey” better, as is often suggested?

Together with my collaborators Zsófia Demjén, Elena Semino, and Lera Boroditsky, we ran some experiments to learn more about the ways that “battle” and “journey” metaphors affect emotions and thoughts about someone who has cancer.

We learned that when people are told that someone is battling cancer, they predict that the person will be less likely to make peace with their situation and more likely to feel guilty if they don’t recover — because they should have “fought” harder.

We found this by running 5 experiments with a total of 1,629 participants. Every participant received a paragraph that talked about someone battling or someone on a journey with cancer. Aside from the metaphor, these passages were the same, and all participants indicated their agreement with the same two statements after reading:

  • He* will feel guilty that he hasn’t done enough if he does not recover.
  • He can make peace with his experience.

The fact that participants believed that someone battling would be more likely to feel guilty and less likely to make peace should give us pause. These are not optimistic beliefs and may not be conducive to healing.

But it’s also crucial to remember that this was an effect averaged over a lot of participants. It does not tell us that the battle is pernicious for all people in all cases. There may very well be people who prefer the battle metaphor, who feel energized and motivated by it, and who feel it most accurately captures their situation. But that’s a decision for people with cancer to make.

It’s not a decision for doctors, journalists, researchers, or even close family and friends to make. We should not impose our language on people with cancer (or any other illnesses, for that matter). If their experience is a battle, it’s a battle. And if it’s not a battle to them, we should not call it one.

The most important take-away for me, then, is not that we should use one metaphor and not another. It’s that metaphors are powerful tools, and we need to be thoughtful about how we wield them.

Here’s the link to the full paper. Please cite it as: Hendricks, R.K., Demjén, Z., Semino, E., & Boroditsky, L. (2019). Emotional Implications of Metaphor: Consequences of Metaphor Framing for Mindset about Cancer. Metaphor and Symbol, 33(4).

Featured image by Timothy Eberly on Unsplash

*In all studies except one, the subject of the paragraph was a male. We did this so we could most clearly understand the effects of the metaphor when all other characteristics of the information were the same. We did explore gender in one study (Experiment 4 in the paper posted above), but a lot more should be done to understand how the ways in which identity might interact with the effects that metaphors have on thinking about cancer.

12 thoughts on “When talking about cancer, metaphors matter

  1. When I was diagnosed with ovarian cancer over 34 years ago, I did consider myself in a battle. I recognized that I could lose or I could win, but it was a battle I wanted to wage. I turned to my faith, my family and the best medical facility and care. I also read as much as I could. I came across one article that talked using mental imagery. This struck a chord with me. And so I created an image in my mind of my cancer cells inside my body and each day I fought my cancer. It helped me to feel as if I had a bit of power at a time when I felt as if my body had turned against me.
    But I definitely feel that all of this is personal to each individual. Whatever metaphor for cancer one adopts it must have meaning to that individual.
    I honestly don’t remember if others used any metaphor about my cancer. I do remember that I felt surrounded and supported as I did whatever I could with my cancer team to defeat the cancer within me.
    Obviously it worked for me. I went from being given a 15% chance of surviving 5 years to being here almost 34 years later.
    I love that you bring things to the front that allow us to think and discuss such topics.

    1. Joan, thanks for your thoughtful comment. It’s so great to hear about what worked for you and how your experience informed the way you think about this topic. Your mental imagery description reminds me a lot of a game I discovered in the course of my research. It’s called “Remission,” (http://www.re-mission2.org/) and players do things like shoot cancer cells. There is some research suggesting that patients who are children who play the game are more likely to adhere to treatment plans. Again, I think this shows us that for patients who identify with the battle, it can be a very helpful thing. Language cannot cure cancer, but my hope is that thoughtful research on the topic can change the way people experience it in more positive ways. Thanks again for sharing.

  2. Oh no, it was extremely grueling to construct my comment on your post, but I’ll try again. (You’d think I’d know better after all these years to trust comment boxes). I’ve always disliked the “cancer as a battle” metaphor. If you lose, then somehow it’s your fault. In your paper, you found:

    the “journey” frame is more likely to encourage the inference that the person can make peace with their situation than the “battle” frame.

    This was very true of my wife. She even had a newsletter for close friends and family entitled, “Sandra’s Cancer Journey”. After she died, I wrote:

    “…This horrific experience was not a “fight.” She did NOT lose a battle against the unchecked proliferation of malignant cells. Instead, Sandra saw the final phase of her life a journey. She was incredibly brave while facing the ravages of this terrible disease, and she was ultimately accepting of her fate. She was gracious and generous in sharing the final stages of her journey with friends and family, and also with nearly 25,000 followers of her @unsuicide Twitter account.”

    I was not so accepting, partially because I “fought” bureaucratic delays and medical incompetence for 7 months to try to get her enrolled in an immunotherapy clinical trial (I wrote about that in another post). But mostly it’s because the grief has been unbearable.

    1. I am so sorry for your loss, but thank you for sharing. Sandra seems beyond amazing, thoughtful and loved. It is interesting though, as you point out, that in some cases “battle” metaphors may have more of a place for describing family members’ experiences. I hadn’t thought about that before.

      But even though I believe the language we use in these situations is important, I know it can hardly put a dent in the horrible experiences and emotions that can come with illness and loss. Thinking of you.

  3. Thank you, she was an amazing person. I did try really hard — learned about immunotherapy, read many papers, checked ClinicalTrials.gov constantly, tried to contact trial coordinators, etc. Obviously, my struggle or “fight” metaphor applied to the system and not to the disease itself, so it’s quite different. Yet I did feel guilty I couldn’t do more (which was impossible), and I know rationally that those feelings are harmful.

    But back to metaphors for cancer. It’s such an important issue, and I’m glad you wrote your paper (and this post). thanks again.

    1. Wow, thanks for passing this on! Couldn’t agree more. Especially with this: “So, when somebody might have cancer progression or when things don’t go in the way that they were hoping, they may feel like they didn’t do enough or like they lost the battle.”

      There’s another statement in here that speaks to a follow-up project I’m working on with some other collaborators: “Also, there are a lot of metaphors just in our everyday language that talk about cancer in warlike terms that can also be harmful for people, too. [For example,] when they talk about something being a cancer in an organization that you need to cut out before it kills things. It’s not helpful for people to hear that, and cancer really shouldn’t be used as a metaphor in that way.”
      We’re trying to figure out what how using cancer as the metaphor to talk about some other topic shapes the way people think about it…

      Thanks again for sharing. Hope you’re doing well!

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