War metaphors in cancer

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War metaphors are often used to describe a person's experience with cancer. Those who have died are said to have lost their "battle with cancer", while the living are described as "fighting cancer".

Contents

While the use of metaphors can help physicians explain cancer in a way that is understood by patients, it has been argued that words such as battle and fight are inappropriate, as they suggest that cancer can be defeated if one just fights hard enough. [1] [2] [3]

History

The use of war and battle metaphors in medicine has been documented back to the 1600s. [4] Over the 20th century, politicians have "declared war" on cancer, diabetes, AIDS, and obesity. [4]

Military metaphors are not an exclusively Western phenomenon. Battle terms are also used in traditional Chinese medicine. Contrarily, in sub-Saharan Africa, diseases are seen as a part of life that should be accepted, not fought. [4]

Usage

Some people perceive cancer treatment as a battle to be fought. Space Force Chief battles, beats cancer (6370458).jpg
Some people perceive cancer treatment as a battle to be fought.

War metaphors are commonly used by scientists, physicians, patients, and the general public. [5]

A 2010 study found that greater use of metaphors by physicians was associated with better understanding by patients. [6]

The phrase is often used when someone dies, and may appear in obituaries. For example, a statement from Victoria Wood's publicist in April 2016 said that Wood had "passed away, after a short but brave battle with cancer". [7] [8] In December 2016, journalist A. A. Gill was described by Sky News as having died after a "short fight with cancer". [9]

Research in 2014 led by Elena Semino, a professor of linguistics at Lancaster University, alongside palliative care specialists, based on 1.5 million words of discussion, led Semino to say, "We have enough evidence to suggest that battle metaphors are sufficiently negative for enough people that they shouldn't be imposed on anyone". The study stated that doctors should avoid battle/fight metaphors unless patients themselves chose to use them, and obituaries should avoid them, especially the idea of "losing" such a battle/fight. By comparison, another common metaphor, comparing cancer to a "journey" was "less likely to lead to feelings of guilt or failure". [10] [11] In a study conducted in 2003 stated that patients using war-related terminology to describe their breast cancer had higher rates of depression and "poorer quality of life". [12]

In a 2014 article in The Guardian titled "Having cancer is not a fight or a battle", physician Kate Granger, who was diagnosed with desmoplastic small-round-cell tumor (a type of sarcoma), explains how the use of military language, whilst perhaps aiming to instill a sense of positivity, can have the opposite effect. [13]

Criticism

Talking about "losing" a battle with cancer can feel hurtful and critical. Laying to rest Lt Col Guerrero (4212001).jpeg
Talking about "losing" a battle with cancer can feel hurtful and critical.

The use of war metaphors can have negative effects for patients. Patients perceive treatment to be more difficult when it is described to them using violent metaphors. [6] These metaphors can also lead to feelings of disempowerment, guilt, and fatalism. [6] One study found that the use of war metaphors in cancer public health decreased engagement in cancer prevention behaviors. [14] Another common criticism of this use of metaphor is that when patients die, the implication is that they did not fight enough, and if they fought harder, they would have been victorious. [15] [6] The term "journey with cancer" has been proposed to replace the war metaphors due to both help with the visualization of the disease and more gentleness for patients. [16]

Sick Kids Hospital in Canada spent $2 million on an advertising campaign depicting children as warriors clad in armor with weapons. This attracted controversy and was decried by some as not portraying the true experience of children with serious diseases. [6] [17] [18] [15] A charity has been named Cyclists Fighting Cancer [19] and foods have been described as "cancer-fighting". [20] Following the death of Robin Gibb, cancer survivor Jenni Murray criticized the media for using 'pugilistic terminology' arguing 'RIP Robin Gibb with an acknowledgement that he drew the short straw of a difficult disease'. [21]

Determinants of identity adoption

Research has indicated that the likelihood of adopting a specific label varies according to different factors. [22] [23] A study of men post-prostatectomy showed that men were most likely to adopt the label of 'someone who has had cancer'. [22] The label 'cancer survivor' was more likely when there was higher cancer severity perception and when there was benefit found in the 'survivor' identity. [22] Those identifying with 'victim' were more likely to receive a positive depression result on a depression screening. [22] Other work suggests that older age and enhanced psychological development following diagnosis are linked with the likelihood of adopting a 'survivor' identity. [23] When examined by gender, men who identified as 'survivors' had lower perceptions of threat, engaged in greater reflection, and had stronger insight from peer communication. [24] Women who identified as 'survivors' were more engaged in posting to online support groups, felt a greater sense of belonging in peer contexts, and were able to better relate to those in support groups. [24]

On the other hand, a study of bone marrow transplant receivers who previously had cancer found that patient identity was not related to age nor income. [25] [26] It was also found to be inversely correlated to education and the amount of time that had passed since the transplant. [25] [26] It is also shown to be unrelated to how well or poorly adjusted psychologically a person is following their cancer treatment. [25] In a study of colorectal survivors, researchers found that adopting a 'survivor' identity was not significantly related to age, status of relationship, level of schooling, or duration since cancer diagnosis. [24]

Other illnesses/conditions

The concept of a "battle with..." is used in similar phrases such as a "battle with depression". [27]

HIV researchers also commonly use battle metaphors. Some commentators have also criticized the use of war terms and militarization of the HIV/AIDS pandemic. [28]

The use of war metaphors spread during the COVID-19 epidemic, in which healthcare workers were described as "brave heroes" and those affected by coronavirus as "victims". [6]

See also

References

  1. ↑ "Stating a Person Lost Her/His Battle with Cancer Is Insulting | Nancy's Point". Nancyspoint.com. 17 February 2015. Retrieved 21 April 2016.
  2. ↑ "Cancer is an illness, not a battle". Dying Matters. 20 May 2013. Retrieved 21 April 2016.
  3. ↑ "Stop Using The Phrase "Someone Lost Their Battle With Cancer"". Chicagonow.com. Archived from the original on 28 April 2016. Retrieved 21 April 2016.
  4. 1 2 3 Nie, Jing-Bao; Gilbertson, Adam Lloyd; de Roubaix, Malcolm; Staunton, Ciara; van Niekerk, Anton; Tucker, Joseph D.; Rennie, Stuart (October 2016). "Healing Without Waging War: Beyond Military Metaphors in Medicine and HIV Cure Research". The American Journal of Bioethics. 16 (10): 3–11. doi:10.1080/15265161.2016.1214305. ISSN   1526-5161. PMC   5064845 . PMID   27653388.
  5. ↑ Marron, Jonathan M.; Dizon, Don S.; Symington, Banu; Thompson, Michael A.; Rosenberg, Abby R. (31 July 2020). "Waging War on War Metaphors in Cancer and COVID-19". JCO Oncology Practice . 16 (10): 624–627. doi: 10.1200/OP.20.00542 . PMID   32735509. S2CID   220909237.
  6. 1 2 3 4 5 6 Marron, Jonathan M.; Dizon, Don S.; Symington, Banu; Thompson, Michael A.; Rosenberg, Abby R. (31 July 2020). "Waging War on War Metaphors in Cancer and COVID-19". JCO Oncology Practice. 16 (10): 624–627. doi: 10.1200/OP.20.00542 . ISSN   2688-1527. PMID   32735509. S2CID   220909237.
  7. ↑ Leon Watson (20 April 2016). "Comedian Victoria Wood dies aged 62 after short cancer battle". The Telegraph. Telegraph.co.uk. Retrieved 17 April 2017.
  8. ↑ Heather Saul (20 April 2016). "Victoria Wood dead: Comedian and actress dies from cancer aged 62". The Independent. Retrieved 17 April 2017.
  9. ↑ Restaurant critic AA Gill dies aged 62 after short fight with cancer. Sky News, 11 December 2016. 11 December 2016.
  10. ↑ Charlie Cooper (3 November 2014). "Mind your language: 'Battling' cancer metaphors can make terminally ill patients worse | Health News | Lifestyle". The Independent . Retrieved 21 April 2016.
  11. ↑ Hendricks, Rose K.; Demjén, Zsófia; Semino, Elena; Boroditsky, Lera (2 October 2018). "Emotional Implications of Metaphor: Consequences of Metaphor Framing for Mindset about Cancer". Metaphor and Symbol. 33 (4): 267–279. doi: 10.1080/10926488.2018.1549835 . ISSN   1092-6488.
  12. ↑ Degner, Lesley F.; Hack, Thomas; O'Neil, John; Kristjanson, Linda J. (June 2003). "A New Approach to Eliciting Meaning in the Context of Breast Cancer". Cancer Nursing . 26 (3): 169–178. doi:10.1097/00002820-200306000-00001. PMID   12832949. S2CID   24852824.
  13. ↑ Kate Granger. "Having cancer is not a fight or a battle | Society". The Guardian . Retrieved 21 April 2016.
  14. ↑ Hauser, David J.; Schwarz, Norbert (2015). "The War on Prevention" . Personality and Social Psychology Bulletin. 41 (1): 66–77. doi:10.1177/0146167214557006. PMID   25352114. S2CID   31973282 . Retrieved 11 November 2020.
  15. 1 2 "SickKids campaign forgets that children aren't always warriors" . Retrieved 11 November 2020.
  16. ↑ Waldman, Katy (30 July 2015). "We're Finally Winning the Battle Against the Phrase "Battle With Cancer"". Slate . Archived from the original on 7 March 2020. Retrieved 10 November 2020.
  17. ↑ "Hospital fundraising campaign shouldn't use 'war as metaphor,' says U of O prof". CBC News. 23 October 2016. Retrieved 11 November 2020.
  18. ↑ "SickKids' New Ad Campaign: Fighting words? | Bioethics Research Library" . Retrieved 11 November 2020.
  19. ↑ "Cyclists Fighting Cancer". Cyclistsfc.org.uk. Retrieved 21 April 2016.
  20. ↑ "6 Cancer-Fighting Superfoods". Health.com. 22 February 1999. Retrieved 21 April 2016.
  21. ↑ "Jenni Murray: Robin Gibb didn't lose any 'battle'". The Independent. 22 May 2012. Retrieved 16 October 2019.
  22. 1 2 3 4 Jahnen, Matthias; Mynzak, Eike; Meissner, Valentin H.; Schiele, Stefan; Schulwitz, Helga; Ankerst, Donna P.; Gschwend, Jürgen E.; Herkommer, Kathleen; Dinkel, Andreas (20 September 2021). "Diversity of cancer-related identities in long-term prostate cancer survivors after radical prostatectomy". BMC Cancer. 21 (1): 1041. doi: 10.1186/s12885-021-08776-7 . ISSN   1471-2407. PMC   8454161 . PMID   34544381.
  23. 1 2 Chambers, Suzanne K.; Baade, Peter; Meng, Xingqiong; Youl, Pip; Aitken, Joanne; Dunn, Jeff (2012). "Survivor identity after colorectal cancer: antecedents, prevalence and outcomes". Psycho-Oncology. 21 (9): 962–969. doi:10.1002/pon.1991. ISSN   1099-1611. PMID   21608073.
  24. 1 2 3 Morris, Bronwyn A.; Lepore, Stephen J.; Wilson, Bridget; Lieberman, Morton A.; Dunn, Jeff; Chambers, Suzanne K. (September 2014). "Adopting a survivor identity after cancer in a peer support context". Journal of Cancer Survivorship: Research and Practice. 8 (3): 427–436. doi:10.1007/s11764-014-0355-5. ISSN   1932-2267. PMC   5402705 . PMID   24706364.
  25. 1 2 3 Park, Crystal L.; Zlateva, Ianita; Blank, Thomas O. (November 2009). "Self-identity after cancer: "survivor", "victim", "patient", and "person with cancer"". Journal of General Internal Medicine. 24 Suppl 2 (Suppl 2): S430–435. doi:10.1007/s11606-009-0993-x. ISSN   1525-1497. PMC   2763169 . PMID   19838845.
  26. 1 2 Beanlands, Heather J; Lipton, Jeffrey H; McCay, Elizabeth A; Schimmer, Aaron D; Elliott, Mary E; Messner, Hans A; Devins, Gerald M (1 November 2003). "Self-concept as a "BMT patient", illness intrusiveness, and engulfment in allogeneic bone marrow transplant recipients". Journal of Psychosomatic Research. 55 (5): 419–425. doi:10.1016/S0022-3999(03)00509-9. ISSN   0022-3999. PMID   14581096.
  27. ↑ "My battle with depression and the two things it taught me | Ben Locker | Opinion | the Guardian". TheGuardian.com . Archived from the original on 24 December 2015. Retrieved 20 April 2016.
  28. ↑ Ross, Judith Wilson (1989). "THE MILITARIZATION OF DISEASE: Do We Really Want a War on Aids?". Soundings: An Interdisciplinary Journal . 72 (1): 39–58. ISSN   0038-1861. JSTOR   41178464.
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