Medicine:War metaphors in cancer

From HandWiki

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".

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 a 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

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] In a study conducted in 2003 stated that war–related terminology to describe their breast cancer had higher rates of depression and "poorer quality of life".[11]

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 instil a sense of positivity, can have the opposite effect.[12]

Criticism

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.[13] 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.[14][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.[15]

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][16][17][14] A charity has been named Cyclists Fighting Cancer[18] and foods have been described as "cancer-fighting".[19] 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'.[20]

Other illnesses/conditions

The concept of a "battle with..." is used in similar phrases such as a "battle with depression".[21]

HIV researchers also commonly use battle metaphors.[citation needed] Some commentators have also criticized the use of war terms and militarization of the HIV/AIDS pandemic.[22]

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

  • "Illness as Metaphor," an essay by Susan Sontag criticizing this type of language

References

  1. ↑ "Stating a Person Lost Her/His Battle with Cancer Is Insulting | Nancy's Point". 17 February 2015. http://nancyspoint.com/stating-a-person-lost-herhis-battle-with-cancer-is-insulting/. 
  2. ↑ "Cancer is an illness, not a battle". Dying Matters. 20 May 2013. http://www.dyingmatters.org/story/cancer-illness-not-battle. 
  3. ↑ "Stop Using The Phrase "Someone Lost Their Battle With Cancer"". http://www.chicagonow.com/god-running-partner/2015/01/stop-using-the-phrase-someone-lost-their-battle-with-cancer/. 
  4. ↑ 4.0 4.1 4.2 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. 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. 
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 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. ISSN 2688-1527. PMID 32735509. 
  7. ↑ Leon Watson (20 April 2016). "Comedian Victoria Wood dies aged 62 after short cancer battle". The Telegraph (Telegraph.co.uk). https://www.telegraph.co.uk/news/2016/04/20/comedian-victoria-wood-dies-of-cancer-aged-62/. 
  8. ↑ Heather Saul (20 April 2016). "Victoria Wood dead: Comedian and actress dies from cancer aged 62". The Independent. https://www.independent.co.uk/news/people/victoria-wood-dead-actress-and-comedian-dies-from-cancer-a6992966.html. 
  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. https://www.independent.co.uk/life-style/health-and-families/health-news/mind-your-language-battling-cancer-metaphors-can-make-terminally-ill-patients-worse-9836322.html. 
  11. ↑ 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. https://pubmed.ncbi.nlm.nih.gov/12832949/. Retrieved 10 November 2020. 
  12. ↑ Kate Granger. "Having cancer is not a fight or a battle | Society". The Guardian. https://www.theguardian.com/society/2014/apr/25/having-cancer-not-fight-or-battle. 
  13. ↑ 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. https://journals.sagepub.com/doi/10.1177/0146167214557006. Retrieved 11 November 2020. 
  14. ↑ 14.0 14.1 "SickKids campaign forgets that children aren't always warriors". https://www.theglobeandmail.com/opinion/sickkids-campaign-forgets-that-children-are-not-always-warriors/article32498752/. 
  15. ↑ Waldman, Katy (30 July 2015). "We're Finally Winning the Battle Against the Phrase "Battle With Cancer"". Slate. https://slate.com/human-interest/2015/07/how-battle-with-cancer-is-being-replaced-by-journey-with-cancer.html. 
  16. ↑ "Hospital fundraising campaign shouldn't use 'war as metaphor,' says U of O prof". CBC News. 23 October 2016. https://www.cbc.ca/news/canada/ottawa/michael-orsini-sick-kids-fundraising-ad-1.3816445. 
  17. ↑ "SickKids' New Ad Campaign: Fighting words? | Bioethics Research Library". https://bioethics.georgetown.edu/2016/10/sickkids-new-ad-campaign-fighting-words/. 
  18. ↑ "Cyclists Fighting Cancer". http://www.cyclistsfc.org.uk/. 
  19. ↑ "6 Cancer-Fighting Superfoods". 22 February 1999. http://www.health.com/health/gallery/0,,20430736,00.html. 
  20. ↑ "Jenni Murray: Robin Gibb didn't lose any 'battle'" (in en). 2012-05-22. https://www.independent.co.uk/voices/commentators/jenni-murray-robin-gibb-didnt-lose-any-battle-7771255.html. 
  21. ↑ "My battle with depression and the two things it taught me | Ben Locker | Opinion | the Guardian". https://www.theguardian.com/commentisfree/2015/jan/30/battle-depression-taught-me-medicine-love. 
  22. ↑ 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. https://www.jstor.org/stable/41178464. 



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