No Losers Here!

War Metaphors and Cancer

by Amy Bruno-Lindner, SPAGN Volunteer.

 

“When it’s my time to go, whatever you do, do NOT let anyone write that I have lost the battle against cancer!”, I tell my husband. He looks surprised at my vehemence. But after many years of living with cancer, I do not, under any circumstances, want to be portrayed as some kind of loser in the end.

Sure, you could argue that the phrase is simply part of the language. It’s also an implied metaphor: Cancer is the enemy, cancer attacks the body, and patients are brave warriors who fight against it. Some win the battle and survive – and others lose.

Fight! Fight! Fight!

War metaphors are used all the time in the context of cancer. “You’re a fighter! You got this!”, people say to a newly diagnosed patient. Cancer “warriors” are advised to rally their forces in response to the enemy: “Imagine your immune system gobbling up and destroying the malignant cells!” Or: “Your attitude is your best weapon!”

What’s more, patients are expected to undergo treatment after treatment, to move from one line of defense to the next, all the while encouraged to soldier on, regardless of side effects and any loss of quality of life. Fight! Fight! Fight! is the rallying cry.

And if someone succumbs to cancer, it’s because they didn’t fight hard enough, or worse, gave up. At least, that’s what the war metaphors seem to imply.

Many rightly point out that such expectations are an additional burden placed upon a person who is already undergoing so much. The writer Susan Sonntag identified this use of war metaphors as a kind of victim-blaming. She even called for a complete liberation from metaphors as the “most truthful” way of speaking or writing about illness.

A helpful coping tool?

And yet – like so many things, it’s complicated. Because sometimes war metaphors can be helpful.

War metaphors can rally my spirits and give me a sense of hope. When I look at the May 28, 2001 cover of TIME magazine announcing the arrival of imatinib, I am overcome with emotion. Imatinib is the medication that has enabled me to live with metastatic Gastrointestinal Stromal Tumor (GIST) for 12 years. Chills run up and down my spine every time I read the headline:

“THERE IS NEW AMMUNITION IN THE WAR AGAINST CANCER. THESE ARE THE BULLETS.”

I am so taken in by the language of war that I feel positively patriotic. My body is my country! These pills are going to kick some cancer a** and defeat the enemy invader! I feel the same fighting spirit that overcomes me while watching science fiction films about aliens threatening the Earth – when the good guys and the bad guys are unmistakable, and it’s clear the war must be waged. We can do this! It’s time to Fight! Fight! Fight!

Honestly, as someone who marched in peace demonstrations in her younger years, these feelings sometimes bewilder me. It feels strange to be glorifying war, at least in my choice of words.

But as a cancer patient it empowers me and gives me hope to think that scientists continue to work – no, battle – to develop more effective treatments. They are on my side in this fight, and they are powerful allies.

Taking an active role in your treatment

War metaphors can also make me feel less like a victim of my disease and inspire me to take action. In an editorial, Robert W. McEachern points out that war metaphors can serve an important function for cancer patients by providing them with a sense of agency.

Language is a helpful coping tool: the way we talk about our illness shapes our own role in it. You are not a victim if you can fight. A warrior is not a passive recipient of care.

When I received my second cancer diagnosis two years ago, I told myself I would fight this thing. Although there are no magic bullets for this cancer like there are for GIST, I vowed I would take advantage of all the treatments I could access for as long as I could.

I was ready to fight to get the best available treatment and care. Cancer patients are often engaged on multiple battlefields: they may have to fight to get a timely diagnosis, to get access to state-of-the-art treatment, to participate in clinical trials, to have genetic and tumor marker testing done, or to find ways to manage the side effects of their treatment.

A fighter will see their oncologist as an ally, and ask questions like these: Could you explain these results so that I can understand them better? Can further mutational testing be done? Can we adjust the medication to make the side effects more tolerable? Is there a clinical trial that would be a good fit for me? What is our next plan of attack?

As a patient advocate, I can encourage patients to develop their sense of agency. I want to help them to take an active role in their own treatment and care, to see themselves as fighters rather than helpless victims.

For me as a patient, having a fighting spirit means pushing myself to do things I may not always feel like doing but are good for me, like taking regular brisk walks, lifting light weights, connecting with other patients in a support group, learning more about my disease, or eating more nutritious foods.

No losers here!

So maybe the war metaphors have a role to play after all. But can we use these metaphors when and how they suit us? Sure, why not? They are coping tools. They can help us frame our situation and our role in it.

But, at least for me, the winner-loser dichotomy has got to go. It’s just wrong.

And of course, it’s any patient’s right to reject all the noisy warrior-hype. Wartime drama is not everyone’s thing. Many of us bristle at being called “brave”, or even “a hero”, when we know that we did not choose this fight – it was thrust upon us. Instead, we strive to be patients with agency, but also with acceptance.

There is one more thing that needs to be said: At some point in the (hopefully distant) future it will be time to lay down the weapons, to put aside the war metaphors like tools no longer needed. That might be when a decision is made to stop all treatment. That might be when it’s time to accept that nature will take its course. That’s OK, too.

And it’s certainly not “losing” – especially if you are at peace with the situation.