A leading expert on language and the mind, cognitive psychologist Steven Pinker suggests in his book “The Stuff of Thought” that “conceptual metaphors point to an obvious way in which people could learn to reason about new, abstract concepts,” as well as provide the imagery and substrate to help store and share knowledge. The metaphorization of illness allows us to describe it in easily-digestible forms which have relevance and relation to our everyday speech. The use of the cancer metaphor has been apparent in oncology for many years, and has given both strengths and weaknesses to the provider-patient relationship. The Sapir-Whorf hypothesis, or linguistic relativity, theorizes that the structure of language — its grammar, syntax and literary devices — affects the way in which its speakers conceptualize the world. Just as oncologists have consciously or subconsciously implemented a military metaphor to describe cancer, so have cancer patients adapted a defense to the threat of the disease.
The language with which we categorize disease is abundant with metaphors. We have devised didactic models that seek to explain disease phenomena, as well as phantasmagoria which serve to create personal significance. Childhood fears about colds, “housewife myths” about catching them, and even contemporary television advertisements for pharmaceuticals pay their respects to the highly imagistic nature of our thinking. We are most capable of grasping the idea of cancer when it is presented in both the language and context of our common experiences. Whether one imagines antibodies as spaceships, cytokines as signals, or lymphocytes as protagonists matters less than the metaphor chosen to fit the patient; it is almost inevitable to narrate cancer progression as anything other than a fight.
The body is mysterious to the layman, and slightly less so to the trained physician; simplistic explanations achieve much needed comprehension in the vast field of medicine. Time, states and causes all rely on metaphor to synthesize a schematic geometry of nouns and prepositions that help make abstract actions realistically possible in the mind of the patient. According to Piaget’s prelogical thinking stage, children regard illness as concrete and the environment continuous with the body. It is unsurprising then that the increasing distance between one’s belief and its reality, and the human tendency to validate symbolical explanations, would lend to the transcendence of disease into metaphysics and metaphor: a qualitative symposium of symptoms and words for them. Children and adults alike mix metaphors, drawing on a vocabulary gleaned from various languages from varying eras, to describe occurrences, and paradoxically complicate the picture by amplifying the analogy. Words used to describe pharmacologic actions, for example, apply a multitude of qualifiers in order to communicate a mechanism, only to confuse the drug action with a plethora of generalizations: busting, beating, stopping, blocking, dissolving and quieting, to name a few.
Cancer is a disease whose metaphorical nature is telling of its societal and personal impressions, and the growth and influence it has attained since its first documentation. The word itself is regrettably spoken, as if its utterance would propagate it. It is the cause of disconcerting discussions and grim speculation. The “disease-which-must-not-be-named,” cancer is acutely feared and aloofly treated as a physical contaminant. It is painfully borne on the tongue of the physician and in the ears of the patient. Cancer is less frequently blamed on poor lifestyle choices than heart disease and gout (despite the majority of cases linked to environmental factors), and often connotes an innate insufficiency. Cancer is a demoralizing diagnosis that is neither demystified easily nor concealed comfortably, and causes significant anxiety in those diagnosed, even in benign cases.
The militant language which surrounds cancer confirms our aggressive approach to the disease, while a solemn one also displays our morbid reverence for it. Mutant cells invade the body and colonize tissue. A tumor advances and recedes as the immune system attacks, defends, suppresses and surrounds the unwelcome insurgent. Cases must be controlled, excised, removed or killed. In the “fight against cancer,” its subjects must be saved; not merely cured, but rescued from a vile perpetrator. Victims are thought to be singled-out, chosen, marked; they are often labelled as cancer-prone, at-risk or even unfortunate. Such teleological assumptions inspire ontological questions in victims — “what is cancer [to me]?” and “why me?” — and arouse contemplations of fairness, justice and equality.
Cancer patients have been described as pallid, sanguine, fatigued. They are often left waiting, wondering and watching. The viciousness of the disease nearly contrasts the delicate vitality of a bedridden victim. It is described as “something gone wrong” — a physicality that no longer suffices. Cancer was once signified as a “repression of passion” and resignation of pleasure, by which a patient’s internal energy has erupted or hidden vitality has transformed. In this sense, privacy and identity continue to be at stake, for the patient believes that he or she not only has something to hide but also something to discover about him or herself. The patient and his or her illness are grandiosely distorted beyond the immediate significations of the disease, often causing him or her to enter “a duplicate world with special rules” dictated by romanticized views of what it means to live with such alien agonies. Their minds are believed to betray, or be discordant with, their bodies. Though their struggle is to thrive in the face of a ruthless antagonist, cancer patients often strive to redeem their fragile lives.
Cancer is popularly (although not accurately) projected as a quintessentially modern disease that parallels the apathy, impatience and selfishness of present-day nations, and has been adapted to a full-scale “body politic.” The biological disease informs our notions of the world (as having qualities of cancer), while our everyday lives also embed opinions into the nature of the disease. The word ‘cancer’ need not honestly replicate the disease itself when used outside of the clinic, though its usage often reflects its existence as a medical phenomenon. A personality or behavior may be cancerous if it is wild, dangerous or damaging to a person and his close circle. The state or an elected official can be likened to a tumor that drains the energy of its host or robs its people of vitality, as Hobbes analogized political disorder to an illness. Marxist theoreticians, such as Antonio Gramsci, have used illnesses like tuberculosis and cancer to describe repressive and radical practices: “the classical formulations which analogize a political disorder to an illness … presuppose the classical medical (and political) idea of balance.” Still others, such as the German philosopher Friedrich Nietzsche, describes disease as less interesting than sickness, which challenges the idea of perfect health and romanticizes illness through the lens of individual power and sublime decadence. To describe a phenomenon as a cancer is an incitement to violence, encouragement of fatalism, and reinforcement of incurability. The patient and his or her disease are often generalized to the world and its degeneracies, in a way which helps individuals and groups cope with the disease but paradoxically dilutes, or eludes, its true essence. “Illness is in part what the world has done to a victim, but in a larger part it is what the victim has done with his world, and with himself…,” with a cure depending predominantly on the capacity of the victim to free him or herself from self-imposed constraints.
Cancer imagery is heavily invested in mythological thinking that is directed by the overt emotionality of the illness. At times, its selectivity and demands contribute a sense of apotheosis in the “chosen” victim who aggrandizes their affliction. Cancer, like many illnesses, is interpreted as a psychological event, such that a patient can believe in the extent of the disease process, their ability to willfully cure themselves, and the way he or she relates to their disease. The close relationship between cancer in vivo and cancer-in-society instigates a heightened response and awareness to its occurrence. Cancer patients may be helped or hindered by the metaphor surrounding their illness; metaphors can illustrate complex issues but can also perpetuate harmful stereotypes. We have given cancer an abstract vitality by installing it in our speech — especially in slander and wartime propaganda, as a rationalization of our enemies — and have nurtured its clinical course by suffusing patient monologues with ideas about how cancer might look, feel, act and progress. Cancer continues to be a widely experienced disease, a leading cause of death worldwide accounting for 8.2 million deaths in 2012, that can arise from multiple causes. So long as it floods the media and draws the attention of physicians, researchers and patients, so will it perpetuate as a protean scourge in the minds of those who must grapple with it.
Metaphor permeates our daily language and allows us to understand one thing in terms of another. Each member of a medical team approaches the discussion of cancer in a different way by making particular use of the presently available metaphors. There is a “tyranny of positive thinking” that accompanies the almost cliché advice to “keep fighting.” While chemotherapy, radiation and surgery are responsible for improved survival rates, “antidotes to a narcissistic character disorder” that often envelops the victim can be helpful to a patient living with cancer. The cultural pressure of distancing (cancer patients as different, isolated, broken), and the semiotic steps we take towards identification of the disease, person, and diseased person, often make cancer a complicated challenge for the physician and patient alike. Metaphor can bridge the gap between a patient and his or her illness, but also prevent a cognitive recovery by overwhelmingly involving the patient in a sea of unclear concepts. We must be careful with the constructions we use, so as not to suffocate patients with the stress of the war and the passive role of the afflicted. An ecologic metaphor which focuses on ideas of balance, sustainability, responsibility and conservation has been suggested as a way of changing the mental landscape in order to better address the subjective view of illness and forge a more wholesome therapeutic environment.