Let’s End Cancer Military Metaphors

The first notable use of illness described in military terms actually came from John Donne, the 16^th century “No man is an island” poet. He described his terminal illness as a “cannon shot” and a “siege that blows up the heart.” In 1864, Louis Pasteur (probably trying to get government funding for his research) used invasion imagery to introduce his new germ theory to the French public. And in 1971, President Nixon publicly declared “war” on cancer, calling it a “relentless and insidious enemy.”

And now, for more than 40 years, when you or a friend or a loved one gets a cancer diagnosis, out trot all sorts of war clichés as “the battle begins.” Your cancer is an evil entity that invaded your body. Your team of doctor/soldiers provides the big guns: surgery, chemo, and radiation therapy. Your surgeon (who could be John Wayne under that mask) confidently says, “Looks like we got it all.” But later that same day, during the second part of the classic one-two punch, your oncologist or radiation therapist proposes what sounds like a scorched-earth approach to “wipe out every last cancer cell.”

Your friends talk about how you’re doing in your battle with cancer, putting up the good fight.

One writer, a consultant to the pharmaceutical industry, in an essay entitled “Military Strategies Used in the War on Cancer,” rather imaginatively separated the different phases of cancer treatment into military maneuvers. Surgery, he felt, could be compared to aerial bombardment and artillery fire, ensuring all enemy troops are killed and removed. By comparison, radiation and chemotherapy recalled the poison gas attacks of World War I (interestingly, a poison gas used then was nitrogen mustard, which later became one of the first cancer chemotherapies). He then gets more sophisticated: the newer enzyme-inhibitor drugs, such as Gleevec for leukemia, will “slow the enemy’s advance.”

Finally, the newest cancer cell-specific monoclonal antibodies (Rituxan) and antibody-drug conjugates (Adcetris) he likens to Navy Seals teams and smart bombs.

Mind-body approach

If you’re into mind-body medicine, you’ll find plenty of creative visualizations originally created by the late Dr. O. Carl Simonton, MD. They encourage you to view your cancer cells as “weak, confused invaders,” and guide you to “mobilize your army of strong white blood cells to attack and destroy your cancer.”

Our current visualization guru is Belleruth Naparstek. Her CD, A Meditation to Help You Fight Cancer, “shows how to cope with cancer with a narrative that imagines tumors shrinking and fighter cells battling and triumphing over cancer cells as a protective cushion of love and support surrounds the listener.”

Outside your window, friends and colleagues, fists held high, pink ribbons fluttering in the breeze, are marching against cancer. Unfortunately, too much of the money raised is directed to more and more chemotherapy, too little toward prevention.

And then, of course, if you’re defeated you’ll be remembered as a good soldier, losing your long battle against cancer, but putting up a good fight to the end.

“Be ready to fight”

This Health Tip was prompted by a small but interesting article published in the British Medical Journal responding to ads created by the fundraising drive of Cancer Research UK (CRUK). This well intentioned organization declared on billboards throughout the UK: “Be full of hope. Be courageous. Be ready to fight,” adding it was “determined to beat cancer.” In press releases, CRUK referred to its cancer research funds as a “war chest,” to some of its work as “recruiting viruses for cancer battle,” and to transforming  fundraising women in pink into an “army who run, dance, and sing.”

CRUK’s ad agency apparently admitted all this was “designed to have cancer quaking in its rubbish boots.” (And, no, despite considering myself widely read I don’t know what “rubbish boots” actually are.)

Essayist Susan Sontag (who herself had breast cancer) wrote about this in her now-classic Illness as Metaphor. Metaphors, she felt, created prejudice. A cancer survivor is a winner, the dying victim a loser. The military metaphors surrounding cancer ultimately confer blame on the victim for not fighting hard enough. But many people, she felt, aren’t by nature fighters. She wondered if a poorly chosen metaphor could make these peaceful souls feel responsible for both their cancer and their fate.

Another brilliant writer with breast cancer, feminist Barbara Ehrenreich, has written of her contempt for the cheery world of corporate-sponsored, pink-ribbon festivities. She, too, decries the endless victim language connected to breast cancer and the nonstop positive attitude among doctors, an approach that leaves little room for the patient to express the normal emotions of fear, shock, isolation, and sadness. For some powerful writing, try her Welcome to Cancerland website.

British writer and inveterate unapologetic smoker Jenny Diski relates in this month’s London Review of Books what went through her mind when she learned she had inoperable lung cancer. In this masterful article,  Diski concludes with:

“One thing I state as soon as we’re out of the door (of her doctor’s office): Under no circumstances is anyone to say that I lost a battle with cancer. Or that I bore it bravely. I am not fighting, losing, winning or bearing. I will not personify the cancer cells inside me in any form. I reject all metaphors of attack or enmity in the midst, and will have nothing whatever to do with any notion of desert, punishment, fairness or unfairness, or any kind of moral causality.”

So what this boils down to is that unless you really like the military metaphor, it’s time to shed it when it comes to cancer. It’s potentially harmful to those who have enough on their minds without being reminded by their oncologist-generals and pink-ribboned fellow troupers to be strong soldiers and keep up the good fight.

In my own opinion, the military metaphor was a mistake from the start because it implies an enemy to do battle against. But is “cancer” one unique enemy for us to do battle against? Cancer is not ISIS. Cancer is a multiplicity of diseases with a variety of causes, a variety of clinical presentations, and a variety of (often very successful, life-extending) treatments. Because of this, there will be no single “cure” for cancer in which cancer becomes, like the bubonic plague, an interesting historical event. Cancer is an incredibly complex puzzle.

You don’t wage war against puzzles. You solve them.

Be well,
David Edelberg, MD