Examine Yourself: Military terms like 'battling cancer' and 'war on cancer' do more harm than good

Military metaphors are commonly used when we talk about cancer but, according to new research, describing the disease as a battlefield is far from helpful and can have a negative effect, writes Marjorie Brennan.

Wed, 25 Sep, 2019 - 17:13

Marjorie Brennan

In the book C: Because Cowards Get Cancer Too, published in 1998, journalist John Diamond wrote: “I despise the set of warlike metaphors that so many apply to cancer. My antipathy has nothing to do with pacifism and everything to do with a hatred for the sort of morality which says that only those who fight hard against their cancer survive it or deserve to survive it — the corollary being that those who lose the fight deserved to do so.”

Diamond, who later died from throat cancer, aged 47, was lauded for his honesty in tackling the subject of the language we use around cancer — which is often framed as a battle to be fought, then won or lost, in which those who have the disease are either victims or ‘brave’ survivors.

However, little has changed since Diamond wrote of his experience more than two decades ago, with recent research finding that the widespread use of war metaphors can have a wide-ranging negative impact, not only on people who have cancer but also in terms of accessing diagnostic services and treatment.

According to research carried out by David Hauser, a psychologist at Queen’s University in Ontario, Canada, using metaphors of battle, war, and enemies can make cancer treatment seem more difficult, lead people to believe there is little they can do to reduce their risk of the disease, and discourage people from seeing a doctor more quickly if they have a cancer scare.

Robert O’Connor, head of research with the Irish Cancer Society, says such studies are important in raising awareness of the impact of the language that is used around cancer.

Language is critically important, but it is also challenging because it is dynamic. We talk about cancer as a single disease but it is not, it is so many hundreds of different diseases — and it is thousands of different experiences.

"This is part of the challenge; we often talk in a uniform way about something that is really broad. We have tended to use militaristic-type language in a supportive sense. It is extremely common to talk about someone battling or fighting cancer — or ‘losing’, a term I have real difficulty with. It implies coming second or third in a race, but it is not a race, and cancer is not a choice.”

O’Connor also acknowledges, however, that some people with cancer may find military metaphors helpful.

“In some situations and with individual interactions, people may feel buoyed by that kind of language. We default to these words as well, because it is the way we have always spoken. It is not that there is any intended negativity or undermining.”

Bernie Carter is an oncology nurse specialist with the Marie Keating Foundation and she says warlike language can heighten the already significant fear around cancer.

“We can often think that by using such terminology, we are explaining it in a way that is easier for the patient to understand, but such words can make [a cancer diagnosis] more scary and negative. In the Marie Keating Foundation, we are trying to make cancer less frightening.

"By using more positive language, it may be more likely a patient will engage with treatment, and might not feel so negative about going in for their treatment. I know about the impact of such language from dealing with patients directly, and even my own sister who is going through the cancer journey. She said the use of such words made her feel like she was losing a ‘war’ that she didn’t choose to fight.”

Carter says such language is so common, that we can use it without even thinking.

“I have been responsible for using words like ‘war’ or ‘battle’, but definitely I am now pausing and thinking. We would aim as much as possible to avoid the use of battle-type metaphors, whether that is in answering queries to our free Ask The Nurse service, or in our cancer-specific presentations in schools, the community, corporate settings, men sheds etc. but we are all guilty of using such language from time to time.

"Behavioural change is something we all need to address. It is about making the journey less fearful for the patient. We can all help in making the change.”

Military metaphors are also an easy shorthand in media reports to describe people who have died from the disease — they have invariably ‘fought’ and ‘lost’ a ‘brave’ battle. While O’Connor says there is no blame to be ascribed in defaulting to such language, it is important for everyone to consider the words we use when communicating about cancer.

“If the media are more cognisant that the tone of the words they use can have consequences, they might give consideration to the implications and recognise the distress they can cause. In general, we [Irish Cancer Society] try to find language that is supportive, inclusive and positive. We work closely with patients and we try and use the language that patients are using with us.”