Revised (November 5th, 2019)
Metaphors and Chronic Disease: An Examination
Metaphor is found everywhere because our understanding of the abstract is limited. We use language to bridge the gaps between the physical and metaphysical worlds through comparisons made to concrete concepts, but even language can seem inadequate in grasping the true nature of a thing without imbuing it with new meanings and connotations, essentially obscuring it. Illness is rife with metaphors and has been since perhaps its very beginning. While metaphors evolve with advances in technology and human knowledge, they can still be harmful, oversimplifying complex issues or otherwise totally obscuring them. In “Illness as Metaphor and AIDs and its Metaphors,” Susan Sontag investigates several metaphors surrounding illness, both historical and modern, to show their implications on society’s perception of the disease and its sufferer. She posits that although it is likely impossible to completely erase the stigma of illness, widely accepted metaphors can worsen it. However, there are instances in which metaphor can inform our understanding of illness and help those who are ill in navigating the disease, its effects on their bodies, and society at large. This paper will discuss the oft-heard comparison of living with cancer to fighting a war as well as another metaphor, which compares chronic disease to a marathon. While both metaphors tackle the issue of chronic disease, their effects on the audience drastically differ; the war metaphor obscures the nature of cancer whereas the marathon metaphor informs the patient’s understanding of living with chronic disease.
One particularly pervasive metaphor that Susan Sontag, a cancer survivor, explores is that cancer is akin to war, which shapes our understanding of cancer as an enemy. Militaristic phrasing is ubiquitous: people “battle” cancer, cancer “colonizes” the body, et cetera (Sontag 64). Treatment is also described in similar terms as a defensive form of warfare; chemotherapy is said to“bombard” patients’ cells, like an airstrike (Sontag 66). While this emerged after the previous take on cancer as a “demonic pregnancy” and is seemingly more rooted in the more objective truth of science rather than the emotional truth of those suffering from illness and the illness’ conflict with one’s faith, it similarly obscures cancer. All these allusions to winning versus losing and even the casualties of healthy cells being a natural part of war can be demoralizing to a cancer patient. This ties into an idea Arthur Frank presents about the quest narrative and the idea of a “sick role” (Frank 130). Though it most likely intended to be motivating to view cancer as a battle, it seemingly demands the person suffering from it to be more than what they were before in order to fight cancer and win.
While this metaphor is a step up from viewing cancer as a reflection of personal failure and shame, it still seems to imply that the person who has cancer bears a responsibility to be strong in order to win and return to the kingdom of the healthy and their social obligations (Frank 130). Originating in the 1880s, this comparison to war seems to have become even more ill-suited now. Sontag recounts that cancer seemed like a colonial war in a period where they were not going well, resulting in widespread pessimism among doctors about the efficacy of treatment, even with great advancements in treatment technology (Sontag 66). This has undoubtedly shaped the attitudes regarding individual cases, possibly contributing to certain outcomes for patients. This metaphor has become even less apt in the modern age, where more and more people condemn war and view it as senseless.
Another somewhat prevalent metaphor about chronic illness is that it is a “marathon, not a sprint,” with “bumps on the road and frequent detours,” as worded by an article from The Atlantic titled “The Trouble with Medicine’s Metaphors” (Khullar). This is a rare example where metaphor informs our understanding of an illness. While only briefly noted in the article, it can be concluded that a marathon represents chronic illness because of the stamina and consistency required in tackling both. A marathon requires months of preparations, not unlike a war. However, its execution is entirely different in nature. Within the context of the article, Khullar uses the marathon metaphor to show the power of metaphor in “creating the milieu in which goals of care are discussed” (Khullar). Unlike the comparison of cancer to warfare, this metaphor seems to compare things that are within the same realm; the marathon relates to the patient’s physical capacity to function in their everyday life or to the idea that they should settle in for a long and winding road to recovery. Therefore, it is easier for a patient faced with another chronic illness to grasp what is needed for their treatment as opposed to those faced with the militaristic phrasing surrounding cancer.
This difference extends beyond the simple difference between the concrete concepts being employed in the metaphors. The language of the cancer metaphor has the opposite effect, obscuring the illness and what is expected of the patient. Training for a marathon is a highly individualized process and its ultimate goal is the completion of the marathon rather than besting others. Khullar delves into the militaristic phrasing of medicine not necessarily relating to cancer, claiming its “adversarial” approach dichotomizes the outcomes of treatment as either a win or loss (Khullar). This adds undue pressure for a cancer patient to maximize their chances of “winning against cancer,” and can be unhealthy in the underlying implication that cancer patients can control the outcome of their treatment the way a nation can influence the outcome of a war. While the vagaries of war and its harrowing nature can convey the unpredictable nature of the illness and its effect on the sufferer, the war metaphor still imposes a pressure on people to adopt a positive front, no matter how false it is. Khullar cites several studies showing the development of “maladaptive coping mechanisms” in response to this commonly espoused attitude towards cancer (Khullar).
While, of course, it is important to note that these metaphors relate to somewhat different illnesses, the difference still stands. Cancer is an example of a chronic illness, albeit not one commonly associated with the phrase “chronic illness.” It seems to exist in a category all of its own partly due to the war metaphor and the promulgation of similar bleak and morbid narratives. On the other hand, “chronic illness” is associated with conditions such as diabetes, arthritis, and asthma. Their associated metaphors are reflective of these prevailing attitudes—because the metaphors are partly responsible for their creation. Both acknowledge the body’s physical limitations, with death being implicit in cancerous warfare. However, the second metaphor contends that it is possible to finish the marathon whereas the “battle” metaphor makes no such promise.
In a way, the first metaphor seems to echo previous conceptions of cancer. We still commonly equate it with a death sentence, no matter how advanced treatment has become. Even if one “beats” cancer, it is associated with death. If not the person’s body, it still “kills” healthy cells and perhaps part of their identity, or at least transforming it as suggested by the culturally preferred quest narrative; “[authors of the narrative] want to use suffering to move others forward with them” (Frank 121). While both metaphors are intended to inspire hope among people diagnosed with these diseases, the cancer metaphor makes the illness seem both daunting yet controllable. On the other hand, the chronic illness metaphor acknowledges that the body is not as physically capable as it used to be, but uplifts the patient, showing that living with it is doable despite its challenges—one only needs to set reasonable and gradual goals.
In conclusion, it is possible for metaphors about illnesses to both inform and obscure our ideas about illness, with the chronic illness and cancer metaphors being prime examples of the former and latter. It all lies within the connotations of the concrete aspect of the metaphor. The more loaded it is with connotations outside the illness, the more it will obscure one’s understanding of it, as seen with cancer. However, emotionally evocative imagery and comparisons should not be eschewed entirely—just used with caution to avoid any negative effects it may have on patients. There is certainly an emotional and human dimension in educating patients about their diagnosis. A doctor cannot simply describe the condition in scientific terms because of disparities in education, not to mention how a clinical tone can hinder the patient-doctor rapport. It is the duty of healthcare practitioners to be culturally competent and aware of the implications of each word and comparison used seeing as their metaphors are adopted by the public, eventually shaping societal views, which fuel the creation of more metaphors and narratives.
Works Cited
Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. The University of Chicago Press, 2013, pp. 130-131.
Khullar, Dhruv. “The Trouble With Medicine’s Metaphors.” The Atlantic, Atlantic Media Company, 7 Aug. 2014, www.theatlantic.com/health/archive/2014/08/the-trouble-with-medicines- metaphors/374982/.
Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors. Penguin, 2013, pp. 54-68.
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Original (October 16th, 2019)
Metaphor is found everywhere because our understanding of the abstract is limited. We use language to bridge the gaps between the physical and metaphysical worlds through comparisons made to concrete concepts, but even language can seem inadequate in grasping the true nature of a thing without imbuing it with new meanings and connotations, essentially obscuring it. Illness is rife with metaphors and has been since perhaps its very beginning. While metaphors evolve with advances in technology and human knowledge, they can still be harmful, oversimplifying complex issues or otherwise totally obscuring them rather than informing our understanding of them. In “Illness as Metaphor and AIDs and its Metaphors,” Susan Sontag investigates several metaphors surrounding illness, both historical and modern, showing their implications on society’s perception of the disease and its sufferer. She posits that although it is likely impossible to completely erase the stigma of illness, widely accepted metaphors can worsen it. However, there are instances in which metaphor can inform our understanding of illness and help those who are ill navigate the disease, its effects on their bodies, and society at large. This paper will discuss the oft-heard comparison of living with cancer to fighting a war, which is found and dissected in Sontag’s piece as well as another metaphor found in a contemporary article. The cancer metaphor obscures the disease whereas the other metaphor, which compares living with chronic illness to running a marathon, informs our understanding of its respective illness.
One particularly pervasive metaphor that Susan Sontag, a cancer survivor, explores is that cancer is akin to war, which shapes our understanding of cancer as an enemy. Militaristic phrasing is ubiquitous; people “battle” cancer, cancer “colonizes” the body, et cetera (Sontag 64). Treatment is also described in similar terms as a defensive form of warfare; chemotherapy is said to “bombard” patients’ cells, like an airstrike (Sontag 66). While this emerged after the previous take on cancer as a “demonic pregnancy” and is seemingly more rooted in the more objective truth of science rather than the emotional truth of those suffering from illness and the illness’ conflict with one’s faith, it similarly obscures cancer. All these allusions to winning and losing and even the casualties of healthy cells being a natural part of war can be demoralizing to a cancer patient. This ties into an idea Arthur Frank presents about the quest narrative and the idea of a “sick role.” Though it most likely intended to be motivating to view cancer as a battle, it seemingly demands the person suffering from it to be more than what they were before in order to fight cancer and win.
While this metaphor is a step up from viewing cancer as a reflection of personal failure and shame, it still seems to imply that the person who has cancer bears a responsibility to be strong in order to win and return to the kingdom of the healthy and their social obligations (Frank 130). Originating in the 1880s, this comparison to war seems to have become even more ill-suited now. Sontag recounts that cancer seemed like a colonial war in a period where they were not going well, resulting in widespread pessimism among doctors about the efficacy of treatment, even with great advancements in treatment technology (Sontag 66). This has undoubtedly shaped the attitudes with regard to individual cases, possibly contributing to certain outcomes for patients. I can only assume that this metaphor has become less apt in the modern age, where more and more people condemn war and view it as senseless.
Another metaphor about illness that I recently read about was that life with chronic illness is a “marathon, not a sprint,” with “bumps on the road and frequent detours,” as worded by an article from The Atlantic titled “The Trouble with Medicine’s Metaphors” (Khullar). I think this is a rare example where metaphor informs our understanding of an illness. While only briefly noted in the article, we can conclude that a marathon represents chronic illness because of the stamina and consistency required in tackling both. A marathon requires months of preparations, not unlike a war. However, its execution is entirely different in nature. Within the context of the article, Khullar uses the marathon metaphor to show the power of metaphor in “creating the milieu in which goals of care are discussed” (Khullar). Unlike the comparison of cancer to warfare, this metaphor seems to compare things that are within the same realm: the marathon relates to the patient’s physical capacity to function in their everyday life or to the idea that they should settle in for a long and winding road to recovery. Therefore, it is easier for a patient faced with chronic illness to grasp what is needed for their treatment as opposed to those faced with the militaristic phrasing surrounding cancer.
This difference extends beyond the simple difference between the concrete concepts being employed in the metaphors. The language of the cancer metaphor has the opposite effect, obscuring the illness and what is expected of the patient. Training for a marathon is a highly individualized process and its ultimate goal is the completion of the marathon rather than besting others. Khullar delves into the militaristic phrasing of medicine not necessarily relating to cancer, claiming its “adversarial” approach dichotomizes the outcomes of treatment as either a win or loss (Khullar). This adds undue pressure for a cancer patient to maximize their chances of “winning against cancer,” and can be unhealthy in the underlying implication that cancer patients can control the outcome of their treatment the way a nation can influence the outcome of a war. While the vagaries of war and its harrowing nature can convey the unpredictable nature of the illness and its effect on the sufferer, the war metaphor still imposes a pressure on people to adopt a positive front, no matter how false. Khullar cites several studies showing the development of “maladaptive coping mechanisms” in response to this commonly espoused attitude towards cancer (Khullar).
While, of course, it is important to note that these metaphors relate to completely different types of illness, I still think the difference stands. Both acknowledge the body’s physical limitations, with death being implicit in cancerous warfare. However, the second metaphor contends that it is possible to finish the marathon whereas the “battle” metaphor makes no such promise. In a way, the first metaphor seems to echo previous conceptions of cancer. We still commonly equate it with a death sentence, no matter how advanced treatment has become. Even if one “beats” cancer, it is associated with death. If not the person’s body, it still “kills” healthy cells and perhaps part of their identity, or at least transforming it as suggested by the culturally preferred quest narrative; “[authors of the narrative] want to use suffering to move others forward with them” (Frank 121). While both metaphors are intended to inspire hope among people diagnosed with these diseases, the cancer metaphor makes the illness seem both daunting yet controllable. On the other hand, the chronic illness metaphor acknowledges that the body is not as physically capable as it used to be, but uplifts the patient, showing that living with it is doable despite its challenges—one only needs to set reasonable and gradual goals.In conclusion, it is possible for metaphors about illness to both inform and obscure our ideas about illness, with the chronic illness and cancer metaphors being prime examples of the former and latter. It all lies within the connotations of the concrete aspect of the metaphor; the more loaded it is with connotations outside the illness, the more it will obscure our understanding of it, as seen with cancer. However, emotionally evocative imagery and comparisons should not be eschewed entirely—just used with caution as to avoid any negative effects it may have on patients.
Works Cited
Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. The University of Chicago Press, 2013.
Khullar, Dhruv. “The Trouble With Medicine’s Metaphors.” The Atlantic, Atlantic Media Company, 7 Aug. 2014, www.theatlantic.com/health/archive/2014/08/the-trouble-with-medicines-metaphors/374982/.
Sontag, Susan. Illness as Metaphor and AIDS and Its Metaphors. Penguin, 2013.
