Media portrayals of cancer as a battle to be fought, and its focus on 'brave fighters' beating the odds, can lead to feelings of guilt and failure in people with a terminal diagnosis, according to research.
'War' metaphors are commonly used to describe people's experiences of cancer - by the media, by charities raising awareness of the disease, and by cancer sufferers themselves. However this approach is not helpful for many patients, according to Elena Semino, Professor of Linguistics and Verbal Art from the ESRC Centre for Corpus Approaches to Social Science based at Lancaster University.
"The message that people get from the media and from charity campaigns is that they have to 'fight' and 'beat' their cancer," says Professor Semino. "Although well meaning, the effect of using war metaphors like this can be damaging to some people."
"If people are diagnosed with terminal cancer, then they are spoken of as 'losing their battle'. Many patients are unhappy with their illness being discussed in this way. Blame is being put on the patient, and there's almost a sense that, if you are dying, you must have given up and not have fought hard enough."
Professor Semino and her colleagues have been studying the use of metaphors in the way we talk about cancer since 2012. As part of their research they have analysed 1.5 million words taken from interviews and online forum discussions involving cancer sufferers, family carers and health professionals. The team found that the type of metaphors people chose to use when describing their cancer reflected and affected how they viewed and experienced their illness. Some patients who had been told their cancer was terminal reported a sense of failure and guilt that they had not won their battle. However, others found war metaphors useful.
"For some patients, some of the time, the idea of being engaged in a fight is motivating. Some people say with pride that "I'm such a fighter", and they find a sense of meaning and purpose and identity in that. The study showed that we are all different, and different metaphors work for different people, and at different times."
Another common metaphor used to describe having cancer was that of being on a 'journey'. People described living with cancer as being on a 'hard road', and there was a feeling of companionship on forums, where everyone is seen as being on the same path. Professor Semino found that this metaphor was much less likely to cause harm and feelings of guilt. However, it could lead to feelings of frustration.
"Some people would say things like 'how am I supposed to navigate this road that I don't want to be on?' and, 'having cancer is like driving a coach uphill with no back wheels'. Others who were at the final stages of their disease would describe themselves as passengers on a journey who have no control over the destination."
According to Professor Semino, metaphors help people to express ideas that are particularly sensitive and emotional, and are therefore especially helpful to cancer sufferers. Rather than discouraging people from using any type of metaphor that may be helpful to them, she is working with the NHS to produce a metaphor manual, featuring many examples of metaphors produced by other cancer sufferers.
"As metaphors are a tool for making sense of our experiences, when you are vulnerable and dying you should have as many tools at your disposal as possible, so that you can choose the one that suits you best at that time."