“The war on cancer rages on”. “It’s the start of a long journey”. “I feel like I’m on a carousel that won’t let me get off”. “I’m on the road to recovery”. “She lost the fight”. “We will beat cancer sooner.”
Whether you’re a patient, a carer, a fundraiser or a doctor – talking about cancer almost invariably means using metaphors.
But is one metaphor better than another? And how do different metaphors affect different people?
That’s the question Professor Elena Semino, a linguist from Lancaster University, has spent the last few years trying to figure out.
Her team’s recent study examined how metaphors are used in different groups of people affected by cancer – cancer patients, family carers and health care professionals – and how they resonated with them.
Drawing on a dataset of 1.5 million words, collected from interviews and online forums, what Semino found was really quite interesting – as she told us at a recent talk.
Battles and journeys
The two most common metaphors her analysis uncovered are what she termed “violence” metaphors – fights, battles wars, etc, – and “journey” metaphors.
When it comes to “violence metaphors” some people find them motivational. Semino remarked that they’re particularly effective at motivating groups of people to do something, which may explain why they are so commonly used for fundraising campaigns.
But they aren’t motivational for everyone – particularly when used about an individual’s experience of cancer, rather than a collective effort.
She explained that patients often feel “disempowered” by violence metaphors as they aren’t given the right “weapons” to fight or that the doctors are “the generals” and they’re just common “foot soldiers”.
“There’s also disempowerment when the person doesn’t want to fight. And then you’ve got people, specifically at the end of life, who feel that they’re losing – and it’s their fault – and that is very negative,” she said.
But Semino isn’t the first person to recognise the harm violence metaphors can have. The BMJ wrote a piece about the negative impacts they can have on patients back in 2014 and the Guardian argued militaristic language is doing more harm than good in March this year.
So journeys are better?
But while the ‘journey’ metaphor doesn’t lead to feelings of failure in some, like violence metaphors can, it’s not necessarily ‘better’.
It can certainly be positive – Semino found in her data that some people use the journey metaphor “in a very empowered way.”
“They talk about being on a journey with everyone else who has the illness, they talk about themselves as companions on the same journey, and the people who have been ill for longer leading the way for the ones that have got a more recent diagnosis. They also talk about a sense of purpose in planning one’s journey one step at a time.”
However, for some the ‘journey’ is less like an epic adventure, and more like the trip from hell.
“For some other people, there is this idea of a reluctant journey. One person says ‘how the hell am I supposed to navigate this road I don’t even want to be on.’ [Another] person says it’s like trying to go uphill in a coach without its back wheels. So they use the metaphor of the journey to express a sense of helplessness and frustration.”
But ultimately, what Semino’s research showed was that everyone is different.
Each person might find that one metaphor better resonates with him or her than another.
But while creative people may be able to come up with their own unique metaphor that works perfectly for them, what happens to those of us who are less creatively inclined? Are we forced to pick between a journey and a fight?
“We need a ‘menu’ of metaphors,” suggests Semino, “a collection of quotes with all these different metaphors: the journey ones, the fight ones, the fairgrounds, the music in nature and unwelcome lodgers, and there are others, so these can be shared with people, and people can pick the ones they want, as you do at a restaurant.”
Semino is currently collaborating with oncologists to create this metaphor ‘menu’ – to help doctors and patients pick a way of talking that works for them.
And what of the war on cancer?
At Cancer Research UK, we know that ‘violence’ metaphors can, in some circumstances, do harm – we’ve got guidelines around using them, and avoid using them when it comes to individual people where there’s clear evidence they can be unhelpful.
However, violence metaphors can be great at unifying and motivating people when it comes to fundraising.
And we’re involved in a collective effort, an odyssey – or, if you like, a struggle– against a disease that claims 161,823 lives a year in the UK alone.
So while we’ll be keeping a keen eye on research like Professor Semino’s, and make sure we’re always aware of the wider context, we’ll also keep on making sure that we can raise every pound we can to fund the scientists in labs around the UK, in their quest of discovery, to find new ways to help more people survive.
To see Prof Elena Semino’s full Passion Talk watch the video here.
David January 31, 2016
So, to sum up your approach: We don’t care what effect we have on people currently dying from cancer. So long as our metaphors encourage people to give us more money, that’s enough for us.
Pam Wade October 5, 2015
Interesting notions . I find that most people are so caught up in their own experiencce that the metaphors they use are the ones they have heard most recently. I don’t think they attribute any special significance to the metaphor as regards their own situation
Ailsa Fulton October 4, 2015
Talking about “beating cancer” and “fighting” it implies that’s all you have to do for it to go away. I don’t find this helpful. It’s a serious disease and we need to find ways to cope with the treatment and after effects. Like we do with other conditions that are life threatening and debilitating. I don’t feel “courageous” living through cancer and with the threat of it coming back. It’s my life just like if someone else who has to live with having had a heart attack or has a condition like coeliac disease. I see a person who is part paralysed, in wheelchair pushing themselves along a city street, totally vulnerable, to me that takes courage.
Lynn Phillips October 3, 2015
Cancer is an illness. It is neither a battle nor a journey. I particularly do not like the terminology of ‘battling’ cancer or ‘beating’ or ‘fighting’ it. I had cancer as did my father, my son and two of my three brothers. The treatments made me very ill and I recovered. Many people now ‘live with cancer’ just as people ‘live with arthritis’ and many other illnesses. The negative language is just silly and I have always ignored it.
julie October 2, 2015
When i was diagnosed i found both fighting talk and talk of ‘being on a journey’ unhelpful. The fact of the matter is that to survive you don’t have many choices open to you. ‘Fighting’ it or ‘kicking it’s ass’ i don’t find motivational as it implies that having the will to fight is all you need when you know that the course of cancer can be unpredictable and you might lose the ‘battle’ despite everything. I would prefer an acknowledgement of how hsrd it is emotionally and would like to see more support services to take you through treatment and help you deal with aftermath of treatment
Christina October 2, 2015
The last paragraph reads that CRUK will prioritise raising money over modifying language used. What would be good I think for CRUK to do, would be to evaluate the impact of language changes on different fundraising activities. Prof Semino’s research seems to have uncovered many other metaphors which could be used, and the introduction of different metaphors by CRUK would also serve to educate people about the reality of the different personal experiences people have with cancer, as highlighted in the other comments. I can think of many large charities who don’t use violence-related metaphors within fundraising for example, Macmillan – “Help make sure no one faces cancer alone.” Also, looking at the top ten charities in the UK (http://apps.charitycommission.gov.uk/showcharity/registerofcharities/SectorData/Top10Charities.aspx) I don’t think any do, except CRUK. I think I, and many others, would welcome CRUK – as a very visible charity – taking the results of this research into its fundraising to improve awareness of how cancer affects individuals : for me it’s been an unwelcome guest, and there were a series of steps I had to take to get it to leave, but of course, it may turn up again, uninvited… this was the metaphor that developed in my head, not a battle, not a journey (unless I’d been hijacked). I think metaphors are incredibly useful to help people (and family and friends) make sense of cancer, and I really hope that CRUK will lead the way in helping people find a metaphor that helps them as individuals, and not just those who are collectively donating.
Carolyn October 2, 2015
I am a Health Professional and feel very uncomfortable being involved in Cancer Research UK fundraising events when there is such blatant use of violence metaphors. Surely this perpetuates use of these terms and attitudes in public conversations about cancer.
Diane October 2, 2015
I was ( am) in the group that was only more frightened and upset by the use of violent metaphors.All the literature given to me by the hospital talked of fights and battles at a time when I was in no state to do either.I just wanted to run and hide!. I think journey is a better term, I’m 18 months into my journey I’m well and happy and stronger than I thought I was.
Emily Hepworth October 2, 2015
Since me and my sister were young we watched our dad have surgery after surgery to get tumors out of his body. When we watched him lay in a hospital feeling fear and helplessness about the situation. But he was a fighter and pulled through every bleak situation.
However eventually the cancer came back and eventually became permanent; which devastated us. However he stayed strong kept fighting and remained close to us; in which this august just gone we ended his bucket list of visiting the states.
The process before his death 5 weeks ago was brutal; he lost so much weight on his body (except for the scarring on his belly), he was pale, he wouldn’t eat at all, he was in constant pain and could do little for himself.
I got a week to say my goodbyes and be beside him up until he passed away; not enough time to say everything I wanted to say but I said all I could.
Watching my dad suffer and the experiences when I was a child made me never wish this on anyone else.
These events and experiences caused me and my sister to mature our views on life at a young age and be grown up and handle a situation; which is hard considering she is 18 next year and I’m 21 now.
I wouldn’t call someone having cancer “Inspirational” or “Brave”; from seeing my father with it I would call it “heartbreaking”, “Emotional”, “Nerve testing” and “cruel”
It tests your loyalty as a family and how far your willing to be pushed as far as nerves and emotions.
But from my point of view; it made me and my sister mature at a young age and now that its over….we don’t know what to do apart from accept it and aclimatize
jujne yates October 1, 2015
September 2009 I was diagnosed with breast cancer. June 2011 I was diagnosed with bowel cancer. Always speak openly and do talk of ‘battle’ but always remain positive. Still here, still healthy, still fighting for everyone dealing with cancer diagnosis-word battle is not offensive to me or my family.
Marie October 1, 2015
I hate being called ‘inspirational’ and ‘brave’, I have no choice, I do my absolute best to be happy and carry on. I have secondary breast cancer, I am 39, I dont see it as a fight I just do everything I am told to by my Consultant and I am positive. What I really hate is when I am in the car with my children and adverts come on the radio about cancer, “more people survive cancer than die from cancer”, etc you know the ones. It is like its being forced down your ears 24 /7, there’s no escape. I dont hide the word cancer or hush it up athome but hearing these types of adverts really can upset them, there should be a watershed, and most definetly not aired at prime times like the school run.
George MacBride October 1, 2015
As some one who has had a prostatectomy and subsequent radiotherapy and am still on hormone therapy, I find both of these metaphors deeply disturbing. I am very pleased that none of the staff here in Glasgow who have been involved in treating my illness (doctors, nurses, radiographers, admin staff, physiotherapists) has ever used either of these metaphors. I have on occasion challenged cancer charity staff (both fund raisers and those involved in supporting cancer patients) on the use of these terms. I don’t feel disempowered by the violence metaphors: it is simply that they demonstrate a profound misundersatnding of how we can effectively deal with illness; the journey metaphor is simply stupid. Indeed I am unlikely to provide funds to any charity using such language. I remain profoundly grateful that I have been treated by staff who have regarded me as an adult and not patronised me with such infantile simplifications.
Rosemary Wright October 1, 2015
My 38year old son died 13 days ago after a 14 month struggle with advanced bowel cancer. When told he had only days instead of months left he said to me ‘the cancer is just too strong’ which suggests he saw it as an adversary.
Sue October 1, 2015
I had breast cancer 2 years ago, to me I felt that I was on a roller coasters going from diagnosis to appointment to surgery and so one. watching my friends and family worrying about me while I worry about what affect I am having on them. I don’t feel brave I have just gone on my roller coaster ride that I had no choice but to go on and have now come out the other end a little bit different but still smiling and happy to help others.
Malcolm October 1, 2015
Had Lymphoma diagnosed last year and received chemotherapy for the first 4 months of this year. Since then I have had a series of infections that has meant getting back to normal is still some way away, but the regular test results are encouraging. Not particularly worried about the words that people use. In my opinion they are just words and sometimes it is not easy to sum up all these feelings and sensations in words. I consider other people’s actions and reactions far more important. I don’t ask for sympathy but kindness and consideration can speak volumes !
Carol October 1, 2015
Five years since a diagnosis and eighteen months treatment for bowel cancer I never felt comfortable with it being described as a battle or journey but speaking about it has always been a very important and positive part of coming to terms with what’s happening. My mother died of the same disease 45 years ago and I remember that the word ‘cancer’ was never even mentioned far less talked about. If it had been spoken about then perhaps the shock to me when I discovered I had the same disease may not have been so traumatic. It’s a complex and individual experience and any description can’t easily fit all… but after the initial disbelief and shock for me I t seemed to become more of a slow process of acceptance and challenges which continue to this day. People are often surprised when I say that the diagnosis made me value what really matters in life and that it has had a profound and dare I say positive and liberating effect. ‘Getting on with life’ describes living with cancer well but for those affected it also means often getting used to using and living with a different set of tools and values for coping with what the future may bring. Conversations about how to describe cancer can only help to dispel myths and raise awareness in a positive and supportive way.
Misha Gajewski October 1, 2015
Thanks for your comment, and we’re sorry to hear about your recent diagnosis. Cancer Research UK doesn’t actually fund Professor Elena Semino’s research – but it’s relevant to many people affected by cancer, and that’s why she was invited to present her work at an event hosted by us, and why we wanted to share her interesting findings with our supporters.
Misha, Cancer Research UK
Georgy Holden October 1, 2015
Having recently been diagnosed with colon cancer I am delighted to see this post and the discussion around it. I feel very uncomfortable with the fight metaphor. This does not mean that I do not want to do everything that I can to improve my chances of successfully getting through this, but I want to learn from the experience, embrace the opportunities for change and re-evaluation of my priorities rather than be combative. Journey sits better with me, though it is a little like a journey mapped on a sat-nav where you can only see the immediate bit of road, however I think we each need to find our own way to think about the situation we face and discuss it with others.
Jue October 1, 2015
I’ve recently been diagnosed with breast cancer from which I’m expected to make a full recovery after Chemo, Surgery and Radiotherapy. Halfway through my chemo – I feel I don’t want to see money spent on this kind of research i.e. talking about language. I want money targeted at research and drug and other treatment funding on the NHS to cure more and more people of whatever cancer they are unlucky to have.
Marbellys October 1, 2015
Could it also be that people use metaphors as a way of avoiding having to talk about the reality of cancer. It isn’t a fight or a journey at least for me and my family. It’s a getting on with life because life doesn’t stop even for cancer. It’s having to still get the shopping in, dinner on the table and children off to school even though you’re in pain and frightened by what the future holds. Perhaps if we talked straight about cancer and what it does to people and their loved ones we wouldn’t need metaphors
Jayne October 1, 2015
During my treatment for breast cancer, I was told I was being “brave” in my “battle” with the disease and that I could “fight” it. I can understand the use of war like metaphors as I guess the assumption was that I was “fighting for my life” which does have connotations of soldiers fighting a war, but that’s where the similarity ends. Soldiers are brave, willingly putting themselves in danger for the good of the rest of us. I didn’t choose to get cancer, it chose me, against my will – so I’m certainly not brave! My family and friends wanted to know how best to support me. I told them that I just wanted to be treated as normal. I didn’t need sympathy, I just wanted to be like everyone else and not be labelled as a cancer patient first – just as me. They were amazing and treated my journey as a challenge rather than a war – which made it incredibly positive for me. I think words do matter – but it’s more important that people actually speak about it – however they describe it.
Nicholas Hankinson October 1, 2015
I strongly believe that a cancer diagnosis, particularly a terminal cancer diagnosis, is more than anything else, a challenge, or rather a number of challenges. First and foremost it challenges the person diagnosed, how they will conduct themselves and their change in circumstances, how they propose to face their inevitable deterioration in health and probable increase in pain, not least, how will they organise their lives around the increasing demands of hospital and clinic attendances, particularly if they live some way away from their hospital. Next, is the effect on family, very often it can more difficult for the partner rather than the ‘victim’ and sadly, there is far less support or sympathy offered to family and partners. Last is the challenge of keeping up with the very fast moving world of cancer research and making sure that you, the sufferer are sufficiently pro-active to make sure you are receiving the best and most effective treatment available. I believe the relationship between the oncologist and the patient is a partnership, and if it works effectively, both parties have much to learn from each other.
Fran October 1, 2015
Every newspaper article that I read about someone who has had cancer, uses the words “battle or “fight” against cancer” . It is not always a battle – it can be a process. Often when you read further into the article it is apparent that it was not a battle at all, but still that word is always used and seemingly loved by the media. I had breast cancer 3 years ago – I had the diagnosis, had a mastectomy, followed by several months of treatment and recovery, and then just carried on with my life. At no time was it a “battle” and I would never had classed it at such. I suppose for more unfortunate people who have the diagnosis and treatment, but it comes back or will not go away, and they have to have more and more treatment or surgery, then it may become a “battle” with cancer, but this certainly does not apply to every cancer case, and I find it extremely irritating every time I read it. I feel that the most important thing that any person who is diagnosed with cancer can do is to have a positive attitude, and just deal with it – the words such as “fight” or “battle” have negativity attached to them
Ronny Allan September 28, 2015
Violence is completely the wrong word to classify a metaphor group sometimes (incorrectly) exclusively associated with ‘war’ scenarios. Ex soldiers like myself are not violent people. In writing this blog, the author has fallen into the same trap.