Cancer Is Not a War

Fighting Words is a column in which writers rub you the wrong way with their unpopular but well-argued opinions on fitness, health, nutrition, what have you. Got something to get off your chest? Send your pitch to tonic@vice.com.

The barrage of metaphors was expected. In the wake of John McCain's recent diagnosis with glioblastoma, former President Barack Obama and other politicians described Arizona's senior Senator in the language that seemed most natural to them: He was a "fighter," a "warrior," a "worthy opponent," and the "toughest." Even former Vice President Joe Biden, whose son Beau passed away in 2015 with the same cancer, noted that McCain "is strong—and he will beat this."

The use of martial terms seems appropriate for someone who is the son and grandson of Navy admirals and who spent nearly six years in a North Vietnamese prison, after his bomber was shot down in 1967. The former POW's spirit endured despite being tortured and isolated in solitary confinement. It feels natural to interpret cancer as just another "battle" for McCain to "win."

Though military metaphors have often been marshaled to raise public awareness of cancer and to fundraise for its research, their recent use after McCain's diagnosis has been misguided and detrimental. Martial language restricts cancer outcomes to either victory or defeat and imposes a framework on how patients understand their disease. As the late journalist Julie Mason, who wrote about her experiences with ovarian cancer for the Ottawa Citizen, put it, "it's language that makes those of us with the disease into unwilling combatants or civilian casualties."

Cancer is just a disease, and little more. Limitations in our treatment options and in our understanding of cancer dictate that the condition, like heart disease or diabetes, must be managed, controlled, and monitored. Nothing is vanquished or annihilated. If we don't speak of a person's glorious fight with arthritis or epic battle versus high blood pressure, we should similarly resist the temptation to pit individuals against cancer.

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Further, casting the cancer struggle as a "war" assumes that there is an enemy invader marauding throughout the body that must be dealt with. But there is no foreign threat in cancer. The enemy is yourself: Cancer cells are simply a person's own cells that have become untethered from regulated division and have gone awry. The newest therapies work in conjunction with a person's immune system to pursue the dysregulated cancer cells on the "battlefield," which, in this militaristic context, is the patient's body. For Mason, "Seeing the cancer cells as my enemy puts me at war with my own body. I'd rather comfort and support my health than declare war on part of myself."

Most crucially, the aggressive language neglects that cancer never bends to the steely determination of those it afflicts. As Susan Montag noted in her seminal Illness as Metaphor, "Theories that diseases are caused by mental states and can be cured by will power are always an index of how much is not understood about a disease." The martial language suggests that triumphing in the war is a matter of sheer effort and resilience alone. It implies that poor outcomes happen only because a patient fails treatment and wholly absolves the treatment for its lack of efficacy. This may propagate the unconscionable and false notion that a person's cancer progressed or became terminal because of a failure to fight hard enough.

In an essay for McSweeney's about dealing with relapsed, refractory Acute Myeloid Leukemia (AML), writer Aria Jones warned that if she was posthumously described by anyone as having 'lost her battle to cancer,' "I swear to God I will come back from wherever my soul may have been sent and haunt the living shit out of you for the rest of your days."

As a patient's cancer becomes end-stage, the cultural emphasis to "fight on" often compels him or her to proceed with therapies whose risks dwarf the marginal benefits to be obtained. While they dispel the perception of being weak or losers, healthcare spending continues to mount and meaningful discussions regarding prognosis and end-of-life goals (palliative and hospice care) are deferred.

Lost in the fight is an opportunity to find a fulfilling, dignified end. Indeed, Gary Reisfield and George Wilson note in the Journal of Clinical Oncology that a steadfast focus on a patient's physical disease and its status (via CT scans, blood tests) neglects the social, psychological, and existential aspects of being gravely ill. "The rest of a patient's life is often disregarded or put on hold because all resources must be marshaled for the war effort."

And yet, despite the consequential drawbacks, metaphors continue to thrive in the physician-patient relationship as a means to make abstract and complex concepts more accessible. In a 2010 study, oncologists deployed metaphors in 64 percent of conversations with seriously ill patients. Those who used metaphors were viewed by patients as being better communicators and presenters of information.

It is essential to remember, as the physician Dhruv Khullar once wrote in an essay for The Atlantic, "Ultimately, any metaphor—military or otherwise—is not inherently good or bad. Rather, the utility of each depends on a patient's culture, values, experiences, and preferences." A metaphor that may empower one patient can be frustrating and deflating for another in the midst of disease.

The language of cancer, which importantly yokes physicians to their patients, should not be determined by doctors or the prevailing culture. That right belongs to the patients who are intimately experiencing the disease and living with it daily, for they will never fluently speak or find comfort in the language of others. Soon, John McCain will choose for himself the words to enable and sustain him.

Jalal Baig is a hematology/oncology fellow at the University of Illinois at Chicago. Read This Next: What It's Like to Have Stage IV Cancer in Your 30s