Use of metaphor in the discourse on cancer.

Abstract

With this metaphoric deluge, the oncologist lost a prospective new patient. A few hours later, Lance Armstrong was on a plane to Indianapolis, where he would establish a successful therapeutic relationship with the oncology team from Indiana University. Armstrong would, of course, survive widely metastatic testicular cancer and go on to win six Tours de France. While this epigraph may represent a wellintentioned effort by an oncologist to prepare a young man with an advanced, lifethreatening malignancy for a long and immensely difficult course of treatment, the image of violence had a devastating and unintended effect. Armstrong himself, probably unconsciously mirroring the oncologist’s martial metaphor, described the reaction in the consultation room as “shell shock.” The comments of both the physician and the patient are emblematic of the fact that metaphors—and especially martial metaphors— play a ubiquitous, but largely unrecognized role in medical and lay discourse. Indeed, as a reader of the Journal of Clinical Oncology recently noted, the “target” in the title of this section of the Journal is itself a military metaphor. And as the above comments suggest, metaphors can be more than mere rhetorical flourishes; they can have a powerful influence on the practice of medicine and the experience of illness. “The essence of metaphor is understanding and experiencing one kind of thing in terms of another.” Lakoff and Johnson have demonstrated that our conceptual systems are wired to operate metaphorically; that is, most concepts, particularly those that are abstract or complex, are at least partially understood in terms of other, more familiar concepts. Metaphors, then, are vehicles for understanding, mediating what is known and what is unknown. Mabeck and Oleson go further, arguing that metaphors don’t merely describe similarities; they create them. When metaphors enter our conceptual system, they alter that system and the knowledge, attitudes, and behaviors to which the system gives rise. For the physician, metaphors can be time-efficient tools for helping patients understand complex biologic processes. For patients, metaphors can impose order on a suddenly disordered world, helping them to understand, communicate, and thus symbolically control their illness. And for the therapeutic relationship, the language of metaphor can serve as the basis for the shared understanding of clinical reality. We will examine the use of metaphor in oncology. We will focus on the predominant metaphor, that of war, in terms of its strengths and limitations, in the contexts of the patientphysician relationship and the patient’s illness experience. Finally, we will briefly survey alternate metaphoric concepts.