August 16, 2019

Editor's note: This popular story from the Daily Briefing's archives was republished on Oct. 1, 2020.

Many doctors who work with patients with incurable conditions often seek to champion their patients by referring to them as "fighters" in a "battle" against their disease. But a new study in Health Communication finds that using war metaphors when talking about cancer "may do more harm than good," Ian Sample writes for The Guardian.

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Why do doctors use war metaphors?

Physician Thomas Sydenham in the mid-17th century is often credited with introducing military language into Western medicine, writing that a "murderous array of disease has to be fought against."

Modern physicians have adopted these phrases, often calling patients "fighters" in a "battle" against an illness. In fact, a 2010 study found physicians use metaphors in nearly two-thirds of their conversations with seriously ill patients. Their patients, in turn, reported that they viewed the physicians who used the most metaphors as the best communicators.

However, a few studies have found, that cancer patients who perceive their disease as an "enemy" also tend to have higher rates of anxiety, depression, and a poorer quality of life than patients who use a more positive characterization.

Are war metaphors helpful for patients?

To better understand how war metaphors impact people's views on cancer treatment, David Hauser, a psychologist at Queen's University in Ontario, Canada, and Norbert Schwarz, a professor of psychology at the University of Southern California, conducted four separate experiments involving almost 1,000 "generally healthy" participants, Sample writes.

The researchers asked the participants to read passages about cancer patients that included battle metaphors, journey metaphors, or no metaphors at all. The passages with battle metaphors included words like "attack," "fight," and "invaded."

Afterward, the researchers asked for the participants' opinions on cancer treatment.

The researchers found no evidence that war metaphors improve people's view of cancer treatment. In fact, the experiments revealed that the battle metaphors "may do more harm than good," Sample writes.

Participants who read passages with war metaphors rated cancer treatment as more difficult than participants who read passages with journey metaphors or no metaphors.

War metaphors also left participants feeling more fatalistic about the disease, according to the researchers. For instance, after reading passages with battle phrases, participants were more likely to agree with statements like, "If someone is meant to get cancer, they will get it no matter what they do."

Is there a place for war metaphors in medicine?

The results, Hauser said, introduce more evidence that "battle metaphors could have a negative impact on how people think about cancer."

For instance, Hauser said the battle metaphors might leave patients feeling like there is little they can do to reduce their risk of dying from the illness, which "could undermine people's intentions to engage in healthy behaviors."

According to Mandy Mahoney, an outreach support worker in London who has incurable metastatic breast cancer, battle metaphors can "put an awful lot of pressure on the newly diagnosed."

"You feel like you're letting people down if you can't manage permanent positivity or you have an emotionally wobbly day," she said. "It's not constructive or helpful when you're focusing on getting through the day-to-day living of a cancer diagnosis and treatment schedule."

Hauser said it would be difficult to do away with battle metaphors in medicine entirely, but said people should consider that the language may be harmful. In the meantime, Hauser said more research is needed to determine whether cancer patients also consider war metaphors to be unhelpful.

Karen Roberts, chief nursing officer at Macmillan Cancer Support, for instance, said cancer patients have "different preferences when it comes to discussing" their treatment. "Talking about 'battling' cancer helps some people remain upbeat, but others find the effort of keeping up a brave face exhausting," she said.

But Mahoney, who tries to avoid battle speech when talking about cancer, said she found a new way to discuss her illness. "I describe myself as 'living' with incurable cancer," she said. "I'm not brave or inspirational, I'm just trying to live the life I have left well" (Sample, The Guardian, 8/10).

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