Jennifer Kilkus, PhD :
As a psychologist, my daily world is one awash in language about emotion. Labeling and describing how we feel emotionally can be a challenging task. Part of what I help people do is translate their emotions into a common language that we can use to explore their subjective experiences. When we struggle to find the right words to describe how we feel, using metaphor can be a way to communicate that in a way that feels more tangible. In fact, a type of psychotherapy, Acceptance and Commitment Therapy, relies on metaphor to assist in improving mood1. For example, a commonly used ACT metaphor is to describe emotions and thoughts like quicksand. The more we struggle against them, the more likely it is we will sink. If we can instead accept our thoughts and feelings, the less we tend to suffer.
I work primarily with individuals who have been diagnosed with cancer, and I am aware of the way that metaphor is used to describe the cancer experience. Words such as “fight,” “battle,” and “journey” are common in the language used to discuss diagnosis and treatment. While these metaphors can be positive and empowering, research has highlighted the ways in which they may be discouraging and limiting. Even in choosing the name for this blog, Navigating Cancer, I found myself debating the choice. Would this read as too close to describing cancer as a journey, and unintentionally alienate readers? Ultimately, I hoped that the idea of “finding your way” is one that could resonate for most.
Researchers have noted that the use of “violence” metaphors such a “fighting a war” on cancer, can be motivational for some, but for others it highlights the ways in which they feel their cancer is outside of their control. What happens if the “weapons” don’t work? If someone dies from cancer, does it mean they “lost” the “battle?” It may create a sense of needing to stay stoic, which could result in someone feeling alone in their experience. A recent study by David Hauser and Norbert Schwartz2 takes this further, finding that individuals who were exposed to battle and war-like metaphors had a higher likelihood of rating cancer treatment as more difficult than those who were not. They were also more likely to endorse fatalistic beliefs about cancer, such as the belief that there is little one can do to prevent cancer. Similarly, describing cancer as a “journey” may allow some to feel that they have a way to describe their progress along their treatment trajectory one step at a time. Others, however, may reject this description, noting that a journey is something one chooses. Cancer, of course, is not.
The metaphors that are used to describe challenging events are important, as the Hauser and Schwartz study (as well as a wealth of others) has found, the choice of metaphor can shape the emotional experience of an event. Time and time again, I hear individuals with cancer struggle with the metaphors used to describe their experience by others – feeling frustrated, unheard, or labeled. There does not seem to be much space allowed for them to contradict these metaphors, particularly when they are used by an authority, such as their physician, or an organization. With the best of intentions, even family and friends may inadvertently use ill-fitting metaphors.
The experience of cancer is individual. As such, it is best to consider the preference of the person who is living with it when using metaphor. Here are a few suggestions when considering language around cancer:
Now that there may be a greater awareness of how the use of metaphor may impact a person’s experience with their illness, see if you can notice the language you use when discussing cancer. Before I started working with those diagnosed with cancer, I often used phrases such as “silver lining” – I quickly learned that this may be alienating, as many cancer survivors are understandably sensitive to suggestions that there is anything positive to be found in their experience. With increased awareness, there is an opportunity to tailor the use of language in a way that can be helpful rather than harmful.
As I learned when developing awareness into my own use of metaphors, it can be much more effective to simply ask: How would your family, friend, or patient describe their experience? Would they find “battle” metaphors useful? People struggling with cancer very often have their experience represented in ways that are not familiar; media and marketing, for example, often dramatize and oversimplify cancer. Asking allows survivors to start to develop their own narrative about their experience.
Maybe your loved one isn’t sure how to describe how they’re feeling. This can be a great opportunity to put your creative hats on and come up with something that feels empowering and authentic. If you get stuck, maybe a “metaphor menu” could help.
No metaphor is “good” or “bad” on its own – each has their strengths and weaknesses and are best understood in the context of the person you are speaking to. Respect, curiosity, and sensitivity can go a long way in helping your loved one feel understood.
(Jennifer Kilkus, PhD, ABPP, is a board-certified clinical health psychologist. She is an Assistant Professor in the Department of Psychiatry at Yale School of Medicine and a member of the Medical Staff at Yale New
Haven Hospital).
