Metaphors and malignancy: making sense of cancer

Cancer Narrative: Words Beyond Disease

Metaphors and malignancy: making sense of cancer

G. Nicholas , MD



The classic description of a metaphor is that it is a linguistic construction of the format A is B. However, that definition fails to capture the centrality of metaphor to human thinking processes and its importance in helping humans to make sense of the world. Our minds seem to contain a few profoundly retained concepts, and we often try to understand or conceptualize external phenomena by identifying them with those core ideas. Metaphors are essential to thought and communication.

Knowing little more than direct experience imparted, early humans made use of metaphor to develop pantheons of nature gods. The deities were syntheses of nature and human personalities: capricious gods of rivers and winds, noble sun gods, ancient immobile gods of mountains. Those metaphors attempted to bring some of the chaos of nature into the human sphere, making it easier to understand—and perhaps to placate.

We don’t have much call for nature gods any more—not because humanity has overcome its need for metaphor, but because we are so seldom required to come to terms with unfettered nature. The history of human progress is not a history of accommodation with nature, but rather of the transformation of nature by human imagination into something else—into right angles and straight lines, into climate control and adjustable light.

But the sense of human triumph over nature is not maintained when we confront a disease like cancer. Cancer reminds us that our bodies are not distinct from nature, but part of it, and that nature is not benevolent or designed for human comfort. Faced with this existential challenge, our need for metaphor becomes manifest anew.

Cancer is not a creation of human imagination, except in the sense that it may be an unintended consequence of modern industrial and chemical exposures. The metaphors that we associate with malignancy try to move cancer from the inchoate natural world into the realm of human imagination. The simplest metaphorical constructions apply human personality traits: cancer is cruel, cancer is sneaky, cancer is remorseless. Those ideas permeate our thoughts of cancer, despite the fact that we recognize that they are not literally true.

Language describing cancer as a warrior or enemy who must be battled to be overcome is pervasive. Although potentially a source of strength for people living with cancer and its therapy, martial metaphors also carry uncomfortable implications that those who have died of cancer were somehow lacking in the fight or might have done better had they only tried harder. We know that those implications aren’t true, but the illusory sense of control offered by the metaphor can have significant consequences for those trying to adapt to a diagnosis or cope with disease progression. Combat-oriented metaphors are deeply ingrained in how we talk about the disease, as is known by any physician who has ever consciously tried to expunge them from his or her conversation.

Also commonly encountered are metaphors that make cancer the physical incarnation of an unclean environment or lifestyle. Those metaphors dovetail with contemporary environmental narratives about the state of the Earth, identifying the corruption of the planet with the diseases of its people. The metaphors may be consoling in that they assign responsibility for cancer to some external actor, such as a polluting oil company or producers of unnatural foods.

Another series of metaphors fall into the category of conspiracy. All assure the listener that the truth about cancer has been hidden, that cancer is something other than what they’ve previously been told. These metaphors may take the form of alternative theories of cancer causation that attribute cancers to bacterial infection or nutritional deficiency. Also surprisingly common is the belief that cancer treatment is a scam—known to be futile, but perpetuated in the financial interests of pharmaceutical companies and physicians. These conspiratorial metaphors are tightly bound to the realm of commerce, in the sense that they postulate a predominantly financial motivation for the behaviour of cancer professionals, and thus the outcomes of cancer treatment. Many of the public proponents of such metaphors are selling books or therapies of their own.

The metaphors used by physicians and researchers have a more technical face than those used by laypeople, but are no less a projection of human thought onto a fundamentally nonhuman entity. The description of cancer cells as “acquiring resistance” or being “oncogene addicted” implies a goal or purpose that cancer is working toward. Teleologic metaphors of this type are foreign to nature, which has neither means nor ends, only necessities.

Human progress has led us to consider ourselves distinct from nature. Cancer emphatically destroys that distinction by being an eruption of nature within our own bodies. Using metaphorical concepts, we confront and try to explain the breakdown of that dichotomy and we try to bring the natural phenomena of malignancy into some sort of alignment with the human world. Human inventions such as war, justice, finance, and science provide the basis for common metaphors about cancer.

If we are little further ahead than the early humans who assigned human personalities to natural phenomena, will we ever see a change in the range of metaphors applied to cancer?

In time, humans began to master nature and to reconfigure it to the specifics of the human imagination. Concurrent with that process, nature gods became superfluous, and our deities tended to ascend skyward, becoming comfortably ensconced in the ether. When cancer, too, becomes sensitive to the tools of human creation, docilely responding to drugs, meekly extinguishing itself on command, then cancer too will be metaphorically transformed into something more ethereal—another aspect of nature brought to heel by humanity.

Correspondence to: Garth Nicholas, The Ottawa Hospital Cancer Centre, 501 Smyth Road, Ottawa, Ontario K1H 8L6. E-mail:

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Current Oncology , VOLUME 20 , NUMBER 6 , DECEMBER 2013

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ISSN: 1198-0052 (Print) ISSN: 1718-7729 (Online)