It’s time to surrender the language of war when it comes to our health

Sarah Harding’s untimely death from breast cancer has hit many women hard, but talking of her “fight” or “battle” with cancer does her – and all those affected by cancer – a disservice. 

It’s almost impossible to read or write a story about someone who has cancer without encountering or using pugilistic terms. Harding, who died on Sunday after undergoing treatment for 15 months, was called “resilient” and her consultant said she had “fought incredibly hard”.

President Nixon is credited with first coining the phrase “War on cancer’, in 1971, though the legislation he enacted in that year, the Cancer Act, does not refer to it as such.

The issue with this sort of terminology is, of course, the fact that not everyone “wins” that fight and terming it as such suggests that anyone who succumbs to the disease has “lost” it; the implication being that they just didn’t fight hard enough. What’s certain, is that the weapons and foe are not equal for all – cancer isn’t the same for everyone and what’s survivable for some, simply isn’t for others. Cancer can be aggressive; it can be a “watch and wait” scenario, the playing field is rarely level depending on one’s health at the time of contracting it, or how soon it is caught. 

But does language really matter?

Whilst cancer survival rates have improved steadily as research improves our understanding of the various types of disease that afflict us, how to detect them and how to treat them, we are still a long away from being able to save everyone. Research on the psychology behind the language we use while we – or our loved ones – undergo treatment show that the analogies we use can actively do harm, making us more fatalistic and fearful of the road ahead. 

What has often been suggested is that “battle vigilance” is similar to monitoring for cancer symptoms; scanning the body as if it were a battlefield, looking for warning signs and enlisting help from a doctor, should “an adversary”; a sign of cancer, appear.

Whilst some might find the idea of a battle inspiring and motivating, research tells us that these metaphors actually have a detrimental effect on our attempts to strive for healthy behaviours.

In 2019, David Hauser and Norbert Schwartz published “The War on Prevention II: Battle Metaphors Undermine Cancer Treatment and Prevention and Do Not Increase Vigilance”. 

Their findings were that: 

• “reading about a person’s “battle” or “fight” against cancer makes cancer treatment seem more difficult”
• “battle metaphors increase fatalistic beliefs about cancer prevention”
• these metaphors “[fail to] motivate people to see their doctor when imagining a cancer scare”
• Battle language “influence the health beliefs of nonpatients in ways that may make them less willing to enact health behaviours”

Participants were asked to read passages that contained significant amounts of “war phrases”, then asked to rate their agreement with phrases such as “if someone is meant to get cancer, they will get it no matter what they do”. They were also asked to read passages that contained references to a cancer “journey” and asked to rate how difficult they thought cancer treatments were. Unsurprisingly, those exposed to pugilistic language rated cancer treatments as far more gruelling, leading researchers to surmise that this terminology is more likely to frighten people away from seeking treatment, rather than galvanising them to seek diagnosis. Indeed, it has been found that people who have “high cancer fatalism” are far less likely to get screened, comply with recommendations and seek treatment for signs and symptoms of cancer. 

“Talking about cancer as a war between me and it exhausted me”

One survivor of cancer I spoke with, Kate, 42, from Cambridgeshire, said that the language of “fighting” had left her “enervated and lethargic, struggling to keep up the brave face and that “toxic positivity” was responsible for her keeping a lot of her feelings to herself. “I tried to bottle up how I felt, because everyone kept talking to me like I was a soldier needing to be pulled up by my bootstraps. Whenever I said how awful I felt, I was told that I was strong and that I must fight. I didn’t feel like I could fight my way out of a paper bag, I couldn’t even wash my face some days. Doing the school run would write off my whole day until it was time to go and get the kids home again. I also feel like talking about cancer treatment like a war between me and the cancer insults those who have experienced real battles. It’s not remotely the same”. 

The “war” on Covid-19

It’s not just cancer that’s framed as a battle, however. We have seen it of late when it comes to “brave” patients struggling with Covid-19. Boris Johnson described the virus as a “physical assailant”, “an unexpected and invisible mugger. Indeed, it is now common parlance to talk about what Johnson described as the “fight” against Covid-19, “in which every one of us is directly enlisted”. 

David Shariatmadari, author of “Don’t Believe A Word: The Surprising Truth About Language”, wrote in the Guardian that his choice of language “provides an insight into his approach to coronavirus”, suggesting “the prime minister’s idea that we “wrestle [coronavirus] to the floor” would seem at odds with the patient, precise work that will have to be done, over many months, to keep it at bay.”

Flu is often described as an “aversive entity” according to the aforementioned researchers, and this apparently “increases people’s willingness to get vaccinated”, as does framing the harmful UV rays of the sun as a “hostile entity” when it comes to encouraging the use of sunblock. 

They also report that there is a sense of community and solidarity amongst some patients who are dealing with cancer treatment, so it can have some positive effects. 

Does attitude matter?

Whilst it might not always be beneficial to frame people with cancer as “battling” their disease, many maintain that a positive mental attitude is essential when you are undergoing treatment; something my interviewee, Kate, found difficult to swallow.

In the twenty year period between the 1940s and 1960s, there was a lot of interest in how personality might relate to one’s prognosis. Some of that research was funded by “big tobacco” as an attempt to blame cancer patients for their traits predisposing them to illness. Whilst having a positive attitude might help us to help ourselves and doing positive things like attending appointments and keeping to healthier habits, it’s clear that an emphasis on maintaining a positive attitude can cross over into “toxic positivity” territory. When positivity invalidates one’s emotions, is insincere or forceful, it’s actively harmful; it means authentic human emotions are quashed and ignored in favour of “looking on the bright side of life”. That pressure to look like we have it under control can just make those emotions even more powerful and overwhelming. 

What’s crystal clear from reviewing the evidence is that it’s imperative that we listen to how people want to talk about cancer and move away from the idea that it can be “beaten”, at least in terms of an individual’s personal cancer story. No one wants – or needs – to feel that they have not tried hard enough and that they are guilty of some kind of failing when treatments do not work. We have to recognise that the way in which we frame our conversations around symptoms, diagnosis and treatment do affect wider society; that our language matters. Let’s surrender the bellicose language and give cancer sufferers room to express their feelings, without the fear that they feel they’re giving up.