Losing the Battle: Goals and Flaws of Battle Metaphors in American Cancer Society Rhetoric
Stevie Rosenfeld
Introduction
Cancer is one of the most prevalent diseases in the United States, and its discussion pervades much of our culture. Yet, while many empathize and care for the wellbeing of cancer patients, many also consistently use rhetoric that many cancer patients consider offensive. I first became aware of this issue working with a local cancer research funding organization, where I began to take issue with the personification of cancer as something that could be fought or killed. Metaphors describing cancer as a “fight” or “battle” are common, but many cancer patients and other academics find these metaphors offensive due to the implication that those who have passed away from cancer have “lost.” Even groups who generally opt to use few or alternative metaphors, such as the American Cancer Society, will still call cancer a “fight” to encourage non-patients to engage in fundraising activities.
The American Cancer Society website explains several goals of the organization, one being to support cancer patients’ mental and physical health, and another being to encourage cancer prevention and testing in non-patients. Several pages on the site call for readers to take political action to help increase the availability of cancer testing, while other pages encourage readers to participate in fundraising activities. These pages, mainly targeting non-patients, utilize battle rhetoric more prevalently than pages offering information on cancer testing or patient resources. Within the machine of healthcare rhetoric, battle rhetoric is a term used to describe metaphors about cancer that refer to “fighting the disease,” “winning the battle,” “attacking the tumor,” or other bellicose analogies that frame having cancer as a war. While this rhetoric may be moderately effective in initiating political action and raising donations, it also causes subconscious associations with losing, violence, responsibility, and burdens that can be harmful to patient mental health. Additionally, there is research to suggest that these metaphors discourage action against cancer, such as early testing or healthy eating. These factors mean the use of battle rhetoric is misaligned with the goals of the American Cancer Society. I propose that the pages would align more with the Society’s described goals if they phased out this language and instead instituted journey metaphors, which describe cancer and treatment as a path one progresses along, rather than a battle they must take on.
Theoretical Basis
This analysis will be based in George Lakoff and Mark Johnson’s “Conceptual Metaphor Theory” (1980). Conceptual Metaphor Theory proposes that metaphors do not solely serve a literary purpose but shape the way we understand common and everyday concepts (Lakoff & Johnson, 1980, 453). The theory explains that metaphors can become so common they integrate into daily conversation and become unnoticeable, becoming “conventional metaphors” (Lakoff & Johnson, 1980, 453). For example, telling someone they are “wasting time” is an extension of the metaphor “time is money” (Lakoff & Johnson, 1980, 456). The metaphor has become so ingrained in speech that most people do not realize they are referencing it and take “wasting time” as a literal statement, even though time is not a physical thing that can be wasted.
The “time is money” metaphor is also an example of how the metaphors we use can have unrealized implications. Time is compared to money because they are both limited resources, they are valuable, and they can be saved or budgeted (Lakoff & Johnson, 1980, 456). However, someone using this metaphor is not likely to consider and analyze these implications every time they use the phrase. These implications are called “metaphorical concepts” and form relationships between the metaphor and the literal concept that make them comparable (Lakoff & Johnson, 1980, 456). Someone using this metaphor may not be consciously considering these implications, but the metaphorical concepts are nonetheless shaping perceptions of the subject.
When perceptions of a concept are changed, actions and decisions are impacted. Continuing with the metaphor “time is money,” someone who has heard that phrase (or extensions of it) is likely to be anxious about missing deadlines because they associate “running out” of time with running out of money, even if the deadline is unimportant. They may also see having extra time in their day as a reward or benefit because they associate it with being given money, even if they enjoy being busy. Exposure to the conventional metaphor “time is money” in its various forms has altered how people perceive and utilize their time. The metaphor has shaped their world view. Consistent exposure to conventional metaphors has shaped their interpretations of concepts.
Kristen Garrison, who has researched and published several works on rhetoric and disability, explores several metaphorical concepts associated with battle rhetoric. These include blame, religious crusades, emancipation, constant threat, and struggle (Garrison, 2007). When battle metaphors are used regarding cancer, patients apply these ideas to their disease and themselves, which can cause shame, guilt, and anxiety in patients (Garrison, 2007). Additionally, this rhetoric and the feelings it causes can pressure patients into continuing courses of treatment that significantly lower their quality of life just so that they can “continue fighting” (Garrison, 2007).
While there are many varied discussions regarding if and how battle rhetoric should be used regarding cancer, I have noted that there is little conversation regarding battle metaphors in advertising. I will use the term advertisement to refer to persuasive works compelling the audience to take action against cancer, whether through participation in fundraising, volunteering, direct donation, political action, or other methods. I will analyze the goals of these pages and the possible intentions for the battle metaphors displayed. While not a cancer patient myself, I will utilize writing by academics and patients to discuss the flaws in the Society’s use of battle rhetoric.
Even though it can be argued that advertising pages intend to encourage the general public and are not aimed at cancer patients specifically, they do not exist in a vacuum. Cancer patients are likely to be exposed to the conventional battle metaphors and internalize them both before and after diagnosis, impacting their perceptions of themselves and their disease.
Goals of Battle Rhetoric
While it is impossible to determine the exact intentions of every individual who has ever referred to cancer as a battle, there are several common goals. These include empowering patients, avoiding what is perceived as pessimistic language, and drawing non-patients to advocacy.
One goal of battle rhetoric, explained by Per Krogh Hansen, is the creation of a counter-narrative (Hansen, 2018, 214). Counter-narratives are those developed by marginalized groups to combat master-narratives, or narratives that exist on a widespread societal scale and perpetuate norms that may be harmful or inaccurate (Hansen, 2018, 214). Hansen defines battle rhetoric as a “counter-metaphor,” i.e., metaphors that serve to combat inaccurate societal ideas (Hansen, 2018, 215). Battle rhetoric developed to combat the idea that cancer patients were useless or pitiful by painting them as brave and strong for “fighting” their disease (Hansen, 2018, 221).
Author and breast cancer patient Barabara Ehrenreich similarly noted that the term “survivor” is used to avoid negative connotations of words like “patient” or “victim” (Ehrenreich, 2001, 48). These connotations arise because of spatialization metaphors, or metaphors that draw on our connections between intangible concepts and physical directions (Lakoff & Johnson, 1980, 464). Unconsciously, human beings interpret things as “up” and good or “down” and bad (Lakoff & Johnson, 1980, 464). Being a “patient” is a “down” metaphor, due to the association of being ill and lying down, making us interpret being a patient as inherently negative (Lakoff & Johnson, 1980, 462). This negative connotation causes an aversion to calling people patients when there is nothing inappropriate or immoral about the term. On the other hand, being a “survivor” has the connotation of winning, being in control, and health. These concepts are “up” metaphors and viewed as positive (Lakoff & Johnson, 1980, 462). The term survivor is used to avoid negative connotations and feelings of being a patient, even if the term patient is accurate.
Although battle metaphors may seek to combat harmful perceptions of cancer patients and to empower them, they have been overused in advertising and stories intended to inspire non-patients. While Hansen describes battle rhetoric as combating stereotypes about cancer patients by giving them the ability to “fight” cancer (Hansen, 2018, 217), it has more often been used to inspire and prompt non-patients to “join the fight” by donating to advocacy groups. These advertisements ignore the harmful nature of battle rhetoric and do not exist for the benefit of patients, but for the benefit and profit of the group.
Cancer exists within a person, but battle rhetoric frames it as an outside enemy. While this can serve as a form of therapeutic externalization of problems (Hansen, 2018), it can also cause intense amounts of shame. Kristen Garrison describes this phenomenon as “the demonic other” (Garrison, 2007), the perception of cancer as a personified enemy that harms and alters the patient as a person. Some patients see cancer as a challenge from God to help them grow or change (Magaña, 2019, 654), while others simply see it as a push to overcome their shortcomings (Garrison, 2017). Both of these groups believe their cancer developed due to a moral or personal lacking. Many cancer patients feel guilty for contracting the disease, no matter their religious affiliation, due to the burden their illness may place on loved ones. But by painting the cancer within the patient as an external enemy, battle rhetoric can further this sense of guilt, making the patient blame themself for becoming sick in the first place. Battle rhetoric frames survival as a “triumph” that only a select few achieve after overcoming their personal or moral shortcomings (Garrison, 2017). This view is referred to as “spiritual compensation,” a belief that those with the strongest spirits and ethics will be rewarded (Garrison, 2017). In other words, battle rhetoric suggests that the disease developed for a reason, just as wars begin for a reason, and only the “best” will survive. Those who “defeat” cancer have overcome their moral problems, and those who do not have “failed.”
Analysis: The American Cancer Society’s Rhetoric and Goals
These common goals of battle rhetoric are often used to describe patients and even by patients describing their experiences. The American Cancer Society, a charitable organization dedicated to aiding cancer patients and educating the public on the disease, does not often use battle rhetoric in this context. Rather, the Society uses battle rhetoric to call on non-patients to support them. The Society extends the “cancer is war” metaphor by using the metaphorical concepts “cancer recruits.” The American Cancer Society uses metaphors of military status and recruitment to convince people to partake in fundraising and advocacy events. Additionally, the Society associates the government’s responsibilities in wartime with the responsibilities it has to end cancer. This association serves to compel government officials to approve funding for research and prevention programs. The rhetoric is most commonly used on the “Making Strides Against Breast Cancer” (American Cancer Society, 2024c) and “Cancer Research Funding Action” (American Cancer Society, 2024a) pages of the Society website, which are not targeted at patients. In this section, I will analyze how battle rhetoric is used by the American Cancer Society on these pages and to what effect, considering the rhetorical goals of the Society and the metaphorical concepts associated with each use.
The American Cancer Society runs the Making Strides Against Breast Cancer program, a series of walks in which participants are sponsored by individuals and the donations they receive fund breast cancer research (American Cancer Society, 2024c). The webpage for this program describes how to become involved in the walks and utilizes battle rhetoric to call on non-patients to participate. Most notably, on the “Team Leader 101” page (American Cancer Society, 2024e). This page describes steps to leading a team of walkers in a Making Strides event. The title “Team Leader” is an extension of the conventional battle metaphors. Assigning someone the title of “Team Leader” is an honorific similar to a military title, creating feelings of power, duty, and status in the reader. These metaphorical concepts make readers associate team leaders with a military leader, compelling them to become one out of a sense of pride and honor. This phrasing does not bolster the status of patients, but of those helping them.
The “Team Leader 101” page also draws on battle rhetoric’s metaphorical concept “cancer recruits.” While the concept “cancer drafts” can be applied to patients who were unwillingly “drawn into the fight,” the recruitment concept draws on the idea that people can be rallied against a common enemy in battle. The second step of becoming a Making Strides team leader is to “Recruit Your Team” by reaching out to friends, family, and coworkers (American Cancer Society, 2024e). Using the term “recruit” associates joining a team with a joining an army. Again, Making Strides uses the metaphor to draw on a reader’s sense of duty and honor. Military recruiters seek to recruit skilled and talented individuals (Reinsch, 2022), so by associating those brought on to a Strides team with recruited soldiers, the American Cancer Society makes them feel talented and special. Again, the American Cancer Society bolsters the egos of non-patients to convince them to support their cause.
The “Cancer Research Funding Action” page of the American Cancer Society website features links to articles about political and funding action, as well as ways for readers to sign up to participate in fundraising programs, email their congresspeople, and sign petitions (American Cancer Society, 2024a). One page states that Texas needs “your help” to “remain a leader in the fight against cancer” (American Cancer Society, 2024d). By using the fighting metaphor and citing the aid the reader could provide, the piece calls on readers’ sense of duty and pride, just as a war recruitment ad would. By referring to cancer as a fight and compelling readers to join the battle, the American Cancer Society acknowledges the metaphorical concept that cancer recruits.
Another Funding Action page offers an opportunity to “thank your lawmakers for supporting an increase in funding for cancer-fighting programs” (American Cancer Society, 2024f). Another discusses how “every major breakthrough in the fight against cancer” received funding from the federal government (American Cancer Society, 2024a). These pages call on readers to engage in civic action to acquire federal funding for cancer research. This is a reference to a person’s civic duty, just as joining a noble war effort can be seen as a civic duty. These pages seek to paint advocating for cancer research as a means of being a moral and valuable citizen. It is not uncommon for governments to ask citizens to join war efforts such as asking to help “fight terrorism,” but the American Cancer Society inverses this ask by asking citizens to encourage their government to fight. Additionally, these pages pressure the government to become more involved by placing the lives of cancer patients in their hands. If the government does not “fight” by approving funding, then people will die, just as a government failing to take decisive action in a war would cause the deaths of soldiers. The Society portrays cancer as the universal enemy that all should be fighting. These calls-to-action put the onus both on the reader and their government to act against it, recruiting the reader into the war on cancer and pressuring the government to help “arm” the fight with resources.
Discussion: Flaws in American Cancer Society Rhetoric
While these goals are honorable, they do not negate the negative impacts of battle rhetoric previously described. Even though the pages that use battle rhetoric most prominently are not aimed at patients, they are still visible to them. Additionally, non-patients who view these pages and participate in programs may be diagnosed with cancer later life, after they have internalized harmful metaphorical concepts like being a “loser” or morally “weak.” Because of these impacts, I argue that the American Cancer Society’s use of battle rhetoric on these pages is in contrast to its own goals. These goals, described in the Mission Statement, include supporting patients, helping patients survive cancer, and to prevent cancer (American Cancer Society, 2022). But the use of battle rhetoric, even in a limited capacity, is harmful to these goals. To accomplish its mission, it is in the best interest of the American Cancer Society to remove or replace uses of battle rhetoric on its advertising pages.
Support
One stated goal of the American Cancer Society is to provide support to patients (American Cancer Society, 2022). But as previously stated, the use of battle rhetoric can significantly harm patient mental health and cause negative feelings. These include feeling guilt for contracting the disease, feeling like a failure when not recovering, and feeling pressure to undertake extreme treatments. By using battle rhetoric, the Society acts in contrast to its goal of supporting patients, harming them emotionally rather than using more sensitive language.
The primary critique of battle rhetoric from patients and loved ones is the implication of loss. When cancer is framed as a battle, the illness appears two-sided. One side is the disease itself, and the other being the patient, doctors, and treatment. This framing can be helpful in simplifying the complexities of treatment for patients and granting them agency when collaborating with doctors to choose how to “attack” (Hansen, 2018, 217). However, it also implicitly states that one of these sides will “win” and the other will “lose.” For recovered patients, this causes positive response, allowing them to celebrate “beating” or “defeating” cancer (Ehrenreich, 2001, 48). But for those in decline, those deemed incurable, and the loved ones of those who have passed away, being portrayed as “losers” can exacerbate feelings of failure and depression that already accompany the traumatic diagnosis. Even in respectful scenarios such as funerals, deceased cancer patients are often described as having “lost the battle with cancer” (Garrison, 2017).
Critics of battle rhetoric also call on the false assumption of bravery and choice. Cancer patient and writer Kate Granger pointed out that those using battle rhetoric painted her as courageous just because she had cancer, not because she had taken any action to help others. “Just because I have cancer, it doesn’t mean I cannot make mistakes or be selfish,” said Granger (2014b). Using battle rhetoric to celebrate cancer patients implies that they have made a choice to fight against their disease, even though it is something intrinsic within them.
Granger also discusses the pressure to maintain courses of treatment that lower quality of life due to a sense of obligation to loved ones (Granger, 2014a). This pressure to continue treatment can be attributed in part to the expectations of horror and pain battle rhetoric projects (Garrison, 2017). By continuously referring to cancer as a war—something human beings naturally and unconsciously associate with violence, blood, gore, and death—battle rhetoric pressures patients into continuing treatments they do not want and worsen their quality of life just to “continue fighting” for a few more years.
These factors make it clear why the use of battle rhetoric may be harmful to patient mental health, but it is tempting to perform a cost-benefit analysis in these scenarios. If the use of these terms helps fund advocacy and research, is it worth the negative emotions in patients? Based on a 2014 study on the use of calls-to-action in online advertising (Brkić, 2014), I argue that battle rhetoric is ineffective in convincing people to participate in American Cancer Society events and therefore not worth the negative impact on patients.
In reference to search engine advertisements (SEAs), call-to-action terminology usually defines direct commands such as “Buy Now!” or “Click Here!” (Brkić, 2014, 6). However, battle rhetoric can serve as a call-to-action for non-patients. The American Cancer Society calls on people to “fight” cancer by participating in charity walks and to “join the battle” by writing to their congressperson for more access to care. While this can make participation in anti-cancer advocacy more compelling to many, there is no statistically significant difference between engagement with SEAs that utilize calls-to-action and those that do not (Brkić, 2014, 24). Therefore, battle metaphors do not cause enough engagement nor encourage enough donation to outweigh the negative impact they have on cancer patients.
Of course, the pages of the American Cancer Society site are not SEAs as they exist within the pages of the site and are not paid search engine results. Yet, engagement with these pages on the site is based on the same metric: clicks. Each page prompts users to click on links that help them sign up for breast cancer awareness walks, sign petitions, send emails to their congresspeople, and other online actions (American Cancer Society, 2024a). But, because calls-to-action do not prompt significantly higher engagement online, the use of battle rhetoric on these pages will not cause the desired effect. The use of battle rhetoric is unlikely to prompt interaction with these pages or create involvement with the cause. Calling on users to “fight” cancer does not encourage donation or advocacy more than other rhetoric, and therefore its use is not worth the damage it does to patient mental health.
Prevention
The American Cancer Society seeks to encourage cancer prevention through early testing, education, and healthy lifestyle (American Cancer Society, 2022; American Cancer Society, 2024b). On the pages “Cancer Research Funding Action” (American Cancer Society, 2024a) and “Making Strides Against Breast Cancer” (American Cancer Society, 2024c) battle rhetoric is used regularly. Despite being separate from prevention information, the use of battle rhetoric on these pages can inhibit the Society’s goal of preventing cancer due to increases in fatalism that make people unlikely to change lifestyle habits.
A 2019 study exposed non-cancer patients to several texts regarding cancer, then surveyed their likelihood of being tested for cancer (Hauser & Schwarz, 2019, 1700). Some of these texts contained battle metaphors while others contained journey metaphors or no metaphors at all (Hauser & Schwarz, 2019, 1700). The study found that those exposed to battle rhetoric were no more likely to be tested for cancer and decreased confidence in the effectiveness of cancer prevention techniques (Hauser & Schwarz, 2019, 1701). This is because battle rhetoric increases feelings of fatalism (Hauser & Schwarz, 2019, 1702). In this context, fatalism refers to the feeling that if one is going to get cancer, there is nothing they can do to prevent it (Hauser & Schwarz, 2019, 1699). Furthermore, those with fatalistic tendencies are more likely to feel that those with cancer will never recover, no matter their course of treatment (Hauser & Schwarz, 2019, 1702). A person overexposed to battle rhetoric who is later diagnosed with cancer is unlikely to have hope or feel confident in treatment due to fatalism. These feelings can also significantly damage their mental health.
The American Cancer Society page “Cancer Risk and Prevention” rarely utilizes battle rhetoric (American Cancer Society, 2024b), possibly due to the knowledge that the rhetoric can decrease one’s likelihood to take prevention action, but it stands to reason that internet users are likely to be exposed to the advocacy pages whether or not they are looking for prevention information. In fact, because “Making Strides Against Breast Cancer” (American Cancer Society, 2024c) is a public event taking place across the nation and “Funding Action” (American Cancer Society, 2024d) often incorporates public protest, non-patients are likely to be exposed to battle rhetoric at these events or to find the rhetoric on the sites after researching events in their area. Exposing non-patients to this rhetoric makes them less likely to be tested for cancer, reducing the benefits of early testing and inhibiting the Society’s goal of prevention for all.
Survive
The American Cancer Society also states that they hope to help patients survive cancer. The use of battle rhetoric seemingly has no effect on treatment, and therefore would not impact this goal. However, as previously stated, battle rhetoric can cause intense feelings of guilt, shame, depression, and anxiety in patients, all contributing to poor mental health. This is significant because having a negative effect has been linked to lower life expectancy in cancer patients (Fontesse et al., 2023, 1638). But more than this, a positive effect has been linked to prolonged expectancy (Fontesse et al., 2023, 1635).
Negative effect can be described as the presence of negative emotions such as sadness, stress, guilt, or shame (Fontesse et al., 2023, 1633). Positive effect is not just the absence of these emotions, but the presence of positive feelings like happiness, hope, comfort, or excitement (Fontesse et al., 2023, 1633). Battle rhetoric can cause positive effect in some, inspiring feelings of empowerment and agency (Hauser & Schwarz, 2019, 1703). But for many, battle rhetoric causes the negative emotions described. These emotions, combined with increased likelihood of fatalism and defeatism, can all lead to negative effect, which is strongly correlated with lower life expectancy (Fontesse et al., 2023, 1638). By using battle rhetoric, The American Cancer Society makes it more likely that patients will develop a negative effect and be fatalistic regarding treatment, harming their mental health and possibly shortening their life expectancy.
Possible Solution
While there are several flaws with using battle rhetoric, The American Cancer Society does not use them excessively. They are mainly only employed on the “Making Strides Against Breast Cancer” (American Cancer Society, 2024c) and “Support Funding Action” (American Cancer Society, 2024d) pages in the manner previously described. This means that it would not be excessively difficult for the Society to remove or replace the rhetoric, helping the language of the website become more aligned with the Society’s goals.
A more positive alternative to battle rhetoric is journey metaphors. Journey metaphors portray cancer as a path that a patient walks along, with different paths of treatment being presented as alternative routes. In journey metaphors, symptoms, side effects, and failed treatments are not losses but obstacles in one’s path that they will pass through (Magaña, 2019, 653). This distinction is vital because when one does not overcome a challenge of cancer, they are not perceived as losing a fight as they would be under a battle metaphor, but as changing their route. For example, if a patient determines that chemotherapy is too harmful to quality of life and they would like to stop treatment, battle metaphors frame chemo as a failed attack strategy and the patient as surrendering. Journey metaphors, however, would frame chemo as an obstacle that the patient could choose to go through or around. Under a journey metaphor, the patient ending chemotherapy simply chose a different path.
Journey metaphors also imply that the journey will eventually reach an end, but no outcome is dubbed better than another. No one is a “winner,” “loser,” or “survivor,” they are simply people who have completed their journey. Additionally, through spatialization metaphor, things moving forward are “up” metaphors and viewed as positive (Lakoff & Johnson, 1980, 463). Therefore, perceiving cancer as a journey in which one is progressing forward along a path can cause more positive, peaceful emotion than battle rhetoric. These feelings can increase positive effects and prolong life expectancy (Fontesse et al., 2023, 1635).
Conclusion
The American Cancer Society utilizes battle rhetoric as a call-to-action appeal as a means of “recruiting” non-patients to aid in their cause and to encourage the government to take on a larger role in curing cancer. Battle metaphors can go unnoticed because they are conventional metaphors, but nonetheless, they hold harmful implications. Battle metaphors can imply that deceased patients are “losers,” give the illusion of agency, and make patients feel weak or like burdens if they do not improve quickly. While it is possible that these metaphors may increase engagement with the American Cancer Society webpage, there is no evidence of this. Additionally, exposure to battle rhetoric can harm the mental health of cancer patients, decreasing life expectancy, and makes non-patients less likely to take action to prevent cancer. This is in contrast to the stated goals of the American Cancer Society, and therefore it may be in the Society’s best interest to phase out this rhetoric and replace it with the more positively oriented journey metaphors.
References
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