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  • BIOETHICS FORUM ESSAY

Cancer: Still a Bad Metaphor

It’s been more than 30 years since Susan Sontag published her classic essay, “Illness as Metaphor.” A cancer patient herself, she was angry that cancer had become a popular metaphor for society’s villains. According to Sontag, calling things like Nazis, Communists, and the Watergate events “cancers” stigmatized and demoralized patients. People with cancer are “hardly helped by hearing their disease’s name constantly being dropped as the epitome of evil,” Sontag wrote.

Did Sontag’s observations change public discourse? Apparently not. During the past year, I have seen popular media stories attaching the cancer label to an array of current concerns, from Islamic extremism, drug violence in Mexico, Sharia law tribunals, and the priest sex abuse scandal, to soccer match-fixing, the national debt, and the mortgage company Fannie Mae.

Why does the cancer metaphor have such staying power? Other illness metaphors don’t have the same appeal. Sudden deadly events aren’t “heart attacks.” Incrementally developing dangers aren’t “diabetes” or “obesity.”

Cancer metaphors are powerful because cancer is, in former President Nixon’s words, the “dread disease,” the one people fear more than any other. Heart disease may be the leading cause of death in this country, but surveys show that more people are afraid of getting cancer.

Cancer is a powerful metaphor, and using it is an effective way to call attention to a serious social problem. The term cancer signifies uncontrolled growth and an urgent need for drastic and painful remedies.  Why not use this powerful metaphor to counter neglect of grave public threats like the burgeoning debt and violent extremists?

Because Sontag was right about how cancer metaphors affect patients. As someone who has faced life-threatening cancer, I cringe at these statements. When someone calls terrorism or drug violence a cancer, I feel somehow tainted by the reference. I know I’m not the real target, but if these vile things are like cancer, are people who have cancer vile, too?

It’s also irritating when public figures call social problems “cancers.” They use a disease that is a real threat to real people to score easy points in political debate. Too often, cancer’s shock value substitutes for solid argument to support their claims.

Sontag condemned a second kind of cancer imagery in “Illness as Metaphor.” It’s not only wrong to use cancer as a metaphor for evil, she declared, it’s also wrong to use evil as a metaphor for cancer. Cancer is not a “predator,” or an “enemy,” she insisted; it is “just a disease – a very serious one, but just a disease.”

I don’t completely agree with the second part of Sontag’s argument. To this cancer patient, cancer did seem evil, like a monster intent on harming me. I hated my tumor and often told it so. But it was a monster my own body had created. Part of the struggle in cancer comes from the sense that your body has betrayed you. Not every patient feels this way, but many do. I doubt that getting rid of the disturbing metaphors associated with cancer would eliminate this feeling.

The true harm in portraying cancer as evil comes from the effect this language has on healthy people. As Sontag asserted, it makes cancer “not just a lethal disease but a shameful one.” With cancer, you become an outsider, someone who may look strange from treatment side effects and can’t fully participate in ordinary life. Friends and acquaintances aren’t sure how to talk to you, and some avoid you altogether. Cancer carries less stigma than it did when Sontag wrote, but more than a few people still act as though cancer patients are somehow contaminated.

In “Illness as Metaphor,” Sontag predicted that medical advances in treating cancer would produce less destructive cancer imagery. We’ve made some progress in this direction. The popular understanding of cancer is more nuanced than it used to be. Virtually everyone knows someone who has been successfully treated. Cancer is still terrifying, but people no longer consider it an automatic death sentence.

In the public square, however, little has changed. Cancer remains a favored metaphor. It remains a metaphor that is, as Sontag argued, “an encouragement to simplify what is complex,” as well as “an invitation to self-righteousness.” Cancer metaphors in public debates are still “cheap shots” that make having real cancer harder than it has to be. Although cancer will become more treatable in the coming years, it will be a long time before cancer loses its fearsome reputation. But we could – and should – put an end to cancer metaphors now.

Rebecca Dresser, a Hastings Center Fellow,  is the Daniel Noyes Kirby Professor of Law and Professor of Ethics in Medicine at Washington University in St. Louis and is editor of the forthcoming book, Malignant: Medical Ethicists Confront Cancer.

Published on: September 6, 2011
Published in: Humans and Nature, Media

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