When the iconic theater actor and director Roger Rees died earlier in July, many reports quoted a gently worded press release written, it seemed, by his family: Rees, the release said, had “passed away … after a brief journey with cancer.” The diction gave me pause, even as I admired it. It was a clear step away from the familiar description of a dearly departed’s “battle” with the disease. But did this euphemism attenuate cancer in a way that felt cruel to the victim or untrue to the actual experience of, well, dying? I imagined a man walking slowly into the sunset, hand in hand with an adumbral figure. It seemed strange that the two silhouettes were moving in the same direction.
A journey “through” cancer might have been easier to visualize. There goes Rees, gracefully picking his way across the changing landscape, its rocks and eddies of sand and occasional sloping idylls. You are now entering cancer, reads the road sign behind him. Do not expect to enjoy your stay. But that preposition might be inapt, given that not every itinerant reaches the other side of the imperial malady. With, then, not through.
While this was the first time I’d encountered a journey with cancer, such quests crisscross the Web. Bloggers relate their “Journey With Inflammatory Breast Cancer,” their “Personalized Journey With Ovarian Cancer,” their “far-from-perfect journey with cancer” and “healing journey with cancer” and “beautiful journey with cancer” and “brave journey with cancer.” Sometimes, cancer is not a fellow traveler or pilgrim but a modifier clarifying the nature of the trip. There are “cancer journeys” and “long cancer journeys” and “personal cancer journeys,” all arcing across our feeds to converge, perhaps, in what Clive James called “the empty regions,” the endpoint of every mortal trek.
And this is good, I think. The metaphors of choice for cancer have long been battle, war, or fight. As physician Dhruv Khullar pointed out, John Donne had already begun to entwine martial and medical imagery in the 17th century: The “siege” of sickness, Donne said, “will blow up the heart, like a Myne…it batters all, overthrowes all, demolishes all, destroyes us in an instant.”* (In this respect, sickness is not unlike Donne’s God, whom the poet famously implored to “batter [his] heart.”) Donne’s contemporary Thomas Sydenham, a doctor known as “England’s Hippocrates,” fulminated that “a murderous array of disease must be fought against, and the battle is not a battle for the sluggard.” Perhaps the idea of doctors nobly defending their patients against malign invaders grates less than the imperative that sick people—who didn’t choose this, who have no training—must themselves suit up for war. But by now, the distinction doesn’t matter. Military lenses for the viewing of bodily ills and betrayals have become standard-issue. (Susan Sontag explored this issue in depth with her book AIDS and Its Metaphors.) The observation seems true for the cancer community especially, where a U.K. research organization made “Together we will beat cancer” its motto, and Lance Armstrong reduced his experience of the disease to a stark dichotomy: “Give up or fight like hell.”
What’s changed isn’t the prevalence of martial rhetoric—it’s that the culture has filled up with supplementary voices decrying the analogy. I’ve written before on how pressuring cancer patients to embody our fond hopes for human fortitude amounts to exploiting people at their most vulnerable. Many feel that likening sick men and women to soldiers places an unfair burden on them: If they “lose,” were they just not fighting hard enough? This framing is insane not only because cancer has no cure, but because it allows us to freight the very ill with expectations we wouldn’t dream of taking up ourselves. Who with a life-threatening illness has the time or emotional space to keep all of our heroic fantasies alive, too? As Aria Jones memorably promised in McSweeney’s, “If I die of this relapsed, refractory Acute Myelogenous Leukemia, and you describe me posthumously as having ‘lost her battle with cancer,’ I swear to God I will come back from wherever my soul may have been sent and haunt the living shit out of you for the rest of your days.”
Science backs up the toxicity of the war metaphor. In several studies, patients primed to think of their cancer as an adversary reported more guilt, higher levels of depression and anxiety, and elevated pain. Furthermore, researchers at the University of Michigan found that “bellicose” medical rhetoric led people to understand cancer as an enemy to be resisted, not a condition susceptible to judicious lifestyle shifts. Accordingly, participants who received a cancer pamphlet salted with words like hostile and fight proved less likely to cut back on cigarettes or red meat.
Still: I get it. The cancer-as-villain trope can simplify the emotional terrain for patients at a messy, bewildering time; some may find it helpful or consoling to connect their ordeal to higher values like courage, grit, and resilience. Plus, the battle rhetoric has social utility: “Since 1971,” explained Khullar, “when President Nixon declared a ‘War on Cancer,’ this imagery has been effective for inspiring the fervor and funds necessary for great advances in cancer care and research.”
Journey, not nearly so grand or stirring, has a gentler virtue. Instead of focusing on outcomes—triumph or defeat—the word zeroes in on the everyday process of managing a chronic illness. It replaces the agon with mindfulness, a sensitivity to one’s needs and feelings, an understanding that the scenery might change. Writing for the Guardian, health care worker (and terminal patient) Kate Granger demonstrated the need for this softer, more variable discourse:
Some days cancer has the upper hand, other days I do. I live with it and I let its physical and emotional effects wash over me. But I don't fight it. After all, cancer has arisen from within my own body, from my own cells. To fight it would be "waging a war" on myself.
Granger’s point, that cancer and person form an uneasy synthesis, is echoed by my colleague Jacob Brogan, who has written that the malady can feel less like a terrifying antagonist than a quiet roommate, an eerie presence whose rhythms sometimes merge with yours. This evokes some of the more recent thinking about the disease, as unspooled in books like Siddhartha Mukherjee’s The Emperor of All Maladies and Atul Gawande’s Being Mortal. Noting that tumor cells thrive by perfecting and magnifying the activities of nontumor cells, Mukherjee calls cancer “an enigmatic, if somewhat deranged, image in the mirror.” Reviewing the book in Slate, Amanda Schaffer termed cancer “our evil, smarter twin.” Meanwhile, Gawande asks readers to think carefully about the costs of a protracted, uncertain campaign against the illness, one that could more closely resemble a civil war than a foreign offensive.
If fights are unnatural events, incidents of overturned expectation, journeys seem constant and inevitable. We’ve worked the imagery of embarkations, milestones, resting points, and destinations deep into our symbolic understanding of a life, so it makes sense to regard cancer as one more leg of the journey. Discourse around the Crab once drew on the Iliad; now it takes cues from the Odyssey. And for all the shivery valor of the first epic, maybe it’s worth remembering that the second one had the more satisfying ending.
*Correction, July 30, 2015: This post originally misspelled physician Dhruv Khullar’s first name.