Metaphors make it simple to communicate complicated ideas and emotions. Using them produces a longer lasting image or impression and gives ideas that are effective when communicating difficult topics. In Susan Sontag’s, Illness as Metaphor, she states “[cancer] the disease that doesn’t knock before entering.” (Sontag, 5). She uses metaphor to create a image of cancer breaking into a house, to express how invasively cancer affects the human body. And physicians use militaristic metaphors such as “cancer as enemy” or “cancer as invader” to help patients “fight” the illness. The use of metaphor here, is to help the patients build courage, resilience, and determination to defeat the disease. The two metaphors used by Susan and the physicians in general compliment each other when building our understanding of pain, suffering, and disease because it helps us see a bigger image.

The first metaphor is by Susan Sontag and it’s from her essay, Illness as Metaphor. In this essay she debates whether the use of metaphor, good or bad, is ethical when talking about diseases like Tuberculosis and Cancer. In one of her metaphors, she personifies cancer stating “the disease that doesn’t knock.” (Sontag, 5). This makes cancer take on a physical form of someone who is obnoxious, that does not care whose property they are in. It shows by breaking in, its intentions are negative, similar to a robber or murderer. Susan uses this metaphor to create an image that is true to what it’s meant to represent. The effect of her language says alot about cancer and its characteristics. Comparing cancer to a realistic being, she is able to plant the image inside the reader’s mind making her point more coherent. It also brings the idea of how anyone can get cancer regardless of age, gender, color, etc. Its intentions are clear, and it has the ability to take away anything a person holds important to them. Furthermore, Susan depicts cancer being, “invisible—until the last stage. When it’s too late.” (Sontag, 12). Just as it enters the house without knocking, the owner doesn’t know its existence until the damage is already done, when it has already taken everything from them or they notice when only a few seconds remain before they’re murdered. Cancer is secretive and most of its victims have no clue, most patients find out they have cancer during their routinely check up and in many cases the cancer is already near the last stages, making it more difficult to save the patient. This shows how painful it is not knowing that cancer has already taken over and by the time it’s found, it’s too late. After its discovery, the patient has no choice but to accept the fact of there being a chance for them to lose everything they love, and creates a circle of suffering starting from them to their loved ones.

Military metaphors are one the most common language used in medicine. By viewing a type of illness like cancer as enemy or invader, it helps the patients build courage, resilience, and determination to defeat the disease. This works because it metaphors give illnesses physical manifestation as someone who can be fought. When talking about cancer, or any sort of disease it is difficult for most people to comfortably communicate their thoughts because it contains complicated ideas and emotions. However, metaphors make it simple, using figure of speech terms and phrases that are easy to understand and have the same meaning. So when talking about pain, suffering, and disease, metaphors help us understand symptoms and behaviors of illnesses more clearly and allow us to deepen our knowledge about them.

The use of medical metaphors by physicians is to, “develop a common language with patients, and offer patients an avenue to express their emotions and exert agency over their conditions.” (Khullar). This means the relationship between the patient and the doctor is more meaningful because they are able to communicate to each other without hiding anything. In most cases when doctors ask patients how their feeling, they reply using metaphors. For example, “There’s someone twisting my organs inside” to describe cramps or “someone is hammering a nail through my head” to express the headaches. These types of metaphors are just common language they use create a picture inside the patient’s or physician’s mind, enabling them to help one another combat the same problem and putting them at position of understanding.

Susan notes the importance of using metaphors to understand pain, suffering, and disease, which shows how medical metaphors can aid patients and physicians to better communicate in common ground. Militaristic metaphors have a similar effect by allowing patients and doctors to express and personify diseases as something or someone that can be defeated, which helps build confidence and gives a chance to look forward to a hopeful future. Both of these tactics give doctors a chance to speak about diseases in a less cynical and practical manner, and helps encourage patients to keep a healthy mental state by making them feel that they have control over their body’s recovery. Some say that, metaphors have serious implications because it makes the patient seem apathetic and inactive and the doctors as active and in control. (Hodgkin). And when militaristic metaphors are used in a wrong way it can cause misconceptions and confusion because the topic is about life and death. However, metaphors give patient the chance to properly explain their subjective view of the illness to the physicians because at the end, building a relationship with each other where both are in control is more important than just one. And as David Hui says in his, Serious Illness Conversations, Paving the Road with Metaphors, where he brings the idea that effective use of communication can help patients become more comfortable about their goals and future. He states by applying metaphors skillfully it can, “personalize challenging discussions, improving patient comprehension and helping patients and their families to plan ahead.”. This means, making difficult decisions simpler in a sense by helping the patients become more aware about their situation and empowering their loved ones to ploy the future with or without them. By doing this, it helps both sides grow and move forward with a positive outlook.

The relation between cancer and military metaphor is they are not naturally good or evil. It is up to the patient on how they prefer them because everyone has their own cultural, values, experiences and preferences. In a study to see if the use of metaphors or analogies improve communication with seriously ill patients, they found that, “of 74 oncologists, two thirds of them used metaphors [those] who used metaphors were perceived by patients to be better communicators.” (Casarett). This shows, patients prefer physicians who use metaphors and analogies because it helps them understand better. Metaphors are used in daily communication by most of our society because we compare our feeling to one thing or another to express grief, joy, and complicated diseases.   

Work Cited

“Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?” Mary Ann Liebert, Inc. | Home, www.liebertpub.com/doi/10.1089/jpm.2009.0221.

Hui, David, and Donna S. Zhukovskya. “David Hui.” The Oncologist, 1 June 2018, http://theoncologist.alphamedpress.org/content/23/6/730.full.  

Penson, Richard T., et al. “Richard T. Penson.” The Oncologist, 1 Nov. 2004, http://theoncologist.alphamedpress.org/content/9/6/708.short  

Sontag, Susan. Illness As Metaphor. New York: Farrar, Straus and Giroux, 1978. Print.

PLANNING

Promt: How does metaphor obscure or illuminate our understanding of suffering, pain, disease or illness?

Does using militaristic language in medicine or adversarial language help patients and doctors?

• YES

The outcomes are victory and defeat, should we call terminal patients and their doctors losers?

• NO

Are they defeated by their disease?

• YES,  but it depends on the person’s situation.

Are the patients managing chronic conditions POW’s (prisoners of war)?

• NO, they fighters.

Key points to focus on:

• Two concrete examples of metaphors.
• One from the Text (Susan Sontag) and the other from your experience.
• Describe the two metaphors exactly
• For each metaphor describe the two things being compared.
• Also which properties are transferred from the first entity (more concrete) to the other (more abstract)  
• Then think about how each of the metaphors shape our or yours understanding of PAIN, SUFFERING, DISEASE, or ILLNESS.
• Lastly, explain how these metaphors representative of how we as a society understand these issues.  

FOCUS ON…

• Frame of Reference- why I chose the two metaphors?
• Grounds of comparison- have some grounds of compatibility and also how their not.
• Thesis- how do the two metaphors connect to each other. Do they support one another or refute one another.

1st Metaphor- “TB was thought to be an insidious, implacable theft of a life. Now it is cancer’s turn to be the disease that doesn’t knock before it enters.”

• Cancer comes in without invitation.
• It doesn’t care whose house it is.  
• Like a thief stealing hope, family, happiness, and future.

2nd Metaphor- Cancer is an ENEMY.

• Cancer is enemy to all. Taking away a person’s hope, family, and making them vulnerable.