Fight or Flight

When I was first diagnosed with breast cancer in March of 2017, the “fight” language/metaphor appealed to me.  As a recovering lawyer and high “type A” person, the illusion of control is really hard to relinquish.  Thinking in terms of fighting to win, of beating cancer, of taking control, of having a say in the strategy and utilizing all tools available to me, this gave me something to focus on.  It helped to think I could do something to affect the outcome.  I honestly don’t remember if any of my doctors utilized the battle/fight metaphor, as so much of that time period is a blur, then and now.

The thing about a cancer diagnosis is that you can’t run from it.  There is no option to opt out, even if that is the thing you want most in the world.

Once I learned that I was actually stage IV from the beginning (a/k/a de novo) and I did some internal work and work with my mental health providers to have a better definition of what was going on for me, I started to resent the the battle metaphor.  It has taken me some time to define for myself why this metaphor is so problematic for me and, as I’ve discovered, for many others as well.

You see, I can implement every bit of fight I can muster into this struggle with cancer and I’ll still lose that fight because the fight isn’t up to me, the deck is stacked, and I have no power over this disease in the end.

Can I affect the outcome?  Thinking positively, changing my diet, etc.?  I’m not quite sure I can define the exact affect of these things within my control, but you can sure bet that I’m employing whatever I can.

Yet, I still don’t embrace the battle/fight/violence metaphor.

“Czechmeister has called the metaphor a “two-edged sword,” suggesting that, while metaphors are fundamental to individual and collective expression, they are also capable of creating negative forces, such as confusion, stereotype, and stigma, within society.” *

The “fight” metaphor can be extremely motivational and attractive.  However, those of us who are “fighting” in the context of illness can feel disempowered by violence metaphors when we are not given the right “weapons” to fight or that the doctors are “the generals” and they’re just common “foot soldiers.”  In my view, the “fight” metaphor enhances the division between patients and doctors and emphasizes the power differential between doctors and patients.

My own professional background as a lawyer put me in the position of advising and guiding clients through difficult legal issues and I have always viewed doctors in a similar context.  I respect the fact that doctors have more education and more expertise than I do; however, I have never viewed doctors as having all the answers.  Being terminally ill means that I have a significant personal stake in my care and I know that what I bring to the table is my own newly found expertise on my own body.  If a doctor doesn’t respect my part in the “team” and my right to refuse or select treatment, then I move on.  I’ve had quite a few rather antagonistic conversations with various doctors and that’s ok with me–if something isn’t right, I’m not going to leave it alone because my actual life depends on it.  It’s not theoretical or an interesting puzzle to figure out, it’s my future with my children   I am quite well aware that my perspective is not the easiest for people (and doctors) to take.  I am blessed to be under the care of doctors who respect my personal autonomy and my consent.

I also get that doctors are working hard every day to find a way to explain very complex issues to overwhelmed patients and metaphors help with that.  When there is a metaphor that resonates with patients, then doctors and others go with that.  I suspect that is why the fight metaphor has existed for so long and is so prevalent among patients, their caretakers and the medical community.

The media also perpetuates this metaphor and this is where things get sticky.  A doctor/patient discussion is private and protected, so whatever metaphors or analogies are utilized stay private and can morph and change with time and circumstances.  However, when the fight/battle language is used publicly and without a patient’s involvement or perspective, I believe that this is the negative side of the metaphor and where stigma attaches.  Not everyone embraces the battle/fight metaphor and that should not be imposed on anyone.

At the end of life, the fight metaphor can be extremely negative and stigmatizing as those who are “losing” the fight with their death can feel as though they are at fault, that they didn’t try hard enough.  This feeling could push a patient into trying more and different treatments rather than focusing on the quality of the time that patient has left.  The patient may feel as though they are letting their loved ones down if they don’t keep “fighting,” even if what is really best for that patient is to focus on comfort and palliative care.

In the end, metaphors are helpful, they clarifying and motivate, yet they are limited and flawed.  I’m all for motivating patients facing horrific issues and odds by utilizing metaphors; at the same time, when those metaphors cause harm, then they should be discarded.  The battle metaphor is one of those.

When a fellow metster reaches the end of his/her life, I typically say that cancer murdered that person.  I realize this phrase isn’t perfect and actually invokes some of the battle/fight metaphor; however, I also feel that it focuses on the fact that the patient had no say, no way to prevent their demise from a foe that cannot be beat.  And there I go again with the battle metaphor.

I have one request, dear readers.  When breast cancer kills me, please don’t say that I lost my battle with cancer.  It’s ok to say that cancer murdered me, because it will eventually do that.

*Czechmeister CA. Metaphor in illness and nursing: a two-edged sword. A discussion of the social use of metaphor in everyday language, and implications of nursing and nursing education. J Adv Nurs 1994;19:1226–1233. CrossRefMedlineGoogle Scholar http://theoncologist.alphamedpress.org/content/9/6/708.full