Metaphors and Malignancy in Senator McCain’s Cancer Diagnosis

When my grandmother died from a mucosal melanoma (a form of skin cancer) in 2015, I sat around with my mother and my aunts talking through the wording of the email we were going to send round to her friends and colleagues to inform them of her death. We rejected the obvious line, “She died after a long battle with cancer,” because we felt it implied a failure on her part — a conflict lost because she hadn’t tried quite hard enough. It struck me, however, how difficult it was to come up with alternative wording and how ingrained such military metaphors are in our semantics of cancer.

I was reminded of this very personal moment while watching the very public fall-out of Senator John McCain’s glioblastoma diagnosis. McCain received messages of support and sympathy from across the political spectrum, many of which drew on this ingrained language and traded on an adversarial model of the cancer experience. President Barack Obama tweeted, “John McCain is an American hero & one of the bravest fighters I’ve ever known. Cancer doesn’t know what it’s up against. Give it hell, John.” Obama was not alone in drawing on McCain’s military background, weaving his martial history into his medical present and positioning cancer as an identifiable and malevolent foe.

Military metaphors are a familiar part of the semantics of cancer that operate in today’s world. On a national or even global scale there is a “fight” or “crusade” against cancer; on an individual level cancer is the “killer” disease and people who have cancer are “cancer victims.”¹ Obituaries record people who died after a “long battle,” friends recall their loved ones’ “fighting spirit,” and efforts to “beat” malignancy. And nowhere is this more manifest than in President Richard Nixon’s promise to “conquer” the disease in his still un-won “war on cancer.”²

Many would see this language as a product of the twentieth century and a consequence of late-modernity and its industrialized biomedicine. Steven Shapin argues that the story of cancer “as a distinctively modern … entity” began in 1940, and I think most people associate the emergence of cancer as a singular threat to body and nation with the post-war, Cold War, North American context of the mid-twentieth-century.

However, this adversarial language has a much longer history. Military metaphors in cancer discourse can be found in the nineteenth century, and the idea of cancer as a disease with agency, which requires a concerted and combative effort to eradicate — both by the individual and by the medical collective — can be dated even earlier.

For centuries, cancer has been conceptualized as a parasitical and intentional being — a creature occupying the body and consuming it from within. In her book on malignancy in early modern England, Alanna Skuse describes how in the seventeenth century, the disease was imagined as “somehow sentient, eating up the body like a devouring worm or a ravenous wolf.”³

This idea that cancer was an animal, distinct from its host, persisted into the nineteenth century. It was endowed with character, temperament, and disposition — with needs in direct competition with those of the body it occupied. By the 1890s, one doctor lamented, “The carcinoma cell is an independent organism, like many a protozoon; that it lives a life which is wholly independent and proper to itself.”⁴

Towards the end of the nineteenth century, this notion that cancer was a disease with a life and purpose of its own coalesced with germ theory, a new medical preoccupation with its own metaphors and analogies. “Germ theory” was the idea — or set of ideas — that some diseases are caused by specific microorganisms.⁵ Enthusiasm for germ theories of disease reached its zenith in the fin de siècle, and this new conceptualization had a profound effect on the prevailing debate over the causes and characteristics of cancer.

Germs were frequently understood as autonomous individuals. The bacteriologist Jakob Henle said, “With the epidemic, the causes of the disease seek out the individual [my emphasis].”⁶ Similarly, metaphors of conquest and colonization permeated medical literature in the nineteenth century. A French writer in 1885 characterized infection as “Coming from outside, penetrating the organism like a horde of Sudanese, ravaging it for the right of invasion and conquest.” ⁷

In bacteriology, military metaphors were used to refer both to the activities of germs and to the actions of medical professionals. Robert Koch articulated his efforts against disease as an “offensive” — “In the past one took a more defensive attitude, we have now moved away from this defensive point of view and have seized the offensive…We must be prepared, first, to detect the infectious material easily and with certainty, and second, to destroy it.”⁸ The medical profession was “Noble, from its many victories in the eternal warfare it wages against disease and death.”⁹

These various conceptualizations mapped easily onto the metaphoric and analogic language that surrounded cancer in the fin de siècle. Just as a litany of scientific researchers began to suggest that cancer might also be transmitted by a microbe, terms such as “invasion,” “infection,” “diffusion,” “germ,” and “seed” infiltrated the disease’s vocabulary. In 1907, the surgeon to the Cancer Investigation Committee of the Middlesex Hospital in London, J. Bland-Sutton wrote, “When the breast is attacked by cancer the cells implicate the lymphatics in the underlying fascia and slowly invade them.”¹⁰

In her seminal work Illness as Metaphor, Susan Sontag warned that the metaphor of cancer as a hostile enemy that has to be battled by all available means leads to excessively aggressive, potentially harmful treatment.¹¹ She implored her readership to rid their discussions of cancer from metaphor, and she argued that combative, adversarial codes for cancer care were detrimental to the wellbeing of cancer patients.

Similar arguments were made in a flurry of think-pieces and tweets published after McCain’s diagnosis and in response to the Obama-style messages of support and sympathy. McCain’s martial “toughness,” commentators insisted, had no bearing on his prognosis and besides, it is just as “tough,” just as “brave,” to choose a palliative course as to go down the adversarial route.

Metaphors in medicine can, however, be useful. They clarify complex concepts and provide meaning to meaningless pain, suffering, and terror. While I am sympathetic to Sontag’s demands, and do not disagree with critiques of military metaphors in the case of McCain, I also wonder what would replace these metaphors? Is it even possible to speak of cancer — the “dread disease” — without recourse to analogy? Thinking back to the nineteenth century, this language came about in response to a disease that was — even by contemporary standards — unusually incurable.

While the landscape of twenty-first-century cancer treatment is utterly unlike that of the Victorian clinic, glioblastomas, for example, continue to hover more in the “incurable” category than in the “treatable.” Cancer still carries with it the specter of death, irrespective of the manifest therapeutic successes with many of its variants. Thus, while martial metaphors might not be the most appropriate, if we were to do as Sontag implores, and strip the disease of its rhetorical coating, how would we cope with the awful reality of what lies beneath?

Agnes Arnold-Forster

Agnes Arnold-Forster is a researcher in the Social Studies of Medicine Department at McGill University. Her first book, The Cancer Problem, was published by Oxford University Press in January 2021. She is co-PI on the Wellcome Trust–funded project, Healthy Scepticism.

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