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John McCain did not 'lose' his battle with glioblastoma — because cancer is not a war

Martial language propagates the dangerous myth that death is the result of a personal failure to fight hard enough.
Image: Senator John McCain To Stop Care For Brain Cancer U.S. Senate Debates Tax Reform Bill
Sen. John McCain (R-AZ) is pushed in a wheelchair between votes on Capitol Hill in Washington on November 30, 2017.Mark Wilson / Getty Images file
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A little more than one year has passed since John McCain was diagnosed with glioblastoma, an aggressive form of brain cancer that carries a grim prognosis. On Saturday, only one day after it was announced that the Arizona senator had decided to “discontinue medical treatment,” he passed away.

Since McCain’s diagnosis was revealed, his cancer has been discussed by colleagues, supporters and media outlets in language rife with military metaphors. This is partly because of the context of McCain’s life — martial terms may seem particularly appropriate for a valiant man who endured more than five years in an unforgiving North Vietnamese prison. As Benjamin Wallace-Wells wrote in the New Yorker, much of his time as a POW was spent “awaiting torture or recovering from it.”

But while McCain left the battlefield many years ago, the rhetoric surrounding his illness was decidedly martial. The Republican was heralded as a “fighter,” a “worthy opponent,” and a “warrior.” He would beat cancer with the same steely determination and courage forged in the crucible that was the Hanoi Hilton. And now in the wake of his death, it is already being written that McCain “lost his battle to cancer,” as CBS New York noted in its headline.

As an oncologist, I have observed how this kind of language has become an ubiquitous part of conversations involving disease.

As an oncologist, I have observed how this kind of language has become an ubiquitous part of conversations involving disease, especially cancer. Indeed, as I have written about before, these are often the words employed by doctors and other healthcare providers themselves. As Gary Reisfield and George Wilson suggested in the Journal of Clinical Oncology: “War has an especially strong focusing quality, and its images of power and aggression serve as strong counterpoints to the powerlessness and passivity often associated with serious illness.”

These metaphors perhaps first entered the popular oncology lexicon in 1971, when President Richard Nixon declared a “war” on cancer, which he described as a “relentless and insidious enemy.” But the bellicose rhetoric, which was intended to galvanize the public and swell the coffers of cancer research, is at best misguided and at worse counterproductive. It forces a patient’s cancer outcome to be viewed solely in terms of victory or defeat, and, most distressingly, dictates the vocabulary that individuals themselves use to understand and speak of their disease.

Though cancer is often regarded as the emperor of all maladies, it is in reality merely one of many equally devastating illnesses. I have seen the effects of crippling and transformative conditions like end-stage heart failure, dementia, amyotrophic lateral sclerosis (ALS), kidney failure and advanced cirrhosis. These conditions dramatically alter the trajectory of a patient’s life, carry poor prognoses, cause anguish for families and require a heightened level of medical and supportive care. Yet patients are not routinely drafted in a war against kidney failure or dementia.

Martial language propagates the dangerous myth that cancer capitulates to patients who possess a dogged resolve and that death is the result of a personal failure.

Further, military metaphors can actually confound a patient’s understanding of his or her cancer. As Xeni Jardin, a writer and cancer survivor, put it in 2017: “Cancer, I soon learned, is my own cells going rogue. Suddenly all the combat language was confusing. Am I the invading army or the battleground? Am I the soldier or a hostage the soldier's trying to liberate? All of the above?”

Most importantly, martial language propagates the dangerous myth that cancer capitulates to patients who possess a dogged resolve and that death is the result of a personal failure to fight hard enough. These intangibles matter little. Research has shown that having a fighting spirit as a psychological coping strategy has little impact on survival in patients with cancer.

Though a willingness to seek treatment and remain compliant with therapy is essential, cancer outcomes are determined by the virulence of the tumor type and the stage at which it is initially diagnosed. It is the limits of our current treatments that inevitably fail patients, not the patients themselves.

Language has consequences in so many aspects of our lives, so it makes sense that the language we use to talk about illness would also matter.

Language has consequences in so many aspects of our lives, so it makes sense that the language we use to talk about illness would also matter. According to linguist Elena Semino, violence metaphors can even be emasculating for patients who feel that their “weapons” are insufficient to fight or that their doctors are the “generals” and they are merely “foot soldiers” without agency.

Tragically, some patients continue to opt for futile treatments and balk at end-of-life care (palliative or hospice care) because of an enduring fear that they'll disappoint family or be perceived as weak. Consistent with this, a study found that aggressive rhetoric and an expectation to “fight” leaves little space for patients to express their fear, shock, or sadness about their diagnosis.

In spite of these potential downsides, metaphors will continue to flourish inside the walls of hospitals and clinics. This is not necessarily a bad thing: Metaphors help physicians make the esoteric world of medical science and research accessible to the uninitiated. And for patients, Reisfield and Wilson remind us, “metaphors can impose order on a suddenly disordered world, helping them to understand, communicate, and thus symbolically control their illness.”

A study found that aggressive rhetoric and an expectation to “fight” leaves little space for patients to express their fear, shock, or sadness about their diagnosis.

In other words, we must remember that language that is inspiring for one person’s disease can be disempowering for someone else. Based on her work, Semino concluded: “We need a ‘menu’ of metaphors... so these can be shared with people, and people can pick the ones they want, as you do at a restaurant.”

Stuart Scott, the late ESPN anchor who died of cancer, once told an audience, “When you die, it does not mean that you lose to cancer. You beat cancer by how you live, why you live, and the manner in which you live.”

Seen from this vantage, John McCain beat cancer admirably.

Jalal Baig is a physician and freelance writer. He is currently a hematology/oncology fellow at University of Illinois-Chicago. His work has appeared in The Washington Post, The Guardian, The Atlantic, Slate, Vice, Salon and elsewhere.

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