DSQ > Fall 2007, Volume 27, No.4
Abstract

The language of war dominates breast cancer discourse, pervading every aspect of the experience, and determining how the patient and others understand the illness. Women are enlisted in a battle against the self, their bodies made war zones, with cancer as the enemy, medical professionals as infallible heroes, and treatments of search-and-destroy by any means possible. While this metaphor may serve to motivate some women, we should not accept it uncritically as the only and right way to make sense of this disease; furthermore, we should recognize how the war metaphor delimits the ways women can talk about breast cancer, potentially silencing women for whom a combat mode is inappropriate or ineffective. Drawing upon narrative theory and rhetorical analysis of disability memoirs, this article first examines breast cancer narratives characterized by sanctioned rhetorical frameworks then considers the potential of alternative discourses, such as those of protest and peace, to write a different kind of illness experience.

Keywords: Breast cancer; rhetoric; war; narrative theory; alternative discourse

"As long as a particular disease is treated as an evil, invincible predator, not just a disease, most people with cancer will indeed be demoralized by learning what disease they have" (Sontag 6).

"It is an unrelenting threat, and a crafty foe. . . .Breast cancer takes a particular delight in fooling people . . . snicker[ing] and pluck[ing] women off . . . at random" (Stabiner xvi).

Stabiner's characterization of breast cancer as "evil, invincible predator" comes twenty years after Sontag's call to reconsider the ways culture had come to mythicize the disease. The conceptualization of cancer as an enemy invading the body represents only one component of a larger, ubiquitous metaphoric system characterizing prevention, treatment, and cure of cancer as war; according to Lakoff and Johnson, the metaphors we accept and invoke not only come to "structure [our] actions" but "can keep us from focusing on other aspects of the concept that are inconsistent with that metaphor" (10). Thus, the hegemony of the war metaphor impedes efforts to conceive of the cancer experience from a non-militant standpoint. Though Sontag wrote persuasively against such images, and though Illness as Metaphor was well-received and widely read, the war metaphor continues to pervade discourse on the disease in general, and breast cancer in particular. Even those who wish to find alternative discourses for understanding and describing their experiences seem to do so within the combat metaphor, formulating anti-war rhetorical frameworks of protest and peace. Since "the essence of metaphor is understanding and experiencing one kind of thing in terms of another," (Lakoff and Johnson 5) we must consider carefully how and why the war metaphor abides as our primary model, including its benefits and liabilities, as well as the potential for alternatives to conceiving breast cancer as a war against the self.

The war against breast cancer

The war metaphor has a rich history. Lerner tracks the evolution of the current conflict, noting that "this use of military terminology to describe breast cancer control was not limited to the 1950s but occurred throughout the twentieth century" (8). The premier organization advancing the fight against the disease arose in 1913: the American Society for the Control of Cancer (ASCC), which in 1945 became the American Cancer Society (ACS). The ASCC sought to motivate women to take active roles, appealing to their sense of responsibility not only to themselves but to their families and society. One such agent of propaganda was the Women's Field Army (WFA). Organized in 1936 to "raise public awareness about cancer and its curability" the WFA wore uniforms, observed rank, and adopted the "Sword of Hope" as its emblem; as Lerner observes, the sword, appropriated from U.S. army literature, "was formed from a twin serpent caduceus, the traditional symbol of the medical profession" (43). The rhetoric of the WFA, boasting over half a million members by 1943, included references to "trench warfare" against a "ruthless killer," and the director of the ACSS acknowledged that war imagery was deliberately chosen, along with "the slogan, 'Fight Cancer with Knowledge,'" in order to mobilize public opinion and provide "cancer patients and their families with the inspiration they wanted and needed" (45).

Despite the image of woman warrior codified in the WFA, it "was hardly revolutionary or liberating. Rather, it expected women to function as caretakers in the public and the private sphere — for their own families and for everyone's family — even while it educated women" (Knopf-Newman 19). Furthermore, though the public presence of the WFA seemed to spark an increase in woman's narratives published in magazines, these were limited to "tales of hope" which reinforced the "importance of following traditional medical guidelines of examination and treatment" (19). Consequently, the WFA promoted a very specific kind of activism, whereby women were strongly encouraged to do their duty to keep themselves, and thus society, healthy. According to Lupton's analysis of western medical culture, such language reflects a general practice of "health promotion rhetoric [which] maintains that the incidence of illness is diminished by persuading members of the public to exercise control over their bodily deportment" (35). The ways in which the medical culture attempted to manage breast cancer placed enormous and unreasonable responsibility on women, virtually marking their bodies as war zones and drafting them as frontline soldiers committed to protecting American interests.

Rhetorical choices

Granted, the breast cancer war metaphor has its value. It offers hope, optimism — an absolute necessity for the kind of life-death experience cancer threatens, even if it does not immediately deliver. "To be told by authoritative figures that you have a deadly disease, for which no real cure exists, is to enter a liminal state fraught with perils that go well beyond the disease itself" (Ehrenreich 80). Frequently, the anticipation of surgery and the horrors of chemotherapy unnerve the patient more than the diagnosis itself, so rallying oneself or another with a call to fight is certainly reasonable and warranted. It also seems an inevitable choice, given "society's attitude toward cancer as the dreaded other. Against this other, combat is the only response" (Frank 83). War rhetoric serves an immediate and worthy purpose for many women with breast cancer, who need access to whatever it takes to cope with this deadly disease. The woman for whom the war metaphor works should be free to pick up her sword.

My concern with war as a metaphor for dealing with breast cancer, however, is not one of condoning or condemning the use of military imagery but of exploring alternatives. Do women with breast cancer feel compelled to enlist in a war when they would rather cope differently? It seems difficult for women to invoke any other system, so it is no surprise that personal stories of women with breast cancer reflect this dominant metaphor; after all, how else can they give meaning to this event except to articulate it "within pre-existing conceptual frameworks," invoking the most accessible language available to "communicate otherwise inexpressible experiences" (Skott)? By virtue of growing up in a culture where cancer is characterized as the ultimate enemy invading the body; where the body becomes battleground, split from the mind that must become a disembodied warrior; where the patient becomes a soldier, entreated to follow absolutely the orders of the heroic medical professional; and where an aggressive, search and destroy strategy often inflicts more damage than the foe, their experience is virtually predetermined. Consequently, "breast cancer discourse [has] enjoyed only limited types of representation in the public arena (Carter 657), and we should not assume that every woman's voice has been permitted to sound. Just as the stigma of breast cancer itself once silenced women, today's prescription of "healthy" language can be just as silencing, leaving many women without a validated means of expressing their experience; likewise, their friends and family, the whole of their support system, have few options but to adopt the war metaphor. What other language do they possess? What other language is sanctioned? My own experience with my mother's cancer has illuminated for me the potential limitations of this kind of combative rhetoric.2

Writing an obituary for my mother was so much harder than I would have thought. After all, as "the English major in the family" I accepted the task as soon as, maybe even before, my dad asked. Describing her life was easy enough. Describing who survived her straightforward. But I had no words to describe her death, and I stumbled over, resisted, what dad, my sister, and my aunts finally advised: she lost a four-year battle with cancer. I had most difficulty with the verb.

Significantly, the war metaphor reflects something about both "the nature of fighting and its role in our lives" (Rossman 6), as well as the way our society copes with an uncontrollable disease Military metaphors reveal deeply embedded cultural values regarding body-as-property, obedience, and justified violence; although breast cancer war rhetoric may seem an innocent means of motivating and uplifting an ill woman, it may also conceal a darker side to organizational and medical efforts aimed at "combatting" the disease. Thus, although war metaphors can be of service, they do not necessarily serve every woman who experiences breast cancer, and the specific ways in which they are used — the kinds of war metaphor invoked and the logical associations that underlie such imagery — deserve careful attention.

The genre of the personal — and cultural — narrative

The personal narrative offers one of the most accessible sites for such exploration; breast cancer patients, survivors, and co-survivors have taken full advantage of this genre to write their experiences and share them with a curious and sympathetic readership. Especially important is the information such narratives provide to help us understand how illness is "given meaning and therefore understood and experienced through social and cultural processes" (Lupton 14). Many stories do not feature cancer; they detail a woman's fear of losing a breast, of losing her hair, of losing her life. Often, the first two concerns loom larger than the last, a focus that must tell us something about the way our society responds to loss of breast, of hair, of femininity. Such individual accounts also influence our subsequent interpretations and perceptions of illness, as "narrators moralize the events they recount and seek to convince others to see some part of reality in a particular way" (Garro and Mattingly 11). The metaphor informing the writer comes to work its magic upon the reader, investing both participants in the meaning that is made. Personal stories, therefore, do more than share one person's story; they sow a seed.

Likewise, the story reflects its own progenitor, a "parent" narrative of cancer as demonic Other. Even as the particular account voices a unique individual experience, it also reflects a link "with more general culturally based narrative patterns or properties" (Garro and Mattingly 14). Consequently, however unique an individual's experience, she tells it in terms everyone can understand; indeed, she may have no tools for telling her story any other way, as the cultural frameworks guiding the personal narrative genre preexist her experience and desire to recount it. She must, then, in an effort to narrate her experience, negotiate the personal details that she may wish to include (or exclude) within an established discourse community. Narration of one's own story becomes a "balancing act" between autonomy and "commitment to others"; autobiography becomes a dialectical process between self and society (Bruner 218). Therefore, although the details of breast cancer narratives may serve the writer's purpose and presumably articulate the uniqueness of a common experience, attention to the "underlying narrative structure may allow [us] to see more clearly the imprint of institutionalized practices and ideology" (Garro and Mattingly 15). Examining narrative frameworks advances our effort to understand the power and implications of the breast cancer war metaphor.

Although narratives express an individual voice, they are highly controlled, and many conditions must be met before anyone can publicly share their narrative — there must be a reason, a "so what?" for the narrative (Couser; Garro and Mattingly). Obviously illness narratives by already established voices — published authors, celebrities, athletes — do not bear the same burden, as it is presumed that anyone of public interest will be of interest in their illness as well. But for the average woman's narrative to be told, she must take the risk of writing it, it must say something, and it must sell. Triumph over adversity, redemption, courage in the face of the unknown, recovery, optimism, hope: these sell. Fear, uncertainty, anger, and chaos do not. Thus, the rhetorical frameworks that arise most often in published narratives reinforce a specific set of values, while discouraging, even shaming, alternative responses, which are ultimately silenced by virtue of their nonexistence in the published record of the Experiences of Women with Breast Cancer. The cycle circles viciously: war imagery characterizes the most visual and prevalent rhetoric of breast cancer; a woman is diagnosed with breast cancer and finds herself and others with no other language to describe the experience; that language thus defines the experience. Once defined as a war, the metaphor system "hides" any aspects of the experience that do not comply, and the only language validated is that of combat (Lakoff and Johnson).

Sanctioned rhetorical frameworks

Couser's analysis of the rhetorical frameworks directing disability memoir serves this discussion well. He argues that disability narratives generally fall into one of four categories, all of which "reinforce conventional attitudes": Triumph, Horror, Spiritual Compensation, or Nostalgia. Though each tells a different individual story, "what characterizes these preferred rhetorics is that they rarely challenge stigma and marginalization. . . . Indeed, their appeal to the reading public may vary inversely with the degree to which they threaten the status quo" (79). In his analysis, the rhetoric of triumph represents those narratives that, though true, are not representative, such as the stories of so-called supercrips. Narratives of horror, employing gothic rhetoric, focus on the dark, squeamish, nightmarish aspects of disability from the standpoint of recovery; the teller is separated, marked off from the experience, and the account represents a stark contrast between diseased and cured. Spiritual Compensation, or conversion, narratives invoke the will of the Creator; "here we see a biblical view of disability, that it is a mark of sin or God's displeasure with an individual" (82). Such a rhetorical framework, significantly, invalidates one's anger even as it emphasizes inferiority. Nostalgia narratives equate disability with death, and tell a romantic story of life before disability, a life made all the more beautiful in retrospect from the disabled position. Finally, Couser presents a fifth option, the rhetoric of emancipation, to which he assigns the potential for "contest[ing] received attitudes about disability" (79). He compares this last rhetoric to testimonio, as testimony to the disabled position; in this case, disability is not depicted as "a flaw in [the] body but as the prejudicial construct of a normative culture" (89). Emancipation, then, is freedom from the disabling culture, rather than from the disabled body. It requires only a modest stretch of the imagination to apply Couser's taxonomy to breast cancer as war narratives.

The first kind of rhetorical framework, that of Triumph over cancer as a formidable foe, creates the same problems for women with breast cancer as it does for other people with disabilities. How can a woman with metastatic bone lesions read Lance Armstrong's story of conquering the disease and feel anything but failure? His story may be true, but does not represent the average person, and such narratives, which get so much press attention and bookshelf space, undercut the comparably determined but unsuccessful efforts of people fighting cancer. Most importantly, the rhetoric of triumph celebrates the living and indirectly censures those who "didn't fight hard enough," as if surviving cancer is wholly a matter of personal responsibility and effort. Barbara Ehrenreich takes exception to the word, survivor. "The mindless triumphalism of 'survivorhood' denigrates the dead and the dying. Did we who live 'fight' harder than those who've died? Can we claim to be 'braver,' better people than the dead?" (87). Susan Wendell voices a similar concern: "'success' at being healthy . . . is always partly a matter of luck and therefore beyond our control. When health is spoken of as a virtue, people who lack it are made to feel inadequate" (269). By this metaphor system, the dead are not only less brave, strong, and virtuous; they are complicit. Illness becomes a choice; "people are encouraged to believe that they get sick because they (unconsciously) want to and that they can cure themselves by the mobilization of will; that they can choose not to die of the disease" (Sontag 55). Equally as worrisome is the impact such narratives have on those of us who haven't had cancer yet. Our unquestioning acceptance of validated cancer narratives as guidebooks for living with the disease negatively impacts our ability to support our family and friends who are trying to recover, and who may very well die from it. If we buy into the rhetoric of triumph, we hold unreasonable expectations for ourselves and others.

The race for the cure, Kansas City, August 2003. My mom had borrowed a wheelchair, so that she could join us in the 5k walk. Convinced that she just needed a little encouragement, my dad, sister, and I began a concerted campaign to let her know we thought she could do the 1-mile walk. She relented as long as we would do it with her, and threatened dad that he would have to carry her if she got too tired. He smiled and agreed. She did the 1-mile walk, pushing and leaning on the stroller of her 11-month old granddaughter as she slowly, painfully, made her way to the finish line, accompanied by family members from St. Louis and several, several friends. We were so proud of her. She couldn't get out of bed for days.

Rhetoric of horror is just as common in the breast cancer story: the story of a woman who has been cured and therefore freed to describe the struggle, despite (or perhaps because of) the heart-wrenching details of post-op bleeding and scars, chemotherapy-induced vomiting and sore gums, clumps of hair clogging shower drains. As with the rhetoric of triumph, the rhetoric of horror privileges the survivor, but in this case, the details of the battle, rather than the experience of winning, are foregrounded. The biographical accounts woven throughout Stabiner's work elucidate the horrors of breast cancer; Jerilyn "'can't pee' [but] she did not want a catheter; she did not want anyone doing anything else to her body" (91); Dee faces the "horrifying" news that treatments of "high-dose stuff [that] kills everything" gave her only a ten percent greater chance of survival (183); Laura was "beginning to feel suffocated by cancer. . . . Death lurked everywhere" (326). Such a rhetorical framework not only emphasizes the dark side of illness but reinforces cultural expectations about women's roles in this war; just as they must monitor the body for illness, they must maintain it and reconstruct it after the battle has been won. For those who internalize these expectations, recounting the illness experience as a horror to be overcome at any cost serves the ideological underpinnings of the war against breast cancer: normalcy. Another of Stabiner's narratives shares Laura's response when confronted with mastectomy but mollified by the assurance of immediate reconstructive surgery: "She could get rid of the cancer and still look like herself. . . . She would never have to confront a flat scar. She sighed, "I just want to take care of it and deal with the reconstruction'. . . . 'I don't want to go around without anything for even three weeks'" (42). Scars, sickness, and surgery become the price to pay for successful transformation from diseased to cured, and it is the woman, whose body has become compromised, who must take full responsibility for the bill. Consequently, the rhetoric of horror, with its implication of returning to normalcy, reinforces conventional expectations regarding body surveillance and control. Though some women may find voice through such a framework, many do not and are instead silenced by the impossible expectations it implies.

Though both my sister and I argued with her, mom insisted that she wear a wig to my sister's wedding. We thought her short, G.I. Jane hair looked fine; she thought it would evoke pity. I don't want people staring at me, feeling sorry for me. We lobbied hard, but she was intractable; she just wanted to be "normal" for her daughter's wedding night.

The rhetorics of triumph and horror represent two orientations for telling the story of one's success; both recognize winners — survivors. The rhetoric of spiritual compensation becomes less about the evils of the enemy and more about the accountability of the soldier who let down her defenses and provoked an attack. This rhetorical framework rests on a belief that cancer, as stigma, "suggest[s] judgments. . . both moral and psychological about the ill" (Sontag 38). Believing one has sinned so grievously to warrant divine intervention might prove utterly debilitating, but the spiritual compensation framework offers an out: the motivation of redemption. For those "atheists . . . in their foxholes," (Ehrenreich 67) the guilt-redemption plot exists in a secular version as well: the woman accepts breast cancer as a sign of a serious shortcoming and interprets it as an opportunity for transformation.

This theme pervades Moch's metanarrative of twenty women's experiences of coping with breast cancer; illness is interpreted as a lesson about "how people care," (65); learning to "relax their need to control" (31); quitting stressful jobs (71); "dwelling on the positive" (93); and "becoming much more sensitive to others" (113). Moch details the comments of a woman who believes cancer is sending messages through vivid dreams, messages about reassessing her priorities; in response, she decides to travel. Another woman learns to "take it a day at a time and enjoy what you have now" (121). Moch's conclusion epitomizes a story of spiritual compensation by attributing cancer with transformative and redemptive powers; in her closing chapter she acknowledges that "no one wants breast cancer. Given the choice, each of these women would have preferred some other means for gaining greater aliveness or personal growth….Yet, paradoxical as it may seem, breast cancer — a brush with death — became a means for becoming more alive" (129). No less soldiers than the narrators of stories of triumph, these women have interpreted the attack as more than physical, as more than body: cancer has attacked them, justifiably, for superficial living. They have "beaten" cancer by saving their souls. Surviving such a battle earns considerable cultural validation.

However, experiencing cancer as an omen of personal sin or flaw does not necessarily motivate all women nor secure redemption. These other stories, usually untold, do not evoke warm fuzzy feelings and thus have no place in breast cancer narrative. Silently, women with breast cancer imagine it is from God, a punishment for sins past. And because they can attribute the real disease to a real indiscretion, they logically conclude they have earned this punishment. Not a story to motivate the masses or cheer the soul, and certainly not in compliance with the soldier ethos.

She's been depressed, sitting in the house by herself too much. A beautiful December sunny day, I drive, we pick up sandwiches and head out to see my sister and brother-in-law's new home, still under construction in a new subdivision. We park, start to eat. She asks me if I believe in God. I answer. I see her chin begin to quiver, her eyes tear. I've done some very bad things, she tells me. With her voice choking on shame, tears, fear, she tells me one of her "sins." Though I am surprised, I am not ashamed of her — as she feared I would be — and I hold her and tell her it's ok. She stops crying, blows her nose, drinks her root beer, and we start talking about the trip she and dad are taking to wine country.

As with other disability memoirs, narratives of nostalgia abound in breast cancer stories. Once diagnosed, the person lives in some degree of apprehension or fear of recurrence, especially in the first few years. Couser explains that nostalgic disability narratives occur when the disability is terminal, death is imminent, and with no hope for future, the individual turns to the past; with breast cancer, every diagnosis can elicit this response. "[Cancer] is (or is thought to be) a death sentence" for most people (Sontag 8); despite statistics to the contrary, and despite the comfort of those who inevitably know someone who has survived for 20 years, the diagnosis seems to immediately mark one as terminal. Thus, many cancer narratives, even when told by folks in remission, can reflect a rhetoric of nostalgia, for life before cancer. In the rhetoric of nostalgia we see clearly the ideology of normalcy articulated in the idealization of the good ol'days. As opposed to the story of horror, which situates remission as a return to normalcy after a nightmarish experience, the story of nostalgia zooms the lens past the illness experience to the days before cancer, implying that the horrors never end. For the former, remission is cure, normalcy; for the latter, normalcy is the innocence and confidence of the healthy body, lost forever to cancer. Though such a rhetorical move may seem defeatist, it serves the war effort by glorifying the healthy body as the ideal for which we all must fight.

She had made the decision to terminate treatments, and dad had arranged for in-home hospice care. Friends and family swarmed, sitting by her bed, holding her hand, laughing about the time they ran up a $500 tab at a restaurant that (they later found) didn't take credit cards, arguing over details of childhood adventures, celebrating the days when she was scarless and strong.

The rhetorical frameworks outlined by Couser draw our attention to the "hegemonic scripts" controlling who gets to speak and determining what is heard (79). But these frameworks often provide important opportunities for some women. The purpose of this exploration, again, is not to dismiss or judge those whose experiences gel with the hegemonic metaphor; after all, "[t]his is the common metaphor that most Americans use and need to use to best deal with treating and recovering from cancer" (Rossman 7). Rhetorics of triumph, horror, spiritual compensation, and nostalgia fulfill the war metaphor and consequently motivate many patients and resonate with their personal experiences. We cannot ignore, however, how such frameworks perpetuate a metaphor that limits and silences others, and we must consider "that the fighting model may not be right for everyone" (Rossman 7). The way in which the war metaphor manifests — with the body as war zone, cancer as invader, treatment as search and destroy — may prove insufficient for some stories, antithetical to others. Women should be allowed to write their stories; their narratives are not just neutral products of memory but living efforts to "construct and reconstruct a self to meet the situations [they] encounter." Ideally, "self-making" through narrative should "leave ample room for maneuver" as it is "our principal means for establishing our own uniqueness" (Bruner 211). Sanctioned, prescriptive rhetorical frameworks can compromise a woman's sense of individuality and agency.

Alternative rhetorics of protest and peace

In addition to the four conventional rhetorical frameworks, Couser also describes the potential of a more subversive approach to narrating one's experiences with disability and illness. Rhetorical frameworks of emancipation make room for the kind of "maneuvering" that grants writers more control over their stories. Specifically, the alternative models that have emerged in breast cancer narrative reveal two strategies: rhetorics of protest and peace. Ehrenreich's essay, "Welcome to Cancerland," both invokes and subverts the war metaphor. Called in for a mammogram, she assumes the "role of a suspect, eager to clear my name, alert to medical missteps and unfair allegations" and later acknowledges that she's supposed to identify the cancer cells as "the enemy" suffering "violent deaths at the hands of the body's killer cells." She has to admit, however, that she is "impressed, against all rational self-interest, by… their determination to move out from the backwater of the breast to colonize…." (70). Here we see her following the script yet diverging as she sympathizes, in a way, with the cancer cell that she recognizes as also, Barbara. Though she opts for traditional treatment, and expresses her full awareness of the war metaphor and how it might serve, her anger quickly redirects from evil cancer cells to the corporate interests that potentially block the race for the cure by polluting the environment.

Ehrenreich's narrative criticizes "the mainstream of breast cancer culture" for its lack of anger, its lack of attention to environment, its acquiescence to treatments that cause more pain and illness than the disease. Post-cancer transformation more frequently refers to "a makeover opportunity" for new perkier breasts than spiritual epiphany. Though she acknowledges the need for optimism, she notes that "cheerfulness is more or less mandatory, dissent a kind of treason" (80). In the end she finds that "the one great truth that I can bring out of the breast-cancer experience" is that it did not make her "prettier or stronger, more feminine or spiritual — only more deeply angry" (87). The anger is not directed at her renegade cancer, but at the environmental polluter whom she hopes to see "along with, say, the last smug health-insurance operative, strangled with the last pink ribbon" (87). For Ehrenreich, the actors in the war have changed, and by deconstructing the role she's supposed to play and identifying a more culpable enemy, she has challenged the hegemonic discourse surrounding breast cancer.

Arthur Frank's emancipatory narrative offers a viable alternative to the combat metaphor, choosing a harmonious mind-body approach rather than self-conflict; as an unlikely bookend to this study, we look to a male narrative of a male disease to find a rhetorical framework that rests on peace rather than conflict. From the beginning, Frank takes issue with the very conceptualization of cancer as other:

When we feel ourselves being taken over by something we do not understand, the human response is to create a mythology of what threatens us. We turn pain into "it," a god, an enemy to be fought. We think pain is victimizing us, either because "it" is malevolent or because we have done something to deserve its wrath. We curse it and pray for mercy from it. But pain has no face because it is not alien. It is from myself. Pain is my body signaling that something is wrong. It is the body talking to itself, not the rumblings of an external god. Dealing with pain is not war with something outside the body; it is the body coming back to itself. (30-31)

Frank's narrative describing his experience with cancer and his reflections on how to make sense of that experience have potential for expanding the rhetorical frameworks guiding breast cancer stories. His book promotes and demonstrates a rhetoric of peace, of recognizing illness as part of health and the life experience. He experiences anger, he experiences pain, but accepts them as valuable, as "opportunities for renewal" (2). In opposition to stories of spiritual compensation, illness is not a punishment and ultimatum to change; instead, illness is as much a part of the body as health, and one does not return to a pre-cancer state but "discovers what else [she] might be" (2). The rhetoric of peace creates an opportunity for an alternate vision of the cancer-body relationship; by presupposing a sense of mind-body harmony, emancipation occurs when we realize we are dependent on health for happiness. Frank argues instead that "we are free only when we no longer require health, however much we may prefer it" (21). Thus the cancer is not alien to the body but an extension of it that is, admittedly, disruptive.

Additionally, this rhetorical framework creates room for alternate treatments, such as the use of "images and models of healing [which] involve loving the cells back into normality, inviting them back into harmony" (Rossman 7). Of course, such an approach runs counter to the image of fighting which has come to seem natural in dealing with illness. To advance a more harmonious approach requires no less than a "functional shift in perception whereby disease can be seen and acknowledged as a manifestation of health rather than some alien entity afflicting, or seeking to destroy, the individual" (Jobst, Shostak, and Whitehouse 496). Such a paradigm shift, like cancer itself, is "no small thing" (Frank). What's important is that it offers alternatives to those who do not benefit from the predominant metaphor of war. However, regardless of the narrative structure a woman chooses to frame the cancer experience, it must allow her to resolve a fundamental struggle, "to embrace the contradiction between [her]self as 'creator' of [her]self and as 'other' — the illness that is destroying [her]" (Skott). Thus, while rhetoric of protest redirects anger toward a "real" enemy, rhetoric of peace emphasizes anger as one part of a whole experience and encourages the ill person to bring harmony to the mind and body rather than pit them against each other as the war metaphor does. Though drastically different in approach, both serve to disrupt mainstream representations of cancer as war against self.

To be sure, as I discussed earlier in this paper, military rhetoric offers an effective mobilizer against a dangerous disease. An essential component of war is hope, and battle is ideological: "use of war metaphors indicates the economic and ideological investment of anticancer organizations and segments of the medical profession in promoting their efforts, both to the public and amongst their own membership" (Lerner 268). War implies unity; no one fights a war (effectively) alone. Situating cancer as "the enemy" and healing efforts as "struggle or combat" is common because it offers a way to "express that you are not alone in this fight" (Skott). Declaring war allows a woman to redefine herself from passive powerless victim to active warrior. Waging war is aggressive, active; characteristics valued in American culture in general. The war metaphor reflects American ideals of self-reliance and individualism. We cannot deny how such a conceptualization appeals to us.

In some ways, then, representing the experience with breast cancer as a war makes sense and seems, if not innocuous, at least powerfully motivating. The breast cancer diagnosis marks a moment of profound fear, uncertainty, in a woman's life, as she is faced with the prospect of an illness that is invisible. My own experience with my mother made this poignantly true: she needed to think in terms of fighting, of the cancer as bad guys, as her white blood cells as good guys. She needed to think of the struggle to achieve health as a bigger battle, with glory, heroics, bravery and duty in the face of the unknown, just to get through the daily pain and disruption of cancer. However, the war metaphor no longer worked for her when the cancer metastasized. She believed that she "failed" her body, and though she lived for two more years, she was defeated the moment cancer returned.

She sat on her bed, indirect light of the afternoon sun coming in under the half-drawn blinds. She hadn't been working out, didn't want to eat, wasn't hungry. Mom, you have to eat — Dr. M said you have to get your strength back so that you can have another treatment. Her eyes filled with tears. I'm tired. You don't have time to be tired, you have to fight. You don't have a choice. She died less than 2 months later.

The war against breast cancer invokes a whole system of metaphors that on the one hand can help to motivate women and their families to mobilize their efforts to address the disease, but on the other hand can limit and determine the ways in which those same women and their families are allowed to think, talk, and act, not just in terms of the cancer, but in every aspect, every decision of the life experience during cancer. Women who have no validated language become isolated. A careful examination of the pervasiveness of this metaphor and the attendant effects on both society and the individual is warranted, as too much is at stake. If we insist on making sense of breast cancer as war, we should go into battle fully aware of not only the historical, cultural and social conditions giving rise to this metaphor, but also the potentially negative consequences of drafting women, and those who love them, into a sustained conflict against the self.

References

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Endnotes

  1. The author would like to thank Dr. Lou Thompson, Texas Woman's University, and the DSQ reviewers for their feedback.
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  2. The journal-style excerpts woven throughout the article reflect the ways in which my own efforts to support my mother were significantly informed by the more conventional rhetorical frameworks; likewise, they reveal how my mother, too, in trying to make sense of her illness, demonstrated (painfully at times) the ways in which she internalized the war metaphor. These excerpts, then, are not intended as exemplars of narrativity-rather, they exemplify the power of the metaphor to dictate experience.
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