In June 2008 a thoughtful article by Jan Hoffman appeared in the New York Times. It was titled "When Thumbs Up Is No Comfort" and discussed how metaphors for illness can be helpful or the opposite. I shared it with two friends who were suffering from cancer. One is still alive; the other, Bo Leuf, died earlier this year. A key point that Hoffman makes is that violent conflict is often not a good image for a cancer victim's situation:

Dr. Gary M. Reisfield, a palliative care specialist at the University of Florida, Jacksonville, believes that the language used by cancer patients and their supporters can galvanize or constrain them. Over the last 40 years, war has become the most common metaphor, with patients girding themselves against the enemy, doctors as generals, medicines as weapons. When the news broke about Senator Kennedy, he was ubiquitously described as a fighter. While the metaphor may be apt for some, said Dr. Reisfield, who has written about cancer metaphors, it may be a poor choice for others.

"Metaphors don't just describe reality, they create reality," he said. "You think you have to fight this war, and people expect you to fight." But many patients must balance arduous, often ineffective therapy with quality-of-life issues. The war metaphor, he said, places them in retreat, or as losing a battle, when, in fact, they may have made peace with their decisions.

To describe a patient's process through illness, he prefers the more richly ambiguous metaphor of a journey: its byways, crossroads, U-turns; its changing destinations; its absence of win, lose or fail.

And likewise so with life—another journey that none of us gets out of alive ...

_{^z - 2009-12-16}