Siddhartha Mukherjee on the language of cancer patients

First aired on White Coat, Black Art (15/10/11)


"The idea that cancer patients enter not a 'ward' but a 'world' has been extensively written about," Mukherjee told White Coat, Black Art host Dr. Brian Goldman in a recent interview.

And that "cancer world" frequently has its own language and metaphors, which can be both helpful and harmful to cancer patients. "The illness, in invisible ways, can confine you," said Mukherjee. "The words in this world, therefore, often have to do with being confined and being released. Patients often talk about their illness as if it was a confinement, a kind of prison. And the medicine, therefore, becomes a mechanism by which they are either released, or which prolongs their confinement further. That's one very common way that men and women with cancer will speak about their own time."

The medical establishment also frequently uses militaristic metaphors: everyone has heard the expression "the war against cancer" and that someone has "won or lost a battle with cancer."

Mukherjee is ambivalent about the use of this militaristic language. "The metaphor of war and the over-usage of military language can become its own problem and can burden patients in ways we cannot even imagine," he explained. "If you relapse, are you then a 'loser' in the war? And if you become a loser, do you then become a pariah of that war?"

Still, some patients find the battle imagery empowering. "I like to say that there is no archetypal cancer," Mukherjee said. "We now know that the biology of cancer is vitally different from one tumour to another."

It follows, then, that there should be no archetypal cancer patient. Everyone has their own understanding and experience of the illness. "And so why should there be a single archetypal metaphor that we use?" Mukherjee argues. "Some people like to describe the process as war, and some hate it. It's theirs, they need to own it, and I think it helps or hurts people depending on the context in which it's used."

Mukherjee believes that physicians therefore must be extremely sensitive to the specific experiences of their patients. "One has to have a sensitivity," he said. "Just as a cardiologist uses a stethoscope, all physicians need to use their brains like stethoscopes all the time to probe and find out what to do and how to react to someone's individual psyche."

In addition to the language used to describe cancer, physicians also develop a specific terminology when it comes to communicating with patients, particularly when it comes to delivering bad news. "Patients need to be told the truth, but there are 100 different ways of telling, and it's the telling that makes the difference," he explained. "The idea that you're going to partner with them helps a lot. I try to use the word 'we.'"

Still, he cautions that physicians shouldn't go overboard with the "we," lest it seem like they're falsely trying to bear the patient's suffering. "That's a kind of peculiar transference that you want to avoid," he said. "But I think patients want to know that you're going to be part of a solution, if there is a solution."

When dealing with cancer, as with many illnesses, a lot of anxiety stems from the unknown. Therefore, Mukherjee emphasizes being as specific as possible about the aspects that can be dealt with concretely.

But why is Mukherjee so fluent in the various languages of cancer, especially when it comes to communicating with patients? His book is evidence of his great compassion for his patients. "I was able to write about them because I was looking for an emotional connection with my patients," he explained. "I'm still looking for one."

curiosity cover.jpgThe Emperor of All Maladies: A Biography of Cancer
by Siddhartha Mukherjee

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"The Emperor of All Maladies is a magnificent,profoundly humane "biography" of cancer-from its first documentedappearances thousands of years ago through the epic battles in thetwentieth century to cure, control, and conquer it to a radical newunderstanding of its essence. Physician, researcher, andaward-winning science writer, Siddhartha Mukherjee examines cancerwith a cellular biologist's precision, a historian's perspective,and a biographer's passion. The result is an astonishingly lucidand eloquent chronicle of a disease humans have lived with-andperished from-for more than five thousand years."

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