Sarah Hulse: The War Metaphor in Metastatic Breast Cancer

About Me

Hi friends! My name is Sarah Hulse, and I’m a rising junior here at the University Honors College. I am a Psychology major with certificates in American Sign Language and the Conceptual Foundations of Medicine. In writing this, I probably spent the most time trying to come up with a fun fact worth sharing. Truthfully though, the astounding range and depth of students here is one of my favorite parts of the UHC. Everyone has a unique perspective and experience to offer, as represented in a lot of the fun facts of my colleagues in the Brackenridge Fellowship!

I’ll offer a slightly less unique fun fact: I am lactose intolerant. I became lactose intolerant my first year of college following a series of antibiotic prescriptions for pneumonia and so on. To go 18 years and then be forcefully and suddenly directed to a dairy-free diet was a surprising adjustment. In support (or perhaps in gentle mockery), one of my roommates and best friends gifted me lactase enzyme pills in a PEZ dispenser.

In a roundabout way, carrying this juxtaposition in my backpack prompts me to consider just what about medication in a candy dispenser deserves such amusement. For me, it is the humor inherent in removing a pill (meant very necessarily to help my body process food) from a heart-eyed emoji face constructed in the function of a candy dispenser. Yet it’s also more than that, I would argue. It represents a certain levity to medicine, true, but at the heart of such an intersection is humanity. This intersection says “yes, I am here and I am science and I am human” all at once.

In the world of busy clinics, electronic medical records, and more responsibility than ever, it can be easy for this human focus to get lost in the shuffle. I believe the humanities are the cure to this struggle in medicine, and I hope for my project to be a positive embodiment of the intersection between science and humanities.

My Project

Through the Summer 2021 Brackenridge Fellowship, I will be studying experiences of the war metaphor in women with metastatic breast cancer alongside Dr. Margaret Rosenzweig in the School of Nursing. Cancer care challenges patients deeply in emotional regulation; emotional distress has been labelled the “sixth vital sign.” The war metaphor is used frequently in cancer to inspire individuals in a fight, enabling patients to express “I am fighting cancer” or “I am not giving up this battle.” The war metaphor informs a vast part of conversations surrounding medicine, especially that of breast cancer and in everyday use that may not even be recognized as metaphor without deeper discernment. This category of metaphor offers patients control and an active role in their experience of illness, which may otherwise feel left up to outside determination.

However, metaphors are inherently value-laden: if the war metaphor encourages women to fight and to battle endlessly, it then equally shames women who make other choices in their care. A diagnosis of metastatic breast cancer – stage 4 breast cancer that has metastasized in other areas of the body – contains terminal implications that are not as inherent in diagnosis of non-metastatic breast cancer. Without acknowledgement of the difference in experiences faced by women with metastatic breast cancer, the war metaphor creates a pressure for women with advanced disease to get well. This misalignment of values and outlook represented through the war metaphor may exacerbate rather than diminish distress.

My research is interested in understanding the emotional experiences of patients with metastatic breast cancer, beginning with usage of this war metaphor language and its implications on emotional distress and regulation. It is my hope that through connecting with patients in an interview format to learn about their experiences as women with metastatic breast cancer, our findings will be used to better inform clinical breast cancer practice. Specifically, I am interested in increasing sensitivity and understanding regarding the use of the war metaphor among patients who it may affect negatively.

The Brackenridge Fellowship is a unique opportunity to pursue this research with dedication and respect to interdisciplinary perspectives. As a student intending to pursue medical education as a physician, it is important to work collaboratively to solve shared and individual questions with a spirited sense of teamwork. Interdisciplinary collaboration empowers a more accessible and committed approach to research. I am excited to represent my own disciplines of psychology, philosophy, and medicine while gaining the nuanced perspectives of my peers.

Thank you to the University Honors College, my mentor Dr. Margaret Rosenzweig, and my cohort of Brackenridge Fellows for making this experience possible!

Leave a Reply