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This transformation of meaning suggests that the men's metaphors were not entirely their own, but Karl: Uh, that plant there [points to an amaryllis]. I visit throughout the paper. In other words, together they planted that on the 8th of November, and it's going to flower shaped each other's interpretation of aging and cancer.
And, uh, for two reasons. One is, that's However, one should not ignore the individual uniquity of what the [instruction] book says…and the other [reason] each metaphor used, particularly the subtle and personal is, I've done it before…And it's a small thing. You know, I meanings that are attached to comparable images.
In the fol- grow roses. So you watch a rose start out and bloom and lowing case, Paul responded to Karl's flower metaphors of blossom and open up. It's unbelievable. So the amaryllis is kind of an image of this. So Paul: It's much like a person's life, like that.
Every step is more effort to raise myself up. But the reward is the beauty and the view and what you see Karl first spoke of the amaryllis and roses as some of those as you get older. As the interviewer about the amaryllis and that. Further aphors of aging. The rungs of the ladder seem to symbolize particular per- blossoming because one has reached a summit of admiration spectives in life, certain understandings of self and world. Wonder, appreciation, and blooming are some of the Paul's image gives the impression that as one climbs higher key words Karl used around this floral metaphor of aging.
Such an image gives aging a much sweeter scent and beauti- Given the ladder image, this new perspective appears to be fied appeal than Langle's metaphor of aging as a with- somehow transcendent or at least an expansion on one's ear- ering, old plant. While Langle's metaphor is very fatalistic, lier perspective, just as Karl's flowers reached new heights Karl's image is more hopeful—though not without consider- while blooming.
Perhaps both men saw the ambiguities of ation of difficulties in aging. As Karl noted just a moment aging as temporary experiences before growth, as necessary later, making it more explicit with this paradoxical image, means toward a desired end. Maybe death was not such a negative possibility for Paul.
He spoke about how his ladder image is connected with his Larry: I've continued to, to develop my interest in spiritual Lutheran beliefs and his practice of the step program.
And, it's, it's getting stronger all the time. He carries these associations over to an- incredible things that I've never even thought of before other image, an image of death as a plane flight.
It doesn't matter whether it's aging or middle age Paul: I met God through the 12 step program…and I or youth that you, you continue to, to explore and, and changed my life completely. And, so I think that is part of try to understand why you're here, you know. And as the view as I climb the ladder too.
And, so a lot of people you do that, you find more reasons why you're here, you are very apprehensive and fearful of death and I'm not. I'm know. I mean, at the top of my list is relationships with ready to go. If it's this morning as I walk out to get in the other people, and that's, that's probably the biggie. And car, I got my ticket, I know the pilot, I know the navigator, then there's a whole series of other things too as well. But I'd just as soon catch a later flight Interestingly, Larry diverged from the other two partici- as an early one.
To carry this metaphor further, was just not as comfortable as Paul and Karl in talking there may well be a palpable feeling of ambiguity and vulner- about death. Second, while Karl talked about the amaryllis ability to being in the air; not having one's feet upon the and Paul about a ladder, Larry spoke about needing others ground can provoke anxiety and uncertainty, and extended in his quest for growth.
This theme did not seem as central heights can be quite fearful for some. However, Paul compli- for the other two men; their stories of growth did not involve mented those feelings with a sense of being closer to God, of other major characters e. Suffering, effort, and death were described life while aging as full of exploration and expan- all experiences Paul had or expected to have in aging life, sion.
All three participants saw development as a matter of but he seemed convinced that they all end in a better form individually creating oneself and one's world, a process of of being. Therefore, the degree arrested development but as an up-and-down of good and to which the three men embraced a self-determinism must bad times, a dynamic of ecstasy and suffering in which the be qualified, but in all their accounts was a strong theme of former overcomes the latter.
In this state of dialectical pro- active agents excavating through the world in search of gression, he cherished his blessings and accepted his difficul- developmental gold.
This image repeated the tensions from before, where a better view of the world comes at the cost of working harder to climb the ladder. Again, the identity and bodily disruption decline and active discourses are altered into a paradoxical The men's flower, ladder, relationship, and overall self- hybrid, where the reality of death and loss acts as a vehicle discovery images all presented aging as upward development for existential growth.
As time appears short, it seems to be- of personal identity, worldview, and spirituality. Despite these come all the more inspiring. Therefore, comment. Although the three men had related metaphors of aging, each participant tailored his meta- 3 The step program is a semi-secular, semi-religious set of guidelines phor according to his unique perspective and life history e.
This normalization of transformation. The alleged male stoicism toward life chal- death constructs living and dying as two sides of the same lenges was not very visible in the men's accounts of aging. But, Paul did not always think this way. He spoke sionate tones. Below Seale, , none of our three participants claimed their are two metaphors he felt dominated his thinking around earlier characters have withstood aging.
Interestingly, they the time he was first diagnosed. I guess my [earlier] image of cancer would be as a men and women can interpret and tell about their experi- kind of kid's horror movie. This horrible thing. And I ences in ways not as dissimilar as often assumed. However, think it relates so much to the fact that, and I'll be very the self-determination promoted in the three men's meta- crude and uncouth, but it relates to shit.
Bowel cancer. Like, uh, I shit my pants a few times before it was ever The invisibility of social resources in accounts of individual diagnosed without knowing what was causing the loss progress is often represented as a typically male attitude of my bowels. Seale, It is thus possible that there are gendered aspects to the men's narratives. The two metaphors both emphasized uncertainty and lack We now shift focus to the men's reflections on cancer.
As of control. The first metaphor of a horror show gives off an will gradually become evident, the men speak about existen- atmosphere of thick suspense and creeping anxiety. Paul's tial matters of cancer that parallel their concerns of aging, incontinence also produced moments of not knowing what though with different emphases. When his symptoms first emerged both the present and the future were layered in uncertainty. Death can be a difficult issue for most of us, and even more Paul then told of a shift in his thinking, around the time that so for many aging cancer patients.
On the one hand, the decline he was receiving treatment. His dominant metaphor changed discourses of cancer and aging still hold sway for many people. Paul's large On the other hand, the spunky survivorship and active aging intestine was supposed to be temporarily rerouted to his abdo- discourses often deny death in their attempts to minimize det- men a procedure referred to as a colostomy , but it could not rimental effects of illness and aging.
Given these varying dis- be reversed because Paul's intestines were mistakenly cut too courses, aging cancer patients may respond to the thought of short.
He needed a colostomy pouch and spoke about it as a death in different ways. It's, Regardless of our self-censorship, the three men, particu- it's an adversary, but we've got dialogue. Uh, I reason with larly Paul, made death the foreground of conversation for him and talk to him in the sense that: Earlier on in the interview, Paul and I don't want you in my body. I don't want anything to made an eloquent comment about what he believed is the do with you…don't think that because we're conversing dominant perception of cancer, namely, a decline discourse: It's, it's synonymous with death.
His colostomy pouch, though a reminder of his ill- death, it doesn't incorporate the fact that death is normal. I accepting [of the pouch], and that is the key to the whole was, people, oh, terminal cancer. Shit, I was terminal in thing. Within Karl's metaphors of cancer, there is interplay It is poignant here that when the lead researcher recently between feeling vulnerable and feeling appreciative—a theme met with Paul shortly before he died , he quite strongly we have already seen in Karl's metaphors of aging.
His domi- insisted on adding to the focus group interview that the pro- nant image of cancer was also a literal aspect of his experience: Paul had come to the realization that, in is rerouted instead of the large intestine.
Paul's changing views of his pouch, like his vary- Karl: I guess, one of the things I think about is the, uh, in my ing images of cancer, suggest that instead of having one cancer it was—I'm, I've got a tremendous amount of scars enduring idea about his experiences, different ideas domi- and I'm going to have some more: I'm not done yet.
But nate his thinking depending on the extent to which he can it's covered by up my shirt…. I know for a fact I would be a manage his present situation. In other words, he seemed to totally different person if, say, I've had had cancer of the hold multiple ideas about life with cancer without coming face or something and then lost a jaw or whatever, you to one singular, or final, conclusion. Totally disfigured. I wouldn't go into public. I would Cancer and aging seemed to work together to shape Paul's be a recluse.
There's no two ways about that. So the cancer present views of death. But I was 74 already. If I'd been 24 and I'd been diagnosed, I don't know what I would have Karl's scars embodied his history of past injuries and surger- thought. In this excerpt, he claimed that his nor- the remainder of his life. Karl acknowledged that there is a malization of death and sense of growth from it came out of threshold to how much vulnerability he could endure from having cancer later in life.
Paul implied that he would not cancer before it would undermine all efforts to accept his suf- have the same sentiment had he been diagnosed fifty years fering.
But, it seems inner growth. Perhaps Karl's scars his cancer was manageable because his scars were coverable Karl was the next to respond after Paul's comments. Karl and thus forgettable. He could conceal or display this aspect concurred with Paul that cancer is culturally constructed as of his identity depending on the situation. He could decide a dying process. Karl grew up with the decline discourse of cancer and so he Karl's narrative of cancer intersected with his narrative of was initially convinced that cancer was terminal.
Being diag- aging, in the way that having cancer and aging simultaneous- nosed with colon cancer in his mids put into doubt Karl's ly enacted his thinking about death: He related youth to thoughts of invincibility, despair and fear of death. Like Paul, Karl began to resist the of taking life for granted; like Paul, Karl asserted that illness strong cultural fear of dying; he tried to integrate death into and fragility is taken much more seriously in aging.
In turn, Karl wanted to challenge the cultural association Larry's nothingness between cancer and death. He offered a brief der—what's cancer spelled backwards? These metaphors brought the two dominant discourses of Larry: The folks were talking about one of their friends cancer i. And, discourse together in a dialectical relation.
On the other uh, I don't know why that image stayed with me. But all hand, Larry's death metaphors of cancer had persisted from I could see was this great, cavernous, uh, nothingness.
Larry suggested his image of cancer had remained And, of course, they talked about death as well. Furthermore, the image of a dark cave suggests that life Aside from their differences, Larry agreed with Paul and with cancer can be a time of significant, terrorizing obscurity; Karl that cancer and aging interact to bring about existential the trajectory of life is clouded with shadow, making it im- concerns. So, cancer and word cancer. Here language threw death although he came to different conclusions from the him into disarray, much in the way Karl and Paul insisted it other two men more so than one or the other alone.
Larry could not shake this devastating feeling, even after an uncomplicated surgery and gentle remission. The Summary: He In general, the men tended to use images of cancer that admitted that his wife's death led him to get involved with brought the body into full view. Shit, scars, and the visceral cancer support groups, both as a participant and a coordina- emotions of fear and horror all direct attention toward bodi- tor.
Larry's image of the cavernous after this personal history with cancer, he confessed: Well, it's pretty hard to get rid of an early image…I unbearable uncertainty, the most salient existential concern would say that the, but it still has that connotation of, of expressed in the nothingness metaphor is the lack of a death or, or—finality.
As much as I try to be objective body. In the vast emptiness of a cavern, no body is there. You Bodily death seems to be what makes Larry's metaphor so know. Because of, well, because of maybe my folks' distressing to him; therefore, we maintain that bodily harm society… is a shared existential concern among the three men.
On the other hand, the men complemented their domi- Finality and nothingness are two very applicable meta- nant bodily metaphors of cancer with metaphors of personal phors to a death discourse of cancer.
Unlike Paul and Karl, and spiritual growth: Karl spoke of acceptance and transcen- Larry was not grateful to think about death while living dence of his scars, while Larry insisted on enjoying his with cancer. When alongside their leading metaphors of bodily decline, indicat- the other two participants spoke about their acceptance of ing a potential narrative negotiation between progress and death, Larry remained quite silent.
After providing his cancer decline discourses of cancer. Certainly I'm going to die. But, uh, bodily decline supplemented the more noticeable growth let's enjoy, or try and enjoy the years remaining. You know, images. They all responded to a death dis- Another contrasting element between Larry and the other course of cancer, believing they were socialized to see cancer two men is the evolution of their cancer metaphors. On the as terminal. This suggestion comes as no surprise because one hand, Karl and Paul admitted to seeing cancer as terminal cancer was indeed much less treatable when these men were growing up i.
But, regardless of the medical and ing the three men. The death discourse is still quite salient today and Initially, the men's cancer metaphors of bodily harm, dis- is perhaps not as forgotten as Sinding and Gray have ruption, and death seem to differ from their somewhat loftier suggested, at least among older patients who have grown and more positive metaphors for aging: Their tragic metaphors of cancer may appear has only superficially hidden the cultural connection between to be in closer proximity to their bodies than these transcen- cancer and death.
We take a cue from Gullette , who dental metaphors of aging, implying a distinction between a argued that the active aging discourse has, at its roots, an more embodied, declining experience of cancer and a more underlying anxiety about the travails of aging p. In a sim- spiritual, progressive experience of aging.
The , an incompatible practice with Paul's and Karl's death- dominant metaphors of bodily damage and death in cancer, aware way of living. Larry also strongly identified with the and personal and spiritual growth in aging, are contradicted death discourse, which kept mortality always within his sights.
With regard to aging, the men ing on death may be one reason why this discourse did not observed more disruptive experiences of bodily decline and arise nearly as much as the death discourse in the men's identity loss: With regard to cancer, expressions contradict gendered discourses about how men the men spoke of the possibility for personal and spiritual talk about illness, especially assumptions of identity mainte- growth in cancer: Paul somewhat controversially claimed nance and stoicism.
These more subtle indications of spectives on life and on themselves, drastically changed personal decline in aging and personal progress in cancer over time. Each participant also spoke vivaciously about his subvert the men's more dominant metaphors.
These exam- and growth. In the space between hardships and develop- ples illuminate the men's complex emotional experiences of ments in aging life with cancer, all three men had to renego- cancer. However, Karl and Paul seemed to maintain some tiate their identities, face unpredictable life trajectories, aloofness or impassivity toward death as they talked about and live out new understandings of life and death.
They it. One could interpret their attitudes, with some evidence, expressed a relative emphasis of existential disruption in as perpetuating a form of stoicism toward an existential their metaphors of cancer and of existential growth in their threat. One may conclude that cancer is more As with aging, the men's metaphors of cancer were con- of an experience of decline and aging is mostly an experience structed around existential changes of decline and progress.
Their metaphors played out ences may affect one another, and may together produce their efforts to rework the opposed decline and progress dis- unique existential changes, but patients may be unclear courses into more personally relevant images. This dialectic, how to talk about one without the other. They all negotiated the oppos- three men. Specifi- For the most part, it seems their narratives contradict gen- cally, the two men constructed suffering as a necessary means, der differences, as the men often spoke more about identity as an instrument, toward a better understanding of life and change e.
Existential disruption e. How are we to which, in turn, would transcend or overcome the disruption make sense of these contradictions? Are the three men and distress that spurred them on. In a way, then, experiences unusual or unique from other men? Unlike most men, all of progress appeared to involve an integration of experiences of three of our participants were involved in a cancer support decline into some new way of thinking and living. Larry self that many men do not otherwise perceive or convey.
He did not find awareness of death and decline produc- when they read a copy of this manuscript—is that they joined tive or beneficial in any way, and maintained that the joys of the support group because they were already inclined toward living and despairs of dying must be kept separate. For him, reflecting on and expressing their concerns. Further to this vulnerability cannot be recast as appreciation, death cannot point, when one looks at published memoirs of cancer one be integrated into a new perspective on life; they can only be sees that roughly one third are written by men, which is ignored or forgotten.
Progress, on this account, is an activity still a substantial portion. Therefore, although our three par- of partitioning rather than of synthesizing.
We conclude that perhaps both ungendered and gendered Men and women may have to contend with gender-based discourses can influence how people interpret cancer and discourses about how to face existential challenges. Seale aging. This is an important caveat wherein we do not assert observed two such representations of cancer patients absolute differences between men and women, but consider in news reports, in which the routes toward dealing with ad- how their experiences may be shared as well as unshared.
Gen- versity were gendered. Female patients were often portrayed der is but one axis by which we may distinguish experiences as having gone through an emotional transformation and and perspectives, and there can be differences within genders explorative journey, while men were said to uphold stoicism as well as similarities across genders.
More critical research and a sense of continuous identity. First of all, their narratives presented images of self-determination and of relative calm toward death, both Conclusion of which follow typical representations of male agency and courage.
These metaphors imply some gendered understand- Embedding people's interpretations of cancer and aging ing of cancer and aging, but there may be more than one way within broader cultural contexts is a crucial part of learning to interpret them.
It is true that the men rarely discussed how about their existential concerns. However, we should not lose others have shaped their understandings of cancer and aging, sight of the creativity with which discourses are interpreted, but does that mean the men did it all alone?
Perhaps, but reworked, resisted, and used in people's metaphors. An exis- alternatively, the men could not cover everything in a two- tentialist perspective, together with knowledge of prevailing hour interview and may not have had time to discuss the discourses, may be equipped to recognize the individual and subject of their social relations.
When we sent this manu- shared aspects of people's experiences, and to address thera- script to the men, they implied that there was more to their peutically the interpretive strategies and difficulties of aging stories than what they were able to say in the interview. In turn, such an approach may help aging can- Some of the most important feedback we received had to cer patients who struggle to make sense of aging life with do with how their social worlds have helped them and have cancer.
In terms of assistance, they noted the importance al, socio-cultural, and structural barriers to speaking about of caring partners who provide invaluable emotional and one's existential changes during cancer and aging. As an exam- practical support during difficult times. In terms of transfor- ple of this type of research in oncology settings, Delvecchio- mation, the men talked about how some new relationships Good et al.
Many patients may find this approach an affront to their expe- These social interactions informed how the men made sense riences of suffering and feelings of uncertainty. In an aging con- of their experiences.
Quality of life of elderly persons with cancer: A 6-month follow up.
The fountain of age. Simon and Schuster. The assumptions healthcare Gagliese, L. Age-related patterns in adaptation to cancer pain: A mixed- providers hold about illness and aging can severely restrict method study. Pain Medicine, 10 6 , — The body, illness experience, and the lifeworld: Medicine, rationality, and experience.
Cambridge University Press. We need to be mindful of the ways in which diverse expe- Griffiths, C. Existential riences are silenced or glossed over in medical encounters concerns in late stage cancer. European Journal of Oncology Nursing, 6 4 , and cultural discourses, as well as the effects this homogeni- — Gullette, M. Aged by culture. University of Chicago Press. Existential concerns among patients with riences.
For our own part, our focus group was comprised cancer and interventions to meet them: An integrative literature review. Though Psycho-Oncology, 18 3 , — Chapter 1: Historical overview. Rowland's Eds. Psychological care of the pretations and other research, our paper does not necessarily patient with cancer pp.
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There is much, much more diversity in experiences of West Lafayette: Purdue University Press. Ignatieff, M. Modern dying. The New Republic, 26 , 28— Metaphors we live by. University of in the confines of our paper.
This limitation accentuates the Chicago Press. Old age from an existential—analytical perspective. Psycho- logical Reports, 89, — Our care of aging cancer patients may be improved Langle, A.