Narratives of life with illness, disability or trauma occupy a rapidly growing field in literary studies, and increasingly so over the last thirty years. Among the illnesses, cancer is the one most often addressed. It is obviously an experience that is enormously difficult to put into language: how should the suffering, the uncertainty, and the fear of dying be stated? Many patients, some of whom were writers before the fact, struggle to find a language that can represent their experience adequately. To them, cancer is not only a biomedical story, but their lived experience. For some, pain and changes in the body that accompany cancer may escape communication through words altogether. Along with other life-threatening diseases, cancer can make one face the very limits of linguistic expression. Therefore, cancer discourse abounds with imaginative tropes such as metaphors. In fact, as Anatole Broyard has noted in "Intoxicated by my Illness" (1992), his autobiographical narrative about life with cancer, "the sick man sees everything as metaphor" (7). Broyard's text, replete with metaphors, is itself a metaphor of his experience. Given the pervasiveness of metaphor in cancer discourse, it is important to examine how these tropes are used in the struggle for meaning. Which metaphors can give expression to, or help people deal with such crises? Cancer is evidently an extreme experience that puts every theory of language developed over the last thirty years to the test. Despite these challenges, cancer narratives have undergone a remarkable explosion, covering the full narrative spectrum from self-help books to highly aestheticized works of art. The language and organization of the writing depend on a variety of factors, including, in addition to writerly skill: the individual's type of illness, its stage, its prognosis, progression and treatment, and the resources at the person's disposal, including support from family and the community. The texts as metaphor and the metaphors in the texts can reveal a writer's general orientation towards the body and self, illness, life and death. As such factors and orientations differ, often radically, from person to person, each cancer narrative tells a unique story. Moreover, the language of each narrative reveals an astonishing variety of attributed or assumed meanings that appear particularly crucial in cancer. Metaphors that may seem constructive and therapeutic to one patient, or writer (or to his/her readers) can be entirely destructive and further traumatizing for others. The language that patients use reveals an ambiguity in meaning whose range is so perplexing that writers—indeed, most people—are only now beginning to come to terms with it. Those who do not have cancer and live in relative certainty may, in fact, enjoy the excess of meaning that metaphor can present. However, when faced with overwhelming existential uncertainty, and longing for more stable ground, the ambiguity of language can become problematic. Despite all these difficulties, many people with cancer struggle to make meaning of their experience and tell or write their story. This ambivalence, between the impossibility of adequately narrativizing radical illness experiences and a fundamental need to try, is the central structuring principle of my study, and constitutes the core problem I will be investigating. The purpose of this thesis is to establish the crucial importance of metaphor in cancer discourse and to analyze its resources, ambiguities and ambivalences in narratives of life with cancer, written in English and German. Primarily a comparative literary analysis, it involves a "synthetic" methodological approach. I examine not only the literary, but also the psychological and therapeutic properties of metaphors, drawing upon my literary training, my skills as a social scientist, and my practice as a nurse. This "therapeutic psychopoetics," as it were, is based on an empirical, cross-cultural study of metaphors in cancer discourse. Metaphors shape our ability to frame our experience. Because our meanings vary so radically, we need to analyze the range of metaphoricity in cancer discourse and map the resources of language for conceptualizing cancer. Elaine Scarry (1985) has described the move from unspeakable pain to speech as the birth of language. In cancer, metaphor can help to make this birth of language possible. Appropriating the unknown, conveying the unspeakable through the known, metaphor provides the building blocks of language and narratives. A fuller awareness of this resource and its ambiguities can help us find patterns of narrative forms and language used to give voice to the experience of life with cancer and improve our sense of the complexity of problems involved in cancer therapy.

Narratives of life with illness, disability or trauma occupy a rapidly growing field in literary studies, and increasingly so over the last thirty years. Among the illnesses, cancer is the one most often addressed. It is obviously an experience that is enormously difficult to put into language: how should the suffering, the uncertainty, and the fear of dying be stated? Many patients, some of whom were writers before the fact, struggle to find a language that can represent their experience adequately. To them, cancer is not only a biomedical story, but their lived experience. For some, pain and changes in the body that accompany cancer may escape communication through words altogether. Along with other life-threatening diseases, cancer can make one face the very limits of linguistic expression. Therefore, cancer discourse abounds with imaginative tropes such as metaphors. In fact, as Anatole Broyard has noted in "Intoxicated by my Illness" (1992), his autobiographical narrative about life with cancer, "the sick man sees everything as metaphor" (7). Broyard's text, replete with metaphors, is itself a metaphor of his experience. Given the pervasiveness of metaphor in cancer discourse, it is important to examine how these tropes are used in the struggle for meaning. Which metaphors can give expression to, or help people deal with such crises? Cancer is evidently an extreme experience that puts every theory of language developed over the last thirty years to the test. Despite these challenges, cancer narratives have undergone a remarkable explosion, covering the full narrative spectrum from self-help books to highly aestheticized works of art. The language and organization of the writing depend on a variety of factors, including, in addition to writerly skill: the individual's type of illness, its stage, its prognosis, progression and treatment, and the resources at the person's disposal, including support from family and the community. The texts as metaphor and the metaphors in the texts can reveal a writer's general orientation towards the body and self, illness, life and death. As such factors and orientations differ, often radically, from person to person, each cancer narrative tells a unique story. Moreover, the language of each narrative reveals an astonishing variety of attributed or assumed meanings that appear particularly crucial in cancer. Metaphors that may seem constructive and therapeutic to one patient, or writer (or to his/her readers) can be entirely destructive and further traumatizing for others. The language that patients use reveals an ambiguity in meaning whose range is so perplexing that writers—indeed, most people—are only now beginning to come to terms with it. Those who do not have cancer and live in relative certainty may, in fact, enjoy the excess of meaning that metaphor can present. However, when faced with overwhelming existential uncertainty, and longing for more stable ground, the ambiguity of language can become problematic. Despite all these difficulties, many people with cancer struggle to make meaning of their experience and tell or write their story. This ambivalence, between the impossibility of adequately narrativizing radical illness experiences and a fundamental need to try, is the central structuring principle of my study, and constitutes the core problem I will be investigating. The purpose of this thesis is to establish the crucial importance of metaphor in cancer discourse and to analyze its resources, ambiguities and ambivalences in narratives of life with cancer, written in English and German. Primarily a comparative literary analysis, it involves a "synthetic" methodological approach. I examine not only the literary, but also the psychological and therapeutic properties of metaphors, drawing upon my literary training, my skills as a social scientist, and my practice as a nurse. This "therapeutic psychopoetics," as it were, is based on an empirical, cross-cultural study of metaphors in cancer discourse. Metaphors shape our ability to frame our experience. Because our meanings vary so radically, we need to analyze the range of metaphoricity in cancer discourse and map the resources of language for conceptualizing cancer. Elaine Scarry (1985) has described the move from unspeakable pain to speech as the birth of language. In cancer, metaphor can help to make this birth of language possible. Appropriating the unknown, conveying the unspeakable through the known, metaphor provides the building blocks of language and narratives. A fuller awareness of this resource and its ambiguities can help us find patterns of narrative forms and language used to give voice to the experience of life with cancer and improve our sense of the complexity of problems involved in cancer therapy. / Arts, Faculty of / English, Department of / Graduate

In the 1960's, cancer became one of the dominating diseases of our time and this has, in the last two decades, been increasingly reflected in German literature. This thesis examines a number of such texts (diaries, autopathographies, short stories and novels) from a literary and psychosocial standpoint. / First, a brief outline of the literary and social context attempts to answer questions concerning the production and reception of this 'cancer literature'. The following thematic analysis examines the role of cancer as a signifier. It shows that endo- and exogenic conceptions of the disease are present, and that mood changes of the afflicted person determine the meanings that are attributed to it. The ways cancer affects the social and bodily identity and different aspects of treatment are analyzed next. Finally, a chapter is devoted to the aesthetics of cancer, examining the metaphors used to describe the disease and the rhetorical means to represent the anxiety that accompanies it. / This study is intended not only as an interdisciplinary analysis of a chapter of contemporary German literature but as a contribution to a better understanding of how cancer is viewed and experienced.

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Bakgrund: Smärta är ett vanligt symtom hos palliativa patienter medcancersjukdom. En del patienter är inte fullt smärtlindrande och detta kan skapa ettonödigt lidande för patienterna som försämrar deras livskvalité.Syfte: Syftet är att belysa kunskapsläget om hur sjuksköterskor utvärderarsmärtsymtom hos palliativa patienter med cancersjukdomMetod: En litteraturstudie med 16 artiklar av både kvalitativ och kvantitativmetod valdes ut från databaserna Cinahl och Pubmed.Resultat: Sammanställningen av artiklarna resulterade i fyra stycken olika teman.Dessa är bedömningsinstrument, att utvärdera med eller utanbedömningsinstrument, sjuksköterskans utvärderande arbete, utvärdering medolika instrument.Slutsats: Genom att använda smärtbedömningsinstrument kan sjuksköterskansarbete att utvärdera smärtsymtom underlättas och smärtsymtom för patientenminskas. Genom en planerad implementering av dessa bedömningsinstrument meden kompletterande utbildning kan sjuksköterskan få bättre kunskap ombedömningsinstrument vilket kan leda till bättre förståelse och förutsättningar förpalliativa patienternas behov av smärtutvärdering. Detta kan leda till förbättradupplevd livskvalité hos de palliativa patienterna med cancersjukdom. / Background: Pain is a common symptom in palliative cancer patients. Somepatients are not fully relieved of pain which can create unnecessary suffering forthe patients.Aim: The purpose is to describe how nurses evaluate pain symptoms in palliativepatients with cancer.Methods: A literature study with 16 articles consisting of both qualitative andquantitative methods from two databases, Cinahl and Pubmed.Results: The compilation of the articles resulted in four different themes. Theseare pain assessment instruements, to evaluate with or without pain assessmentinstruments, the nurse's evaluation work, and comparison of different instruments.Conclusions: By using pain assessment tools, the nurse's work to evaluate painsymptoms can be facilitated and pain symptoms for the patient reduced. Through aplanned implementation of these assessment instruments with a supplementaryeducation, the nurse can gain better knowledge of the assessment instrument canlead to a better understanding and conditions for palliative patients' needs for painevaluation. This can lead to improved perceived quality of life in the palliativepatients with cancer.