The OBJECT Metaphor in the Conceptualisation of Cancer in Malay Women’s Narratives

Our conceptualisation of life-threatening illness such as cancer is said to be highly metaphorised and often grounded in some fundamental contrastive categories of experience in the physical environment. As such, some studies have revealed the use of different metaphors, such as WAR, JOURNEY and GAME in cancer related discourse. Related to this, the current paper seeks to examine the use of the OBJECT metaphor in Malay women’s narratives on cancer, utilising the framework of Conceptual Metaphor Theory (CMT) as propounded by Lakoff and Johnson (1980). This dimension of metaphor has not been explored before among Malay women specifically on cancer. It illustrates some examples of the relevant metaphorical expressions and discusses how the source domain OBJECT structures the women’s thinking of cancer. Findings of the study indicate that conceiving cancer in terms of a heavy object, an unwanted object, and as a gift provides insights into the women’s reality in coping with this life-threatening illness. The OBJECT metaphor structured in the women’s narratives highlights not only their conception of the disease, but also their expectation and optimism in coping with the illness. Findings of the study could be useful for health professionals and caretakers in that a more effective communication could occur between them and cancer patients, which, in turn, could lead to a better understanding of cancer patients’ experiences.


INTRODUCTION
A cancer diagnosis can be a devastating experience that exposes people to fear, frustration and despair. Those experiencing a cancer illness may find it challenging to cope with the specified treatment and grapple with the overwhelming uncertainty caused by the disease, which could lead to difficulties in expressing their cancer experience (Bowker, 1996;Gibbs & Franks, 2002;. Moreover, it is difficult to find clear, effective ways to communicate about cancer as an experience with cancer may be complex and subjective. As such, various research have been devoted to cancer, amongst which are in different fields of inquiry, namely, medicine, social studies, and language and discourse.
The use of metaphor in illness-related discourse such as cancer is a growing field of inquiry in the social sciences and health communication. Research devoted to this topic has shown that a particular use of metaphor can lead to a better understanding of one's experience with the illness (Magaña & Matlock, 2018;. There have been various studies on the use of different metaphors to conceptualise cancer in diverse languages. However, a study on how metaphor can lead to a better understanding of experiences of illness in Malay language suffers a dearth, especially on cancer. Published by Australian International Academic Centre PTY.LTD. Copyright (c) the author(s). This is an open access article under CC BY license (https://creativecommons.org/licenses/by/4.0/) http://dx.doi.org/10.7575/aiac.ijalel.v.8n.5p.131 Most cancer-related studies had focused on the way individuals use metaphors in talking about their experiences with the illness (Magaña, 2019;Magaña & Matlock, 2018;Magaña et al., 2016;. To date, various studies have shown that metaphor is regarded as a framework for patients to make sense of their cancer illness, and it provides intellectual and linguistic tools for communicating cancer patients' senseless suffering, and also plans for personal transformation in coping with such an illness (Bowker, 1996;Gibbs & Franks, 2002;Hurley, 2014;Magaña, 2019). In other words, the use of certain metaphors provides valuable insights into the shared and individual ways patients make sense of their illness, and particularly, of their cancer experience (Hammond et al., 2012).
The use of metaphors provides a way of understanding a subjective and complex experience in terms of another more familiar experience. In this regard, a deep personal experience such as cancer is often verbalised through metaphors. Cancer patients often "devise their own metaphors based on things they know and value" (Reisfield & Wilson, 2004, p. 4026)which enables them to make sense of their personal experience with the illness in meaningful ways. Various past studies focusing on the use of metaphor in the conceptualisation of cancer in both spoken and written discourses revealed that the most popular metaphors used by cancer IJALEL 8(5): [131][132][133][134][135][136][137][138] patients are WAR and JOURNEY (Magaña & Matlock, 2018;. Such metaphors have enabled cancer patients to elucidate their ineffable experience with this chronic disease in a more tangible manner. However, it must be pointed out that no single metaphor is completely adequate in describing cancer (Gibbs & Franks, 2002;Williams Camus, 2009) as cancer patients often provide their own unique conceptualisation in describing the disease (Harrington, 2012).
Apart from the aforementioned WAR and JOURNEY metaphors, one source domain that evokes rich metaphorical expressions is OBJECT. Conceiving cancer in terms of an object has enabled cancer patients to think and speak about the disease in a concrete manner (Harrow et al., 2008;Magaña & Matlock, 2018). Drawing on eleven Malay women's narratives on cancer, this study presents examples from the Malay women's narratives on cancer and discusses how cancer is perceived and spoken about as an object, as well as how this conception helps the women understand and cope with their feelings towards the illness.

LITERATURE REVIEW
The use of metaphors in the discourse of cancer has been one of the subject matters examined by many scholars with interest in the fields of cognitive semantics and health communication. The common analysis framework of researchers who work within this field is the Conceptual Metaphor Theory (CMT) (Lakoff &Johnson, 1980),which describes the mapping of two domains known as the source and target domains. This theory has been commonly adopted in the analysis of metaphorical expressions in various studies related to certain concepts, such as emotion (Moradi & Mashak, 2014;Türker, 2013), learning (Berendt, 2008;Imran Ho-Abdullah, 2008) and illness (Lendik et al., 2017). The Conceptual Metaphor theory has also been extended to other areas, namely, law (Greenwood, 2005;Hanne & Weisberg, 2018), politics (Charteris-Black, 2011Meisenberg & Meisenberg, 2015), economy (Arrese, 2015;Arrese & Vara-miguel, 2016;Nurul Hijah bte Jasman & Kasim, 2013), psychology (Mc-Mullen & Conway, 2002) and medicine (Ferguson et al., 2010;Golden et al., 2012) due to the pervasive linguistic manifestations of metaphors in different types of discourse.
Metaphors on cancer have been studied from various perspectives, amongst which, the focus is on the source domain, particularly, the manifestation of the VIOLENCE and JOURNEY metaphors in the expressions related to cancer in spoken and written discourses. In fact, resulting from the interest in the significant use of metaphors by cancer patients, researchers have examined the use of metaphors in various languages, such as English (Demmen et al., 2015;Hauser & Schwarz, 2015;, Spanish (Magaña, 2019b;Magaña & Matlock, 2018;Williams Camus, 2016), Latin (Magaña, 2019b), and German (Teucher, 2000).
Such studies have reported that metaphors bridge communication and help cancer patients to convey their inexpressible experience in a vivid manner. For instance, in a study on the conceptualisation of cancer among native speakers of Spanish, Magaña and Matlock (2018) focused on 60 online cancer narratives by cancer survivors and found that the metaphorical concepts VIOLENCE and JOURNEY are prevalent in their narratives on cancer. They argued that the frequent use of VIOLENCE metaphors portrayed patients as warriors, and cancer as a malevolent enemy, thus conjuring support to fight the disease whereas the JOURNEY metaphor portrays progressions and hope that offer encouragement. In similar vein, Semino et al. (2015) had comprehensively discussed the frequent use of VIOLENCE and JOURNEY metaphors among English cancer patients in a UK online forum. Their study posits that the use of these metaphors empower cancer patients in their battle with the disease.
Past studies have discovered VIOLENCE and JOUR-NEY metaphors as the most dominant metaphors used in cancer discourse. However, the OBJECT metaphor, an ontological metaphor (with one to one correspondence mapping), has not been commonly cited as a dominant metaphor in cancer discourse . Nevertheless, a study by Harrow et al. (2008) reported that women with breast cancer often utilize daily objects such as peas, eggs or coal in their visual representation of the disease, which reflect the women's understanding of the disease.
Similarly, a study conducted by Magaña and Matlock (2018), which focused on Spanish-speaking cancer patients' use of metaphors in their cancer narratives, revealed that the use of the source domain OBJECT has allowed the patients to describe cancer as a physical object that has sides, which gave them a new perspective of life. Another study by Magaña (2019) reported that Latin and Spanish cancer patients portray cancer as a gift, an object that has transformed their lives.

Data of the Study
Data of this study comprised a corpus of 28,052 words derived from 11 Malay women's narratives on cancer. The participants of this study are 11 educated Malay women aged between 20 to 56 years. At the time of the data collection, all the women were suffering from different types and stages of cancer. A written consent to participate in the study and for the data gathered to be used for academic and publication purposes was obtained from all the participants.
The data, in the form of transcribed narratives, were gathered through in-depth interviews with the 11 Malay women at the location of the participant's choice. This is important to make it comfortable for the participants to talk about their cancer experiences in a leisurely manner, such as homes, restaurants and offices. The interviews with the women generated a total length of approximately 660 minutes of narratives on cancer related experiences. Specifically, each of the audio recorded interviews lasted approximately 45-70 minutes. The recordings were later transcribed verbatim, generating a total of 28,052 words.

Data Analysis
The metaphorical linguistic expressions related to cancer in the transcribed narratives were identified using the Metaphorical Identification Procedure (MIP) by the Pragglejaz Group (2007), which is the first explicit and systematic method in the metaphor identification (Steen et al., 2010, p. 4). Following the proposed steps, firstly, the entire Malay narrative transcriptions on cancer experience were read to establish a general understanding of the narratives. Secondly, the potential metaphorical items in these narratives were determined and circled. Thirdly, the contextual meanings of each of the potential metaphorical items from the narratives were then established. Next, the basic meaning of each lexical unit in the context were determined using Kamus Dewan Bahasa dan Pustaka Fourth Edition as a reference tool to support the intuition of the researcher to establish if a word is metaphorical or literal. This was followed by determining whether the contextual meaning contrasts with the basic meaning, and if the contextual meaning can be understood by comparison. If there is a contrast between the contextual meaning and the basic meaning, the lexical unit is marked as metaphorical. Finally, the identified cancer related metaphorical expressions were assigned a 'semantic field' corresponding to their literal meaning. For example, the lexical items 'benda' (a thing) or 'anugerah' (award) were identified as a metaphor and assigned to the semantic field 'OBJECT'. In other words, this semantic field OBJECT was inferred as the source domain of the identified metaphors following the CMT framework by Lakoff and Johnson (1980). These were then further tagged, with a focus on the more specific source and target domains involved in the metaphors (e.g. CANCER IS A GIFT within the more general conceptual metaphor, CANCER IS AN OBJECT). This is done by linking the target domain to its source domain by using "IS" as postulated by the CMT conventions (Lakoff & Johnson, 1980), e.g. CANCER IS AN OBJECT. The researcher's knowledge about the semantic field related to the source and target domains of the unravelled metaphor will be considered in the interpretation of the metaphors related to the women's cancer experience.

RESULTS AND DISCUSSION
The analysis of the data revealed a total of 108 metaphorical linguistic expressions in the Malay narratives manifesting cancer in terms of an object. Various metaphorical expressions identified in the Malay women's narratives manifest the OBJECT metaphor, as it allows the women to describe their illness in more concrete terms, hence, evoking the conceptual metaphor CANCER IS AN OBJECT, and the specific-level metaphors: CANCER IS A GIFT, CANCER IS AN UN-WANTED OBJECT and CANCER IS A HEAVY OBJECT. The following section presents and discusses some examples of metaphorical linguistic expressions for the OBJECT metaphors, focusing on the Malay women's structuring of their cancer experience and their understanding of the disease.

Cancer is an Object
An object is a thing that is physical, tangible and often solid. Conceiving cancer as an object enables the Malay women to express their painful experience with the disease more vividly. This can be observed from the frequent use of "benda" (thing) which manifests cancer as a physical object such as in the excerpts below: (1) Benda (kanser sel) tu ada kat sini, atas sini pun ada.
[I don't want that thing (cancer) in my body.] In the examples above, cancer is conceived as "a thing" (benda) which is recurrent throughout the corpus. Such a conceptualisation is frequently manifested in the Malay women narratives whereby cancer is conceived as something undesired, uncertain, unspecific or temporary. In Malay, "benda" (a thing) is part of the nuances used in daily speech to indicate an uncertain thing. Perhaps a function of describing cancer as a thing (benda) is to avoid using the word "cancer", which some people might find it a taboo as reflected in (1), (2) and (3). This could be related to its close connection with death, or the lack of scientific clarifications on its causes and threats it poses to human existence. Thus, in this case, it appears more comfortable for the Malay women to refer to the disease as "benda" rather than "cancer". Similar use of "benda" (a thing) in reference to the disease cancer can be observed in (4) whereby the women described cancer as an unexpected "thing" that cannot be avoided, bearing on the fact that the disease is known for its unforeseen diagnosis and that it can happen to anyone, regardless of age.
[Cancer is a thing that can't be avoided, it was so sudden. At that time, I was only 26 years old] In addition, cancer is frequently conceived as a tangible or physical object that can be seen, taken or possessed. This is linguistically realised by the following metaphorical expressions:  (5) and (6) the word "ambil" (take) describes the women's positive perception and optimism towards cancer, particularly, in their fight for recovery or to combat the disease. Whereas in (7) and (8), cancer is conceived as an object that gave them lessons in life, something that taught and reminded them to live healthily. In this case, conceiving cancer as an object that can be possessed alludes to the women's personal transformation, i.e. in leading a healthier lifestyle.
This analysis also revealed that cancer was depicted as an object that can be held or carried by a certain people. For example, a woman in (9) uses the word "bawa" (carry) to talk about her endurance in bearing the illness that is only experienced by the chosen few. (9) Tak semua orang boleh bawa benda ni (kanser), hanya orang yang terpilih saja yang mampu.
[Not everyone can carry this thing (cancer), only the chosen ones are capable). Furthermore, the OBJECT metaphor is also used to express a sense of control over an individual's illness. Thus, in the narratives, the way cancer is perceived is a very important aspect of healing as it gives the woman a sense of control of her illness: (10) Cara kita pegang sakit tu (kanser) penting, kena positif.
[The way we hold on to (perceive) that disease (cancer) has to be positive. If we are not positive, it will be difficult to heal.] In working with abstract concepts (such as cancer experience), objectifying them aids people's understanding, as it enables them to make sense of the phenomenon in familiar terms. This strategy is also reported to support patients with mental health illnesses in talking about it (Magaña, 2019a).

Cancer is a gift
The specific-level conceptual metaphor CANCER IS A GIFT is recurrent in the data. Within this metaphor, the physical experience of receiving, accepting, or obtaining something is metaphorically applied to cancer. In general, conceiving cancer as a gift emphasises that the women's battle with cancer has allowed them to reassert control over their life in the face of such unexpected illness. This is manifested in the following metaphorical expressions: (11) Allah tak akan bagi penyakit ni kalau saya tak kuat.
[Allah will not give me this disease if I am not strong.] (12) Saya banyak belajar untuk redha dengan pemberian Allahni.
[I have learnt a lot to embrace this gift from Allah.] Evidently, in the expressions above, the women metaphorically describe cancer as a gift from God. Specifically, excerpt (11) conceives cancer as a gift that is given to persons who are capable of coping with it. However example (12) portrays that cancer was delivered to them as a gift, to teach them to be more accepting of their sufferings with the illness.
Additionally, a few of the women described themselves as being thankful to God for giving them cancer, as the cancer gives them strength and helps them become more spiritually connected to God (13). Cancer is also conceived as a reward that strengthens the women's relationship with their family and thus helped them to better appreciate life (14). These expressions do not only emphasise the women's positive conceptions towards their sufferings but also highlights the concept of acceptance ingrained in their faith. The general use of the OBJECT source domain also allows the women to express metaphorical reference such as in (15), (16) and (17)  [This cancer might be an award that is better than before this that Allah has given me because it taught me about patience and sacrifice.] (17) Saya melihat kanser ni satu anugerah dari Dia (Tuhan) yang ubah hidup saya.
[I see this cancer as an award from Him (God) that has changed me.] Cancer as an "award" or "anugerah" from God was also depicted in several of the women's narratives. In Malay, "anugerah" (award) is a form of recognition that is given to appreciate and acknowledge a recipient's dedication and contribution in a role. In this case, cancer and award share a common ground; it is only for the chosen ones who get to experience it. However, an award is a thing with high value that is given to honour someone for his/her achievements. On the contrary, cancer is a life-threatening disease that immobilises a person's life. The manifestation of the lexical item "anugerah" (award) in (15), (16) and (17) portrays cancer as a special gift that has taught them and transformed their lives. Acknowledging cancer as an "award", thus, emphasises the women's acceptance of the disease which contradicts the nature of the disease itself. This significant discovery highlights the women's optimism in battling with the illness, bearing in mind that not all individuals are capable of accepting this life-threatening illness as a gift, or a grace from God. Additionally, it also highlights the concept of acceptance rooted in Islamic teaching which is expressed when a person is faced with difficulties.
As noted above, cancer is also conceived as an "award" to emphasise that cancer is a gift in making the Malay women become more spiritual. One woman said that the meaningful gift from cancer was her becoming closer to God (18), and another woman described herself as becoming more grateful to God and more devoted to her religion. For her, the cancer experience is seen as a wonderful gift (19)

Cancer is an unwanted object
The women also metaphorically described cancer as an unwanted object, which evoked another specific-level conceptual metaphor CANCER IS AN UNWANTED OBJECT. This conceptual metaphor is evoked by the frequent use of "buang" (to throw) in referring to the process of removing cancer from the women's bodies. Portraying cancer as an unwanted object or a waste material to be thrown away allows the women to express their strong abhorrent experience with the disease. This is implied in many of the OBJECT metaphors and is stated explicitly in (20) where a woman shares her feelings about the need to see cancer as a disposable object. Similarly, this is portrayed in (21), where cancer is projected as an unwanted object that needs to be removed due to rapid growth of the cancer tumour. In general, the use of "buang" in the expressions emphasises the seriousness of the disease and the vulnerability of the person who is ill of it.
[…doctor has already thrown away (removed) that cancer through an operation because that thing (cancer tumour) has become bigger.] With regard to cancer treatment, specifically on the removal of cancer from the body, this is likened to throwing away of an object. A woman in (22) described the complexity and the time consumed in removing the disease from her body by referring to cancer treatment as the procedure involved in 'throwing away' (buang) the disease. In addition, the removal of cancer is also metaphorically expressed in terms of "disposal" (pembuangan) in (23) and "take out" (keluarkan) in (24). Objectifying cancer by using the disposing analogy creates a sense of understanding on the women's abhorrent perception of the disease; it expresses their attempt to cure their illness, projected in a way that is simple and easier to comprehend. [I was forced to go through physiotherapy not only mastectomy, but also disposal of the cancer that was at the lymph nodes.] (24) Keluarkan dia (kanser) dari badan saya.
[Take it (cancer) out from my body.] Metaphor involving "buang" is also used to express their determination and effort of removing the disease from their body by going through treatments. (25) Doktor cakap buang dia (kanser), saya beranikan diri untuk buang supaya tak pergi ke tempat lain.
[Doctor asked to me to throw it away (remove cancer), I brave myself to throw it away (remove) so it didn't go to another place.] Other expressions which illustrate the conceptualisation of cancer as an undesirable object can also be observed in difficult situations where the disease has become progressive or metastasized, thus requiring immediate treatment. Example (26) and (27)

Cancer is a heavy object
An object can be physically moved, lifted and carried. Within this metaphor, cancer is conceived as a heavy physical object that exerts force on the women as manifested by related words such as "pikul" (carry) and "tanggung" (bear). In the narratives analysed, Malay women's use of OBJECT metaphor portrays cancer as a heavy object that they have to carry as manifested in the expressions (28), (29) and (30) Cancer epitomises a threat to human existence. There is much uncertainty about the prognoses and the negative effects of the disease, likewise the costs of treatment, including chemotherapy, which can be emotionally and physically devastating to the sufferers. The portrayal of cancer in terms of heavy object highlights that it can be frightening, hard to take, and can be a horrifying experience. This highlights the women's emotional, mental and physical struggle in their battle with the disease. In this regard, by conceiving cancer as a heavy object, the women were able to express their fear and vulnerability. Specifically, several women expressed their frustrations by conceiving cancer as a forceful burden that they could no longer endure as manifested in (29). Therefore, the women expressed the need to have strength, patience and positive thinking in the way they handle the illness as reflected in (29) and (30).
A battle with cancer can have a huge impact on the sufferers. This life changing experience has altered the women's lives. Conceiving cancer as a heavy object conveys the negative perceptions and emotions associated with not being able to live as one wants, including the inability to be the person that one would like to be. As is evident in (31) By conceiving cancer as a heavy object, the women were able to express their emotional struggles and vulnerability. One woman provides an explicit explanation of her worries when she was informed of her cancer relapse, as illustrated in example (34). (34) Bila doktor bagi tahu yang kanser datang balik, saya risau, 'boleh ke saya tanggung sakit ni?' Lagi-lagi sakit bila buat rawatan kemoterapi.
[When doctor told me that cancer has returned, I was worried, 'can I bear this illness?' especially, the pain of doing the chemotherapy treatment.] In some cases, the OBJECT metaphor is used to emphasise the women's struggle in battling cancer. For example, the woman in (35) described the disease as something that is getting heavier for her to endure.
[It has been 3 years since I have cancer. It has become heavier for me to bear this illness.]

CONCLUSION
A cancer diagnosis can be one of the most traumatising experiences for those affected by it. The present study has been directed at Malay women's use of OBJECT metaphors in their narratives on cancer experience. Some evidence have been gathered to show how the OBJECT metaphors were used by the Malay women to describe cancer and their cancer experiences in a more concrete manner, conveying the realistic impressions of the disease. It also provides us with insights into their reality in dealing with with this life-threatening illness.
In addition, the pervasiveness of culture in the women's conceptualisation of the disease as related to the women's faith and spirituality is evident in their narratives. This finding suggests that one's faith in religion also has a powerful influence on how cancer patients cope and perceive the illness (Venter et al., 2008). Evidently, religion does not only provide valuable source of support, but also offers patients with a basis that helps them to understand the disease better Ogden (2007).
In conclusion, the OBJECT metaphors do not just make it possible to verbalise experiences that could not easily be expressed using literal language. They also reveal the women's perceptions, views, attitudes and challenges in facing their testing moments when faced with such a life-threatening disease. Through the analysis of the metaphors of cancer in the Malay women's narratives, this study has provided some evidence that the OBJECT metaphor offers creative ways for women facing cancer to express their ineffable experience more vividly. This in turn, can provide health practitioners with an approach to engage with the metaphors used by cancer patients, which can further facilitate them in giving appropriate advice for cancer treatment and recovery.