Cancer as Metaphor…
(We’re doing it wrong)
Last summer I read The Emperor of All Maladies: A Biography of Cancer while still fresh from a year of studying leadership and conflict. The proximity of my studies and reading Siddhartha Mukherjee’s beautiful narrative on the history of cancer, cancer treatment, and the fallible human beings who have sought to cure it led me to contemplate the accuracy of cancer as a metaphor for insurgencies as well as whether practitioners of counterinsurgency can learn anything from the War on Cancer.
The analogy is a crude comparison:
Cancer is to the body as an insurgency is to the population.
Cancer is dangerous tissue that needs to be removed from the surrounding tissue in order to cure a patient. In the same way insurgents are dangerous people who must be removed to restore legitimate governance.
Unfortunately the analogy is wrong. Excision alone almost never works… for cancer or insurgencies. Our use of this analogy shows a lack of understanding of both.
The metaphor of cancer and insurgencies is far more nuanced and far more powerful.
Until very recently Cancer as a disease was understood only superficially. There were masses, doctors cut them out and (sometimes) people got better. The problem was that not a lot of people got better. The thinking then became that not ‘enough’ of the bad tissue was removed. The solution then became to cut more, and cut deeper. The most extreme example is found in the history of breast cancer treatment: The supraradical mastectomy. In a supraradical (or its variation the extended supraradical mastectomy) a surgeon removes not only the breast and underlying breast tissue, but also entire strings of lymph nodes, the muscles of the chest wall, and entire sections of the clavicle. These were painful and disfiguring surgeries that did not improve survival or relapse rates. These surgeries failed to improve outcomes not because the surgeons were bad surgeons, but because the surgeons did not understand how to cancer spread.
Much like we now have multiple approaches to counterinsurgency operations, doctors developed radiation therapy and chemotherapy as alternate treatments for various cancers. Unfortunately, physicians followed the same pattern with radiation and chemotherapy treatment cycles as they had with the surgical approach. The treatments showed some efficacy at low levels, so extreme levels of treatment were eventually applied without much increase in effectiveness, while inflicting enormous suffering upon patients, including secondary cancers due to treatment.
This cycle went on for decades.
It was not until doctors and scientists began studying cancer itself, at the genetic level just a decade or so ago, that the discipline began to make great strides in understanding the mechanisms of cancer. Physician researchers began to develop a deep understanding of some cancers. These scientists began to understand how individual cancers developed, what allowed them to thrive, how they adapted to treatment and spread throughout the body. This understanding of context and content of these individual cancers at the genetic level allowed for therapies that not only killed the cancer, but did so without putting the patient’s life at great risk during treatment.
Yet even after the understanding was developed in the lab, it took years until the knowledge transitioned into treatment options for average patients.
That is the metaphor.
I know I’m not the first person to compare insurgencies to cancer. In fact, Dave Kilcullen, one of the foremost experts in the field, described the problem in his 2010 book Counterinsurgency this way:
“Insurgencies, like cancers, exist in thousands of forms, and there are dozens of techniques to treat them, hundreds of different populations in which they occur, and several major schools of thought on which to deal with them. The idea that there is one ‘silver bullet’ panacea for insurgency is therefore as unrealistic as the idea of a universal cure for cancer.”
The U.S. even has a counterinsurgency (COIN) doctrine (FM 3–24; MCWP 3–33.5). It details the necessity of understanding the strategic context and operational environment and emphasizes the importance of understanding culture, social norms and economic incentives. It also acknowledges the important roles of non-governmental organizations and non-military governmental organizations in countering insurgencies.
Why then, are we still getting the analogy wrong at the highest levels of the national security establishment?
(And we ARE getting it wrong)
Two of the primary culprits
1. Our understanding of insurgencies, specifically Islamist insurgencies has been and continues to be superficial.
At the tactical level, where the fighting happens and where the effort ultimately succeeds or fails, efforts are still mainly executed by military personnel and in checklist form: dismounted patrols (check), talk to people (check), build them a ___________ A) School B) Clinic C) Road D) Well (check), ask them where the bad guys are (check), send up daily SITREPS (check). There has been some shift in the Special Forces community with the focus on Village Stability Operations after several years of grappling with the problem, but its not nearly fast enough and there are not nearly enough Green Berets to succeed if they are the only units immersing themselves in this problem.
Targeted cancer therapy was only possible once the human genome was mapped, an understanding of the genetic mutations that caused cancer to express itself was understood and specific therapies were developed that address the core causes. That is where we HAVE to get if we are to develop specificity in our strategies for combatting insurgencies. Instead of mapping the genome, you have to map the environment and understand what the specific triggers and pathways are that allow insurgencies to flourish.
Force is a necessary component to ending insurgencies, but it is not sufficient. Force must be accompanied by an understanding of the grievances of the population and concrete steps to address the specific grievances through application of all of the instruments of power of the international community: diplomacy, economy and information cannot be left on the sidelines as afterhoughts.
In the same way, just “cutting out” cancer, is seldom sufficient. The ideal course of treatment for long-term survival and remission rates almost always pairs either radiation or chemotherapy with surgery (if surgery is possible). The new targeted therapies that pair treatment regimes based on the specific mutations and cancer-causing biological behavior pathways are making cancer treatment much less harmful to the patient overall. In the same way, if a deep understanding of the basis of an insurgency and the specific pathways that garner popular support can be gained, methods of defeating an insurgency that don’t also lay waste to entire societies can be developed.
We do not understand the societies we are attempting to assist. Insurgencies cannot thrive without the help of the population. Lack of legitimate governmental structures which provide for the needs of their people are the key ingrediants of thriving insurgencies. Our lack of cultural and historical context becomes part of the problem, feeding the insurgency rather than defeating it. Counterinsurgency does not work without legitimate governmental partners. And we do not get to decide who the people deem legitimate. If we don’t understand the population, we also won’t understand what type of government they will support.
2. The United States and our western allies undertake counterinsurgency as a third-party.
The first culprit can be tamed through study, intention, critical thinking, courage and political will. The second is more difficult to overcome. Because of our third-party status in the countries where we conduct counter-insurgency operations there our accomplishments are limited by our partner nation.
For this reason, counter-insurgency must be a whole-of-government effort and is immensely dependent on the success of diplomatic efforts to encourage and support the local, national and regional governments in the affected states to undergo the reforms required to earn the support of their populations.
Counter-insurgency is dependent on a government that is a legitimate alternative to what the insurgents espouse. If the government is seen as illegitmate and cannot meet the needs of its people our approach will continue to look far more like the cancer surgeries of old: crude and incomplete.
Actions speak louder than words. The United States and her coalition partners are failing to fully resource the doctrine they’ve published. In the absence of resources the options shrink to air strikes and poorly equipped partner forces that, in some cases, carry out retaliatory atrocities.
In order to fully implement a COIN strategy as outlined in FM 3–24 thousands more servicemembers and interagency civilians would have to be dedicated to the effort. Cultural training would have to be dramatically expanded and tour lengths would have to be measured in years rather than months.
We must fight global Islamism with that level of dedication and nuance. We must willingly undertake decades-long committments to supporting legitimate governance through non-military means. If we do not, we will keep playing whack-a-mole and pretending that a regular supply of individual dead terrorists weaken insurgent networks enough to win.
At least we have a moonshot for cancer.
