Suddenly feeling a lump in one’s breast is terrifying, yet it is an experience suffered by one in every eight women in Britain and America. Its etymological root is karkinos after the claws of a crustacean. The ‘crab’ was well known to ancient societies. In the oldest surgical treatise, an Egyptian text written around 3000 BC, eight of the forty-eight case-studies involve breast tumours or ulcers. Depressingly, the author contended that he knew of no treatment or cure.
In more recent centuries, historians have uncovered a few diaries and letters in which female sufferers write about having breast cancer. The most famous is Fanny Burney’s 1812 account of the torture of undergoing a mastectomy without anaesthetics (chloroform and ether would not be available for another three decades). Burney’s searing descriptions of the agony of having ‘the dreadful steel… plunged into the breast’ and hearing her own screams echoing around the room remains the most graphic account of mastectomy ever published.
However, until the late twentieth century, personal accounts of breast cancer were relatively rare. It was only in the 1970s when pathographies (that is, first-person illness narratives, often dealing with cancers) became widespread, even popular. Furthermore, pathographies relating to breast cancer and published in the 1970s and 1980s were fundamentally political texts, emboldened by feminism, civil rights, and other liberationist struggles.
Poet, critic, and Black activist Andre Lorde published some of the most eloquent. Her classics books are The Cancer Journals (published in 1980, after Lorde’s 1978 mastectomy) and A Burst of Light (1988, after her cancer had metastasized to her liver). Like many other breast cancer patients at that time, Lorde was critical of the dominant medical responses to the disease. As late as the 1980s, many breast cancer surgeons performed the radical mastectomy, propagated by Surgeon William Stewart Halsted in the 1890s. Breast tissue, axillary lymph nodes, and pectoral muscles were all removed. The radical mastectomy was accompanied by ‘one-step’ surgery: that is, while the patient was anesthetised, a biopsy would be taken and tested, and, if it proved cancerous, the breast would be removed before the patient woke up. This was abhorrent to women like Lorde. As she put it, ‘it’s my body and my life… I ought to have a say’. Lorde challenging physicians to pay more attention to individual women’s preferences, needs, desires concerning treatment and surgery.
Crucially, however, Lorde drew attention to the fact that public commentary about the disease was middle-class, heterosexual, and white. As a specialism, oncology was certainly elite and almost exclusively white, but so too were breast cancer charities and lobbying groups at that time. Thinking about her cancer diagnosis, Lorde reflected on the fact that she was a ‘black lesbian feminist poet’, but there were no ‘models for what I’m supposed to be in this situation’. She said to herself, ‘That is it, Audre. You’re on your own’. Out of such reflections, Lorde developed a critique about the cultural fetishization of the breast. Two breasts, good; one breast or none, bad. This harmed women (like herself) who had experienced a mastectomy.
Lorde was rebellious, stating that ‘I refuse to hide my body simply because it might make a woman-phobic world more comfortable’. This was not simply an aesthetic comment: it was a political statement. She contended that ‘By accepting the mask of prosthesis, one-breasted women proclaim ourselves as insufficients dependent upon pretense’. This isolated women from each other; it rendered women with breast cancer as invisible. She complained that ‘Women have been programmed to view our bodies only in terms of how they look and feel to others’. She was not going to acquiesce, swearing that ‘Either I would love my body one-breasted now, or remain forever alien to myself’.
Lorde was not alone. Nearly a decade earlier, in September 1971, Era Bell Thompson, an editor at Ebony (the leading magazine for African American communities) wrote about her breast cancer diagnosis, including undergoing a radical mastectomy. Thompson candidly admitted to feeling shame of her diagnosis, as if she was ‘unclean, guilty of some unknown sin’. She was also scathing about the fact that women of colour had inferior access to medical, technological, and surgical resources. Unusually, Thompson included a discussion about the specific difficulties experienced by men of colour who had breast cancer. In this way, she also sought to confront the shame and stigma often felt by male breast cancer survivors.
Daring women like Lorde and Thompson were joined in their endeavours by numerous other breast cancer survivors and victims, all of whom were angry about the stigma attached to breast cancer and their treatment by medical professionals, journalists, and even family members. Notable examples are the memoir written by Betty Rollin, whose First, You Cry (1976) was infused with what she called a ‘feminist bile’, and Rose Kushner whose Breast Cancer: A Personal History and an Investigative Report (1975) angrily objected to typical responses by the ‘malevolent… male-dominated medical profession’. In later decades, it also includes Eve Kosofsky Sedgwick, author of ‘White Glasses’ (1999), and Barbara Ehrenreich, author of ‘Welcome to Cancerland’ (2001). These writers insisted that breasts and breast cancer were political issues. They rebuked political and medical elites for overlooking the ways that women’s bodies were being poisoned by corporate interests that add toxins to food and drink and contaminate the environment. They accused the ‘cancer industry’ of reaping huge profits from women’s suffering. Together, they embraced ‘green’ activism directed against ‘Cancer Inc.’, or the Corporate Cancer Industry.
These writers were also sensitive to the prominence of militarised languages in debates about cancer. They observed that biomedical approaches to breast cancer were premised on a belief that a ‘war’ was already being waged within the cancerous body, which made counterattacks seem to be the ‘natural’ response. The aptly named Women’s Field Army, which was set up in the mid-1930s by the American Society for the Control of Cancer (now, the American Cancer Society), even promised to mobilise ‘trench warfare with a vengeance against a ruthless killer’. In 1940, an advertisement appealing for funds for the Royal Cancer Hospital headlined the need to ‘Defeat the Silent Enemy’ and ‘swiften the attack on Cancer wherever it raises its hideous head’. Breast cancer charities announced that ‘Cancer attacks without declaring War’. Cancer was an ‘enemy’ to be fought and ultimately defeated. In the words of one woman writing to Betty Ford, wife of President Gerald Ford and the most prominent survivor of breast cancer, ‘Remember that your attitude is most of the battle’. By thinking ‘only about winning’, a breast cancer sufferer would survive.
Many cancer patients also adopted militarised languages. Even Lorde, who was relentless in critiquing conventional cancer narratives, sometimes referred to her ‘battle’ with cancer. But Lorde also acknowledged that violence was not the only way to conceptualize the disease. After her surgery, she confessed that she had expected her chest to ‘look like the ravaged and pitted battlefield of some major catastrophic war’. Instead, she admitted that she simply saw a scar that was not only ‘smooth and tender and untroubled’, but also an integrated part of her ‘same soft brown skin’. Like many of this generation of cancer writers, she came to recognise that militaristic metaphors were damaging because they turned patients’ bodies into battlefields, over which both physicians and patients fought. Breast cancer patients who ‘failed’ were stigmatized as having not been sufficiently ‘determined’. They hadn’t ‘fought’ hard enough.
In more recent decades, a very different approach has emerged. So-called ‘post-feminist’ accounts of breast cancer were highly individualised. From the early 2000s, breast cancer pathographies turned ‘pink’ not ‘green’ (let alone an angry feminist scarlet!). Unlike the earlier generation, wo had developed trenchant critiques of chemical corporations and pharmaceutical, while enjoying strong ties to global feminisms and AIDS activism, ‘pink’ advocacy focused on consumption. Women with breast cancer and their allies were encouraged to purchase pink bows and balloons, cuddly pink teddy bears, pink coffee mags, pink brooches, and even infantilizing colouring-in books.
These breast cancer pathographies were ensnared by beauty and fashion industries, and propagated a highly individualizing account of illness. For example, Geralyn Lucas’ Why I Wore Lipstick to my Mastectomy (2004) tells readers that wearing red lipstick to their mastectomy is nothing short of an ‘act of courage’. ‘Isn’t attitude everything?’, Lucas asks on the front cover of her book while words like ‘guts’ appear on the back cover. The performance of a kind of stoicism is required. As activist Kushner put it, patients are expected to enact the ‘red-badge-of-courage’: they need to ‘Glue a stylish wig on [their] pate, chew some Rolaids, and grin and bear it’. Or, as Barbara Ehrenreich complained in ‘Welcome to Cancerland’, in the twenty-first century, ‘cheerfulness is more or less mandatory, dissent a kind of treason’.
Of course, there are exceptions to this narrative of change-over-time between the 1970s and the twenty-first century. Movements such as Breast Cancer Action develop political analyses and are committed to forging ties of solidarity; and minoritized communities have always helped their own. Nevertheless, the most visible national (as opposed to local) initiatives continue to focus on specific clinical inadequacies rather than environmental or economic crises. Cancer patients who do not survive continue to be stigmatized as at least partly responsible for their own deaths: they must have lacked the ‘right attitude’ or will-power. What continues to be muted in debates today are the more radical critiques of earlier generations, which contended that inequalities in access to professional medical care, inadequate health insurance, and underdeveloped systems of support must bear a large share of responsibility for suffering.
If you are interested in this topic, take a look at my book, The Story of Pain: From Prayer to Painkillers.
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