Bright-Sided (5 page)

The First Year of the Rest of Your Life
, a collection of brief narratives with a foreword by Nancy Brinker and a share of the royalties going to the Komen Foundation, is filled with such testimonies to the redemptive powers of the disease: “I can honestly say I am happier now than I have ever been in my life—even before the breast cancer”; “For me, breast cancer has provided a good kick in the rear to get me started rethinking my life”; “I have come out stronger, with a new sense of priorities.”
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Never a complaint about lost time, shattered sexual confidence, or the long-term weakening of the arms caused by lymph node dissection and radiation. What does not destroy you, to paraphrase Nietzsche, makes you a spunkier, more evolved sort of person.

Writing in 2007,
New York Times
health columnist Jane Brody faithfully reflected the near universal bright-siding of the disease.
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She gave a nod to the downside of breast cancer and cancer generally: “It can cause considerable physical and emotional pain and lasting disfigurement. It may even end in death.” But for the most part her column was a veritable ode to the uplifting effects of cancer, and especially breast cancer. She quoted bike racer and testicular cancer survivor Lance Armstrong saying, “Cancer was the best thing that ever happened to me,” and cited a woman asserting that “breast cancer has given me a new life. Breast cancer was something I needed to experience to open my eyes to the joy of living. I now see more of the world than I was choosing to see
before I had cancer. . . . Breast cancer has taught me to love in the purest sense.” Betty Rollin, one of the first women to go public with her disease, was enlisted to testify that she has “realized that the source of my happiness was, of all things, cancer—that cancer had everything to do with how good the good parts of my life were.”

In the most extreme characterization, breast cancer is not a problem at all, not even an annoyance—it is a “gift,” deserving of the most heartfelt gratitude. One survivor turned author credits it with revelatory powers, writing in her book
The Gift of Cancer: A Call to Awakening
that “cancer is your ticket to your real life. Cancer is your passport to the life you were truly meant to live.” And if that is not enough to make you want to go out and get an injection of live cancer cells, she insists, “Cancer will lead you to God. Let me say that again. Cancer is your connection to the Divine.”
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The effect of all this positive thinking is to transform breast cancer into a rite of passage—not an injustice or a tragedy to rail against but a normal marker in the life cycle, like menopause or grandmotherhood. Everything in mainstream breast cancer culture serves, no doubt inadvertently, to tame and normalize the disease: the diagnosis may be disastrous, but there are those cunning pink rhinestone angel pins to buy and races to train for. Even the heavy traffic in personal narratives and practical tips that I found so useful bears an implicit acceptance of the disease and the current clumsy and barbarous approaches to its treatment: you can get so busy comparing attractive head scarves that you forget to question whether chemotherapy is really going to be effective in your case. Understood as a rite of passage, breast cancer resembles the initiation rites so exhaustively studied by Mircea Eliade. First there is the selection of the initiates—by age in the tribal situation, by mammogram or palpation here. Then come
the requisite ordeals—scarification or circumcision within traditional cultures, surgery and chemotherapy for the cancer patient. Finally, the initiate emerges into a new and higher status—an adult and a warrior—or in the case of breast cancer, a “survivor.”

And in our implacably optimistic breast cancer culture, the disease offers more than the intangible benefits of spiritual upward mobility. You can defy the inevitable disfigurements and come out, on the survivor side, actually prettier, sexier, more femme. In the lore of the disease—shared with me by oncology nurses as well as by survivors—chemotherapy smoothes and tightens the skin and helps you lose weight, and, when your hair comes back it will be fuller, softer, easier to control, and perhaps a surprising new color. These may be myths, but for those willing to get with the prevailing program, opportunities for self-improvement abound. The American Cancer Society offers the “Look Good . . . Feel Better” program, “dedicated to teaching women cancer patients beauty techniques to help restore their appearance and self-image during cancer treatment.” Thirty thousand women participate a year, each copping a free make over and bag of makeup donated by the Cosmetic, Toiletry, and Fragrance Association, the trade association of the cosmetics industry. As for that lost breast: after reconstruction, why not bring the other one up to speed? Of the more than fifty thousand mastectomy patients who opt for reconstruction each year, 17 percent go on, often at the urging of their plastic surgeons, to get additional surgery so that the remaining breast will “match” the more erect and perhaps larger new structure on the other side.

Not everyone goes for cosmetic deceptions, and the question of wigs versus baldness, reconstruction versus undisguised scar, defines one of the few real disagreements in breast cancer culture. On the more avant-garde, upper-middle-class side,
Mamm
magazine—in which literary critic Eve Kosofsky Sedgwick served as a columnist—tends to favor the “natural” look. Here, mastectomy scars can be “sexy” and baldness something to celebrate. A cover story featured women who “looked upon their baldness not just as a loss, but also as an opportunity: to indulge their playful sides . . . to come in contact, in new ways, with their truest selves.” One woman decorated her scalp with temporary tattoos of peace signs, panthers, and frogs; another expressed herself with a shocking purple wig; a third reported that unadorned baldness made her feel “sensual, powerful, able to recreate myself with every new day.” But no hard feelings toward those who choose to hide their condition under wigs or scarves; it’s just a matter,
Mamm
tells us, of “different aesthetics.” Some go for pink ribbons; others will prefer the Ralph Lauren Pink Pony breast cancer motif. But everyone agrees that breast cancer is a chance for creative self-transformation—a make over opportunity, in fact.

In the seamless world of breast cancer culture, where one Web site links to another—from personal narratives and grassroots endeavors to the glitzy level of corporate sponsors and celebrity spokespeople—cheerfulness is required, dissent a kind of treason. Within this tightly knit world, attitudes are subtly adjusted, doubters gently brought back to the fold. In
The First Year of the Rest of Your Life
, for example, each personal narrative is followed by a study question or tip designed to counter the slightest hint of negativity—and they are very slight hints indeed, since the collection includes no harridans, whiners, or feminist militants:

Have you given yourself permission to acknowledge you have some anxiety or “blues” and to ask for help for your emotional well-being? . . .

Try keeping a list of the things you find “good about today.”
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As an experiment, I posted a statement on the [http://Komen.org] Komen.org message board, under the subject line “Angry,” briefly listing my complaints about the debilitating effects of chemotherapy, recalcitrant insurance companies, environmental carcinogens, and, most daringly, “sappy pink ribbons.” I received a few words of encouragement in my fight with the insurance company, which had taken the position that my biopsy was a kind of optional indulgence, but mostly a chorus of rebukes. “Suzy” wrote to tell me, “I really dislike saying you have a bad attitude towards all of this, but you do, and it’s not going to help you in the least.” “Mary” was a bit more tolerant, writing, “Barb, at this time in your life, it’s so important to put all your energies toward a peaceful, if not happy, existence. Cancer is a rotten thing to have happen and there are no answers for any of us as to why. But to live your life, whether you have one more year or 51, in anger and bitterness is such a waste. . . . I hope you can find some peace. You deserve it. We all do. God bless you and keep you in His loving care. Your sister, Mary.”

“Kitty,” however, thought I’d gone around the bend: “You need to run, not walk, to some counseling. . . . Please, get yourself some help and I ask everyone on this site to pray for you so you can enjoy life to the fullest.” The only person who offered me any reinforcement was “Gerri,” who had been through all the treatments and now found herself in terminal condition, with only a few months of life remaining: “I am also angry. All the money that is raised, all the smiling faces of survivors who make it sound like it
is o.k. to have breast cancer. IT IS NOT O.K.!” But Gerri’s message, like the others on the message board, was posted under the inadvertently mocking heading “What does it mean to be a breast cancer survivor?”

The “Scientific” Argument for Cheer

There was, I learned, an urgent medical reason to embrace cancer with a smile: a “positive attitude” is supposedly essential to recovery. During the months when I was undergoing chemotherapy, I encountered this assertion over and over—on Web sites, in books, from oncology nurses and fellow sufferers. Eight years later, it remains almost axiomatic, within the breast cancer culture, that survival hinges on “attitude.” One study found 60 percent of women who had been treated for the disease attributing their continued survival to a “positive attitude.”
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In articles and on their Web sites, individuals routinely take pride in this supposedly lifesaving mental state. “The key is all about having a positive attitude, which I’ve tried to have since the beginning,” a woman named Sherry Young says in an article entitled “Positive Attitude Helped Woman Beat Cancer.”
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“Experts” of various sorts offer a plausible-sounding explanation for the salubrious properties of cheerfulness. A recent e-zine article entitled “Breast Cancer Prevention Tips”—and the notion of breast cancer “prevention” should itself set off alarms, since there is no known means of prevention—for example, advises that:

A simple positive and optimistic attitude has been shown to reduce the risk of cancer. This will sound amazing to many people; however, it will suffice to explain that several medical studies have demonstrated the link between a positive attitude and an
improved immune system. Laughter and humor has [
sic
] been shown to enhance the body’s immunity and prevents against cancer and other diseases. You must have heard the slogan “happy people don’t fall sick.”
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No wonder my “angry” post was greeted with so much dismay on the Komen site: my respondents no doubt believed that a positive attitude boosts the immune system, empowering it to battle cancer more effectively.

You’ve probably read that assertion so often, in one form or another, that it glides by without a moment’s thought about what the immune system is, how it might be affected by emotions, and what, if anything, it could do to fight cancer. The business of the immune system is to defend the body against foreign intruders, such as microbes, and it does so with a huge onslaught of cells and whole cascades of different molecular weapons. The complexity, and diversity, of the mobilization is overwhelming: Whole tribes and subtribes of cells assemble at the site of infection, each with its own form of weaponry, resembling one of the ramshackle armies in the movie
The Chronicles of Narnia.
Some of these warrior cells toss a bucket of toxins at the invader and then move on; others are there to nourish their comrades with chemical spritzers. The body’s lead warriors, the macrophages, close in on their prey, envelop it in their own “flesh,” and digest it. As it happens, macrophages were the topic of my Ph.D. thesis; they are large, mobile, amoebalike creatures capable of living for months or years. When the battle is over, they pass on information about the intruder to other cells, which will produce antibodies to speed up the body’s defenses in the next encounter. They will also eat not only the vanquished intruders but their own dead comrades-in-arms.

For all its dizzying complexity—which has kept other graduate students toiling away “at the bench” for decades—the immune system is hardly foolproof. Some invaders, like the tuberculosis bacillus, outwit it by penetrating the body’s tissue cells and setting up shop inside them, where the bacilli cannot be detected by immune cells. Most diabolically, the HIV virus selectively attacks certain immune cells, rendering the body almost defenseless. And sometimes the immune system perversely turns against the body’s own tissues, causing such “autoimmune” diseases as lupus and rheumatoid arthritis and possibly some forms of heart disease. It may not be perfect, this seemingly anarchic system of cellular defense, but it is what has evolved so far out of a multimillion-year arms race with our microbial enemies.

The link between the immune system, cancer, and the emotions was cobbled together somewhat imaginatively in the 1970s. It had been known for some time that extreme stress could debilitate certain aspects of the immune system. Torture a lab animal long enough, as the famous stress investigator Hans Selye did in the 1930s, and it becomes less healthy and resistant to disease. It was apparently a short leap, for many, to the conclusion that positive feelings might be the opposite of stress—capable of boosting the immune system and providing the key to health, whether the threat is a microbe or a tumor.

One of the early best-selling assertions of this notion was
Getting Well Again
, by O. Carl Simonton, an oncologist; Stephanie Matthews-Simonton, identified in the book as a “motivational counselor”; and psychologist James L. Creighton. So confident were they of the immune system’s ability to defeat cancer that they believed “a cancer does not require just the presence of abnormal cells, it also requires a
suppression of the body’s normal defenses
.”
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What could suppress them? Stress. While the Simontons urged cancer patients to obediently comply with the prescribed treatments, they
suggested that a kind of attitude adjustment was equally important. Stress had to be overcome, positive beliefs and mental imagery acquired.