Cancer with no smiley faces. Barbara Ehrenreich frowns at the cost of sugar-coating illness

The Guardian has an interesting piece on Barbara Ehrenreich’s reaction to her own cancer as described in her new book, Smile Or Die: How Positive Thinking Fooled America And The World. She was immediately struck by what she calls “pink ribbon culture” and the insistence on “positive thinking,” an intrusive ideology that has a strong hold on the American imagination. For Ehrenreich cancer was not a rite of passage or a “gift.”

But rather than providing emotional sustenance, the sugar-coating of cancer can exact a dreadful cost. First, it requires the denial of understandable feelings of anger and fear, all of which must be buried under a cosmetic layer of cheer. This is a great convenience for health workers and even friends of the afflicted, who might prefer fake cheer to complaining, but it is not so easy on the afflicted. One 2004 study even found, in complete contradiction to the tenets of positive thinking, that women who perceive more benefits from their cancer “tend to face a poorer quality of life – including worse mental functioning – compared with women who do not perceive benefits from their diagnoses.”

I am reminded of Zizek’s analysis of our society’s generalized injunction “Enjoy!” We are all under the spell of this injunction, what Zizek calls the superego aspect of today’s “non-repressive” hedonism – the constant provocation we are exposed to, enjoining us to explore all modes of jouissance – with the result that our enjoyment is more hampered than ever. Recall the classic yuppie type who combines narcissistic self-fulfillment with the utterly ascetic discipline of rigorous workouts and obsessions around health food. This injunction to smile through thick and thin, through disease and world calamities, can have profound consequences. In a pseudo-permissive society in which the more we are encouraged to care for ourselves the more we lack a fixed identity, ideology directly mobilizes that lack to sustain the endless process of consumerist “self-re-creation.” We no longer have any choice but to pursue happiness forever.

The very injustice of our economic and political system is what allows us to perceive failure (or success) as undeserved or contingent. It is much easier to accept inequalities or misfortunes if one can claim that they result from an impersonal blind force such as the “free market.” This ideology is also at work in the cheerful acceptance of disease that Ehrenreich finds so intolerable.

Breast cancer … did not make me prettier or stronger, more feminine or spiritual. What it gave me, if you want to call this a “gift”, was a very personal, agonizing encounter with an ideological force in American culture that I had not been aware of before – one that encourages us to deny reality, submit cheerfully to misfortune and blame only ourselves for our fate.

Smile or Die will be released in Canada in August 2010. An excellent essay by Ehrenreich on this topic, originally published in Harper’s Magazine, can be found at the Breast Cancer Action website: Welcome to Cancerland: A Mammogram Leads to a Cult of Pink Kitsch.

Here is how it ends:

For me at least, breast cancer will never be a source of identity or pride. As my dying correspondent Geni wrote: “IT IS NOT O.K.!” What it is, along with cancer generally or any slow and painful way of dying, is an abomination, and, to the extent that it’s manmade, also a crime. This is the one great truth that I bring out of the breast-cancer experience, which did not, I can now report, make me prettier or stronger, more feminine or spiritual-only more deeply angry. What sustained me through the “treatments” is a purifying rage, a resolve, framed in the sleepless nights of chemotherapy, to see the last polluter, along with, say, the last smug health insurance operative, strangled with the last pink ribbon. Cancer or no cancer, I will not live that long of course. But I know this much right now for sure: I will not go into that last good night with a teddy bear tucked under my arm.


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4 Responses to “Cancer with no smiley faces. Barbara Ehrenreich frowns at the cost of sugar-coating illness”


  1. 1 Jackie Fox January 5, 2010 at 8:52 am

    Well said! I don’t trust anything that turns into ideology, whether it’s politics or breast cancer optimism.

    That said, I am one of those women who feels like breast cancer gave me more than it took away. But that certainly doesn’t mean everyone else should feel the way I do, nor does it mean I didn’t have moments of anger and fear.

    To me this is just part of a larger cultural shift where if you’re not with me you’re against me. We’ve certainly seen it in American politics (I can’t speak for Canada–is it true there as well?) What a shame that it has to come down to this for breast cancer. We should be supporting each other, not making each other feel like traitors if we don’t feel particularly cheerful about our diagnosis. To each her own.

    • 2 gossypiboma January 5, 2010 at 9:50 am

      I agree, Jackie. We should be supporting one another; and the best way to do that is to ensure that when a person is diagnosed with a life-threatening disease he or she will at least not have to worry about financial consequences.

      However we react to a diagnosis, we should have the comfort of knowing that – beyond our circle of family and friends – society as a whole will not abandon us as we deal with disease.

  2. 3 Kay January 6, 2010 at 12:01 pm

    A friend that does not have cancer but know how I feel about pink ribbons, emailed me a link to this posting. I like what Ms. Ehrenreich has to say and how she states things. I’ve had a few too many people tell me they are “praying for me” or if I keep a positive attitude, cancer isn’t any big deal. I do feel abandoned with this disease. Those that were so concerned when I was first diagnosed, went back to their normal lives and rarely ask how I am doing. If I mention the subject, they find a way to change the subject. Or if they do comment, it is usually to say, “Oh, you’ve lost so much weight, has the cancer come back?” I believe I’ve lost weight because of taking Tamoxifen. It is the only thing that has changed in the last year. Every test that I’ve taken in the last year has been negative or in the normal range. I am a trained scientist along with a medical librarian. The fact that the oncologist won’t acknowledge the horrible side effects from this medication makes it that much more difficult to deal with this situation

  3. 4 Catherine Voutier January 27, 2010 at 9:05 pm

    Interesting article. I’m also a librarian who has had cancer. I detest the pink ribbon movement – in a way, it manufactures fake guilt as well as fake cheerfulness. Oh – your friend has breast cancer – you better rush out to buy a pink ribbon to show your support when you next see her or you will feel guilty! When I worked at the Centre for Grief Education in Melbourne, I learnt so much about the loss of grief customs in the Western world. And reading this article made me think that the gulf is being filled by fake cheerfulness. Clinicians are not trained in how to cope with the emotional impacts of grief on the people they diagnose. The common behavioural technique is to remain distant and hurry the patient on through shock to the next thing that has to be done. People can’t process grief – the traditional trappings and behaviours of grief have gone. Do you feel emabarrassed when a dear friend or relative is very ill? You don’t know how to act? Thanks for sharing!


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