THE FIRST ATTEMPT to recruit me into positive thinking occurred at what has been, so far, the low point of my life. If you had asked me, just before the diagnosis of cancer, whether I was an optimist or a pessimist, I would have been hard-pressed to answer. But on health-related matters, as it turned out, I was optimistic to the point of delusion. Nothing had so far come along that could not be controlled by diet, stretching, Advil, or, at worst, a prescription. So I was not at all alarmed when a routine mammogram aroused some “concern” on the part of my gynecologist. How could I have breast cancer? When she suggested a follow-up mammogram four months later, I agreed only to placate her.
I thought of it as one of those drive-by mammograms, one stop in a series of mundane missions, but I began to lose my nerve in the changing room, and not only because of the kinky necessity of baring my breasts and affixing tiny X-ray opaque stars to the tip of each nipple. The changing room, really just a closet off the windowless space that housed the mammogram machine, contained something far worse, I noticed for the first time—an assumption about who I am, where I am going, and what I will need when I get there. Almost all of the eye-level space had been filled with photocopied bits of cuteness and sentimentality: pink ribbons, an “Ode to a Mammogram,” a list of the “Top Ten Things Only Women Understand” (“Fat Clothes” and “Eyelash Curlers,” among them), and, inescapably, right next to the door, the poem “I Said a Prayer for You Today,” illustrated with pink roses.
It went on and on, this mother of all mammograms, cutting into gym time, dinnertime, and lifetime generally. In the long intervals between X-rays, I read The New York Times right down to the personally irrelevant sections like theater and real estate. Finally there was nothing left to read but a free weekly newspaper, where I found, buried deep in the classifieds, something even more unsettling than the growing prospect of major disease—a classified ad for a “breast cancer teddy bear” with a pink ribbon stitched to its chest.
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Yes, atheists pray in their foxholes—in this case, with a yearning new to me and sharp as lust, for a clean and honorable death by shark bite, lightning strike, sniper fire, car crash. Let me be hacked to death by a madman, was my silent supplication—anything but suffocation by the pink sticky sentiment embodied in that bear and oozing from the walls of the changing room. I didn’t mind dying, but the idea that I should do so while clutching a teddy and with a sweet little smile on my face—well, no amount of philosophy had prepared me for that.
The result of the mammogram, conveyed to me by phone a day later, was that I would need a biopsy, and, for some reason, a messy, surgical one with total anesthesia. My official induction into breast cancer arrived 10 days later with the biopsy, from which I awoke to find the surgeon standing at the far end of my gurney, down near my feet, stating gravely, “Unfortunately, there is a cancer.”
LUCKILY, NO ONE has to go through breast cancer alone anymore. Forty years ago, before Betty Ford and other pioneer patients spoke out, the disease was a dread secret, endured in silence and euphemized in obituaries as a “long illness.” Something about the conjuncture of “breast,” signifying sexuality and nurturance, and that other word, suggesting the claws of a devouring crustacean, spooked almost everyone. Today, however, it’s the biggest disease on the cultural map, bigger than AIDS or cystic fibrosis, bigger even than those more prolific killers of women—heart disease, lung cancer, and stroke. There are roughly hundreds of websites devoted to it, not to mention newsletters, support groups, a whole genre of first-person breast cancer books, even a glossy upper-middlebrow monthly magazine, Mamm.
As I waded out into the relevant sites after my 2000 diagnosis, the first thing I discovered is that not everyone views the disease with dread. Instead, the appropriate attitude is upbeat and even eagerly acquisitive. There are between 2 million and 3 million American women in various stages of breast cancer treatment, who, along with anxious relatives, make up a significant market for all things breast cancer–related. Bears, for example: I identified four distinct lines, or species, of these creatures, including Carol, the Remembrance Bear; Hope, the Breast Cancer Research Bear (which wore a pink turban as if to conceal chemotherapy-induced baldness); and the Nick and Nora Wish Upon a Star Bear.
And bears are only the tip, so to speak, of the cornucopia of pink-ribbon-themed breast cancer products. You can dress in pink-beribboned sweatshirts, pajamas, lingerie, aprons, and socks; accessorize with pink rhinestone brooches, angel pins, scarves, and earrings; brighten up your home with breast cancer candles, coffee mugs, pendants, wind chimes, and nightlights; and pay your bills with “Checks for the Cure.”
This is not entirely, I should point out, a case of cynical merchants exploiting the sick. Some breast cancer accessories are made by breast cancer survivors themselves, and in most cases a portion of the sales goes to breast cancer research. What’s more, the ultrafeminine theme of the breast cancer marketplace—the prominence, for example, of cosmetics and jewelry—could be understood as a response to the treatments’ disastrous effects on one’s looks.
But the infantilizing trope is a little harder to account for, and teddy bears are not its only manifestation. A tote bag distributed to breast cancer patients by the Libby Ross Foundation contained, among other items, a tube of Estée Lauder Perfumed Body Crème, a hot pink satin pillowcase, a set of three small, inexpensive rhinestone bracelets, a pink-striped “journal and sketch book,” and—somewhat jarringly—a box of crayons. Marla Willner, one of the founders of the Libby Ross Foundation, told me that the crayons “go with the journal—for people to express different moods, different thoughts,” though she admitted she has never tried to write with crayons herself. Possibly the idea was that regression to a state of child-like dependency puts one in the best frame of mind for enduring the prolonged and toxic treatments. Or it may be that, in some versions of the prevailing gender ideology, femininity is by its nature incompatible with full adulthood. Certainly men diagnosed with prostate cancer do not receive gifts of Matchbox cars.
I—NO LESS than the bear huggers—needed whatever help I could get and found myself searching obsessively on-line for practical tips on hair loss, how to select a chemotherapy regimen, what to wear after surgery, and eat when the scent of food sucks. At first, I couldn’t seem to get enough of other women’s stories, reading on with panicky fascination all the things that can go wrong. But, despite all the helpful information, the more testimonials I read, the greater my sense of isolation grew.
None of the bloggers seemed to share my sense of outrage over the disease and the crudeness of available treatments. What causes it and why is it so common, especially in industrialized societies? In the mainstream of breast cancer culture, there is very little anger, even though, in all but the more advanced cases, it is the “treatments,” not the disease, that cause the immediate illness and pain. In fact, the overall tone is almost universally upbeat. The Breast Friends website, for example, featured a series of inspirational quotes: “Don’t cry over anything that can’t cry over you”; “When life hands out lemons, squeeze out a smile.”
The cheerfulness of breast cancer culture goes beyond mere absence of anger to what looks, all too often, like a positive embrace of the disease. As a “Mary” reported, on the “Bosom Buds” message board: “I really believe I am a much more sensitive and thoughtful person now. I enjoy life so much more now and in a lot of aspects I am much happier now.” Cindy Cherry, quoted in The Washington Post, went further: “If I had to do it over, would I want breast cancer? Absolutely. I’m not the same person I was, and I’m glad I’m not.”
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.
As an experiment, I posted a statement on the Susan G. Komen Foundation’s 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, but mostly a chorus of rebukes. “Suzy” wrote to tell me, “I really dislike saying you have a bad attitude toward all of this, but you do.” “Kitty” thought I’d gone around the bend: “You need to run, not walk, to some counseling.” 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. Gerri was angry, too.
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 websites, 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.”
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, apparently, and it becomes less healthy and less resistant to disease. It was thus 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, even if the threat is not a microbe but a tumor.
But where were the studies showing the healing effect of a positive attitude? One of the skeptics, Stanford psychiatrist David Spiegel, told me he set out in 1989 to refute the popular dogma that attitude could overcome cancer. But to his surprise, Spiegel’s initial study showed that breast cancer patients in support groups lived longer than those in the control group. Spiegel promptly interrupted the study, deciding that no one should be deprived of the benefits provided by a support group. The dogma had been affirmed.
The dogma, however, did not survive further research. In the 1990s, studies began to roll in refuting Spiegel’s 1989 results. The amazing survival rates of women in Spiegel’s first study turned out to be a fluke. In 1997, a team led by Spiegel himself effectively contradicted his earlier finding, reporting that support groups conferred no survival advantage after all.
It could be argued that positive thinking can’t hurt, that it might even be a blessing to the sorely afflicted. But the sugarcoating of cancer can exact a dreadful cost. When positive thinking “fails” and the cancer spreads or eludes treatment, the patient often blames herself. 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, at least, was saved from this additional burden by my persistent anger. But I can report that breast cancer did not make me stronger or more 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.
From the book Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. ©2009 by Barbara Ehrenreich.
