Exploring the Political Landscape of Cancer

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Image: Macmillan

“I didn’t know anything about having cancer,” Anne Boyer writes in her challenging new book The Undying: A Meditation on Modern Illness, “but I knew something about how to avoid telling a story.” There is, as Audre Lorde explained in The Cancer Journals, a curious silence around cancer. The silence doesn’t come from not talking, but is instead produced by how the disease is supposed to be spoken about. In her new memoir, Boyer does not narrate the experience of cancer, writing that “cancer’s near-criminal myth of singularity means any work about it always resembles testimony.” Instead, Boyer illuminates both the deep personal trauma of the disease and its inextricable link with the indignities of living under a rapacious capitalism that demands happy and healthy participation from the citizens it overwhelms: “Disease is never neutral. Treatment never not ideological. Morality never without its politics.” Through her uniquely penetrating perspective, Boyer’s text is a paradigm-shifting work that asserts that the life of the body can (and should) never be divorced from the political landscape in which it moves.

Diagnosed with breast cancer at the age of 41, Boyer’s experience as a cancer patient is determined by her circumstances: young, a single mother of a teenage daughter, a teacher, without a partner, and without immediate family nearby. Her account of chemotherapy, the so-called “drive-by mastectomies” that her insurance allowed her, and her subsequent pain, illness, and exhaustion are finely wrought in extraordinary clarity. But formally, this is a complex book: Boyer’s writing of her own experiences is always in among other voices, from ancient literature, contemporary accounts of cancer, YouTube comments, and vloggers. Her response to the pain and profound difficulties of her diagnosis and treatment is to look to writing: The Undying is a wide-ranging book that is both complicated and complicating in its engagement with the many narratives of cancer and pain.

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Literature has never shied away from writing about illness: Virginia Woolf 1926 essay “On Being Ill” includes an observation that ‘English, which can express the thoughts of Hamlet and the tragedy of Lear, has no words for the shiver and the headache,’ but this hardly seems the case anymore, when illness memoirs are abundant. But Boyer’s comes at a moment in which many other writers are thinking about the more overtly gendered, racial and political dimensions of illness in particular and medical treatment in general. Porochista Khakpour’s memoir Sick (2018), for example, focuses on the writer’s diagnosis and experience of chronic Lyme disease, in which she has to fight to be believed by her doctors, and this year, Esme Weijun Wang The Collected Schizophrenias discusses the still-taboo subject, even in the medical profession, of schizoaffective disorder. Johanna Hedva fashions theirSick Woman Theory” in an essay of the same name as a way of countering the dominant languages of sickness and in honor of “those who are faced with their vulnerability and unbearable fragility, every day, and so have to fight for their experience to be not only honored, but first made visible.” In their account of bipolar disorder, depression and chronic illness, Hedva finds that “The most anti-capitalist protest is to care for another and to care for yourself.”

Boyer’s work continues this emphasis on care and solidarity, and the politics of care are the crux around which the rest of the book turns. Though she worries about “cashing in” on care before she old and after she is young, those ages in which we understand everyday care to be a necessary part of everyday life, Boyer also notes that sickness is not rare nor is it singular. Care is premised on its inexhaustibility, and, at different points in our lives, we can and will have to look out for and care for each other. Boyer describes looking to friends to help her, and how through their help she finds “inventive forms of love” through “extralegal and unofficial relationships” outside of immediate familial ones.

But she also looks to other forms of medical care that occur in the process of becoming a patient. Boyer carefully lays out the way that she saw her body being made “legible” through the various medical procedures she undergoes, before having these results analyzed and interpreted by oncologists and specialists. These processes, undertaken by receptionists, technicians, nurses, are part of the very fabric of the operation of medicine or more specifically, of the giving of treatment, but are not considered as the most essential, because, as Boyer points out, the idea that this sort of care work is “women’s work.” This “unnoticed” labor lays the groundwork for the interaction with doctors: “It is the doctors who read me” she writes, “or rather, read what my body has become: a patient made of information, produced by the work of women.”

In her consideration of the treatment of cancer as part of a gendered hierarchy, Boyer also considers the problems of treating the disease as a personal struggle. Cancer, patients are told, must be aggressively fought, and with traditional treatments. Boyer takes the case of the writer Kathy Acker as an example of the fury that cancer sufferers are met with if they go down “non-normative routes,” specifically, in her case, refusing to undergo aggressive chemotherapy. Boyer speculates that the severity of Acker’s cancer meant that the chance of successful chemotherapy was minimal, while the possible side-effects of the treatment were horrendous. In spite of this, many of Acker’s close friends were furious with her in what they viewed as her decision to die, or at least to not fight.

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But what can it mean to “fight” against such an amorphous and difficult disease? As Ben Marcus writes in the essay “Watching Mysteries With My Mother:” “It is simply not clear, has never been clear, how exactly one fights for one’s life, with no tools, no weapons, no training, no information whatsoever.” How hard does one have to struggle to stay alive to prove you deserve to stay alive? Like Susan Sontag, Boyer considers how these familiar cliches unite the progression of disease with the efforts of the patient—that is, that those who live “fought off” their cancer and those who died did not. As she so powerfully writes: “Dying of breast cancer is not evidence of the weakness or moral failure of the dead. The moral failure of breast cancer is not in the people who die: it is the world that makes them sick, bankrupts them for a cure that also makes them sick, then, when the cure fails, blames them for their own deaths.” Can we allow the narrative of death to be so full of the promise of agency?

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Perhaps there is also a protection to be found in the assurances of the dominant language of cancer, a narrative that can be slipped into as a person with cancer or a relative or friend of someone with cancer. Boyer throughout wants to disavow those narratives, while understanding their potential for comfort; she allows friends to start crowdfunding for her and drinks green juices. But Boyer is quick to criticize the public face of cancer: hypocritical pink ribbon campaigns, for example, which are deeply tied to corporate sponsorship, raising awareness for a disease that for millions, is all-too-familiar. “[...] Every pink ribbon looks like the flag of a conqueror stuck in a woman’s grave,” Boyer writes.

Most compelling about Boyer’s astonishing writing is that she presents a crucial way of thinking about the medical industry as it exists at the intersection of medicine, capital, war, and the environment. As someone who as a child took cyclophosphamide as an immunosuppressant in the treatment of nephrotic syndrome, I already knew that the drug was a derivative of mustard gas, but Boyer elucidates an aspect of the drug I had never considered: its effect on the environment. Boyer describes that cyclophosphamide cannot be completely eradicated from water supplies, and another drug necessary to her treatment comes from a tree that is now endangered. In writing of the environmental impact of life-saving medicine Boyer exposes another impossible strain to an already fraught situation: How can we weigh up the cost of these treatments? For Boyer, this impact, to the planet, to her family and friends, and to herself lead her to ask the most difficult of questions: “My problem is that I wanted to live millions of dollars’ worth but could never then or no answer why I deserved the extravagance of this existence.”

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This question, of course, is not one that Boyer answers. But her method of gleaning as much material, as much thought, and as much potential as she can from a truly awful experience makes this book deeply affecting. So much of what Boyer writes here is crucial to any contemporary discussion of disease, pain, care, and capitalism. Her work goes far beyond a memoir of her diagnosis and treatment of breast cancer, into profound considerations of the politics of suffering any disease or being in any kind of pain under capitalism, and particularly under voracious for-profit private medicine. Boyer is not only a deeply intelligent thinker, but she is also an extraordinary writer. The Undying gives an astonishingly moving and terrifying account of her own experience and gives language and feeling to the political, cultural, and social elements of an ever-present disease.

Katie Da Cunha Lewin is a writer, researcher and teacher based in London. She has a PhD in the work of Don DeLillo and J.M. Coetzee from the University of Sussex. Her work can be seen in Hotel, The London Magazine, Times Literary Supplement, Irish Times, The White Review, and Los Angeles Review of Books, among other places. She wrote an entry for the Dictionary of Literary Biography on DeLillo and is the co-editor of Don DeLillo: Contemporary Critical Perspectives, published by Bloomsbury in 2018.

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Update: This piece has been updated to accurately reflect Johanna Hedva’s pronouns. We apologize to Hedva for the mistake.

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