The trouble with surviving cancer 'against all odds'

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The trouble with surviving cancer 'against all odds'

Cancer culture's emphasis on 'surviving' places undue burden on the individual, obscuring collective responsibility, says Lochlann Jain

by Karli June Cerankowski on Monday, June 3, 2013 - 8:56am

Cancer awareness poster stating "Early is the watchword for cancer control"Cancer. It is a word that can instill fear, despair, shame, and sadness. It is also a word that can call up hope and survival. It is a word that tarries simultaneously in worlds of illness, death, and loss, in worlds of celebration for those who overcome it, and in worlds of remembrance for those who fought the battle. Cancer. The word alone is enough to chill a person to the bone.

According to the National Cancer Institute, 41 percent of Americans will get cancer. Given that cancer affects such a large amount of the population, one might imagine a sense of collective responsibility for dealing with the causes and treatment of cancer. However, Stanford anthropologist S. Lochlann Jain suggests that cancer survival has become an individual burden. Jain's own experiences living in cancer prognosis led her to a scholarly examination of cancer culture, for a forthcoming book to be titled, “Malignant: How Cancer Becomes Us.” Combining ethnographic work at cancer support groups with critical cultural analysis, Jain argues that what she calls "survivor rhetoric" obscures collective responsibility toward the millions annually affected by cancer.

Living in prognosis brings the possibility of one’s death into closer view. The realization that death is more imminent can throw a person into a frenzied search for his or her chances of survival. After all, the discourse of survival pervades American cancer culture.

In order to get to the root of this survivor rhetoric, Jain begins with a seemingly simple question that turns out to be anything but simple: What is cancer?

What is cancer? It refers to everything... and nothing

To some, cancer is simply a disease that causes cells to divide rapidly and clump together into deadly tumors. But it is also much more than that. Different kinds of cancer affect different parts of the body, raising doubt as to whether it should be understood as one disease or as many. Different cancers respond (or don't) to different treatment methods. There is widespread debate about what causes it, how to test for it, how to prevent it, and how to treat it. The very concept of “cancer” grows, well, like a cancer.

Jain concludes that cancer is ubiquitous yet evasive. She remarks paradoxically, “Cancer, in all its nounishness, refers to everything . . . and nothing.”

We encourage individual responsibility for early detection and prevention, even while acknowledging that many environmental causes of cancer are out of our control.  

Cancer culture reveals many contradictions and paradoxes. In the United States, says Jain, “both causing and treating cancer are big businesses.” We live in a world where t-shirts meant to promote hope for a cure are manufactured using the very chemicals that potentially cause cancer. We encourage individual responsibility for early detection and prevention, even while acknowledging that many environmental causes of cancer are out of our control.  

Jain’s book offers new ways for thinking about cancer through a serious consideration of the ramifications of this contradictory culture. Jain traces the ways in which lives become erased in the production of statistics and in the cultural imperative to “survive against all odds.”

Calculating the odds and surviving 'against the odds'

“We assume survival – until we don’t,” Jain says. “You don’t really think about it until you are called into the position of survivorship (by age, illness, anxiety, prognosis), until you are asked in some way to inhabit the category, to live amid those who are not, in fact, surviving.”

Those who wish to survive are told they must do so against the odds. But this phrase — “survival against the odds” — invokes the alienating practice of calculating odds by which lives and deaths are rendered into numbers and charts.

Shoes of deported in Auschwitz“Statistical aggregations provide a logic through which bodies become interchangeable numbers for which nothing need be felt, neither guilt nor pleasure, nor horror,” says Jain. “They enable prediction.” These statistics, in all of their predictional promise, lose touch with individual lives and deaths.

As an analogy, Jain offers the poignant example of Holocaust museums in which piles of shoes come to represent the thousands murdered. The shoes, she says, resist the logic of statistics. Each shoe maintains its history in having belonged to an individual, having been worn by a specific foot. In this sense, the shoes are reminders of each individual person that died.

Data in mortality graphs on the other hand, while reflecting a heaping curve of numerical deaths, loses any reference to flesh or the individual. “The search for oneself in this chart will always end in disappointment, for numbers are not shoes,” Jain says.

In forgetting the lives lived and lost, the phrase “survival against the odds” then neglects those dying in the odds, or those whose very deaths have created the odds. The survivor literally vanquishes those who do not survive.

 “Survival against the odds” invokes the alienating practice of calculating odds by which lives and deaths are rendered into numbers and charts.

 Cancer is no individual’s fault — refocusing on communal survivorship

Survivor discourse additionally shifts our vision of accountability. It puts pressure on the survivor to survive, to sometimes unrealistically imagine oneself on the “right side” of the numbers chart. The rhetoric of survivorship often circulates around the idea that one only need adopt the “right attitude.”

Chart of cancer survival rates This approach can imply that dying is a personal failure. As Jain explains, survivor discourse “preys on fear and adds guilt to the mix.” A person might start to wonder, at deathbed, whether she or he had laughed enough, believed enough, or maintained enough of a positive attitude.

Our modern tendency to celebrate individual survival has put us out of touch with a sense of communal survivorship. Communal survivorship, Jain notes, is a concept eloquently reflected by English writer John Donne:

“No man is an island, entire of itself; every man is a piece of the continent, a part of the main . . . Any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee.”

We have lost this communal reference to survivorship, Jain argues, as survivors become distinguished from the collective of those dying because they have outlived them. Survivors are determined by their individual longevity. Our attention is then shifted onto the individual who must survive against the odds, detracting our attention from collective responsibility and corporate accountability.

Collective responsibility and corporate accountability

“Everyone knows that we are all exposed to a torrent of carcinogens every day, yet no one can tell you which, if any, caused a particular cancer,” says Jain. In fact, most carcinogens go unregulated and it is nearly impossible to bring a legal suit against a corporation that may be responsible for carcinogenic exposure. Jain argues that this lack of justice and accountability leads to a culture of fear in which we know that some things cause cancer, but we don’t know which things, or when.

Even in rare cases when a person or corporation can be held accountable, the larger contradictions between the individual and the community, between cause and cure, between surviving and dying, remain in place.

Most carcinogens go unregulated and it is nearly impossible to bring a legal suit against a corporation that may be responsible for carcinogenic exposure.

“Someone might be held accountable for a misdiagnosis or an exposure, and for that, you might yet win a compensatory award from a court of law,” Jain says, and she examines legal suits of various kinds in the book.  “But in the grand scheme of things, cancer is no individual’s fault.” If not an individual’s fault, then why is the burden of surviving placed on so many millions of individuals, while society fails to hold corporations and manufacturers responsible for contributing to collective illness?

In “Malignant,” Jain asks us to recognize how we make things like cancer become logical and acceptable. We are challenged to acknowledge those living in prognosis as not always being the ones to “beat the odds” and to recognize that there are larger entities that need to be held accountable. We must remember that statistics are sinister in their erasure of lives and in their ability to invoke fear and worry in those searching for themselves on the side of survival.


Lochlann JainLochlann Jain is an Associate Professor in the Department of Anthropology in the School of Humanities and Sciences. She received her Ph.D. in History of Consciousness from the University of California, Santa Cruz in 1999.



Karli June CerankowskiKarli June Cerankowski is a doctoral candidate in the Program in Modern Thought and Literature at Stanford University. Her research explores the queerness of abstaining from sex and the erotics, desires, and pleasures that constitute less genitally-centered forms of relationships and sexualities.



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