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Sarah Rubin

Dr. Lee

GWSS 490

19 March, 2015

Sociopolitical Issues in the Cancer Culture

“Cancer” – the very word is enough to strike fear in the hearts of many a

person. Millions of people around the world die from cancer each year, and as of yet

there is no known, definite cure. However, there are issues within cancer treatment

that go beyond the disease itself. While it is commonly accepted that cancer is a

horrible disease, there is still a hierarchy present in terms of both the form of cancer

and the type of person affected. Certain types of cancer are much more widely

publicized than others – for example, there are hundreds of charity events for breast

cancer awareness each year, but far fewer for colon cancer, prostate cancer, or

cervical cancer. There is also a tacit code regarding “right” and “wrong” ways to be a

cancer patient. This paper will argue that the issues surrounding the culture of

cancer and cancer treatment in the United States are just as problematic as the

disease itself.

The model cancer patient has lots of support from family, friends, and

community members. A sort of competitive atmosphere may arise, in which various

people try to prove how much they care about the patient through donations of

time, food, flowers, or money. There is nothing wrong with empathy and kindness,

of course – the problem develops when the sick person actually becomes a vehicle

for other people’s self-expression. When other people attempt to use someone’s
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situation to demonstrate their own character, the environment can quickly turn into

a toxic one. This “keeping up with the Joneses” mentality stands in stark relief with

the experiences of cancer patients with few or no friends or family to support them.

If no one is wearing T-shirts with that person’s face or posting Facebook updates

about their condition to a concerned crowd, are they sick in the same way as

someone who does experience those things? Does sickness need external

validation? Most of all, what constitutes a perfect patient?

There are several components that comprise the “perfect patient,” and these

criteria apply to cancer patients as well. The perfect patient is obedient, and always

follows the doctor’s orders. They are determined to recover, and practice socially

acceptable methods of self-care. Of course, these stereotypes are also dependent on

things like race, nationality, class, gender, ability/disability, sex, and age. If a person

is part of a marginalized group or groups, their experience as a cancer patient will

be different than someone who better fits the “mythical norm.”

Perhaps the most harmful manifestation of the “perfect patient” narrative is

the implication that an individual, and solely the individual, is responsible for the

outcome of their illness. While it is true that there are certain measures everyone

can take to improve their health, it is unrealistic and in fact harmful to suggest that a

person holds the keys to their future. The historical American “pull yourself up by

your bootstraps” attitude, which is still pervasive today, is a form of ableism that

delegitimizes the experiences of many people. There will always be circumstances

that are out of our control, and pretending otherwise benefits no one. This is most
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definitely true with cancer; while we want to believe that cancer follows certain

trends and patterns, this is not always visibly the case.

These thought patterns support the Just-World Phenomenon, which is “the

belief that what happens to people is what they deserve” (Psychology Dictionary).

Few people feel comfortable confronting their own mortality. To avoid this, they

choose to believe that when something bad happens to someone else, that person

deserved it. These assumptions may not be conscious or outwardly voiced, but this

does not make them any less problematic. As Susan Sontag astutely points out:

Ceasing to consider disease as a punishment which fits the objective moral

character, making it an expression of the inner self, might seem less

moralistic. But this view turns out to be just as, or even more, moralistic and

punitive. With the modern diseases (once TB, now cancer), the romantic idea

that the disease ex- presses the character is invariably extended to assert

that the character causes the disease—because it has not expressed itself.

Passion moves inward, striking and blighting the deepest cellular recesses.

(Sontag 46)

This line of thinking is apparent in common attitudes toward lung cancer

patients who currently smoke or have smoked in the past. In many people’s minds,

these individuals merit less sympathy than do lung cancer patients who have never

touched a cigarette. Such discrepancies in attitude often fall along the lines of class,

race, age, and gender, as well. For example, the treatment of cancer patients who

abuse drugs and/or alcohol versus the treatment of those who adhere to a strict diet

of organic food is radically different. Members of the former group are more likely to
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be brushed off as hopeless cases, while members of the latter group are more likely

to receive extra attention, greater sympathy, and even access to better drugs or

experimental treatments. However, membership in one of the afore-mentioned

groups is often tied to class – it is hard to eat organic on food stamps. In this way,

cancer patients may be discriminated against based on class.

In a similar vein, cancer patients who decline to receive traditional cancer

treatments, such as chemotherapy or radiation, are made to feel ashamed of their

decision. Even though autonomy and independence is considered to be a very

important aspect of United States culture, when it comes to medical decisions, some

choices are more socially acceptable than others. In the end, the authority of medical

professionals typically overrides any other opinions the patient themselves may

have. When a patient does choose to pursue a treatment (or lack thereof) that is not

in line with what their doctor suggested, they are often viewed as holding more

responsibility for the outcome of their illness (including blame, if the outcome is not

good). The authority of medical professionals is reinforced by the structure of health

care in our society – chiefly, by the medical-industrial complex. To frame healthcare

as part of a medical-industrial complex is to suggest that the healthcare is not

merely set up for the social good of the population’s well-being, but also for political

and economic purposes. While this paper will not go into the specifics of the

evidence supporting this concept, there are many well-written papers that examine

the issue. For the sake of brevity, this paper will operate on the assumption that the

medical-industrial complex is an accurate lens through which we can view the

current state of healthcare in the United States.

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Within the medical-industrial complex, sickness is not considered legitimate

unless diagnosed by a medical professional. Once a person is deemed sick, they are

expected to fit into the “sick role” determined by society. The sick role mandates

that an individual relinquish certain personal freedoms and autonomies in exchange

for acceptance in the face of their deviance from social norms. For people who

already differ significantly from the mythical norm (i.e. anyone who is not white,

male, young or middle-aged, upper middle class, cisgender, heterosexual, etc.), this

sense of deviance is even more isolating. One of the dangers of this isolation is the

potential for internalization of these repressive social expectations, at which point a

person begins to police themself and others according to social norms. As Susan

Bordo explains in her discussion of anorexia nervosa, hysteria, and agoraphobia,

certain “pathologies of female protest […] actually function as if in collusion with the

cultural conditions that produced them” (Bordo 159). In this way (especially with

anorexia nervosa), self-policing is taken to new extremes, and an internal war is

wrought upon the body by the mind. Perhaps these disorders are, in part, a result of

people fighting themselves in an attempt to fight the repressive system that they

have internalized and can no longer distinguish from their own self. Self-destructive

behaviors may seem to be the only answer in a society in which few people actually

feel accepted as they are.

When a person is diagnosed with cancer, they are labeled as sick and thus

isolated, at least in part, from society. As stated previously, when considering

intersectional identities, it follows that for those who do not fit the mythical norm,

this isolation is felt even more intensely. Breast cancer is an especially interesting
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case to consider, since most instances of breast cancer occur in female bodies.

Breast cancer is arguably the most publicized form of cancer, with organizations like

Susan G. Komen mobilizing thousands of people and millions of dollars to raise

awareness and funds for research. However, with this level of publicity also comes a

new level of policing. Since women are already affected by institutional sexism, the

demands of the sick role are even stronger. Women are shamed for taking less than

perfect care of their bodies, be it in terms of diet, exercise, sleep, or alcohol and/or

tobacco use. Despite the evidence suggesting mammograms may not be the be-all-

end-all that they are purported to be, the pressure for women to undergo these

breast screenings annually has intensified. There is a significant amount of guilt

induced through this persuasion as well – an American Cancer Society poster from

the 1980s sums up this attitude well with the accusatory slogan: “If you haven’t had

a mammogram, you need more than your breasts examined” (Orenstein).

Statements like this underline the culture of blame that exists within the healthcare

system; a culture in which the patient is blamed for any negative outcome

associated with their supposed “deviance” from the recommendations of medical

professionals.

Another component of breast cancer that differentiates it from other forms of

cancer is society’s view of the breast. Some people undergo surgery during their

treatment for breast cancer, which can involve removing part or all of one or both

breasts. Mastectomy, in which the breast is surgically removed, can be a very

emotional surgery. To fully understand the impact of a mastectomy, one must first

consider the social and political role of the breast. While breasts are a part a
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person’s body, they are also, in a sense, seen as belonging to the public. From dress

codes to breast-feeding controversies, everyone seems to have an opinion about

where and when breasts should or shouldn’t be seen. However, within a patriarchal

society, breasts are also a commodity. They are used to sell products, featured in

entertainment, and seen as prizes to be won. With all the value placed on breasts, it

should come as no surprise that the threat posed to breasts by breast cancer is one

that interests more people than those whom it directly impacts. This vested interest

is likely part of the reason behind the widespread publicity of breast cancer. For

many people, mastectomies or other such surgeries greatly diminish their self-

esteem, and can negatively impact the sexual relations and intimacy they

experienced in their relationships pre-surgery. However, despite the very real

concerns experienced by many women with breast cancer, it is just as harmful to

assume that breast cancer is limited to female bodies.

While “[l]ess than 1% of all breast cancers occur in men,” breast cancer can

affect anyone (breastcancer.org). For some males who develop breast cancer, there

is a certain amount of shame associated with having a “woman’s disease.”

Oftentimes men may feel isolated within spaces for breast cancer

patients/survivors. In a local example, the Mount Baker Imaging website lists

mammography, breast ultrasound, and other similar procedures under the heading

“Women’s Services” (Mt Baker Imaging). As B.D. Colen remembers:

Finally, about four weeks after first discovering my lump, I found myself in

the Comprehensive Breast Health Center at Brigham and Women’s for an

examination by a nurse practitioner. And boy, did I feel out of place. The
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young women at the front desk did their best to make me feel less

uncomfortable, but it’s hard to feel you belong when you’re filling out a form

filled with questions clearly written for women. How many pregnancies had I

had? Well…. (Colen)

Clearly, Colen did not entirely feel as though he was in the right place, even though

he had the same form of cancer as the other patients at the clinic. There are real

dangers associated with such feelings of isolation and lack of belonging, such as

people with breast cancer ignoring the symptoms or forgoing treatment out of fear

of the stigma associated with having breast cancer in a non-female body. While the

large majority of breast cancers occur in women, it is important to acknowledge that

like all cancers, breast cancer does not discriminate. Anyone can be affected.

At first glance, it might seem that cancer involves just the affected individual

and perhaps some select family members or friends and medical professionals.

However, there is another type of figure in this situation that is at once both ever-

present and largely invisible: nonprofit organizations. To many people, these

organizations merely serve as a neutral midway point between monetary donations

and the research organizations or hospitals that receive them. However, some of

these groups are much more involved than meets the eye. A prime example is the

Susan G. Komen Foundation. According to their website, at Susan G. Komen they

“educate, support research, offer grants that provide financial and emotional

assistance and advocate for better breast cancer policy. But in a broader sense,

[they] empower others, ensure quality care for all, and invest in science to find the

cures” (Susan G Komen). This paper does not mean to suggest that these objectives
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are not in themselves beneficial or well intentioned, but rather to critically examine

other possible incentives behind such objectives. For instance, upon navigating to

komen.org, one is immediately confronted with a pop-up window asking for

donations. Such reminders are scattered liberally throughout the pink-accented

website.

It is clear that the Komen Foundation, while a registered nonprofit, operates

under a standard business model. This in itself is not surprising – after all, most

large nonprofits must aggressively fundraise in order to maintain their efficacy.

However, a more substantial problem arises upon consideration of the political

involvement of such organizations. Susan G. Komen, for example, was the subject of

a major controversy in January 2012, “when it summarily cut off funding to Planned

Parenthood in what appeared to be a bow to anti-abortion crusaders” (Hiltzik). This

marks a continuation of the disturbing trend of corporations participating in politics

in the United States, and is especially distressing with an organization like the

Komen Foundation, whose sole goal is supposedly “[t]o save lives and end breast

cancer forever by empowering others, ensuring quality care for all and investing in

science to find the cures” (Susan G Komen). In addition, there have been

controversies regarding the way the Komen Foundation (and other similar

nonprofits) spend the donations they receive, such as whether they really donate

the majority of the money they raise to research.

However, even if these organizations do raise large sums of money for

research purposes, how might they be affecting the course of research? In a sense,

the existence of large nonprofits contributes to the commodification of

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philanthropy, and may influence research even more than most people realize. After

all, cutting-edge cancer research is nearly impossible without access to large sums

of money. By funding some research projects and not others, nonprofits are in effect

determining the direction in which cancer research proceeds. With so many lives

potentially at stake in the development of new treatments and early-detection

methods, it is distressing to think that a large nonprofit organization could

arbitrarily decline to help fund a research study, when that very study might have

led to the development of a drug that would have saved someone’s life.

In sum, there are numerous issues that arise when considering the ethics of

cancer and cancer treatment in the United States. It is no secret that there have been

incredible advances made in modern medicine, with thousands of lives saved thanks

to the tireless work of scientists, medical professionals, nonprofits, and others.

However, there is always room for improvement, and the U.S. healthcare system and

its approach to cancer is no exception. The existence of the medical-industrial

complex raises many concerns, several of which were addressed in this paper. There

is a hierarchy within cancer treatment, with the pervasive narrative of the “perfect

patient” resulting in the guilt and shaming of people who do not conform to social

standards and those who choose to pursue alternative treatments outside of the

recommendations of medical professionals. The commodification of philanthropy is

also a problem, with the roles played by nonprofit organizations in politics and

medical research dubious at best and harmful at worst. Finally, the social

ramifications of breast cancer and the role of the breast are a major factor as well. It

is true that there may not be a cure for cancer anytime soon. However, that does not
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mean that it’s too early to begin addressing the toxicity present in the United States

medical culture; indeed, there may not be a cure for cancer itself until we do.
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Works Cited

Attebery, Lisa, Jennifer Harned Adams, and Marisa Weiss. Breastcancer.org.

Breastcancer.org, 3 Feb. 2015. Web. 17 Mar. 2015.

Bordo, Susan. Unbearable Weight: Feminism, Western Culture, and the Body. Berkeley

& Los Angeles: University of California Press, 1993. Print.

Colen, B.D. "My Right Breast: One Man's Tale Of Lump And Mammogram." wbur's

Common Health. Trustees of Boston University, 25 July 2014. Web. 18 Mar.

2015.

Mt Baker Imaging. Mt Baker Imaging. N.p., 2008. Web. 18 Mar. 2015.

Orenstein, Peggy. "Our Feel-Good War on Breast Cancer." The New York Times 25 Apr.

2013. Web. 18 Mar. 2015.

Psychology Dictionary. Psychology Dictionary. Ed. Pamela Brian. N.p., n.d. Web. 16

Mar. 2015.

Hiltzik, Michael. "Susan G. Komen Foundation discovers the price of playing politics."

LA Times 8 Jan. 2014. Web. 19 Mar. 2015.

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Sontag, Susan. Illness as Metaphor. Toronto: McGraw-Hill Ryerson, Ltd., 1978. Print.

Susan G Komen. Susan G. Komen. N.p., 2015. Web. 18 Mar. 2015.