Norm Macdonald had it right on how we talk about cancer. (So did Barbara Ehrenreich).
Of battles and brightsiding...
This week, NPR published a piece entitled, “Why ‘lost their battle’ with serious illness is the wrong thing to say.” Basically, it’s a restating of an important idea many have said before which is that using militaristic language and imagery to describe a person’s illness is problematic. The largest issue, of course, is that this verbiage casts survivors as winners and the dead as losers.
That hardly seems fair, when almost all of it comes down to factors well outside of any person’s control. Outcomes are less about personal fortitude and more about clinical pathology and the state of modern medicine. Surviving stage I adenocarcinoma of the prostate does not crown a person stronger than someone who died, say, of stage IV adenocarcinoma of the pancreas.
The author Barbara Ehrenreich noted that there was something uncomfortably “Darwinian” about all of this, when she described her own cancer (from which she eventually died—as do nearly a quarter of all Americans who reach age 50) in Harper’s.
Ehrenreich was equally skeptical of the opposite of the militarizing of cancer—a phenomenon she called “brightsiding.” From that perspective, cancer was some sort of “rite of passage.” In Ehrenreich’s description, a subculture of relentlessly positive thinking among cancer patients resembles some kind of creepy religion centered on embracing something that is demonstrably bad, rather than succumbing to the very reasonable observation that the whole thing sucks.
In reality, both the militarizing and brightsiding of disease represent two sides of the same coin—a currency trading on the faulty notion that personality traits or the right attitude have more influence on end results than they actually do.
So, I often go out of my way to avoid the language of battle when describing diseases or outbreaks. I’m not always successful. The imagery can be surprisingly hard to avoid. The reasons for this are probably twofold. First, like all of us here, I’m a product of this culture, which is disappointingly violent. Second, sometimes war (or sports, which also centers on images of the victorious and the defeated) happens to offer the best or simplest analogy that people can quickly get. These comparisons are cognitive shortcuts which often prove too tempting to resist. But that does not make them optimal.
The late comedian Norm Macdonald was all over this exact topic. Most of the world didn’t know that Norm had what turned out to be terminal cancer when he delivered this now classic two-minute bit (see below or click here). The fact that he knew he had advanced cancer when he performed this routine makes his observations all the more poignant, if only a tad less funny.
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Funny and interesting to me. I have CAD and APC, then yesterday, I received the results of a DEXA bone scan, and now I can add extreme osteoporosis to this increasing list of ailments. I’ve gone into “battle” with the CAD and used a CABG5 to extend things awhile which followed a RARP to pull out a chunk of cancer cells all at MGB. I got great care from skilled docs, so I’ve decided not to succumb to the war analogy, but instead compare myself to an old car on the New England back roads trying to keep going as the under carriage rusts out from salt on the roads, and the mechanical systems clog up and break apart. The car’s parts held up for a long time as I beat the shit out of it on those New England roads, and instead of bitching at it when it stalls and is slow to start, I am going to nurse it along, pamper it and urge it to keep going. Ernie, my local,garage closed so I can no longer go to him and ask him how to fix this or that without now driving east to MGB and plugging myself into a computer that will spit out a report about which part of my insides is going to fail next. This is not a battle with an increasing number of diseases. It’s just the old body wearing out faster than I’d prefer it would. I’ve had a good run for seventy-six years, and now I just hope when everything stops running completely, it’s quick and not too painful.
When I was diagnosed with breast cancer, I didn't realize the October phenomena led by Komen et al, of "cancer is a gift", "positivity will beat cancer", "cancer warriors"--I really appreciated a post on breastcancer.org that discussed the tyranny of positive thinking--and that it's often imposed on cancer patients to relieve others of their uncomfortable feelings. A negative attitude is just a bad day, not an implication about your prognosis. I strongly recommend "Bright-Sided".