Gita Ralleigh reviews , Breast Cancer Inside Out: Bodies, Biographies & Beliefs, edited by Kimberly R. Myers (Peter Lang, 2021)
In Breast Cancer Inside Out, Kimberly Myers, a medical humanities scholar who has herself undergone treatment for breast cancer, brings together essays from patients, practitioners involved in breast cancer treatment and academics from the health humanities field in a single volume.
The aim of the project, as Myers ably lays out in her introduction, is to move towards an inclusive health humanities account of breast cancer, one which gives voice to those with lived experience and attempts to bridge two prevailing views of the field: as a utilitarian means of ‘humanising’ medical practice or as an academic discipline, aiming to interrogate prevailing medical ideologies. Myers refers to an article on the critical medical humanities, by Viney Callard and Woods, as influencing her approach: to produce a book on breast cancer which encompasses, in their words, ‘a heterogeneous and interdisciplinary set of practices – clinical, therapeutic, artistic, scholarly, activist and educational’ (Viney, Callard and Woods 2015: 4).
There are limits to this approach, however. Myers highlights in her introductory chapter the many differences between breast cancer treatment in the United Kingdom and the United States. She alludes to socioeconomic barriers in receiving access to optimal care but does not interrogate sociocultural or race-based inequities further in this collection of essays. Because of its extremely broad scope, the book is divided into four sections, the first deals with diagnosis, treatment, and palliation; here Kevin B. Knopf’s contribution does recount his practice at a not-for-profit ‘county hospital’ and discuss the implications for health outcomes in his group of impoverished patients, many of whom present with advanced disease.
In the second section, dealing with physical and mental well-being during cancer treatment and recovery, as Myers acknowledges, much here will not be applicable to those outside a privileged context, or in today’s parlance, the countries categorised as Western, educated, industrialised, rich democracies or W.E.I.R.D. (Henrich, Heine and Norenzayan 2010). In the main, the women (and one man) who give personal accounts of their own experience of breast cancer are educated, white and middle-class, as are most of the authors writing as clinicians, practitioners, or health humanities scholars in the first section. Despite these limitations, Elva J. Winter’s chapter on intimacy and sexuality (179-192) is commendable for its straightforward approach to providing information on a topic often neglected by healthcare staff.
From a health humanities scholarship perspective, the third section is most engaging, beginning with Deborah Bowman’s hybrid autoethnographic account of her breast cancer diagnosis and treatment (195-112). Bowman discusses how as a professor of medical ethics, her perspective on patient autonomy shifts with this experience, ‘I appeared contained, constant and recognizably myself; yet I was changing and vanishing as a result of crossing into the land of the sick. It would reveal autonomy to be more complex, more contested, more nuanced than I could ever have imagined.’ (197).
This gap between medicalised language and patient experience is demonstrated in Bowman’s account. Her own advocacy, for patients to receive copies of letters from specialists, is challenged by ‘the effect of seeing my own experience captured in clinical terms with its brutal specificity, detached evaluation and the unavoidable facts laid bare’ (202). Bowman has an intense physical reaction to seeing these envelopes from the hospital on her doormat. Both her own emotions and her team’s response to them bring her to a new understanding, that ‘fundamentally, autonomy is relational. It is predicated on interaction and exchange. It does not and cannot exist without the kindness, patience, sensitivity, wisdom, honesty, commitment, and expertise of professional staff.’ (204).
Elsewhere in the same section Jennifer Hayden, in a coda to the story recounted in her graphic memoir, The Story of My Tits (Hayden 2015), provides a humorous account (249-254) of her emotional reaction to receiving a mammogram reminder, despite having already undergone double mastectomy with reconstruction. This chapter is followed by Myers’ own story (255-272) of being diagnosed with breast cancer while teaching the graphic novel Cancer Vixen (Marchetto 2009) to medical students. Although Myers has taught this text many times previously, she finds herself identifying strongly with the experience depicted, one which parallels her own, ‘Marchetto was my constant companion throughout the entire next day …and several of the weeks and months to come.’ (259). Myers decides to use individual panels of the graphic novel to discuss her own feelings with the medical team, colleagues, and her students. The experience confirms for her the unique role of graphic medicine ‘not only for teaching factual material but also for instilling in others – and reminding ourselves of – the importance of compassion and presence with one another, breast cancer or not.’ (271).
A key chapter by Joanna Shapiro places the decades-long history of women poets writing about their own breast cancer within the framework of illness narratives, focusing on how the voice of the poet resists the prevailing ‘restitution’ narrative of the medical illness models. She demonstrates how, through poetic language, these poets’ voices also break the silence around the contingent nature of life as a breast cancer ‘survivor’ while still facing the possibility of death. This silence is described by Shapiro as ‘a malignant veil dropped not only over breast cancer, but also over death itself.’ (235). Shapiro also touches on racialised experienced of healthcare, referencing the work of Black American poets Audre Lorde and Lucille Clifton (213-247).
The fourth and final section of the book includes a historical overview of breast cancer, an update on advances in treatment and genetic testing, as well as an interrogation of (U.S.) advertising tropes for drugs used to treat metastatic breast cancer patients. In addition to Siobhan Conaty’s chapter (331-368), an extensive historical review of breast cancer depicted through art, I would have liked for more space to be given to women artists’ own visual autopathographies of breast cancer, including alternate forms such as artists books (see Bolaki 2018). As Conaty herself says, ‘Understanding positions of power becomes more important and complex when looking at images of women and illness. In the end, two critical questions remain: Whose story is being told? Who has the power to tell it?’ (364).
The book ends with a moving account, published posthumously, of living with metastatic disease by Ariane B Anderson, juxtaposed with a poem, ‘The Support Group’ from Lisa Katz, whose poetry is interspersed throughout the book.
How time dies in the waiting room: months weeks
You’d counted on
longer, hadn’t you? (465)
As a radiologist who images breast cancer patients, a poet and medical humanities scholar, I found Breast Cancer Inside Out, with both personal narratives and original artistic expressions placed alongside medical and scholarly accounts, ground-breaking in its approach. It made me reconsider why medical training – or indeed medical humanities scholarship – rarely allows for individuals with different perspectives to cross divides and share their stories. As Myers states in her introduction, upon receiving her diagnosis, ‘I needed stories, both sweeping and intimate, because stories show us alternatives for how to live; they show us options we might otherwise never have considered.’ (1)
Gita Ralleigh is a poet and NHS doctor born to Indian immigrant parents in London. She teaches creative writing to science undergraduates at Imperial College London and has an MA in Creative Writing from Birkbeck, University of London and an MSc in Medical Humanities from King’s College London. Her debut A Terrible Thing was published by Bad Betty Press in 2020 and her pamphlet Siren is forthcoming from Broken Sleep Books in 2022. You can find her on Twitter @storyvilled or at https://grdelamere.wordpress.com
Bolaki, Stella. 2018 ‘Artists’ Books and Multisensory Experience: Reflections on Teaching a Visual Medical Humanities’. The Polyphonyhttps://thepolyphony.org/2018/11/12/artists-books-and-multisensory-experience-reflections-on-teaching-a-visual-medical-humanities/
Hayden, Jennifer. 2015. The Story of My Tits. Marietta GA: Top Shelf Productions.
Henrich, Joseph, Heine, Steven, & Norenzayan, Ara. 2010. The weirdest people in the world? Behavioral and Brain Sciences, 33: 61-83.
Marchetto, Marisa Acocella. 2006. Cancer Vixen: A True Story. New York: Pantheon Books.
Myers, Kimberly (ed). 2021. Breast Cancer Inside Out: Bodies, Biographies & Beliefs. Oxford: Peter Lang.
Viney, William, Callard, Felicity and Woods, Angela. 2015. Critical Medical Humanities: Embracing Entanglement, Taking Risks. Medical Humanities 41: 2–7.