Illuminating Gender II

by Heike Hartung, Berlin

1     In a recent collection of critical essays on The Voice of Breast Cancer in Medicine and Bioethics (2006), Susan Sherwin illustrates the contradictory perspectives on breast cancer in American society by drawing up an extensive list of "common thinking" about the disease, which she supplements with the critical alternatives less widely shared. Here are a few examples from her list:

Breast cancer is curable if detected early. Breast cancer can be lethal no matter when it is diagnosed. (Lerner 2000, 2001)

Breast cancer is primarily genetic. Breast cancer is primarily environmental. (Rothman 1998; Steingraber 1998; Eisenstein 2001)

Breast cancer begins in a specific location and spreads cells from that site in a gradual, orderly fashion to expanding circles of surrounding tissue; if caught early, it can be fully removed by excising all affected tissue. Breast cancer is systemic; its cells spread through the body before any particular tumor can be located. (Lerner 2001, 3-4)

The dominant knowledge represented by the anonymous statements is related, Sherwin argues, to the use of two war metaphors in the public discourse on breast cancer: the disease as the enemy, with whom we are at war, and the woman's body as battlefield. While Sherwin's observation about the link between war metaphors and illness is not new[1]In her book on patient narratives, <em>Reconstructing Illness, Studies in Pathography</em> (1993), Anne Hunsaker Hawkins describes warship metaphors as belonging to one of the possible myths of illness around which patient narratives are organized — and as one that is very much in tune with Western medicine. This connection between war and the rise of modern medicine is also established in medical histories, see Daniel de Moulin, <em>A Short History of Breast Cancer</em> (51) and Peter Stanley, <em>For Fear of Pain</em> (97-129)., her argument highlights the limits of the public discourse on breast cancer. After having long been regarded as belonging to the private domain, often adding shame to a woman's painful experience of illness by the need to keep it secret, breast cancer emerged into the public domain in the context of the 1970s second wave of feminism. The feminist slogan that the personal is political has effectively politicised breast cancer, and has also influenced European campaigns for better methods of treatment for women and for giving them an informed choice with respect to those methods of treatment (Schmidt 2000). In the media, the discussion of breast cancer tends, however, to be restricted to certain aspects of representation, which favour "heroic tales of personal confrontations with breast cancer. Generally, such stories are structured around an optimistic formula of hope and strength, though occasional reports of tragic outcomes serve as reminders that the battle is not yet won" (Sherwin 7). The dominant public discourse on breast cancer, then, rests on the common metaphorical framework of war, reinforcing the shared perspectives of the American cancer establishment (medicine, science, commerce). As a result, the choice of the individual woman's approach to her illness is limited by the force of this institutional perspective, which restricts, or even excludes, a diversity of research approaches to cancer.

2     Taking Sherwin's critical analysis of the recent public discourse on breast cancer as my starting point, I wish to put into dialogue three different kinds of narrative approaches to breast cancer: Frances Burney's "mastectomy letter" (1812) as a personal (and also semi-public) letter which describes a patient's perspective, Maria Edgeworth's Belinda (1801) as a novel which (mis-)represents breast cancer for moral purposes, and Susan Sontag's Illness as Metaphor (1978) as an essay which analyses the cultural meanings attached to illness, while also being part of a personal strategy of coming to terms with it.[2]Lisa Diedrich, too, has read Sontag's essay as "paradoxically, a depersonalized personal narrative of illness" (54). In comparing Sontag's rationalist and depersonalized approach with Eve Kosofsky Sedgwick's performative and affective engagement with breast cancer, she gives preference to Sedgwick's relational strategy as the one more adequate to a postmodern illness experience that "queer[s] the experience of patienthood" (65). While Sontag's work does not challenge the binaries of health and illness, her approach is, however, seen as "effective in challenging the normalizing judgements attached to the experience of illness" (64). Since Diedrich's article has focused on criticism for Sontag's complicity with the dominant "biomedical approach," I will put my emphasis instead on the (mis)readings and rewritings of her essay, including her own in <em>AIDS and its Metaphors</em>, that have proved productive of new/adapted metaphors as well as providing dialogic positions for illness experience. In order to illustrate the complexities of narrative voice in Burney's letter, I will compare it to the "eye-witness" account of a mastectomy in the Edinburgh physician John Brown's story "Rab and his Friends" (1863). Before describing the theoretical frame of illness representation, I wish to draw on for placing these three narratives in a transhistorical dialogue, I will briefly introduce two related concepts that are important for my analysis: second personhood and relational subjectivity.

3     The concept of "second personhood" has been introduced into narrative theory by Mieke Bal in order to register a mistrust in narratives which mask their voices and conceal the subjects about which they speak. The distrust in third person narrative, which assumes a tone of objectivity that renders the subject of enunciation invisible, leads Bal to ask how the second person, which is often implied and referred to in narrative, can be addressed as the object and/or subject of knowledge. Her example for illustrating the importance of making the second person explicit is ethnographic writing. As a kind of academic writing which promotes a self-reflexive awareness of the "other" it constructs as second person, ethnographic writing provides Bal's model for an analysis of shifting subject positions which she defines as "second personhood." Furthermore, she draws on the work of the philosopher Lorraine Code, who has criticised the Cartesian conception of knowledge with its emphasis on the first person, on isolated individualism, as a self-contradictory notion. While the Cartesian cogito ergo sum is "itself a mininarrative in the first person," the epistemological notion of objective truth and impersonal knowledge that it sustains "is bound up with the narratological notion of 'third-person narrative'" (Bal 171; emphasis in the original). Code proposes to mediate between the positions of a self-contradictory objectivity, on the one hand, and relativism, on the other, by highlighting the importance of narrative structures for establishing forms of knowledge. The paradigm she advocates for the construction of knowledge is based on a model of friendship, setting relational subjectivity against an isolated, autonomous subject.[3]Code argues for a shift in emphasis towards communality rather than for a rejection of the idea of autonomy, since "[t]heorists who start from communality and interdependence can accommodate the requirements of autonomy better than theorists for whom autonomous existence is the 'original position' can accommodate the requirements of community" (79). Particularly in the context of illness and medical ethics this preference for relational models of subjectivity seems more adequate than sticking with the ideal of autonomy which, in the words of David Callahan, "'shrivel[s] our sense of obligation' toward one another and impoverishes health care by taking as the norm 'physicians who, far from treating us paternalistically, treat us impersonally and distantly, respecting our autonomy but nothing else" (emphasis in the original; qtd. in Code 79).[4]Sherwin, in her analysis of public discourses on breast cancer, also introduces her concept of "relational autonomy" which measures "the social and political conditions" under which a woman's choices for treatment can be made. Even more pointedly, in the context of mental illness relational subjectivity becomes an issue. In the application of performance theory to dementia care this has been explored by Anne Davis Basting 2000 and 2005, see also Annette Leibing 2006.

4     The concept of second personhood in Bal's subject-oriented narratology indicates the derivative status of personhood. Also, it draws attention to the reversible relationship of complementarity between first- and second-person pronouns, highlighting deixis as an important function of language and narrative. It is these two aspects, especially, that make Bal's approach to narrative both inclusionary and able to expose power relations. In my analysis of the three texts I will draw on this relational narratology in order to examine the subject positions involved. Additionally, I will use a form of transhistorical comparison to put the texts into a dialogue in order to expose the ways in which the ill person is conceived in these narratives, and how illness as second personhood emerges between interacting first and third person voices.

Illness Experience — Patient Narrative: A Twentieth-Century Literary and Autobiographical Genre

5     Frances Burney's detailed account of the mastectomy she underwent in Paris in 1811 is a singular document that is referred to as one of the rare historical precursors of the genre of illness narrative emerging in the late twentieth century (Hawkins xiv). Anne Hunsaker Hawkins describes the advent of the genre, which she terms "pathography" and defines as the patient's narrative of his or her illness experience, as coinciding with a moment of both scientific triumph and crisis in technological medicine, drawing attention to the "human factor," and to the perceived lack of the ill person's voice. She describes different kinds of myths (the battle, the journey, death and rebirth, healthy-mindedness) on which pathographies draw in order to come to terms with the destructive experience of illness. She attributes therapeutic function to pathography, regards it as the "missing part" which complements the medical case study, draws attention to its relation to autobiography and life writing, and hails it also as a new kind of literary genre: "In some sense, the pathography is our modern adventure story. Life becomes filled with risk and danger as the ill person is transported out of the familiar everyday world into the realm of a body that no longer functions and an institution as bizarre as only a hospital can be [. . .]" (1).