Commentary: Surviving Terrorist Cells : Academic Medicine

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Commentary: Surviving Terrorist Cells

Herzig, Rebecca M. PhD; Jain, Sarah Lochlann PhD

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Academic Medicine 84(1):p 11-12, January 2009. | DOI: 10.1097/ACM.0b013e3181906c99
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The use of violent imagery, war metaphors, and the “survivor” persona in relation to cancer research and treatment are examined, as are consumer-driven approaches to “working toward a cure.” The authors ask, what are the cultural and environmental trade-offs of these types of rhetoric? The positions of good guys (survivors, researchers, consumers) versus the enemy (cancer) are critically evaluated. Of especial note is a recent print advertisement that, despite its arresting visual presence, delivers an exceedingly vague message. The authors conclude that the practice of medicine plays a pivotal role in these cultural determinations and that caricatured attributions of cellular violence ultimately divert critical attention from sustained scrutiny of the institutional, social, economic, and political processes that in fact may contribute to the forces that bear on causing cancer.

As Susan Sontag has explained, war metaphors have long shaped cultural responses to cancer. From Nixon’s War on Cancer to obituary reports of lost or surrendered battles with the disease, cancer is widely represented as an individual and collective enemy. A recent, arresting advertisement for the Susan G. Komen Foundation lends fresh vitriol to the tradition, encouraging us to “punch,” “strangle,” “kick,” “spit on,” “choke,” and “pummel” the adversary. Here, the disease’s personification—the attribution of malevolent agency to lumps of proliferating cells—helps ratchet up calls for violence. When prominent cancer researchers suggest that we need to get smarter about “torturing cancer cells and getting them to confess to us which pathways they are dependent on,” one might start to wonder how to ensure that the disease gets a good lawyer.1

But for all the combative rhetoric of this particular image, the message is ambivalent. What is the point of the ad—what is it trying to show or tell us? It certainly does not highlight that staggering numbers of women are ill and dying. Rather, it looks as though this lean and muscular young woman might go on to model for Calvin Klein. Nor does it point out that carcinogens continue to be pumped into the environment (including more than a few generated from the production and distribution of glossy print magazines). The ad’s language is forceful, its message exceedingly vague.

It does suggest, though, that cancer is dangerous, meriting all manner of choking, pummeling, and strangling. If, in this story, the cells are part of an evil best spit on (if not summarily extracted, forced to confess, and executed), who might be considered the good guys, and what are their roles?

It would seem that the answer here is to be found in the taut female torso and the heroic cancer survivor it emblematizes. The survivor’s valor, beauty, and goodness act as the necessary foil to the identified enemy: lethal, personified cells. Indeed, we reflexively recognize the torso as a survivor because the figure has become such a widely recognizable social persona in recent years, providing a habitable identity for people living within statistical calculations of death’s likelihood.2,3 Within this ominous, uncertain realm, taking on the position of “survivor” carves out a vital sense of hope amid inherently uncertain probabilities; it allows the prospect of clear triumph over hazy, potential ruin.

Here, for instance, is Chip, cited in a 2003 article about new combination therapies for breast cancer:

I had a quote 40% chance of survival for 5 years and 25% for 10 years…. Now did I live by those statistics? No … [w]ith a positive attitude and hope, you can conquer anything.4

Chip offers a view, rife in popular writings about cancer, that endows the willful survivor with numinous force, one in which a “positive attitude” is the key to overcoming even the most adverse odds. The survivor chooses life and, in so doing, conquers death.

Given the quasi-mystical power attached to the figure of the “survivor,” it is hardly surprising to find how just regularly it is used to mobilize social action. In a consumer society, the cultural esteem invested in cheerful, willful survival is swiftly converted into concrete financial gain, as when the Republic of Tea invites us to “Sip for the Cure,” Yoplait Yogurt urges us to “Save Lids to Save Lives,” or BMW raises money for the Susan G. Komen Foundation through its “Ultimate Drive” campaign. Yet in writing this commentary, our concern with the survivor does not center on the unvarnished ways that images of personal grit are used to push products. Instead, we want to draw attention to how the figure at once presumes and erases certain forms of violence.

It seems worth remembering, for instance, that the suffuse pink glow surrounding the breast cancer survivor allows the repackaging of industrial by-products (such as exhaust from BMW engines or effluents from the mass production of plastic Yoplait containers)— not ordinarily construed as violent, yet incontrovertibly harmful—as somehow particularly effective in the “fight against cancer.” Such purchases allow us the conceit of cultural expiation, reparation for the grim human toll of our frenetic progress. Stirring as we may find the image (for who doesn’t love a feisty gal?), focus on the individual survivor allows us to recast uneven, systemic distributions of literal or figurative violence into cartoonish battles between good patients and bad cells, shunting aside tougher, more recalcitrant political questions.

This is not to suggest that these proliferating cells ought to be beloved rather than vilified. Our point is instead that each representation of the heroic cancer survivor (and the correspondingly repellent enemy) helps to shape what we, as a culture, are willing to consider a legitimate sacrifice and what we instead consider insufferable, illegitimate abuse. The practice of medicine plays a pivotal role in these cultural determinations, at once reflecting and directing broader distinctions between tolerable and intolerable pain. We imagine that oncological caregivers and medical professionals might join the individuals suffering cancer in eschewing packaged stories about heroic violence. For caricatured attributions of cellular intent ultimately distract from sustained scrutiny of the institutional, social, economic, and political processes that distribute the very cancers we purport to drive, drink, or walk toward curing.


1 Glaspy J. Cited by: Wallis C, Part A. Living with cancer. Time. April 9, 2007:40.
2 Jain SL. Living in prognosis: Toward an elegiac politics. Representations. Spring 2007:77–92.
3 Jain SL. Cancer butch. Cult Anthropol. Fall 2007:501–538.
4 Steinberg D. Combination therapy Tames Stage III. CURE Cancer Updates Res Educ. Fall 2003;2:34–41.
© 2009 Association of American Medical Colleges