I’ve been reading a lot recently about the new book from Barbara Ehrenreich, Smile Or Die: How Positive Thinking Fooled America And The World, and it looks fascinating. I first have to admit to not reading it yet – it's published in the UK at the end of the week and on pre-order. But the extracts I’ve read have been interesting, disturbing and depressing in equal measure. I’ll do my first book review as soon as I’ve got through it. But here are a couple of my initial thoughts about some of the issues Ehrenreich raises.

Firstly, I’m genuinely very interested in her views on chemotherapy and the science and medicine behind the development of breast cancer treatment. Its not my area of expertise, but I’ll follow up on her sources from the book. If any readers know more please link to studies in the comments. But in summary, here is Ehrenreich talking about her book and why if she ‘had her time again’ she wouldn’t go through chemotherapy:

Plus, she believes (probably rightly) that it was the HRT that she was on that ‘caused’ or increased her risk of getting breast cancer. Certainly, there is increasing evidence for a link between HRT and breast cancer.

The two things that really struck me from the extract from her book in the Guardian was a) the devaluing of negativity and b) the particular reliance on a narrow definition of 'ultrafemininity' in breast cancer campaigning.

Ehrenreich’s whole book is about how alienating and divisive the positive-wash that cancer is given can be, how she was encouraged to view her cancer as an ‘opportunity’ or even ‘gift’ and how her anger and frustration were often scorned by others. This kind of approach is something that pisses me off on a far less extreme or important level than Ehrenreich – but I think is part of an approach within Western cultures to gloss over the shite in life.

I agree we shouldn’t wallow in negativity and if we focus on all the bad things in life we become insular, boring Emos, or worse, Goths. But sometimes we need to call a spade a fucking useless piece of shit shovel. Sometimes negativity is a good thing, a real emotion, actually brings perspective to what is positive and denying the steaming piles of turd in life can be hugely damaging.

Ehrenreich points to a few studies in the Guardian column*:

• Emotional well-being does not predict survival in head and neck cancer patients: a Radiation Therapy Oncology Group study. Cancer. 2007 Dec 1;110(11):2568-75.
• Guardian article links to Discover article on the study: Hope may be useless against cancer.
• Tomich, P. L., & Helgeson, V. S. (2004). Is finding something good in the bad always good? Benefit finding among women with breast cancer. Health Psychology, 23, 16-23. Summary here.
• Optimism and survival in lung carcinoma patients, Cancer. 2004 Mar 15; 100(6): 1276-82.
• Guardian article links to Medical News Today article: A positive attitude does not help cancer outcome.

* See some writers can link to primary sources!!

These studies show that at best “positive thinking” does not affect cancer survival but at worse that it can lead to the “tyranny of positive thinking” which can conceal distress and leave patients feeling worse. So if you’ve got cancer – its alright to feel shit, angry and frustrated. That doesn’t mean you’re allowed to be a full-time arsehole but you can let rip once and while.

The second point that I found striking was the specific type of femininity attached to breast cancer and breast cancer awareness/campaigning and again I don’t think this is a wholly positive thing. Breast cancer campaigning has been incredibly successful, has turned around society’s perception of what was once a hidden and shameful disease and with that has raised phenomenal amounts of money for breast cancer research. But, as Ehrenreich points out, this has been inextricably linked to stereotype of ultrafemininity which is pink, fluffy, appearance-focussed and somewhat reductive of womanhood to boobies.

Possibly the worst example of this, which I have linked to before, is this breast cancer awareness advert for a 'BoobiBall' fundraiser:

Breast cancer awareness tends to promote the notion that women are and indeed should be obsessed with their appearance and that the loss of a or both breasts is the worst possible thing that could happen to a woman. Not to mention the hair loss, weight gain or loss, effect on skin etc.

Now there is no doubt that hair loss and mammectomy hugely affect a number of women with cancer and alter their sense of identity or femininity. My concern would be that this emphasis on the femininity of those going through cancer treatment may exacerbate this impact. Ehrenreich talks about the breast cancer marketplace with the prominence of cosmetics and jewellery and websites that talk about chemotherapy helping you to lose weight and smooth out the skin.

What is significant here is that this same femininity is not associated with lung cancer or heart disease - both huge killers of women as well as men. It is associated with uniquely female breasts** and therefore with women’s bodies being the be-all and end-all of their identity.

** I’d be fascinated to know how men with breast cancer relate to breast cancer campaigning.

Breast cancer is seen not only as a disease attacking part of the body but attacking a woman’s identity because women’s identity is so dominated by their physical appearance and attractiveness (with a special focus on breasts). Unfortunately, as with many things, this focus on ultrafemininity is couched in feminist empowerment language and indeed, in America at least, feminism seems to have been replaced by a breast cancer cult.

Maybe less of a focus on how a woman looks during treatment for a life threatening disease is the least we can offer them?