Resisting the Heritage of Breast Cancer

“Those of us who stand outside the circle of this society’s definition of acceptable women; those of us who have been forged in the crucibles of difference know that survival is not an academic skill. It is learning how to stand alone, unpopular and sometimes reviled, and how to make common cause with those others identified as outside the structures in order to define and seek a world in which we can all flourish. It is learning how to take our differences and make them strengths. For the ‘master’s tools will never dismantle the ‘master’s house. They may allow us temporarily to beat him at his own game, but they will never enable us to bring about genuine change. And this fact is only threatening to those women who still define the ‘master’s house as their only source of support.” Audre Lorde, Cancer Journals (pg. 112)

 

The Breast Cancer Industry has become a power house, a ‘master,’ at utilizing tools provided through medicalization enabling the silencing of women through ‘advocacy.’ Subverting women’s mental, physical and emotional expressions and needs unintentionally or intentionally, women may or may not consensually comply and consent is rarely informed; informed as having all the options available and easily accessible through education. Exploring how this is accomplished through the intersectional qualities of nationalism, medicalization, and marginalization we begin to see how the barriers are blurred, effectively distracting from the reality of any true boundary. Treatment options appear limited and confined to the ‘master’s tools’ of surgery, chemotherapy and radiation while in reality there are a multitude of successful treatment options and preventative measures that remain unexplored and unacknowledged by conventional western medicine, the ‘master.’ “Expert knowledge creates the conditions for measurement, surveillance, and calculation as means of managing and regulating populations as forms of governance.” (Nichter, pg. 6) Prevention remains an afterthought to diagnosis and denial while detection and treatment remain the sustainable focus given to women in the United States. “The judgment of ‘who is better qualified’ is fraught with complex and subjective assessments.” (Harris, pg. 1770) Women experience breast cancer as bystanders, patients, victims and or ‘survivors’. Efforts to wage a national ‘war’ on breast cancer are facilitated though investment and visibility of ‘viable’ options that have been predetermined by the ‘master’ and reinforced through medicalization. The function of medicalization marginalizes alternatives, their ‘viability’ and those who seek them. It is these marginalized women searching for their own options that deserve a voice to uncover options allowing their stories to be discovered by others who may be marginalized themselves and in need of alternative options.

 

Women maintain an ideal of nationalism defined by motherhood and nurturing manifested symbolically through breasts and breast health. The ‘traditional’ nuclear family consists of a heterosexual, white, middle to upper-class ideology. “American motherhood and family must be protected from a disease that threatens not just individual lives but also the normalized socioeconomic identities and relationships that constitute a nuclear family.” (King, pg. 45) Physical impairment assumed or real threatens the ideal nuclear family, home, community and feminine nationalism. Female nationalism standardizes values and reproduction of norms, beliefs and practices. A ‘good’ family is a healthy and productive, by working and reproducing, adding to the population and value of a state through human capital. If the visual symbolic source of reproduction is damaged or stigmatized the home, family and community are degraded. The symbolic nature of feminism, motherhood and motherland produced by the landscape of healthy reproductive women is destroyed by breast cancer. Stigmatizing and transforming the normal, healthy and pure into the abnormal, unhealthy and polluted. “The concept of social norm, an important element in labeling theory, has never been denotatively defined.” (Scheff, pg. 444) The normal or nuclear family epistemology is not sustainable within the reality of breast cancer. In order to save the nuclear family, breast cancer and the symbolic nature of the breast was transformed into heroic survivorship. “The process whereby a social representation is accepted and absorbed by an individual as her (or his) own representation, and so becomes, for that individual, real, even though it is in fact imaginary.” (de Lauret, pg. 12) Gayle Sulik sociologist and author of Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health, defines this imaginary woman as a ‘she-ro’, a battle hardened woman who maintains her femininity while surviving the brutal onslaught of a breast cancer ‘war.’

 

National feminism informs and shapes the space that women inhabit. “Woman’s place in human social life is not in any direct sense a product of the things she does (or even less, a function of what, biologically she is) but the meaning her activities acquired through concrete social interactions.” (Mohanty, pg. 68) Women are placed in the domestic space; it is this space that creates complicated socialization in the arena of breast cancer. Help that is offered especially by another ‘aggressive’ woman who refuses to take no for an answer is acceptable assistance while asking for help is a social taboo and weakens the ‘nation.’ A true ‘she-ro’ would not ask for or accept help, she helps others while miraculously healing. Women colonize each other, monitoring appropriate behavior and decorum, allowing for the ‘she-ro’ model to prosper. Breast cancer walk-a-thon participants are discouraged from negativity by posted no whining signs on walk-a-thon route as observed by Samantha King the author of Pink Ribbons, Inc. and associate professor of physical and health education and women’s studies at Queen’s University in Kingston, Ontario. “To be ‘colonized’ is to be subjected to modern regimes of measurement and surveillance at the level of the body, which is subject to notice at the moment of its difference (insane, deaf, dumb, and blind) from a whole and well body.” (Hong, pg. 80) ‘Good’ women must therefore maintain their own healthy body projecting appropriate qualities to sustain the nuclear family as a ‘good’ family and capable of exemplifying the state of nationalistic prosperity.

 

The boundaries and intersections between individual, family, community and state become blurred in the mechanism of nationalism informed by neoliberalism. “The emergence of a reconfigured ‘neoliberal’ state formation in which boundaries between the state and the corporate world are increasingly blurred as each elaborates the interests of the other, often at dispersed sites throughout the social body and through practices that misleadingly appear to be outside the realms of government or consumer capitalism.” (King, pg. xi) Blurring allows misdirection and distraction from the reality of mortality relations to breast cancer. The mortality numbers are no longer daughters, wives, sisters or mothers they become collateral damage, faceless. She is a heroic soldier lost in the ‘war’ against cancer leaving her compatriots behind in a state of ‘she-roic’ martyrdom. Sulik defines the ‘she-ro’ as a hybrid between acceptable feminine and masculine qualities that perform nationalism. The ‘good’ ‘she-ro’ has a feminine appearance, conciliatory behavior, emotional sensitivity, social restraint and is adorned by feminine accoutrements. She is a successful soldier returned from battle victorious and a shining example for others to follow. “Although women are considered to be peace-makers, they have no voice in arbitration, and in times of ‘war’, more civilian women and children are injured, tortured and killed than are men in combat.” (Wetzel, pg. 207) This is true of ‘real’ ‘war’ and the ‘war’ on breast cancer, where the male deaths from breast cancer are also outnumbered. The nuclear family does not exist in reality here it is only an imagined space. Breast cancer in our society allows for minimal arbitration and the ‘master’s tools’ are forms of torture that must be survived to claim your space as a ‘she-ro’.

 

Proper nationalism has stigmatized breast cancer and even though the ‘advocacy’ movement is alive and well so are the stigmas, they have not been erased or forgotten. “Denial of [breast cancer] had been ingrained in the culture for so long that resistance to it had become second nature. Any woman drawing attention to her own cancer brought disgrace not just on herself but on everyone else with the disease….Shame itself proved to be contagious. Given these obstacles, the surprise may not be that it took so long for women to speak out about it rather that they ever had the courage to do it at all.” (Leopold, pg 214) Leopold’s statement could be shrunken to become a nationalistic motto of: ‘Drawing attention brings disgrace not just on herself but on everyone.’ Nationalism does not advocate or accept sustaining polluted burdens or nuisances of the weaker sex. “Within social fields (networks of social positions), perceptions are structured by repeated and reinforcing practices and sanctions that lead one to acquire predisposed ways of thinking, classifying, acting, and feeling, from his position within local worlds.” (Nichter, pg. 4) It is here that women have the preformed foundations of acceptable social nationalistic qualities of accepting breast cancer. “Women have learned to see our resentment and despair about our social place in the social structure, as an individual problem, and emotional disorder. Women are trained to invalidate our own experiences, understanding and feelings and to look to men to tell us how to view ourselves. Ideas, concepts, images and vocabularies available to women to think about our experiences have been formulated from the male view point by universities, professionals, industries and other organizations.” (Murphy, pg. 291) The current electronic technological resources are being utilized for questioning the relevance of practiced ideals, demanding information, and creating individual agency to determine personal relevance and irrelevance.

 

Past training provided the production of ‘good’ soldiers, women who occupied the space given to them and followed the ‘correct’ protocols. Women turned to men for these answers and trusted that their best interests were being protected and maintained. The ‘good’ soldier did not question her orders, she did as she was told and continued to uphold to the best of her ability the ideology of the nuclear family. “The logic of rationalized, categorization, measurement, and classification is that of Fordist capital, which is portrayed as having its own self-perpetuating existence. Rather than validating the human will, it subsumes the human as merely another component of the factory. Human agency is pointless and nonexistent.” (Hong, pg. 67) The breast cancer industry has implemented Fordist protocol utilizing women’s bodies as spaces to manipulate and capitalize on through detection, treatment and consumerism. “Corporations, politicians, and consumers alike use the purchase of breast cancer-related ‘good’ and services as a proxy for ‘good’ will and responsible citizenship.” (Sulik, pg. 112) Responsible citizenship is propagated from the individual, family, community up to the corporation unifying the national image while going global. Volunteer participant purchases of breast cancer-related products also osmotically transposes to consumer the ‘good’ nationalism female characteristics from the corporation associated with pink ribbon branding. Qualities of innocence, ‘good’ness, decency, morality, dependence, virtue and optimism just to name a few are for sale.

 

Marketing visually reinforces the national feminist image. It, however, maintains the first wave feminist image, supplying us with a majority of representatives that are heterosexual, white and middle to upper class. “The popularity of representations and the rationalities they propagate beg examination given cultural heterogeneity, unequal distribution of knowledge and power within societies, contests of meaning, and the subtle and not so subtle agendas of stakeholders.” (Nichter, pg. 3) The stakeholders are in reality the women who are sustaining the image of nationalism and productive citizens, yet the capital stakeholders are the corporations that have sprung up around a disease that has turned a considerable profit from anything incorporated into the pink ribbon space. The ribbon is the ultimate symbol of female nationalism, projecting generosity, inspiration and hope while suppressing the pain and death experienced through breast cancer. “The pink ribbon is an instantly recognizable set of meanings and values related to femininity, charity, white middle-class womanhood and survivorship.” (King, pg. xxiii) The pink ribbon is protected by philanthropy, the standard of ‘good’will towards all men, the surface projects ‘good,’ the ‘good’ motivations of the corporate stakeholders are profitable.

 

Advocacy and awareness sells: “The assumption that quick, convenient, and relatively inexpensive acts of giving have nonetheless powerful effects and deep spiritual meaning constitutes a common theme in contemporary discourse on philanthropy.” (King, pg. 73) Nationalism encourages ‘good’ citizens to help their neighbors through donations and volunteering, corporations have invested and profited from this ‘good’will. The pink ribbon was débuted at a polo club by Nancy Brinker, the founder of the Komen Foundation. This reality lends to the perceived marketability of the product, the market being heavily defined in an upper-class white environment. “A broad cultural preoccupation with philanthropic solutions to social problems, the discourse of efficiency and cost-cutting in business practice, changing psychological conceptions of the consumer, and invigorated consumer demands for a more ethical form of capitalism have converged to produce the transformation of corporate philanthropy from a relatively random, eclectic, and unscientific activity to a highly calculated and measured strategy that is integral to a business’s profit-making function.” (King, pg. 2) The profitability has attracted association from automobiles to lingerie and stuffed animals. “Breast cancer became a philanthropic cause par excellence not simply because of effective political organizing at the grassroots level, but because of an informal alliance of large corporations (particularly pharmaceutical companies, mammography equipment manufacturers, and cosmetic producers), major cancer charities, the state, and the media that emerged at around the same time and was able to capitalize on growing public interest in the disease.” (King, pg. 111) The ‘war’ on cancer supports this growth, participation of the masses in the ‘war’ through volunteerism and generosity, qualities of ‘good’ citizens validate the process of nationalism through consumerism.

 

Feminism is associated to consumerism by the assumed ‘innate’ female need to shop. Consumerism facilitates production contributing to the ‘good’ citizen and productive nation. “The insidious gendered nature of cause related marketing that helps reproduce associations between women and shopping, and of a more general tendency to deploy consumption as a major avenue of political participation.” (King, pg. xxv) Thus coupling of shopping with political volunteerism and generosity associated with philanthropy was perfect for the successful flourishing of a breast cancer industry and the pink ribbon. The nationalism imbedded in the success of a ‘good’ cause is rendered invisible by the emotional connection, satisfaction and the desire to do ‘good’.’ The Fordist model is apparent here. The industrious assembly line worker mentality limits the worker from being involved or having knowledge of what happens beyond that particular moment or space, this is apparent in popularity of consuming pink ribbon culture. The purchase is a satisfying and limiting experience with the consumer alleviating guilt towards an ‘afflicted’ woman through donation, as a final benevolent act with no desire to follow-up or impose any accountability upon the corporation selling ‘good’ in regards to the ‘afflicted.’ “The character’s will and desire have nothing to do with their eventual outcomes. The character’s collective inability to become cogs in the machine is not portrayed as the individualized faults of these flawed characters. The irony of evacuating agency and will from human subjects is that their failings are not their own either. Rather, the process of being incorporated into labor discipline produces the material histories of difference at the very moment these differences are supposedly being erased. Capitalism must attempt to perform the impossible trick of using these differences in the service of uniformity and standardization.” (Hong, pg. 104) The act of generosity is enough for the donor, the donor trusts that the stakeholders will utilize his or her donation in the spirit that the donation was made. These assumptions of ‘good’ uses of money donated to ‘good’ causes had varying definitions between donator, intermediary and promoted beneficiary. Ford and Tayor models ensure the continuation of uniformity and standardization of the advocacy message supporting breast cancer.

 

Prevention through screening is not prevention. The breast cancer industry purports that screening and mammograms save lives, this is under criticism. “Angie’s mother had died from the disease; she already knew that early detection was a misnomer for all breast cancers.” (Sulik, pg. 258) Angie’s mother had followed all the ‘rules,’ participating in frequent screening that never found her cancer: “for every 2,000 women screened in a 10-year period, ten women will be treated unnecessarily and only one woman will have her life prolonged.” (Sulik, pg. 20) Suggestions for screening aggressively begin at the age of 40 and earlier if you have a family history. Breast tissue in this age group is dense and the success of mammograms significantly decreases. “Mammograms frequently provide insufficient information to reach clear conclusions about the presence of tumors, and suspicious areas on a mammogram may or may not indicate cancer. The Institute of Medicine reported that 75 percent of all positive mammograms, upon biopsy, were ‘false positives.’” (Sulik, pg. 181) False positives are not the only mammography mistakes that are missed, masses undetectable in denser tissue fall into a false negative category. “Mammograms on average miss 25 to 40 percent of tumors that are actually cancerous.” (Sulik, pg. 181) The American Cancer Society states “only 2-4 mammograms of every 1,000 lead to diagnosis of cancer. About 10% of women who have a mammogram will require more tests, and the majority will only need an additional mammogram. Don’t panic if this happens to you. Only 8% to 10% of those women will need a biopsy, and most (80%) of those biopsies will not be cancer. The oft repeated statement: “Don’t panic if you are one of these women” is an impossible bit of advice to follow. Panic is the primary emotion when a mammogram must be repeated or a biopsy performed, transcendence through breast cancer is not desired nor is the loss of hair or breast. Women attach their identity to their body and losing control of it along with possibilities of breast amputation creates a well founded panic in the reality of breast cancer mortality.

 

The question here is; are there any answers to be found out of all of these ‘false’ answers? “Even the most conservative scientists agree that approximately 80 percent of all cancers are in some way related to environmental factors. The inescapable conclusion is that if cancer is largely environmental in origin, it is largely preventable.” (Arditti, pg. 666) Cancer is defined as a disease derived from an assumed exposure that you had no control over, when in reality cancer is your body attempting to heal itself from chronic injury. Rapid growth and healing cells, T cells, that created us in the womb are suppose to remain dormant after birth but in the face of chronic injury they become desperate and attempt to help, creating uncontrollable growths as they were never suppose to be stimulated in this way. “AstraZeneca and its allies in the National Breast Cancer Awareness Month, such as the American Cancer Society, continue to carefully avoid environmental issues, or indeed reference to prevention in general.” (King, pg. xxi) Cancer and other diseases are not ubiquitous; the high rates of cancer in the U.S. do not correlate globally, yet. “The incidence of breast cancer and of heart disease in [Japanese] men and women is about one-third of that in North America.” (Lock, pg. 500) The Japanese culture as the leaders of global health statistically proven through longevity and incidence of illness and disease results in analysis of what are we doing differently than the Japanese and how can we change to become healthier. Change is difficult in a nationalism attitude that potentiates instant gratification as a social entitlement, especially when the change comes from a culture that we are socially and economically competitive with. “Focus on finding a cure for breast cancer, rather than on prevention of the disease, has been subject to critique from some prominent scientists and breast cancer activists.” (King, pg. 38)

 

If there is any questioning left about the corporate interest in cancer Ralph Moss answers it in The Cancer Industry exposed in 1989. “The close ties between industry and two of the most influential groups determining our national cancer agenda – the National Cancer Advisory Board and the President’s Cancer Panel—are revealing. The chair of the President’s Cancer Panel throughout most of the ‘80’s, for example, was Armand Hammer, head of Occidental International Corporation. Among its subsidiaries is Hooker Chemical Company, implicated in the environmental disaster in Love Canal. In addition, Moss, formerly assistant director of public affairs at Memorial Sloan-Kettering Cancer Center (MSKCC), outlines the structure and affiliations of that institution’s leadership. MSKCC is the world’s largest private cancer center, and the picture that emerges borders on the surreal: in 1988, 32.7 percent of its board of overseers were tied to the oil, chemical and automobile industries; 34.6 percent were professional investors (bankers, stockbrokers, venture capitalists) Board members included top officials of drug companies—Squib, Bristol-Myers, Merck and influential members of media—CBS, the New York Times, Warner’s Communications, and Reader’s Digest—as well as leaders of the $55 billion cigarette industry.” (Arditti, pg. 669) The cancer industry search for a cure is better defined by the American Cancer Society’s statistical definition of the term cure, any patient that survives beyond 5 years of initial diagnosis living to be treated again with the ‘master’s tools’ creating the economic dependency on this cycle of treatment. “Lorde was concerned that normalizing women’s experience through appearance and artificial restoration gave the medical system permission to pathologize, discipline, and profit from women’s cancerous bodies.” (Sulik, pg. 341)

 

“I believe that socially sanctioned prosthesis is merely another way of keeping women with breast cancer silent and separate from each other.” (Lorde, pg. 14)The female body is regenerated through prosthetic manipulation to secure the healthy appearance of the medicalized body. “The strategy of much beauty-related advertising is to suggest to women that their bodies are deficient; but even to those without such explicit teaching, the media images of perfect female beauty that bombard us daily leave no doubt in the minds of most women that they fail to measure up.” (Bartky, pg. 33) Media direct to consumer advertising leaving imprinted ideology indelibly written on the subconscious of women. The idea that a pill can fix any of your ‘problems’ no matter the contraindication or side effects, a pill is the answer. In other words western medicine is infallible. “The danger, of course, is that the ‘Western’ body remains unproblematized. But increasingly research suggests that perhaps it is this body that should be thought of as anomalous.” (Lock, pg. 503)

 

Feminine medicalization has been compliant with feminine nationalism leading to breast cancer marginalization. “The construction of gender is the product and the process of both representation and self-representation.” (de Lauret, pg. 9) This compliance has lead to the medicalized transformation or transcendence through breast cancer, where women enter the realm of breast cancer weak, agreeable, compliant and fearful and emerge like a newly formed butterfly; strong, determined, assertive, courageous, prideful and last but not least beautiful. The ideology surrounding ‘survivorship’ advocates these transitions as expected outcomes. “The insignificance of these character’s lives leads to a sense of their interchangeability. Not only are the events of character’s lives repetitive within their own narratives, but they start to repeat each other.” (Hong, pg. 101) Sulik’s ‘she-ro’ lives here enforcing the necessary steps toward transcendence as a rite of passage to true womanhood. Proper participation is monitored, there is no room for negative emotions or experiences and as King noted ‘whiners are not allowed.’ “Breast cancer groups that embrace patient-empowerment as a way to mobilize critical engagement with biomedical research, anger at governmental inaction, and resistance to social discrimination remain a small minority, swimming against the tide of pink ribbon perkiness.” (King, pg. 108) The myth that a positive attitude towards breast cancer will heal becomes overpowering in the pink ribbon culture. “Social support and positive mental attitude can contribute to positive health outcomes, but they do not predict survival.” (Sulik, pg. 243)

 

“The assumption of women as an already constituted and coherent group with identical interests and desires, regardless of class, ethnic or racial location, implies a notion of gender or sexual difference of even patriarchy which can be applied universally and cross-culturally.” (Mohanty, pg. 64) The largest mistake in the machinery of the breast cancer industry is implied identical status of all women, that each woman enters the machinery of Taylorism or Fordist quality and is produced into a ‘she-ro’ assembly line quantity. “While we thought that we marking the F on the form, in fact the F was marking us.” (de Lauret, pg. 12) The social conditions here are out numbering and overpowering the biological conditions. “If the deconstruction of gender inevitably effects its [re] construction, the question is, in which terms and in whose interest is the de-re-construction being effected.” (de Lauret, pg. 24) The stakeholders are controlling the effect and the affected interests. Class is marginalized by the machinery while it confuses it simultaneously; several studies have noted that there is a higher incidence of breast cancer in affluent women. Syd Singer a medical anthropologist contributes this to fashion and specifically to bra use. Affluent women wear tighter bras for longer periods of time effectively castrating their breast from their bodies with a tourniquet like action.

 

Women’s disadvantage in the realm of breast cancer is not balanced with their resistance to it. “When group identity is a predicate for exclusion of disadvantage, the law has acknowledged it; when it is a predicate for resistance or claim of right to be free from subordination, the law determines it to be illusionary.” (Harris, pg. 1766) The illusionary status of women who resist the ‘she-ro’ status and the pink culture around it find themselves in segregated states. “Setting the standard for survivorship, ‘she-ro’ has become the public voice for breast cancer survivors, drowning out alternative ways of thinking about, and dealing with, breast cancer.” (Sulik, pg. 326) The women who resist become the missing women in statistical evidence of breast cancer. “Today’s breast cancer culture dictates the terms of women’s shared experience in ways that marginalize those who do not passionately participate and cheerfully comply with the culture’s rules of survivorship. There is no room for lackluster support, contemplation of scientific controversies that do not rely on the mass proliferation of screening programs.” (Sulik, pg. 274) Vicki has stage 4 breast cancer; the evidence is in her missing breast and the pictures she has taken of its evolution and separation from her body. Vicki has chosen to use nutrition as her tool to health and life; she has lived 6 years pain free and is now healing as evidenced by her body’s attempt to rebuild breast tissue. The ‘master’s tools’ were never used on Vicki’s body, and according to the American Cancer Society she is already cured surviving 5 years after diagnosis. The resistance to conformity and conventional medicine here is a voice silenced by the lack of medical acknowledgement that she could and does exist outside their boundaries and intersections. “As a key figure in the women’s health and breast cancer movements, Rose Kushner especially emphasized a medical consumerist philosophy that recognized that information varied in quality and did not necessarily lead to the kind of knowledge that would save a person’s life.” (Sulik, pg. 34)

 

Imaginary knowledge and ideals surround breasts. Breasts do not uniformly fit into A, B, C, D or DD categories any more than women fit into assumed homogenous categories capable of ‘she-ro’ transformation. “Poor women for example, are much more likely to suffer from cervical cancer. By contrast, at least among older women, breast cancer is more common among the affluent. These patterns, which at times can become quite complex, illustrate the general point that, even in the case of reproductive health, more than biological sex is at issue.” (Krieger, pg. 18) It is the patterns that separate women in the U.S. from Japanese women that need to be addressed as Syd Singer has done to initiate movement towards a healthier outlook for breast cancer. “It is a particular academic arrogance to assume any discussion of feminist theory without examining our many differences.” (Lorde, pg. 110)

 

Women’s position in medicine and society repeats the cyclic reproduction of nationalism, medicalization and marginalization. “Identity of ‘the other’ is still objectified, the complex, negotiated quality of identity is ignored, and the impact of inequitable power on identity is masked.” (Harris, pg. 1764) The ‘she-ro’ identity while forcefully presented as the majority position lacks power and sustainability. She cannot exist in this imaginary vacuum forever. “The crux of the problem lies in that initial assumption of women as a homogeneous group or category (‘the oppressed’), a familiar assumption in western radical and liberal feminisms.” (Mohanty, pg. 79) The ‘she-ro’ attempts to reinstall first wave feminism, the ideology of the white heterosexual middle to upper class women performing super human feats and becoming stronger in the process when in reality she weakened by the mirage she must maintain and the reality of what the ‘master’s tools’ have written into her body in Kafkaesque qualities. “To being to understand how our social constitution affects our health, we must ask, repeatedly, what is different and what is similar across the social divides of gender, color, and class. We cannot assume that biology alone will provide answers we need; instead, we must reframe the issues in context of the social shaping of our human lives- as both biological creatures and historical actors. Otherwise, we will continue to mistake—as many before us have done—with is for what must be, and leave unchallenged the social forces that continue to create vast inequalities in health.” (Krieger, pg. 21)

 

“As long as the breast cancer agenda is dominated by multinational corporations and their nonprofit partners, there is little hope that the ‘barriers and burdens’ encountered by poor women will penetrate the peppy public consciousness or elicit the kinds of policy responses that might actually make a difference to them. Indeed, one of the key features of the neoliberal state is its refusal to view the amelioration of poverty as one of its central obligations or to view the ‘subject of compassionate action, to quote Lauren Berlant, as ‘any member of a historically and structurally subordinated population.’” (King, pg. 118) The female subordinated position leaves her victim to social contributions to her medicalized status and her marginalized state. “It is not always possible to see where nature ends and culture begins.” (Scheper-Hughes, pg. 19) It is possible today to see how culture affects nature and vice versa, the answers are not where the two meet but in the areas where the two overlap. The dichotomous world does not create answers only questions, in moving beyond dichotomies and searching out the patterns answers may be found. “The idea that users of health services should be able to make informed decisions about their medical choices seemingly places control in the hands of patients and advocates. In reality, the medical system, the breast cancer industry, and the pink ribbon culture work together to control the information women need when making their choices, while defining the options available to them. The industry that benefits from the increased use of mammography and pharmaceuticals is at the core of what has become pink ribbon culture.” (Sulik, pg. 210)

 

The pink culture must be questioned, how it works, what it creates and how it effects to find the answers outside of the dichotomy of participant or nonparticipant. “The upbeat message of breast cancer survivorship provides a counterbalance to the feelings of fear and uncertainty that accompany diagnosis and treatment. The simplistic overemphasis on normalization, transcendence, and empowerment in pink ribbon culture obscures this complexity. The mandate for optimism involves an aesthetic approach to normalization through appearance and self-preservation, which integrates social expectations for women’s conciliatory behavior, specifically the suppression of any feelings that might destabilize upbeat social interaction. Many diagnosed women refuse to participate in pink ribbon culture precisely for this reason.” (Sulik, pg. 237) Resistance to participation should not be grounds for action against these women socially or medically. “The social pressures that women serve others even when facing a life-threatening illness reverberated throughout interviews, making it difficult for women to set boundaries that would allow them to put their health first.” (Sulik, pg. 293)

 

Real women have real questions that medicalization has been unable to answer. “Have I survived? I won’t know unless I die of something besides breast cancer. The term is overused.” (Sulik, pg. 320) Women are demanding better answers and instigating a movement towards alternative medicine in the face of unsuccessful conventional options. “In our world, divide and conquer must become define and empower.” (Lorde, pg. 112) Women no longer want to participate in a stalemate ‘war.’ The risks are too great and the benefit too little for the foot soldiers involved. “The worst thing anyone can ask about any war is whether those who died in vain.” (Sulik, pg. 363) Sadly many may categorize the deaths from breast cancer that could possibly be prevented as senseless loss of life and meaning that could be prevented. “The embrace of a lie could occur only when oppression makes self denial and the obliteration of the identity rational and in significant measure, beneficial.” (Harris, pg. 1743) The obliteration of these foot soldiers in the ‘war’ on breast cancer is only beneficial to the machinery that continues to operate and flourish in cyclic system, we cannot use the ‘master’s tools’ to dismantle his house as Lorde states yet maybe we should take Kafka’s approach and destroy the machine.

 

“It is obvious enough that ever since a discipline such as history has existed, documents have been used, questioned, and have given rise to questions; scholars have asked not only what their documents meant, but also whether they were telling the truth, and by what right they could claim to be doing so, whether they were sincere or deliberately misleading, well informed or ignorant, authentic or tampered with.” Michele Foucault (pg. 6)

 

 

 

 

Works Cited

 

Arditti, R., & Schriber, T. “Breast cancer: The Environmental Connection.” Sojourner: A Women’s Forum. 1992.

Bartky,S.L. “Foucault, Femininity, and the Modernization of Patriarchial Power.” 2003.

De Lauret. “Technologies of Gender.” Bloomington: Indiana Univerisity Press, 1987 1-30.

Foucault, Michel. The Archeology of Knowledge. NY: Harper and Row, 1976, 3-39.

Harris, Cheryl. “Whiteness as Property.” Harvard Law Review 1993:Vol. 106, #8, 1707-1791.

Hong, Grace Kyungwon. The Ruptures of American Capital: Women of Color Feminism and the Culture of Immigrant Labor. Minneapolis: University of Minnesota Press. 2006. 

King, Samantha. Pink Ribbons, INC. University of Minnesota Press. 2006.

Krieger, N.,& Fee,E. “Man-made Medicine and Women’s Health: The Biopolitics of Sex/Gender and Race/Ethnicity.” Women’s Health, Politics and Power: Essays on Sex/Gender, Medicine, and Public Health. Amityville: Baywood Publishing Company. 1994.

Leopold, E., A Darker Ribbon. Boston: Beacon Press. 1999.

Lock, M.M. and Kaufert, P. “Menopause, Local Biologies, and the Culture of Aging.” American Journal of Human Biology. 2001. 13, 494-504.

Lorde, A. Sister Outsider: Essays and Speeches. Tinmonsburg, NY: The Crossing Press. 1984.

Lorde, Audre. The Cancer Journals. San Francisco: Aunt Lute Books. 1980.

Mohanty, Chandra. “Under Western Eyes: Feminist Scholarship and Colonial Discourses.” Femininist Review. 30, Autumn. 1998.

Murphy, M. “Women and Mental Health.” Personally Speaking. Dublin: Attic Press. 1985.

Nichter, M. “Theories of Representation:Why Cultural Perceptions, Social Representations, and Biopolitics Matter.” Global Health. Tucson: University of Arizona Press. 2008.

Osherson, S.,& Singham, L.A. “The Machine Metaphor in Medicine.” Social Contexts of Health, Illness, and Patient Care. Cambridge: Cambridge University Press. 1981.

Pierce, Tanya Hearter. Outsmart your Cancer. Stateline, Nevada: 2004.

Scheff, T. “The Labeling Theory of Mental Illness.” American Sociological Review 1974. 39, 444-452.

Scheper-Hughes, N. and Lock, M.M., 1987. The Mindful Body: a prolegomenon to future work in Medical Anthropology. Medical Anthropology Quarterly, 1, 6-41.

Singer, Sydney Ross & Soma Grismaijer. Dressed to Kill. Hawaii. 2002.

Sulik, Gayle A. Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health. Oxford: Oxford University Press, 2011.

Tortora, Gerard J. & Sandra Reynolds Grabowski. Principles of Anatomy and Physiology. Harper Collins College Publishers.1996

Weitz. “The Politics of Women’s Bodies.” Sexuality, Appearance and Behavior. Oxford: Oxford University Press.

Wetzel, J.W. “Women and mental health: a global perspective.” International Social Work 2000. 43.

 

 

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Pink Ribbon Blues by Gayle A. Sulik: Book Review

Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health. Gayle A. Sulik. OxfordUniversity Press. 2011. 402 pp.

The forward for Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health authored by Bonnnie Spanier PhD, as a microbiologist and molecular geneticist, frames Gayle Sulik’s book as providing “an authoritative, evidence-based approach to distinguishing well-grounded hope from misleading hype,” (pg. viii).  The Pink culture is described as ubiquitous, this statement does not overreach today’s pink climate, the headlines on the internet contain a pink ribbon, your kitchen appliances now come in the appropriate shade of pink, steering wheel covers sport the ribbon, logos pertaining to pink cover collegiate bodies walking to class…. It is everywhere, and for breast cancer ‘survivors’ like my mother this is overwhelming and unwanted external stimulus. Sulik uncovers the optimistic face of breast cancer and the statistical manipulation required to sustain the ‘pink’ optimism.  Mortality rates for women have not changed in fifty years despite the not so ‘new’ progress in treatment and detection while genomics and protemics confuse and obscure twistable data towards the ‘tyranny of cheerfulness” while examining the morality of corporation participation in further embodiment of human medicalization, discourages analyzing the voices that are missing or silenced by this pinked culture. Sulik herself puts it this way; “Lives are at stake. The plausibility of reaching that goal (or ‘cure) has been diminished not through lack of effort, investment, visibility, or will but through misdirection and distraction,” (pg. xiv). Sulik explores the misdirection and distractions and allows those silenced to speak and the missing to be found in an accepting space that does not require a ‘tyranny of cheerfulness.’ Through research and encouragement of co-writers she confronts a challenge of moving outside of the pink box to analyze health information that can empower and or pressure patients into utilizing treatments that may not improve quality or quantity of life.  It is the ‘quality’ that Sulik focuses on as the goal for any sustainable life.

Sulik’s first chapter frames the question; ‘What is Pink Ribbon Culture?’ Her use of visually loaded descriptors is eloquent in her articulation of a doctor’s office maintaining an ambiance of an ‘ultra-feminine pink kitsch’ referencing the ability of pink ushering women backwards into an infantile innocence where it is acceptable to sell grown women ‘pinked’ stuffed animals while men with prostate cancer are not given Mattel toy cars with blue ribbons on them.  This infantilizing bleeds over into every aspect of breast cancer treatment’s promotional consumeristic aura.  The kitsch is an appropriate descriptor of this phenomenon; the direct to consumer advertising has potentiated this kitsch aesthetic. Suvivorship becomes a rite of passage to return these women back to adulthood after the regression to innocent childhood through the transformative powers of disease and its ability to transcend their previous existence into an enlightenment of survivorship.  The transformative qualities of disease create a level of pride earned by successful completion of this ‘rite of passage.’ Sulik places research agendas, promoting profitable systems of screening, pharma and consumerism as counterproductive and in no way reflective of the breast cancer ‘survivor’ experience. Advocacy does not erase the ugly reality it only silences it through maintaining a stigma against ‘bad’ attitudes that undermine the ‘tyranny of cheerfulness. “Sober accounts that reveal realism, cynicism, ongoing struggle, or death often fall on the margins,” (pg. 14).

Breast cancer is not a unitary ‘pinked’ experience nor is the movement unitary yet the facade creates a ‘pinked’ unitary norm.  Gender roles designated at birth by the traditional painting of a little girls room pink creates the ideal of pink enhanced through cultural norms of innocence, nurturance, sensitivity, support and an awareness that expands and reinforces societal gendered expectation through a simple recognition of the color pink.  “Since breast cancer places the social integrity of a woman’s body in jeopardy, restoring the feminine body (or at least normalizing its appearance) is a sign of victory in the war on breast cancer,” (pg. 15). The dichotomy of protecting ‘pink’ values is championed by the war analogy.  Historically women and children are collateral damage outnumbering the deaths of actual acknowledged war related deaths; it is an irony here that breast cancer that kills more women than men is used to sustain a ‘pink’ war attitude.  Feminine and masculine aesthetics merge to create the survivor.  ‘Pinked’ gender norms expand to include strength, courage, and aggressiveness forged through a battle returning victorious, revitalized and ultimately transcended.  Women are better for having had breast cancer. Tragedy can, has and will be utilized to create opportunities for profit through the vehicles sympathy and empathy. Narrowing the expectations of breast cancer through pinking creates specific values and ideas about normalization creating an invisible disease.  Audre Lorde’s army of one breasted or no breasted women does not rise up to defend these women, they are hidden behind and under the wigs and prosthetics erasing the evidence of any war.

The history of breast cancer is developed in; Chapter 2 The Development of Pink Ribbon Culture.  Breast cancer began as socially stigmatized deviation that the ‘victim’ bore some level of responsibility for.  This assumed deviant behavior responsibility is not an expired notion.  Women still carry a personal form of doubt about what causes breast cancer.  Science has not found the silver bullet explanation and the community of breast cancer has difficulty seeing cause in pyramidal effects. “In addition to high mortality and a corresponding fear that breast cancer was synonymous with a death sentence, the taboo surrounding breast cancer intensified medical and social mores that promoted women’s dependence on paternalistic medicine,” (pg 27).  Outreach communities and bodies of support for breast cancer patients with forums of information and funding raising abilities for a deviant disease was unthinkable. The Breast Cancer Movement created an atmosphere reversing these preconceived notions.  The 1970’s were the decade of empowerment following a decade of uprising demanding empowerment.  Medical knowledge began its public debut through information sharing and informed patient doctor relationships.  Following in the war analogy the Department of Defense Peer-Reviewed Breast Cancer Research Program of 1993 began active participation in ‘defeating’ breast cancer and the growing community of a known breast cancer population, this growing acknowledged population began an erosion of the stigma surrounding the disease.  An optimistic ‘culture of survivorship’ takes root and flourishes through the birth of the pink ribbon that merged advocacy and industry. Medical Consumerism fosters the informed patient consent though Sulik continues to question the validity of the information allowed to be dispersed to the reality of censoring information to steer or manipulate the desired decisions. The 1970’s maintained radical mastectomies that are questioned today as possibly inappropriate health care, “the results were debilitating and produced no real health benefit,” (pg. 33).

Aesthetics and normalization had its foundation in Victorian etiquette.  “Breast cancer was characterized to be a malady of the weaker sex, just another female problem that resulted from women’s reproductive malfunctioning, negligence, sexual impropriety, or some other undisciplined behavior,” (pg. 36).  This was the basis for stigmatization and created a space of assumed accountability and punishment. A multitude of programs were developed from the 70’s that propagated information in censored ways.  “Reach to Recovery even forbade volunteers from discussing medical information to avoid contradicting doctors,” (pg. 38). Focus remained appropriate to Victorian standards a white, heterosexual, and upper class discouraging access here to multitudes of women, just as first wave feminism did. Breast cancer ‘survivors’ were expected to normalize and appear ‘happy, whole, restored, and better than ever.’

Sulik presents three key factors to what is getting in the way of the eradication of breast cancer.  “The known risk factors account for only thirty percent of breast cancer cases,” Secondly “Pink ribbon culture omits, marginalizes, or downplays environmental factors, even though individual breast cancer advocates an grassroots breast cancer organizations have increasingly focused on the environmental links to breast cancer,” Thirdly “Big Pharma uses advertising to exaggerate the benefits of their products, conceal risks, and expand their market base, even though the benefits of chemotherapy are often fewer than we think,” Resulting in a booming cancer industry that performs ‘proper’ citizenship with profits “with the goal of dominating the market, pink ribbon culture provides the organizational structure and cultural resources necessary to gain consumer loyalty and public trust while taking advantage of the good will and intentions of individuals who would like to do something about breast cancer,” (pg 62-63).

The dichotomy created by the pink ribbon is discussed in; Chapter 3 Mixed Metaphors: War, Gender, and the Mass Circulation of Cancer Culture. “Forcing sides in the war enabled the emergent cancer culture to blame women who did not engage properly in battle, castigating women who did not follow the commands of medical authorities,” (pg. 74). Ambiguity is met with the fear of uncertainty creating unmanageable issues that were unacceptable to the ‘pink’ culture, adhering to the business rule of ‘know the answer before you ask the question.’ Culture values are higher for the healthy, normal and pure, while no one fits these categories, all of us only being able to find unity under a title of ‘mutant’ where the abnormal, unhealthy and polluted reside as a population thinking that we are normal even though we acknowledge personal variants that move us away from normal.  Lance Armstrong is brought into play here by Sulik to demonstrate the male ethos of the American Cancer Culture in contrast to Gilda Radner’s female appropriate ethos exemplifying generosity, inspiration and hope as pink femininity is maintained. Sulik uses the term ‘pink femininity’ to describe an assumed softness, innocence, dependence, and virtue of girlhood and true womanhood as they are posed and defined by female deviant traits of opposition to independence, cunning and manipulative seduction. “Pink ribbon culture reminds women that the problem of breast cancer can be solved if women know their place and do what they’re told,” (pg. 99). The She-ro becomes Sulik’s ultimate ‘survivor’ who knows her place and does exactly what she is told exemplifying the perfectly pink role model.

Sulik begins Chapter 4 Consuming Pink: Mass Media and the Conscientious Consumer with “In modern capitalist society, everything has its price,” (pg. 111).  Samantha King’s Pink Ribbons, Inc. is cited throughout Sulik’s writing coming to focus in this chapter.  Women magazines reinforce the ‘pink’ attitude awareness and support for the ‘cure.’  Early attitudes toward health allowed doctors to decide what their patients should or should not be told.  Magazines printed disclaimer statements following guides to self breast examination such as “intended to help you know more about your breast, but not to help you make judgments about your health.  Leave that to your doctor,” (pg. 117). Women’s actions limited to established medical ideals about the feminine body that did not allow for any questioning establishing dependence on men, doctors and husbands. Two events that are credited for expanding and creating ‘The Breast Cancer Audience’ are the 1985 National Breast Cancer Awareness Month and the 1992 branding of breast cancer with the pink ribbon. “Cultural representations (including advertisements, promotional material, and mass media) are a dimension of social reality in which people learn what should frighten them, offer them hope, and make them feel good about themselves and their situations,” (pg. 125).  In 2007 Komen redesigned the pink ribbon into a form that they could patent along with a ‘cure’ logo.  Corporation competition demanded ribbon availability at the price of a donation and Komen desired to distinguish themselves from generic donation.  The ribbon propagates, sustains and expands appropriate ‘pink’ attitudes and actions.

“The absolute risk of dying from breast cancer as decreased about 0.05 percent from 1990 to 2005.  Yet a woman diagnosed with invasive breast cancer gets more treatment spends more money, and has about the same chances of dying from the disease as she did 50 years ago.  Why aren’t we winning the war?” (pg. 1  59).  Sulik asks this question in Chapter 5 Consuming Medicine, Selling Survivorship, after already providing the answer.  The ‘cure’ would collapse and multibillion dollar business, why would they want a ‘cure.’ “The force of profitability of breast cancer detection and treatment cannot be ignored as a key element of society’s failure to eradicate breast cancer,” (pg. 160).  Prevention is rarely advocated in these circles although society is applying pressure to reverse this standard.   Mammography exposes women to 5 years of radiation if the protocol of one every two years starting at the age of 40 is followed.  The Institute of Medicine reports that 75% of ‘positive’ mammographies are false positive, and that they miss on average 25-40% of cancerous tumors,” (pg. 181). These errors lead to over diagnosis, under diagnosis and overtreatment. The cost benefit analysis leads one to believe that screening may not be ‘worth’ it. General Electric’s revenues from mammography increased from $3 billion in 1997 to $9 billion in 2007.  Pharma statistics paint a similar picture only exchanged billions for trillions.  The amount of money produced through the ‘disease’ of breast cancer with minimal change in mortality rates is a sobering reality supported by Sulik’s data.

Chapter 6 Under the Pink: Optimism Selfishness, Guilt and Chapter 7 The Balancing Act, are emotional personal stories of women that either adhered to the ‘pink’ rules or were deviant, supporting Sulik’s previous 5 chapters with analyzed testimony. Sulik develops the Feeling Rules.  Feeling the Rule I: Optimism (Incorporation of the She-ro and Rejecting the She-ro) advocates normalizing, avoiding complaints and empowerment; Feeling Rule II: Selfishness (She-roic Selfishness (i.e., Rational Coping Strategy) and Selfishness as Confessional) promoting sisterhood, symbolic activities and transformation supporting mental health and Feeling Rule III:  Guilt (The Inadequate She-ro, Embodied Social Stigma and Family Disruption) failed she-ro attempts, embodied social stigma and being a burden.  These rules access how a woman should or should not feel or act, and the consequences of following or deviating.

“Today’s breast cancer culture dictates the terms of women’s shared experience in ways that marginalize those who do not passionately participate and cheerfully comply with the culture’s rules of survivorship.  There is no room for lackluster support, contemplation of scientific controversies, inquiry into conflicts of interest between cancer advocacy and the cancer industry, alternative ways of coping that do not involve pink consumption, or public health strategies that do not rely on the mass proliferation of screening programs,” (pg. 274).

Truth is sought out and defined in; Chapter 8 Shades of Pink.  The truth presented by Pink Ribbon Blues is the silenced and marginalized section of women that are left out of the perky pink parade.  War remembers the victors and conquerors not the fallen or the unpopular, or as the old radio talk show celebrity Paul Harvey used to say “and now we know the rest of the story” that Sulik is unveiling.  The rest of the story for breast cancer exists underneath of and pushed out to the margins waiting for their time and their voices to be heard.  The women whose experiences are exhibited here speak of the inaccuracy of being a survivor, they won’t feel that they have survived unless their death is caused by something else and they do not wish to survive, they wish to live.  These sentiments echo the message that Audre Lorde gave voice to in the 1980’s.  She feared that normalization and the dogma of appropriate cause and effect relationship between women and breast cancer would be exploited for profitability.  Sulik confirms Lorde’s fears.

The ideology that being against pink ribbons translates to being against women with breast cancer is resituated in; Chapter 9 Rethinking Pink Ribbon Culture.  We can think of the yellow ribbon here as well. Just because you are against the war does not default to a reality that you’re against the solider.  Anti-war sentiment can and have been taken as a personal assault towards the soldier and the soldier’s family, this may not be accurate, as the soldier is ‘victim’ in the machinery just as the breast cancer war ‘victim’ is.  Presenting an anti-war against those in charge of said war could present a new avenue that is needed to change the tide in favor of those ‘victims’. “The worst thing a person can ask about any war is whether those who died, died in vain,” (Sulik, pg. 363).

Sulik’s arguments are well placed and grounded.  She utilizes a variety of sources and experts to evaluate the breast cancer culture that has grown and continues to grow at amazing rates.  The book is stimulating and readable for most who are interested in ‘the rest of the story’. This book is a productive addition to any woman’s library.

For more of January

Pink Ribbons Inc, book review

King, Samantha. Pink Ribbons, Inc.: Breast Cancer and the Politics of Philanthropy. University of Minnesota Press 2006.

Samantha King’s primary goal in writing Pink Ribbons, Inc.: Breast Cancer and the Politics of Philanthropy is stated as; “I have sought to offer a genealogy account and critique of the place of organized giving under neoliberalism.” (pg117) King’s book is written in an easily read style and length creating access to an entire population surrounding breast cancer from the men and women who experience it, their family, friends and any interested in the culture surrounding breast cancer for multiple motivations through the sharing of issues that could and do affect over a quarter million new patients yearly and their extended networks. She brings a complex and controversial subject into the management of common sense through the exposure of finances, taking a culturally acceptable and societal fashionable cause to an intended dichotomy between philanthropy and capitalism. Critiquing industrial profit from increased exposure of a stigmatized disease transitioned to a popular charity and the industry that has grown up around it and because of it. King is an associate professor of physical and health education and women’s studies at Queen’s University in Kingston, Ontario. She received grants and awards supporting this writing from Illinois University, Arizona University and Queen’s University.

The book begins with a strong foundation for the rest of the book in the: Introduction: Breast Cancer and the Culture of Giving. Her first three pages visually demand attention utilizing photographs from cover of The New York Times Magazine. The first photo is from 1996 of a common model persona type, from any popular magazine cover, draping her left arm over her apparently healthy breasts and body representing the accepted ideology of beauty through embodiment mediated by commercialization. She conforms to cultural expectations of beauty and femininity answering the subtitle ‘How Breast Cancer Became This Year’s Hot Charity’. The next visual on the opposing page is from the same magazine three years earlier. The photography artist Matuscha’s self portrait is raw and exposing, it is not sexy, answering it’s subtitle ‘You Can’t Look Away Anymore,’ it is arresting and the subtitle is provocative and accurate. Matuscha’s mastectomy scar is front, center and provocative to a society with a breast fetish focus. Dichototic photos provoke emotions of pain and suffering and the mirage of feminine ideals shattered by breast cancer. King utilizes these dichotic photos to focus her point of illusional ideology versus the harsh reality that surrounds a ‘disease’ that kills. King’s point is direct and compelling, she has few visuals interlaced in her type, none of them are superficial each has a unique voice strengthening King’s goals. King frequently speaks of a ‘tyranny of cheerfulness’ that covers up the culturally perceived ugliness of Matuscha naked and exposed scar where a breast should be. King’s marks her audience with her unspoken message of how things have changed in just three years. King does not use negative or derogatory statements towards any involved in this transition yet she subtly successfully. She acknowledges the difficulty of going against the grain of popular ideals with financial backing yet she logically proceeds convincing you along the way. The path takes you from a stigmatized disease to neglected epidemic that results in an enriching and affirming process that leads to the ‘tyranny of cheerfulness’ silencing the unpleasant deaths of over 40,000 women and over 400 men yearly.

She theorizes that the greatest strength of the causes for breast cancer has also become its weakness. This is explored in; Chapter 1: A Dream Cause: Breast Cancer, Corporate Philanthropy, and the Market for Generosity. “In the practice of corporate philanthropy and marketing over the past two decades, a broad cultural preoccupation with philanthropic solutions to social problems, the discourse of efficiency and cost-cutting in business practice, changing psychological conceptions of the consumer, and invigorated consumer demands for a more ethical form of capitalism have converged to produce the transformation of corporate philanthropy from a relatively random, eclectic, and unscientific activity to a highly calculated and measured strategy that is integral to a business’s profit-making function.” (pg. 2)  The NFL and Avon are examples of this. The NFL utilizing ‘pinking’ as a means to absorb innocence from the breast cancer culture defusing rowdy and occasionally incarcerated players through association. Surmising that someone who supports the ‘cure’ for breast cancer cannot be capable of criminal activities thus sanitizing public opinion of rich playboys gone wrong to players that women will root for. It brings to mind the Sears commercial campaign “The Softer Side of Sears” that targeted the growing consumer population of women to expand their business. Big burly men wearing pink ribbons create champions for ‘survivors.’ Women wearing their favorite player’s jersey in pink represented a new avenue of consumer productivity and participation. “Consumers are yearning to connect to people and things that will give meaning to their lives.” (pg. 11)  Generosity is advocated here by finding the ‘cure’ through pink purchase participation. King balances this overwhelming generosity by presenting actual amounts donated being capped by corporations upfront regardless of profits incurred by corporations. Corporations are also charged with supporting breast cancer while ‘causing’ or contributing to it, attaching the pink ribbon to products that are carcinogenic or emit carcinogens, using the cosmetic industry and later the automotive industry as proven examples of this strategy.

Volunteerism is the focus in; Chapter 2: Doing Good by Running Well: The Race for the Cure and the Politics of Civic Fitness. Irony is exhibited here by the financial gain of cosmetic corporations sponsoring multiple day walk-a-‘thons’, highlighting exercise and the production of proper citizenship through activity, action and association. You are expected to feel ‘good” about volunteering your time and money and as an additional bonus you can feel ‘good” about an exercise program facilitated by participating in helping the ‘cause.’ Nationalism is satisfied here by inhabiting ‘good’ citizenship space. This absolves you of any selfish purpose in fitness through altruist conduits. Altruism hazes the financial motives presented for multiple corporations presented by King. The Komen foundations participation is described as “committed to the state as a crucial vehicle in the ‘elusive search for a cure,’ and for creating and maintaining the conditions in which free enterprise and the market for breast cancer can flourish.” (pg. 46)    Komen’s assets were tripled from $109.3 million in 2003 to $316.9 million in 2007.

King describes the lack of knowledge and assumptive nature of pink advocacy as an act of doing ‘good” can also be interpreted as, “to be innocent is also to refuse to know.” (pg. 43)  The ‘thons’ advocate early detection thus opening another opportunity for financial gain for corporation supporters. Companies producing ‘detection’ devices are noted in sponsorship commercialization mutually inhabiting the altruistic haze. ‘Thons’ become a space of physical, moral and civic participation producing ‘proper’ citizens nationalizing a feminine ideal.

The ‘cause’ not only produces proper citizens but proper bipartisan politics. Utilizing the power of pink properly and creating the very first ever postal stamp to provide proceeds for any ‘cause’ is analyzed in; Chapter 3: Stamping Out Breast Cancer: The Neoliberal State and the Volunteer Citizen. Congress excited by an issue that could rally bipartisan support  “claimed it was an effective way to enlist grassroots participation in the fight against breast cancer and a means by which to inject consumption with ethical value and meaning, it is an ideal vehicle through which the state could enable the public to demonstrate their spirit of volunteerism and generosity, and it was a vital tool in preservation of the nation’s mothers and, by extension, nuclear families.” (pg. 71)  Breast Cancer now encompasses proper patients, citizens and government. Hillary Clinton is even observed by King to experience a chameleon like change through breast cancer akin to the NFL player’s ugly caterpillar transformation to beautiful butterfly. Hillary’s masculine, domineering and independent persona is pinked into ‘good” mother, sympathetic wife and compassionate mother, (pg. 76)

Breast Cancer ‘Cause’ goes global in; Chapter 4: Imperial Charity: Women’s Health, Cause-Related Marketing, and Global Capitalism. Pharmaceutical corporation participation is noted here by their promotion and production expansion of Breast Cancer Awareness Month to a global market by sponsoring chapters in Germany, Greece and Italy in 2000. European skepticism has kept the pinking from reaching epidemic proportions in the ‘global’ breast cancer world as it has been targeted for scrutiny through the fact that other diseases are real epidemics in other countries and breast cancer does not have the numbers or social presence to surpass other global issues growing from poverty. “The greatest risk factor facing women living in third world poor countries [is] living in third world countries.” (pg. 96) Breasts are not a focus globally; the ‘American’ fetish has not spread far enough to pink the world. The altruist haze is penetrated by the fact that early detection is not in the global budget. The marketing ploy of philanthropy, ‘early detection’, has not been able to gain ‘proper’ citizen cooperation abroad. “Businesses that are seeking to produce and sell goods in an ever-expanding number of locations, has increasingly deployed philanthropy not merely to further some social ‘good’, but as a technique for market penetration and retention.” (pg. 98)

Audre Lorde is a voice utilized by King to sound discord in; Chapter 5: The Culture of Survivorship and the Tyranny of Cheerfulness. Lorde is used throughout the book but her arguments are poignant in this chapter. “Lorde’s warning that to look on the bright side of things is to obscure realities that might prove threatening to the dominant order is more relevant now than ever before.” (pg. 102) King’s central argument is stated here, “breast cancer became a philanthropic because of an informal alliance of large corporations (particularly pharmaceutical companies, mammography equipment manufacturers, and cosmetics producers), major cancer charities, the state, and the media that emerged around the same time and was able to capitalize on growing public interest in the disease.” (pg. 111)  The veil of ‘awareness’, volunteerism and goodness protects the ‘pink’ from logical analytical discourse by involving and heightening over-emotional response. ‘Pink’ critics are not popular, they are stigmatized, ironic isn’t it. “The culture of breast cancer survivorship does not, in other words, embrace patient-empowerment as a way to mobilize critical engagement with biomedical research, anger at governmental inaction, or resistance to social discrimination and inequality, even if its history is bound up with attempts to do just this.” (pg. 105) The survivor discourse has eliminated the patient just as it eliminated the victim creating a health illusion for only the tyranny of cheerful survivors to remain. This tyranny has no tolerance for criticism.

The reality of breast cancer is reached in the; Conclusion: Beyond Pink Ribbons. “The fact remains that women diagnosed with breast cancer today face essentially the same treatment options; surgery, radiation and chemotherapy that were offered when the War on Cancer was first declared thirty years ago. And when it comes to prevention, the only options we are given are powerful pills with dangerous side effects, and surgery more drastic than that often prescribed for women with the disease.” (pg. 119)  While this conclusion is grim King does follow up with: “[Needed is] a coordinated, adequately funded approach to breast cancer research, with the ultimate goals of understanding the causes of breast cancer and the reasons for different incidence and mortality rates among different racial and ethnic groups, and discovering more effective, less toxic treatments. Outcome-driven research, in which the researchers look for answers to these types of questions of most concern to the affected community, is necessary to achieve our goals. As a new approach to the standard scientific model, outcome-driven research frames the hypothesis to get the answers we need to important public health questions.” (pg. 119)

King hypothesizes and proves a darker side to the tyranny of cheerfulness. Yet King has missed a movement towards alternative medicine that is gaining momentum and a record of ‘successful’ cancer treatments that have existed in the United States possibly as early as the 1930’s. Options are available and are being used. Alternative medicine is gaining ground as demonstrated by the Pills, Potions and Poison seminar held at the University of Wyoming this fall. Attendance to the seminar was higher than expected and subject matter ranged from lobbying against the FDA to a speaker from the FDA.

The goals stated by King are met however. She sketches a landscape and history of a pink ribbon culture and how even the best intentions of philanthropy can be corrupted and manipulated for profit. King is cited in peer type research and in books along similar research lines like Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health by Gayle A. Sulik. King’s analysis is practical, convincing and moving. She is passionate about her subject and kind to her ‘adversaries.’

Anthropologist’s answer to the Pink Ribbon Success

Today there are many stories about why the pink ribbon has been more successful than other ribbons, here is an anthropologist’s answer.

Our culture has an extreme breast fetish, in Japan it is the neck and wrists, every culture has one. We love kids and childhood cancer is devastating, but we can’t save their ‘tatas’ or their ‘second base’. Can you even imagine a save the  prostate campaign being as popular? We shouldn’t use these slogans in breast cancer either but we do, our culture loves it, thinks it is awareness. I had to explain saving second base to my mother.  She was offended as many breast cancer participants/experience-rs are, I dislike using the survivor term, she has/had cancer twice so her odds of recurrence are not good.

Groups like these have fantastic intentions, unfortunately these intentions are propagating disrespectful ideals about women’s bodies. The branding is genius, I have an art degree too, I can see a winner, but the anthropologist/women’s studies student in me cringes. The pink ribbon is a champion of a capitalist/fetish culture. Breasts are linked to sexuality and feminism.

Breasts are also a nationalism concern.  The ability to mother and nurture are strong traditional family values. Discovering just how deeply women are subjugated requires forcing yourself to an unbiased position, stepping back and really looking at your culture. It is difficult. I used to think that there was nothing wrong with it either, until I became a breast cancer participant too. My mother has/had it, my aunt died of it, my sister is preparing for it (she cut her hair from her waste to her shoulders and put it in the safe for her wig). They would cut both of  my breasts off right now without a second thought  if I would let them.

Women’s bodies have historically been sites of medicalization, nationalism and marginalization. Women’s natural processes are now disease, if you don’t believe me look in the DSM V , having any issue with your period is bound to land you on a cute little purple pill or on a couch, when these issues have traditionally been solved by natural changes in diet and lifestyle, today we want another pill.

A porn company wants to donate sales percentages to Komen…… Does anyone else see the oxymoron here? “A socially-conscious porn site that donates to charity for each video watched” Socially conscious porn……… I can’t wrap my women’s studies head around that one. When did porn become socially conscious?  Saving the tata’s and second base are just one step away from this, no wonder the porn industry felt it could capitalize on the pink ribbon.  Everyone else has.

This is human nature, you may wish to argue with me, but if you look around, I like to sit watch people at WalMart, you will admit it is true.  The pill is so much easier than education. And if you disagree try naming any of the ribbon colors for any other advocacy group, and AIDS does not count, it was here first.

For more: Resisting the Heritage of Breast Cancer by January

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