In last Sunday’s “Washington Post,” Elaine Schatter, a doctor, professor of medicine and cancer survivor, objected to the ubiquitous talk about John McCain and his glioblastoma diagnosis. Particularly the wearying notion that since he’s “a fighter” he will “beat” the disease.
Schatter provides useful evidence from several studies that the idea that one’s grit or tenacity, toughness or attitude has an influence on whether your cancer will “win” or be “defeated” is a myth, an old wive’s tale, a misguided fiction, and a hurtful way to discuss the subject.
There is no correlation between one’s psychology or mood or character and the chances for survival. Cancer is not a competitor, an enemy, or a villain, that you can beat by being a superhero, or allow to beat you if you are wimpy or neurotic. Frankly, if you are upbeat about being in a “fight” with cancer, you are out of touch with reality.
The fact that cancer is a disease, not a Rorschach test is not news. Forty years ago in “Illness as Metaphor,” Susan Sontag eviscerated the notion by looking at the long history of blaming the victim for his or her cancer. It was viewed as a disease of weak, repressed, melancholy, anxious people. It was so shameful and frightening it was whispered about.
Some of this false narrative was apparently imported from the notion that happy people did not get the plague. So, similarly, peppy extroverts were thought not to get cancer. And those who did were often seen as losers, eaten up inside by the disease as they had been in life by failure and regrets. So Napoleon, Grant (the loser president, not the winning general), Robert Taft and Hubert Humphrey all had their cancer attributed to their being political losers. But Ike and Lyndon Johnson didn’t have their character blamed for their heart attacks.
It is amazing we still think is such primitive ways. If we must make a martial metaphor out of cancer, it makes more sense to say that we are the territory over which cancer and our doctors are fighting. If cancer wins, it’s the doctors who have lost the battle.
Or perhaps cancer should be seen as an insane and sadistic serial killer who cruelly tortures its victims before they die. Unless, of course, Doctor Van Helsing arrives in time with a wooden stake or silver bullet or whatever it takes to kill the fiend and rescue the victim. Of course, all too often the doctor joins in the torture with chemo, radiation, or knives. The Hippocratic Oath now reads, first, do something billable.
Since both my parents died of cancer and I may be next, I take this judgmental poppycock seriously. We can all be faulted for bad choices such as smoking, drinking, a lousy diet or not using sunblock. But we can’t be faulted for living in an era when exposure to carcinogens in the environment or workplace is hard to avoid, and when cures for our disease, though promised since Nixon’s “War on Cancer” fifty years ago, have not yet materialized. And then there’s the genetic luck of the draw, and the fact that the longer we live, thanks to preventive medicine, public heath and vaccines, the more likely it becomes that cancer rather than some other disease will get us.
To some extent cancer is a crapshoot, and we aren’t the one’s throwing the snake eyes. Whether we are stoic or sniveling, sunny or sunk in the slough of despond, has no bearing on whether the disease will kill us or if we get it. So, supposing that our bad attitude is responsible for our getting cancer or will determine whether we recover from it is not just false, but cruel.
Cancer is bad enough without acting as if those who die of it deserve what they got because their character was weak. We all die, those of good character and those of bad, but those who die of strokes, aneurysms, Alzheimer’s, ALS or the thousand natural shocks that flesh is heir to don’t get shamed for not having enough fight in them.
If I were John McCain, I’d want to be treated with love, kindness and sympathy, not with high expectations by people behaving like drill instructors urging me to do better on the obstacle course. Life, and death, are hard enough without unrealistic demands for courage or psycho-babble about character flaws inviting cancer to come calling.
Cancer isn’t a person. It doesn’t have volition or motives or animus. It’s a disease, a bug in the code of life. We aren’t to blame. It’s not to blame. It’s just the way life works, until we figure out a way to debug it. Give the cancer sufferer a break. And donate a buck to research for a cure.