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Cancer Culture avant la lettre

Figure 1. Two views of Clara Jacobi (Netherlands, 1689). U.S. National Library of Medicine
https://collections.nlm.nih.gov/catalog/nlm:nlmuid-101392944-img

In the class I teach on illness narratives, cancer comes after the plague. In the realm of representation and cultural memory, infectious diseases have a long visual and allegorical pedigree. Pestilence is always already more than an epidemiological reality. With cancer culture things are different. A cursory search for early modern images of cancer in the U.S. National Library of Medicine (NLM) digital collection will not yield much. Among the few documents retrieved is an unattributed seventeenth century Dutch engraving. The patient, Clara Jacobi, is seen in profile, first with a melon-size tumor protruding from her neck, and then without the tumor. In this image, cancer has the visual reality of a corps étranger.It exists in a sequence within a surgical imaginary of extraction as a conspicuous mass to be removed. The mass on her neck might not be cancerous. What if it is an enlarged cyst? Only a tissue sample can tell the difference and possibly confirm the position of the image in a visual memory of cancer culture. It is too late for that. But at the limit between biology and biography Clara’s likeness survives as the trace of her encounter with cancer—if only by virtue of a bibliometric tagging.

Of course cancer existed for a long time in the absence of cancer narratives and cancer culture, but how can we commemorate Clara’s impossible relation to oncology now that it seems precisely impossible for cancer and cancer culture to exist separately (Jain 2013)? By way of figuring out elements of answer, I should like to toy with the idea that the 1962 French New Wave movie, Cléo from 5 to 7, represents something like another point of departure in the history of cancer culture. The argument is not chronological in the sense that Agnès Varda’s film would be the first conscious effort to come to terms with that it means to have cancer (to have cancer as a woman)and reoccupy the volatility produced within oncology and cancer epidemiology. Cléo from 5 to 7 is a point of departure in that the relationship between corps, cancer, and image is yet to be settled—yet to be tagged. Instead, Varda gives us time: a late afternoon, from 5PM to 7PM, in the life of a fictional young woman waiting for the result of a biopsy (“prélèvement” in French) in the radiant light of Paris in June.

 

Figure 2. Still from Cléo de 5 à 7.

A tarot card reader delivers Cléo’s first diagnosis and prognosis, neither as a disease nor as a deadline, but in the more spiritual terms of a “profound transformation of [her] whole being.” The nine cards arranged in three rows of three—one for the past, one for the present, and one for the future—read like a graphic novelization of Cléo’s trajectory, made even more salient by the fact it is the only sequence in color in an otherwise black and white movie. At this point, there is no such thing as Cléo’s cancer. Cancer is but a word, only pronounced once, but never directly in front her. It is a radiotherapy referral nonchalantly delivered by her physician toward the end of the journey. In the meantime, cancer is but a nauseous episode or an overwhelming sense of fatigue and anxiety. It is part of a sensory vocabulary that pertains to the positioning of her body on the screen. It pertains to a way of relating to stories, when Cléo confides in a tempting metanarrative moment her dislike for film critiques because she does not like to know the end of the story in advance: “It spoils the movie. And it’s like wishing a birthday ahead of time, it’s bad luck.” In her landmark article, “Breast Cancer. Reading the Omens,” Margaret Lock revisits the story anthropologists tell about the decline in the reliance of industrial and post-industrial societies on the arts of divination (1998). In this context, the present is defined by the fact that the relationship to uncertainty is mediated by statistics and probability. One is at risk rather than fated. In Varda’s film, cancer is not caused nor linked to environmental factors. It is not inherited nor part of an intergenerational plotline. Cléo’s fear is not legible against a background of cancer prevalence and of survival rates. For Cléo does not inhabit a landscape of risk (Alaimo 2012). She is not identified as member of an ever-evolving statistical population in which a certain percentage of women will be diagnosed with cancer at some point during their lifetime. Conversely, her oncoscape is not an abstract space of statistical or surgical possibilities. It is urban, cinematic, and sensorial. It is shot through and through by the pulse of ordinary affects, humming radiophonic voices, familiar and unfamiliar faces, eavesdropped conversations, and inquisitive gazes.

Cancer might be the new image of death in the West (Ariès, 1975: 173), for Cléo, cancer, in any of its forms, is yet to be the object of a collective effort of representation, recognition, and mobilization. When her friend Dorothée inquires, “where is your disease?” She answers: “my belly. I prefer to have it there than somewhere else…. At least you can’t see it.” Dorothée models for students in an art studio. Nudity for her corresponds to an enthralling state of abandonwhere a body can become a form, something relinquished—in exchange for money. Cléo fears nudity. For her, it is almost something akin to a form of clinical foreplay: “It seems to me that one is even more naked than naked when in front of people. I would be afraid someone would find me flawed.” Or later—between 6:15 and 6:30—Cléois even more explicit: “For me, nudity means illness.” Nuor not, cancer remains invisible as an oncological reality in Varda’s film. In fact, and starting with Cléo, cancer is the effect of disjuncture that detection and screening practices open between the biomedical body and a lived experience of illness.

In The Normal and the Pathological, Georges Canguilhem imagines the following forensic paradox based on the theories of French surgeon René Leriche (1879-1955):

If an autopsy of medical-legal intent were to reveal a cancer of the kidney unknown to its late owner, one should conclude in favor of a disease, although there would be no one to whom to attribute it—neither to the cadaver which is no longer competent, nor retroactively to the formerly live man who had no idea of it, having had his life come to an end before the cancer’s stage of development at which, in all clinical probability, pain would have finally announced the illness. (1989: 92)

Canguilhem adopts a different outlook on Leriche’s paradox. He reframes the deductive contours of the hypothetical case by foregrounding the temporal and experiential realities that inform histopathology’s insights. “If, today,” Canguilhem argues, “the physician’s knowledge of disease can anticipate the sick’s man’s experience of it, it is because at one time this experience gave rise to, summoned up, that knowledge.” (1989: 93) In other words, Leriche’s unattributable cancer is but an isolated episode in a narrative arc. The notion of illness narrative would have been foreign to Leriche’s hypothetical case. There is nothing in his clinical practice to recognize that “the patient is somehow both the object of medical work and an object of speech (spoken to and about)” (Meyers, 2013:10-11). By the second half of the twentieth-century, the notion of illness narrative has gained considerable traction, at least in the US. With Leriche’s forensic paradox, there are no narrative provisions that would allow the patient to undertake a series of corporeal or spiritual transformations. The layering of tissues does not add up to form something like a biographical entity.

Cancer as a biochemical process was there before the narrative that strives to situate it, retrospectively, as an event on a biographical timeline. A biopsy can give an estimate of when it all started, but this beginning is not articulated as such, for cancer inception is not verbal but cellular (Belling 2010). Histology—the tissular image of cancerous cells—cannot really serve as the proof of existence across the passage of time, only as the site of a disjuncture between biology and biography—only as the oncological meantime in which a patient finds herself stranded. For American author and health activist Barbara Ehrenreich, cancer is simultaneously a histological reality, legible in the pathology slides from her breast biopsy, and a grammatical event, in the form of a diagnostic sentence pronounced by the surgeon: “Unfortunately, there is cancer.” Ehrenreich recounts in her influential essay “Welcome to Cancerland”:

It takes me all the rest of that drug-addled day to decide that the most heinous thing about that sentence is not the presence of cancer but the absence of me—for I, Barbara do not enter into it even as a location, a geographical reference point. Where I once was—not a commanding presence perhaps but nonetheless a standard assemblage of flesh and words and gesture—“there is cancer.” I have been replaced by it, is the surgeon’s implication. This is what I am now, medically speaking. (2001: 44)

In her parsing of the new biographical configuration Ehrenreich finds herself in, in the aftermath of the biopsy results, it is as if the present of cancer was incompatible with the past where she once was.

Likewise, on the other side of history, Clara’s excised tumor sits between two versions of herself, before and after cancer, even though cancer registers at a medial level in the very existence of her portrait. In Varda’s film, Cléo’s biopsy occurs outside cinematic time and yet, everything from 5 to 7 happens in its wake to constitute a biographical prélèvement. Clara and Cléo’s trajectories both speak to cancer as the new face of l’écriture de soi (Foucault 1983), as if cancer culture had to take the form of a biographical capture of the self—new, as if making sense of the lived experience of cancer in the age of biomedicine was a way to keep up with oncological time and keep track of its present, no matter how volatile.

Vincent Bruyère is assistant professor of French at Emory University and affiliate faculty in the Center for the Study of Human Health. His new book Perishability Fatigue: Forays Into Environmental Loss and Decayis forthcoming with Columbia University Press in September 2018.

 

References

Alaimo, Stacy. 2012. “Material Memoirs: Science, Autobiography, and the Substantial Self.” In Bodily Natures: Science, Environment, and the Material Self. Bloomington: Indiana University Press: 85-112.

Ariès, Philippe. 1975. Essais sur l’histoire de la mort en occident du moyen âge à nos jours. Paris: Seuil.

Belling, Catherine. 2010. “Narrating Oncogenesis: The Problem of Telling when Cancer Begins.” Narrative18. 2: 229-247.

Canguilhem, Georges. 1989. The Normal and the Pathological. Trans. Carolyn R. Fawcett in collaboration with Robert S. Cohen. New York: Zone Books.

Ehrenreich, Barbara. 2001. “Welcome to Cancerland. A mammogram leads to a cult of pink kitsch.” Harper’s: 43-53.

Foucault, Michel. 1983. “L’écriture de soi.”Corps écrit, no 5 (L’Autoportrait): 3-23.

Jain, S. Lochlann. 2013. Malignant: How Cancer Becomes Us. Berkeley: University of California Press.

Lock, Margaret. 1998. “Breast Cancer. Reading the Omens.” Anthropology Today14.4: 7-16.

Meyers, Todd. 2013. The Clinic and Elsewhere: Addiction, Adolescents, and the Afterlife of Therapy. Seattle: University of Washington Press.

Varda, Agnès, dir. 1962.Cléo de 5 à 7.Irvington, N.Y. : Criterion Collection, 2000. DVD.


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