J’ai passé un peu de temps pour mettre le pdf en texte ici (en OCR car ce sont des images du livre de mauvaise qualité), de manière à ce qu’il puisse être lu par les non anglophones. J’ai corrigé les premières pages, si j’ai le courage je ferais la suite au fur et à mesure.
Dans tous les cas, ce texte méritait d’être diffusé, j’espère que l’auteur sera d’accord.
I don’t blame people for not knowing how to engage with a person with cancer.
How would they? Heck, I hadn’t either. Despite the fact that each
year 70,000 Americans between the ages of fifteen and forty are diagnosed
with the disease and that incidence in this age group has doubled in the last
thirty years, many of my friends in their thirties have never had to deal with
it on a personal level.
I remember when my cousin Elise was undergoing chemotherapy treatment while in her early thirties. When I met her I couldn’t even mention it,
couldn’t (or wouldn’t, or didn’t) say that I was sorry or ask her how it was
going---even though it was so obviously the thing that was going on. I was
thirty-five for God’s sake, a grown—up, a professional, a parent, and cancer
was so unthinkable that I couldn’t even acknowledge her disease. When my
former partner’s sister showed up at our house all bald after her chemotherapy, my only remark was, “Hey, you could totally be a lesbian.” I was terrified,
or in denial. More likely I had picked up the culture of stigma and this disabled me from giving genuine acknowledgment. But whatever sympathetic spin you want to put on it, I sucked in all the ways that I had to learn how to deal with later. Indeed, an assumption of exceptionalism was only the flip side of my own shame.
Fantasies of agency steep both sides of diagnosis. On the “previvor” side,
images continually tell us that cancer can be avoided if you eat right, avoid
Teflon and smoking, and come from strong stock. Alternatively, tropes of
hope, survivorship, battling, and positive attitude are fed to people post-
diagnosis as if they were at the helm of a ship in known waters, not along
stormy and uncharted shores. And yet, so little of cancer science, patient
experience, or survival statistics seems to provide backing for the ubiquitous
calls for hope in the popular culture of cancer. After all, who would celebrate
a survivor who did not stand amid at least a few poor SOBs who fell?
Everyone who has "battled,” “been touched by,” “survived,” been “made
into a shadow of a former self,” or has been called to inhabit the myriad can-
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car cliches has been asked to live in a caricature. As poets say in rendering
their craft, clichés serve to shut down meaning. Clichés allow us not to think
about What we are describing or hearing about: we know roses are red. People
with cancer are called to live in and through—even if recalcitrantly—these
hegemonic clichés by news articles, TV shows, detection campaigns, patient
pamphlets, high—tech protocol—driven treatments, hospital organizations and
smells, and everyday social interactions. Such cultural venues as marches
for hope, research funding and direction, pharmaceutical interests, survivor
rhetoric, and hospital ads constitute not distinct cultural phenomena, but
overlap to form a broader hegemony of ways that cancer is talked about and
that in turn control and diminish the ways that cancer culture can be inhab-
ited and spoken about. Cancer exceeds the biology of multiplying cells. But
the paradoxes of cancer culture can also be used to reflect on broader Ameri—
can understandings of health and the mismatch of normative assumptions
with the ways people actually live and die. "lhe restricted languages of cancer
are not innocent.
For an example of how individuated agency is used in cancer, one might
look to the massive literature and movement spurred by Bernard Siegel,
which is based in the moral complex of cancer and what he describes as the
“exceptional patient.” In Love, Medicine, and Miracles: Lessons Learned about
Self—Healing from a Surgeon’s Experience with Exceptional Patients, Siegel
writes about having the right attitude to survive cancer(1). In Siegel’s View and
its variants, surviving cancer becomes a moral calling, as if dying indicates
some personal failure. Siegel—style literature offers another form of torture
to people with cancer: Did my mind declare war on my body? Am I a cold,
repressed person? (Okay, don’t answer that.) This huge and punishing industry preys on fear as much as any in the cancer complex and adds guilt to the mix.
As one woman with metastatic colon cancer said on a retreat I attended,
“Maybe I haven’t laughed enough. But then I looked around the room and
some of you laugh a lot more than I do and you’re still here.” She died a year
later, though she laughed plenty at the retreat.
It’s no wonder that shame is such a common response to diagnosis. The
dictionary helps with a description of shame: “The painful emotion arising
from the consciousness of something dishonoring, ridiculous, or indecorous in one’s own conduct or circumstances, or of being in a situation which
offends one’s sense of modesty or decency.(2)” Indeed, cancer does offend. People in treatment are often advised to wear wigs and other disguises, to joke
with colleagues; they are given tips on how to make others feel more at ease.
One does want to present decency, to seem upbeat. And so do others. A quick
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“you look good,” with a response of “oh, thanks,” offers a Welcome segue to
the next discussion topic and enables a certain propriety to circumscribe the
confusion of proper responses to illness, to the stigma embodied by the possibility of a short life and a painful death. One person with metastatic disease
calls herself, semi-facetiously, “everyone’s worst nightmare.” Others Speak
about how hard it is to see the celebration of survivors while knowing that
they themselves are being killed by the disease.
Social grace is a good thing. But given the scope of the disease --- half of all
Americans die of it and many more go through treatment --- one might wonder what or whom such an astonishing cultural oversight serves. After all how can cancer, a predictable result of an environment drowning in indus:
trial and military toxicity, be dishonoring or indecorous ? I don’t mean its
side effects; the physical breakdown of the body is perhaps definitive of the
word “indecorousf” But these pre- and post-diagnosis calls to disavowal can
help illuminate the ugly underside of American’s constant will to health, its
normative assumptions about health and the social) individual, and generational traumas that it propagates. Expectations and assumptions about life span and their discriminatory and generational effects offer but one of many venues for such an exploration.
Survivorship in America
Perhaps it’s a class issue, but I didn’t really think about survival until I was
called to consider being in the position of the one who might be survived.
I was just tootling along until I was invited by diagnosis to inhabit this category, to attend retreats, camps, and support groups, to share an infusion
room—to do all kinds of things with many people who have not, in fact,
survived cancer—and thus to survive them at their memorial services, the
garage sales of their things> and in the constructing and reading of memorial
Websites and obituaries.
To be sure, cancer survivorship (as opposed to either cancer death or
just plain survival) comes with its benefits. I got a free kayak, albeit with a
leak. When things are going really wrong I think about how my life insur-
ance could pay for some cool things for my kids, or that maybe I don’t have
to worry about saving for a down payment since in order for a home to be
, a good investment you should really plan to live in it for five years. Some-
times,when you find yourself buying into those cancer mantras of living in
the moment, you can look around from a superior place at all the people
scurrying around on projects you have determined do not matter—and then
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go and do the laundry or shop for groceries, just like everyone else. Or like
Bette Davis does in the movie Dark Victory as she dies of a brain tumor; you
can consider yourself the lucky one, not having to survive the deaths of those
You love. You have that strange privilege of being able to hold the materiality
of your own mortality up against every attempt to make value stick. You may
Wonder, as I do, how anyone survives the death of a parent or a sibling or a
close friend or lover—the things that are purportedly normal life events—
until you go through it yourself.3
On the other hand, it may be easy to devolve into the narcissism of unremitting fear.
I like to keep in mind what a driver once told me when I asked
him what it was like to drive celebrities such as Oprah Winfrey around New
York He said, “They like to think they are important. But after every funeral
I’ve been to, people do the saaaaame thing. They eat.”
The doctor survives the clinical trial, the child survives the parent, the
well survive the sick But how have we come to take this survivorship for
granted, as something to which we are entitled? Even a century or two ago
there would have been a good chance that several of us would have died in
childbirth or of some illness. Devastating as it may have been, we would have
expected this. And we don’t exactly live in a medical nirvana. The United
States is not even in the top ten for the longevity of its population. In fact, the
United States is missing from the top twenty or even thirty for longevity in
the world. In some studies, it’s not even in the top forty.4 Despite this statistic,
the United States spends more than any other nation on health care. Part of
Americans’ dismal life expectancy results from the broad lack of access to
health care as well as the broader and well-documented discrimination in
health care against the usual suspects: African Americans, women, younger
people, and queers. But other factors that afiect even those with excellent
access to excellent care play in as well: the high levels of toxins in the environment, including those in human and animal bodies; cigarettes; guns; little
oversight for food, automobile, and other product safety; high rates of medical error.
In short, despite the insistent rhetoric of health, American economies
simply do not prioritize it. That’s okay. There is no particular reason that the
general health of a population should trump all other concerns. But given the
evidence, how do we come to believe this disconnect between dismal health
status in the United States and the entitlement to normative health and life
span? What kind of management has this necessary disavowal required? And
what about the obverse of this question: how do these stories constitute those
who are forced to drop out? After all, if survival is a moral and financial
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Figure 13.1: The 2006 “Put Your Lance Face On” campaign from American Century
Investments. This version of the promotional photo omits the warning, required in print
advertisement publications, that it is possible to lose money by investing (included in the
original).
expectation and entitlement, then mortality must be constituted as something outside of normal life, even though these early deaths pay for pension:
and other deferred payments. Even though everyone will die. I hypothesize
that stigma and shame offer a way to examine and challenge ideals of health
and the Ways that normative life spans have been constructed.
Accumulation
For analytical wealth in this matter, nothing beats a recent advertisement for
American Century Investments that featured Lance Armstrong (figure 13.1).
Armstrong has provided something of a translational figure for the nexus
of industry, cancer, and humanitarianism that constitutes the discourses of
cancer survivorship, foregrounding and even heroizing cancer survivors. His
own story relentlessly underpins this cultural work.
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While some accounts of Armstrong’s success go so far as to credit chemotherapy for literally rebuilding his body as a cycling machine, and others link his drive and success to his cancer experience, Armstrong continually presents himself in public as a survivor, claiming that his greatest success and pride is having survived cancer. In his autobiography, It’s Not About the Bike, Armstrong describes how, when diagnosed with testicular cancer in 1996,
he actively sought the best care available to overcome a poor prognosis. He
chose a doctor Who offered a then-new treatment that turned out to revolutionize the treatment for testicular cancer, turning the disease from a highrisk cancer to a largely curable one even in its metastatic iteration. This coincidence in the timing of his disease and this new treatment has enabled him to make his own agency in finding medical care into another inspirational aspect of his cancer survival story.
In fact, cancer treatments are some of the most rote, protocol-driven
treatments in medical practice, perfect examples of what historian Charles
Rosenberg has detected as the rationalization of disease and diagnosis at
the expense of the humanness of individual patients.5 Yet Armstrong’s story
serves several purposes. It overemphasizes the role of agency in the success
of cancer treatment, a View that correlates well With the advertising messages
of high—profile cancer centers. It overestimates the curative potential of treatments for most cancers, something we would all like to believe in. And it
propagates the myth that everyone has the potential to be a survivor—even as, ironically, survivorship against the odds requires the deaths of others.
This Armstrong story comes with real social costs for many people surviving with and dying of cancer. Mixiam Engelberg’s graphic novel, like so many cancer narratives, ends abruptly with the recurrence of her metastatic disease and her subsequent death. One prominent page other book has a cartoon with her holding a placard stating, “Lance had a different cancer,” in response to her friends’ and colleagues’ comparison of her With Armstrong and their terrifying denial of her actual situation.6 So, While many cancer survivors consider Armstrong an icon and inspiration, others feel that he is misrepresentative of the
disease. He at once gives them impossible standards of survivorship while at
the same time building his heroism on the high death rates of other cancers.
The American Century Investments advertisement summons the reader
to “Put Your Lance Face On.” After gazing into the close—up image of a determined looking Armstrong and thinking quietly to oneself, “What the fuck?”
one reads that “putting on a Lance face” “means taking responsibility for your
future. . . . It means staying focused and determined in the face of challenges.
When it comes to investing . . .” This ad is about Lance the Cyclist, sure; it
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is also about Lance the Cancer Survivor. Control over one’s future h
together the common thread of cancer survival, Tour de France victor Olds
smart investing. But all this folds into the tiny hedge at the bottom of tfieand
Past performance is no guarantee of future results . . . it is possible to lad:
money by investing.” Even the Lance Face can see only so far into the fumrose
’This warning, necessary by law, echoes a skill essential to living in cae:
talism. In heij study of market traders, Caitlyn Zaloom finds that “a tradJ 1.
must learn to manage both his own engagements with risk and the ph 31 Z
sensations and social stakes that accompany the highs and lows of wignc
and losing. . . . Aggressive risk taking is established and sustained by routiIlTig
zation and bureaucracy; it is not an escape from it.”7 The conflation of Arm—
strong as athlete and cancer survivor in this ad offers the perfect personifica-
tion of market investing, since the healthy functioning of a capitalist orde;
requires a valorization of focused determination and responsibility for one’s
future. By now a truism, liberal economic and political ideals require citi—
zens to place themselves within a particular masochistic relationship to time
What else but an ethos of deferred gratification would allow such retirement
plans to remain solvent?
As offensive as this ad is in its use of disease to create business, Ann.
Strong’s story constitutes a culturally acceptable version of courage, cancer
and survival that serves to comfort a population With increasing cancer rates,
and the ad puts to use and propagates these notions of survivorship. As one:
person wrote about giving Armstrong’s autobiography to her mother as she
was dying of cancer, “I wanted her to be a courageous ‘surVivor’ too. I think
we find it less creepy or at least difficult When people assume the role of sur-
vivor, where they pretend they’re going to live an easy and long life.”8
You can be angry at cancer; you can battle cancer. One campaign under-
written by a company that builds radiation technology even allows people to
write letters to cancer. But to be angry at the culture that produces the dis-
ease and disavows it as a horrible death is to be a poor sport, to not live up to
the expectations of the good battle and the good death witnessed everywhere
in cancer obituaries. A bad attitude of this genre certainly will never enable
you to become an exceptional patient. It’s as though a death threat blackmails
cancer anger and frustration. But more astonishing still is the way in which
this “poor sport” characterization carries over even into other cancer events.
There is nothing wrong With having fun while making money. As one
under—forty person who has been living in the cancer complex for over tWO
decades said, “A fundraiser is where you invite people to a big fun event,
serve great drinks, and do everything oossible for them not to think about
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cancer.”You do want people to feel good and strong so that they will open
their wallets, but this humanitarian charity model (“Swim for women With
cancerl”) obscures the politics and paradoxes of such divisions. As one per—
son organizing a fundraiser for her particular and rare cancer said as she
thought about asking her doctors to attend her event, “They’ve made enough
money off my cancer, they could pay some back” I signed on as the mixolo—
gist for the event and spent several hours designing circus—themed drinks
with little cotton candy garnishes.
Time and Accumulationv
Armstrong’s class, gender, and curable cancer allow his iconic status to
overshadow the simple fact that cancer can completely destroy your financial
savings and your family’s future. Sixty percent of personal bankruptcies in
the United States result from the high cost of health care.11 This news, won—
derful for people working in the healthcare industry since many people wifl
pay anything for medical goods and services, means that cancer can be a
long, expensive disease, paid for over generations.
When one’s financial planner asks, semi—ironically, how long you plan to
five, he calls up the paradox of survivorship. Middle— and upper—class Ameri—
cans are asked to plan for an assumed longevity, and to be sure, a properly
planned life span combined With a little luck comes with its rewards. But in
times of trouble, the language of financial service starts to show cracks, even
for healthy youngish people. The other day, When interviewing a Fidelity rep—
resentative about my decreasing retirement account, the representative kept
using the phrase “as your retirement plan grows.” When I pointed out that it
had, in fact, shrunk by 45 percent, he just stared at me blanldy.‘ When, as an
experiment, I asked him about people who don’t make it to the age of sixty-
five, he pleaded, “You really need to think about it as a retirement plan.”
No matter how we are interpellated to think about these accounts, non—
normative life spans tell us about the ways that capitalist notions of time and
accumulation work both economically and culturally. Many kinds of eco—
nomic benefits, for example, are based in an implied life span: you work now,
and we’ll pay you later. Social Security benefits are granted on the basis of
how much you have put into the system over the years, and they last until
you or your survivors are no longer eligible. Middle-class jobs often include
not only salaries, but what are known as “deferred payments.” Pensions fall
into this category, as do penalty—free retirement savings, and the benefit some
academics get of partial payment of their children’s tuition.
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If you croak, some of these contributions may revert back to your estate;
others may be disbursed to qualifying survivors; others Will be recycled into
the plans that will pay for the education of your colleagues’ children. As With
any insurance policy, such calculations require that the state or the employer
offer salary packages in the form of a financial hedge on your mortality and
calculate the averages over the Whole workforce. Payments for those Who
get old depend on the fact that some will die young. It’s not personal; it’s
statistical. ‘
Actually, I take that back. I guess there is not much that is more per50na1
than your sex life, and if you are heterosexual and married—that is, if you say
you are sleeping with one person only and that person is of the opposite sex
and over a certain age—your cancer card Will play more lucratively. If you
fit these criteria, you may be able to pass on these benefits and enable your
loved ones to pay off some of your medical debts or provide a way toward
a more comfortable life in (and sometimes because of) your absence. The
survivorship of a spouse is a state—endowed right, enabled in the form of a
cash benefit and various forms of tax relief. A husband’s or Wife’s death will
enable his or her spouse to receive Social Security checks for decades. This
cash enables a sort of proxy—survival by fulfilling your responsibility toward
the support of your spouse and possibly the support of your children.
This is precisely how one person explained to me his reasoning behind
a recent change of genders: he can now legally have a Wife, legally bring her
into the country, and legally offer her the protections of Social Security. For
the same reasons, my lawyer advised me to marry a man, so that my hus-
band could give the survivor—cash to my girlfriend. For the same reasonS,
my mother was bummed out When I turned out not to be straight. Health is
social and institutional as well as physical. Capital and family legitimate and
live through each other, in some sense rendering each other immortal.12
Social Security might be seen as ensuring that those Who do not conform
to its measures of social legitimacy—people with forms of support that do
not fall into the marriage category—are not given the forms of security into
Which they are asked to pay while they live. Straight marriage presents a form
of cultural longevity for the institution of marriage, and the labor of those
who cannot partake in such survivorship literally underwrites the security of
the individuals who can.13
Historians of marriage have documented how ideas about the well—being
of children led to these forms of social support. But take a closer look, and
you will see that it’s only some children who benefit from these protective
policies. Here’s an example. My employer offers a housing benefit that gives
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some employees financial assistance in purchasing a house. It also describes
death as a “severed relationship.” The relationship between my employer and
an employee of the university can pass through a surviving partner—they
included same—seX couples in their benefits plan in 1992, alb eit as taxable ben—
efits rather than the untaxed benefits that straight people receive#such that
a surviving partner may continue to live in a house purchased with the help
of this fringe benefit. However, if an employee has children and no partner,
the relationship is severed and the children are “SOL” (shit out of luck); they
must sell the house no matter what the market is like and return the down
payment loan to the employer. The debt cycles of illness and the early deaths
of a parent are thus differently borne out through what counts as legitimate
survival, thus reinforcing and rewarding normative social structures.
But more important to my argument here, these retirement and Social
Security benefits offer one means by which the terms of life span come to
be taken for granted by the middle class in the United States. They make life
span into a financial and moral calling, albeit one that the state will be will—
ing to partially subsidize in the event of the deaths of the citizens who fulfill
its principles of economic and sexual responsibility
All this rests on a premise critical to economies in America: time and
accumulation go together. You need the former to get the latter, and you have
more smfi as you get older. No wonder people want to freeze themselves.
Seriously. Cryonics offers an obvious strategy to maximize capitalist accu—
mulation. On my salary, I’ll be able to pay for my kids’ college tuition in one
hundred and fifty years. If I could freeze myself and my daughters and let
my savings grow over that time, then come back to life after all the work of
accumulation has been done for me, well, I could take full advantage of both
the deferral and the gratification.” This may sound ludicrous, but it’s basi-
cally the next step of what is already happening; people already freeze their
eggs and sperm in order to maintain their fertility to a point at Which they
have gained the sort of financial security that time and accumulation (are
supposed to) bring.
While cryonics suspends biological life as capitalism proliferates, uncon-
trollably duplicating cells work to immobilize biological life. Cancer paro-
dies excess. It could not be farther from the metaphors of an external enemy
attacking the body imagined by visions of targeted chemotherapy, the broad
political imaginary of the war on cancer, or the trope of the courageously
battling and graciously accepting patient. If wealth rots the soul, accumulat-
ing tumors rot the host. It just grows, sometimes as a tumor you should have
noticed but didn’t, sometimes as a tumor you can’t help but notice but can’t
179
remove. It may just live there; you may touch it each day. It may disappear 0r ‘-
it may wrap its way around your tongue. Either way, its changing size may 7’,
make it seem living or dying. It inhabits a competing version of time, not ,
yours, to which such things as savings and retirement are supposed to cor. ’
relate, but its own, to which such words as “a o tosis” and “runawa ” ,
Y aCCrue.
These versions of competing time reveal a lot about life spans in capitalism ,
Conclusion
Alas, the Lance Face aims not toward the growing demographic of cancer
survivors whose bodies experience the fissures of the immortal pretensions of :
economic time. Unlike manypeople who calculate their odds and cash out their
retirement policies after diagnosis, or the friends of mine Who told me thatI L
was the inspiration for them to live in the moment and renovate their home, or ~
those ads that regularly appear in Cure magazine that offer to buy the life insux. 3
ance policies of people with cancer in exchange for a percentage, the Lance ad;
replays tiresome injunctions to future thinking, saving, and determination. :
The ad encourages the potential consumer of banking products to workin the ;
broader interests of capital. Simply put, the ad uses cancer for its own ends and ’
is able to do so because of the way that cancer rhetorics have so unquestion—
ingly oyerlapped With notions of progress and accumulation in capitalism.
The cultural management of cancer terror follows to some extent the,
Cold War strategies of damping nuclear terror. You may have wondered why
the phrase “you are the bomb” presents itself as something of a compliment
Whereas, in a romantic situation, the comment “you are the gas chamber”,
may not go over that well. Anthropologist Joseph Masco has analyzed how
Americans didn’t just turn the threat of nuclear annihilation into atomic
cafes, bikinis, and B—sz cocktails on their own; we were taught to survive
through specific governmental programs sought to manage the emotional
politics of the bomb. Nuclear terror, as a paralyzing emotion, was converted
into nuclear fear, “an affective state that would allow citizens to function
in a time of crisis.”5 Such emotional management required a two-pronged
approach. First, citizens were asked to “take responsibility for their own
survival.” Second, enemy status was displaced from nuclear war onto public
panic, such that the main threat was perceived as inappropriate reactions to‘
detonation, rather than to the bomb itself. Even With increased bomb testing
and its release of radiation into the atmosphere, the discovery of high levels
of radiation in American flesh and teeth, and the corresponding increasing
of cancer rates along fallout routes and among nuclear workers, the nuclear
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threat was always constituted as coming from the outside, never as the pre-
dictable and calculated risk of American nuclear programs. In that sense, the
forms of emotional management that resulted from military technologies
underpin cancer culture in the United States as much as the technologies of
Chemotherapy and radiation do.
To be sure, the increasing use of the language of survivorship in main—
stream cancer culture offers a welcome change from the days when people
with cancer were asked to use plastic cutlery so as not to infect those around
them or were not told of their diagnoses in order to protect them. Now, the
Person who survives cancer walks a fine line between courage and deception,
horror and the quotidian, in ensuring that American models of health retain
their normative status. Lance Armstrong offers the perfect venue for such
disavowals, as he currently rises as if in a second coming, high above the
Nike building at Union Square in San Francisco and other American cities,
his Lance face in perfect shape, With another sufficiently vague, sportsmanly
tag line: “Hope Rides Again.”
What if, instead of some broad and grammatically, if not afiectiyely,
meaningless aim as marching and riding “for hope,” fundraisers attempted to
ban any one of the thousands of known carcinogens in legal use? What if we
walked, ran, swam, rode not for hope, but against PAH, MTBE, EPA or any
other common carcinogen? Such an effort would require naming. the prob—
lem rather than the symptom, and recognizing how we are all implicated. It
would require that we invest in cancer culture not as a node of sentimentality
but as a basic fact of American life.
NOTES
1. Bernie S. Siegel, Love, Medicine, and Miracles: Lessons Learned about Ser—Healing
from a Surgeon’s Experience with Exceptional Patients (New York: Harper and Row, 1986).
2. Oxford English Dictionary, 2nd ed., s.v. “Shame.”
3. Again, I think it is easier to speak facetiously from the position of having a non—
metastatic diagnosis.
4. Stephen Ohlemachter, “US Slipping in Life Expectancy Rankings,” Wash—
ington Post, August 12, 2007, httpzllwww.washingtonpost.com/wp—dyn/content/arti-
c1e/2007/ 08/12/AR2007081200113html.
5. See Charles E. Rosenberg, “The Tyranny of Diagnosis: Specific Entities and Indi—
vidual Experience,” The Milbank Quarterly 80, no. 2 (June 2002): 237—60.
6. Miriam Engelberg, Cancer Made Me a shallower Person (New York: Harper,
2006).
7. Caitlin Zaloom, “The Productive Life of Risk,” Cultural Anthropology 19, no. 3
(Angust 2004): 365.
181
8. Personal correspondence with author, April 10, 2008.
9. Personal correspondence with author, March 15, 2009.
10. Personal correspondence with author, April 11, 2009.
11. See David U. Himmelstein, Deborah Thorne, Elizabeth Warren, and Steflie W001-
handler, “Medical Bankruptcy in the United States, 2007: Results of a National Study)” "me
American Journal ofMedicz’ne 122, no. 8 (August 2009): 741—46. -
12. These structures carry invisible costs even for straight people Who believe
themselves to be outside of these cycles. Think for example of the shooting of Harvey
Milk and George Moscone. The short sentence given to Dan White for the shooting is
usually ascribed to the fact that, since Milk was queer, the judge believed that his life Was
not worth much. Moscone Was considered collateral damage. See The Times of Harvey
Milk, dir. Rob Epstein, 90 min, Black Sand Productions, 1984.
13. This kind of structural attention to cultural institutions and actual care are
understudied For example, When President Barack Obama made an exception to his i
usual homophobic platform to call for allowing same-sex couples to be able to visit their
partners in hospitals, he was making a way for partners to be able to love each other
and to be able to share a deep experience. Advocacy and protection are huge parts of
contemporary medical care. I have eome across hundreds of examples of this in my years
of research. This aspect of contemporary medical care includes everything from making
sure that medical records are transferred properly or read, that medical allergies are made
known, that machinery is working, that people wash their hands and are given the proper
doses of medication. Such bedside advocacy is an enormous, and understadiei part of
healthcare provision.
14. Tiffany Romain is working on an important dissertation on this subject in the
Department of Anthropology at Stanford University.
15. Joseph Masco, “Survival Is Your Business: Engineering Ruins and Affect in Nuclear
America,” Cultural Anthropology 23, no. 2 (May 2008): 366.
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