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Abject Ontologies: Cancer and ‘Living On’

Abstract

This paper examines cancer through the lens of abjection. While cancer can be understood as an abject lifeform, we explore what we name the abject ontologies created through both cancer detection technologies/practices and cancer treatment, specifically the drug combination Adriamycin and Cytoxan. We ask: what are the abject ontologies produced through living with and living on from cancer diagnosis and treatment? Our concern is to map how cancer undoes our supposedly stable categories inherited from modernist logic, challenges our very ideas of what it means to be human, and demands an ethical reorientation of public cancer discourse.

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Correspondence to Nadine Ehlers.

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Endnotes

1 Other representations of cancer as monster appear, for instance, in the novel, A Monster Calls (Ness, 2011).

2 For a general overview of ‘freakery’ and freak discourse, see Garland-Thompson (1996).

3 We use the term ontology here to refer to the ‘nature’ of being or what exists. Necessarily, however, we do not presuppose there is a ‘truth’ to this ‘nature’ of being, but instead use the word to mark how certain ways of being or forms of existence are discursively framed (for instance, within biomedicine) or subjectively experienced (and here experience must also be understood as always-already fashioned through socio-cultural processes of meaning-making).

4 This is addressed below. Cancer exceeds the boundaries of what we know as life, because it develops when the cell growth and division essential for life neglects all growth control mechanisms and the cells themselves lack the “differentiated, specialized traits of their ancestors” (Varmus and Weinberg cited in Stacey, 1997, 80). Undifferentiated, these cells do not have the representative characteristics of other cells of the organ that houses them, and they replicate until they outnumber healthy cells.

5 Also see Shildrick’s chapter ‘The Self’s Clean and Proper Body’ (2002, 48-67).

6 According to Kristeva, the life/death dyad most clearly registers at the sight of the corpse: “[c]orpses show me what I permanently thrust aside in order to live. These bodily fluids, this defilement, this shit are what life withstands, hardly and with difficulty, on the part of death” (1982, 2).

7 See, for instance, Broom and Kavanagh (1998) and Yadlon (1997).

8 Shildrick 1997; Cohen 2009.

9 BRCA1 (located on chromosome 17 and BRCA2 (chromosome 13) belong to a class of genes known as tumor suppressors; in normal cells, BRCA1 and 2 help ensure the stability of the cell’s genetic material and help prevent uncontrolled cell growth. A recent study estimated that about 72% of women who inherit a harmful BRCA1 mutation and about 69% of women who inherit a harmful BRCA2 mutation will develop breast cancer by the age of eighty. The study also estimated that about 44% of women who inherit a harmful BRCA1 mutation and about 17% of women who inherit a harmful BRCA2 mutation will develop ovarian cancer by the age of eighty (see Kuchenbaecker, Hopper, Barnes, et al., 2017).

10 However, not every woman in families that carry the mutations, and not every cancer in such families, is linked to one of the BRCA genes. Furthermore, not every woman who has a harmful BRCA1 or BRCA2 mutation will develop breast and/or ovarian cancer. For more on the controversial patent rights case, see Matloff and Caplan (2008).

11 On IVF gene selection and preimplantation genetic diagnosis see Mohney (2016), Bitran (2018), and Breastcancer.org (n.d).

12 See Ehlers and Krupar (2019).

13 The body is generally absent to consciousness when it is in a state of health (Leder 1990). If detected, however, cancer rules out the possibility of the body remaining absent and instead it becomes a highly present reality.

14 This is killing in order to ‘make live,’ a biomedical imperative that produces a range of specific forms of abjection.

15 To take this a step further, for Arthur Frank, “chemotherapy fits with disturbing ease into Elaine Scarry’s definition of torture as ‘unmaking the world’” (in Gubar 2011, 653).

16 Many patients on the community forums of Breastcancer.org (one of our major ethnography sites in previous studies) describe the sensation of the drug in the veins as simultaneously ice-cold and burning.

17 Also see Segelov (2006) and Schirrmacher (2019).

18 See ABC News (2008).

19 Stacey states that her “body would remember the traumas of treatment. The trigger may have been an association of somatic sensation with place, taste, or sound” (1997, 100).

20 See Ehlers (2016) and Lorde who, for instance, asks: “how do I live with myself one-breasted? What posture do I take, literally, with my physical self?” ([1980] 2006, 47).

21 See Dumas (2012).

22 Importantly, we need to recognize how this disease ravages particular populations, communities, and bodies, with a particular genocidal impact on women of color. See U.S. Cancer Statistics Working Group (2020).

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Ehlers, N., Krupar, S. Abject Ontologies: Cancer and ‘Living On’. J Med Humanit (2021). https://doi.org/10.1007/s10912-021-09711-4

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Keywords

  • Cancer
  • abjection
  • ontology
  • corporeality
  • biomedicine