Abstract
A life-threatening illness such as cancer can bring about much existential suffering and a disconnect to self in spite of surviving cancer. In my recent research project, I interviewed 14 long-term cancer survivors on being post cancer. Contrary to common assumptions about long-term survivorship, my interviewees reported grave existential difficulties in finding a firm footing in their sense of self, fostering a variety of stories of despair. This article examines long-term cancer survivors’ suffering from the vantage point of selfhood and provides a philosophical interpretation of the reintegration of the self by illuminating their stories of despair through the Danish philosopher Søren Kierkegaard’s seminal work The Sickness Unto Death. The participating survivors described how the cancer experience had quaked old perceptions of self, instigating them to question the depth of their self-understanding before the cancer and who they really were. In relating to themselves, they realized the dynamic process of becoming who they are by continuing to balance opposing poles within the self. This act of relating to self revealed the limit of the autonomous self in the creation of selfhood. The article intends to illustrate how a philosophical reading of selfhood and suffering in survivorship can inform medicine and inspire models for follow-up cancer care for long-term survivors.
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Notes
All names have been changed to protect the privacy of the participants.
Long-term cancer survivorship generally refers to survivors who are five or more years post diagnosis and not receiving active treatment like chemotherapy or radiation though they may go to regular medical checkups to have their state of health monitored.
The research project was funded by the Danish Cancer Society and ended in December 2018. It consists of in-depth interviews with 14 survivors on their sense of existential being post cancer. I conducted all the interviews that were subsequently transcribed. Interviews would last between 1 and 2 h. Some participants were interviewed twice. My participants had, on average, been out of treatment for 8½ years and represented a variety of cancer types, such as breast cancer, ovarian cancer, non-Hodgins and Hodgins lymphoma, kidney and pancreatic cancer. Four participants were in their 60s, four in their 50s, four in the 40s, one was in her late 30s and one was 25 at the time of the interview. The oldest participant was 69. There were 12 women and two men in the project. Educationally, the group was diverse and included, for example, a physiotherapist, a journalist, an actor, a nurse and a primary school teacher. There were no university scholars or academics. Participants had heard of the project online either through an interview I did for the Danish Cancer Society's newsletter, for the Danish patient organization for late-effects of cancer or through the website of a participant of a former research project. Selection was based on whether the participants still struggled with finding a firm, existential footing post cancer and if they had been out of treatment for 5 years or more.
Hannah never sought professional help and was therefore not diagnosed.
Self and selfhood are a recurring theme in the history of philosophy from Plato to Dan Zahavi. It is a notion that is still to this day philosophically contested. Even within Kierkegaard scholarship there are differing interpretations of Kierkegaard's concept of selfhood in SUD. As the article is not a scholarly account of these differing interpretations of Kierkegaardian selfhood or selfhood in general, it, hélas, falls outside the parameters of the article to dive into this aspect that is otherwise highly interesting.
Translation modified. The Hong translation has 'upbuilding' for the Danish word 'opbyggelse'. I prefer Alastair Hannay's choice of the word 'edification' in his translation of The Sickness Unto Death (New York: Penguin Books, 2004).
The first abbreviation refers to the English translation of Kierkegaard's Writings, senior eds. Howard & Edna Hong, Princeton: Princeton University Press. The abbreviation specifically refers to the work in question, here The Sickness Unto Death (SUD) followed by the page number. The second abbreviation refers to Kierkegaard's collected works in Danish: Søren Kierkegaards Skrifter (SKS), 55 volumes, ed. Niels Jørgen Cappelørn, et al. Copenhagen: Gads forlag, 1997–2009. Sygdommen til Døden is volume 11, hence SKS11 followed by the page number.
Translation modified. The Hong translation has “a relation that relates itself to itself”. I purposely leave out the reflexive ‘relates itself’ as it better captures the Danish ‘at forholde sig’ (to relate) which is already a reflexive verb. There is no need to add a reflexive in an already convoluted sentence.
Vigilius Haufniensis and Johannes Climacus are other pseudonyms who examine this relation that relates to itself. See Concept of Anxiety and Concluding Unscientific Postscript.
The role of despair in selfhood was already explicated by an early pseudonym in Kierkegaard's authorship: Assessor Wilhelm in Either-Or Part II (1995, 1997b). See Either-Or Part II: p. 155. SKS3, p. 201; particularly the chapter "The balance between the esthetic and the ethical in the development of the personality".
Both forms express a despair over self, one indirectly, the other directly though we learn in SUD that the two forms can essentially be traced back to one another (SUD, p. 20. SKS11, p. 136).
Merold Westphal (Westphal 1987, pp. 53–54) makes this exact point about the fluid boundaries between the forms of despair.
Translation modified. See note 4.
'Necessity' already indicates this.
There is a long-standing debate within Kierkegaard scholarship about the nature of Kierkegaard's Christianity and understanding of faith. Unfortunately, the scope of this paper does not allow for a discussion on the matter. My read lends itself on the interpretation that Kierkegaard did not promote faith as regurgitating dogma or orthodoxy. Rather, he advocated faith as subjective passion (Danish: Lidenskab) that was to be lived, not mediated by clergy.
I thank Anna Strelis Söderquist for inspiring me to link my participants' perspective with the entry by Camus. Söderquist's translation.
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Acknowledgments
I would like to thank the Danish Cancer Society for a generous grant that enabled my research (Grant No. R120-A7522-15-S36), for the kindheartedness awarded to me by the participating long-term cancer survivors and for Marcia Robinson for her useful comments on Kierkegaard.
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As no human tissue or social security number were procured or obtained, no official consent form was needed according to the Danish Research Ethics Committee. However, I insisted on getting the consent of all individual participants at the beginning of the research project. I handed them a letter explaining the project and informed them that they could withdraw from the project at any given moment (none did).
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Knox, J.B.L. Stories of despair: a Kierkegaardian read of suffering and selfhood in survivorship. Med Health Care and Philos 23, 61–72 (2020). https://doi.org/10.1007/s11019-019-09908-4
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DOI: https://doi.org/10.1007/s11019-019-09908-4