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My wife is working on her Masters thesis these days, hoping to have it wrapped up in the summer. Her research concerns people who have cancer and the nurses who care for them. So when, passing through an airport last November, I saw the cover of Harper’s magazine announcing an article on breast cancer by Barbara Ehrenreich, I picked it up, hoping it might help.
Ehrenreich writes about what it’s like to be a woman with breast cancer in modern-day America. She’s quite negative, not despite, but because of, all the attention that has been brought to the disease in the past decade.
Her passion is largely directed at the message that hope is now a “must” for any woman who gets breast cancer. “Cheerfulness is more or less mandatory, dissent is a kind of treason,” she writes. When Ehrenreich posted a message on a breast cancer site, using the subject line “angry,” she was bombarded with rebukes.
It’s not that she is simply a sourpuss. She admits that there’s truth in the idea that hope and optimism have a proven role in combating cancer. (Norman Cousins, who was a faculty member of the UCLA program in medicine, law and human values when I was there, wrote a full account of the “laughing cure” that helped when he had cancer.)
Hope is very important in all life. Andrew Delbanco has written an interesting short history called The Real American Dream: A Meditation on Hope in which he says, “without some symbolic structure by which hope is expressed, one would be, as the anthropologist Clifford Geertz has put it, ‘a kind of formless monster with neither sense of direction nor power of self-control, a chaos of spasmodic impulses and vague emotions.’ We must imagine some end to life that transcends our own tiny allotment of days and hours.”
People do not live only moment by moment-to be human is to think of the future. Sometimes the future is in our control and we can strategize how to get from here to there. But many things cannot be strategically planned because not everything is in our control. (Who can be sure, for instance, that they won’t get cancer some day?) If this lack of control fills us with dread or makes us despair, we will not venture the steps needed to achieve or receive the good things that could be ahead of us. Hope is not a method, but it is a spirit without which we can barely live.
As I said, Barbara Ehrenreich is not ignorant of the virtue of hope. So why is she so angry about being told she must perk up?
The first reason is that she feels manipulated by a breast cancer awareness “industry” that has taken to marketing hope. Generating hope, building hope, racing for hope, wearing pink ribbons for hope…. In her view the buzz about hope has become the goal, not the spirit that sustains a person pursuing other goals. If she’s right, it’s not the first case in which hope has been hyped. Have you ever studied the ads for lotteries and casinos? How they play up the dream, not the realization? I have been told that this is because the mind of the habitual gambler feeds on the anticipation of winning, not the winning itself. Should he win, he’ll actually feel a significant letdown. It’s hard to admire the ethics of those who exploit hope like this.
The second reason Ehrenreich is angry is that she feels there’s something false about the hope that’s being expected of her. Not just false in the sense of untrue, but false in the sense of betrayal. “The mindless triumphalism of ‘survivorhood’ denigrates the dead and the dying. Did we who live ‘fight’ harder than those who’ve died? Can we claim to be ‘braver,’ better, people than the dead? And why is there no room in this cult for some gracious acceptance of death?” Is the price of optimism deception of oneself and judgment of those who lose hope? That can’t be right.
There was a time when medical ethics taught that the very last thing a physician should do is tell his terminally ill patients the truth. The rationale was that the news would only add to their affliction. Doctors are taught differently now; not because they’ve “cured” death, obviously, but because they’ve seen that there is something unfair and dehumanizing in denying people the truth. It’s a kind of betrayal of people who trust you.
There still are dilemmas of truth-telling, and I don’t think Barbara Ehrenreich speaks for all people who have cancer, but generally we believe that hope should be grounded in reality, don’t we?
This is part of what Paul is saying in 1 Corinthians 15: 17-20. “If Christ has not been raised, your faith is futile….If only for this life we have hope in Christ, we are to be pitied more than all men. But Christ has indeed been raised!” Christian hope is a good thing, a thing to foster in ourselves and others precisely because it is not all so much hype and whistling in the dark. Christ is risen indeed! And on that fact rests the hope of all the world’s tomorrows.
e-mail Dr. Read at ethics.centre@sallynet.org