Fighting for Breath: Living Morally and Dying of Cancer in a Chinese Village by Anna Lora-Wainwright (review)

In the summer of 2004, Anna Lora-Wainwright first stepped foot into Baoma village, an exceedingly poor hamlet about three hundred kilometers east of Chengdu.¹ She would stay there for a total of eighteen months of field research, living with a local family and working beside them in the fields. Originally intending to pursue an anthropological investigation into rural understandings of health and disease, Lora-Wainwright was drawn to a particularly striking feature of life in Baoma: the high incidence of cancer within the village, particularly that of the stomach and esophagus. Although Baoma village is home to only five hundred residents, eleven died of cancer during the period from 2003 to 2007; in a neighboring town, nine out of eighty residents died of cancer during the same span of time. Through her fieldwork, Lora-Wainwright aims to unpack how local inhabitants understand and come to terms with the experience of cancer.

It is a testament to Lora-Wainwright’s skill as a cultural anthropologist that she was able so effectively to embed herself in the home of one of Baoma’s poorest families. There, she witnessed the process by which Gandie (the patriarch of the family) was diagnosed and treated for esophageal cancer, an illness to which he would later succumb. Her privileged access to sensitive discussions, familial negotiations, and healing practices provided her with critical insights into the often contradictory ways in which local families conceptualized cancer and treated those who were afflicted. Through her research, Lora-Wainwright makes the argument that cancer in Baoma is not simply understood as an illness but also as a social problem. Fighting cancer is, therefore, not just a question of restoring health, but also of “debat[ing] one’s position within the family and the local community” (p. 6).

The first two chapters of the book are largely contextual, so it is not until chapter 3 that Lora-Wainwright begins to foreground her own observations of cancer and its treatment within Baoma specifically. Her argument in this chapter centers on the claim that cancer etiologies among Baoma villagers are flexible, and that respective etiologies are consciously deployed so as to achieve certain social goals. For example, although Lora-Wainwright notes that villagers were aware of the connection between water pollution and esophageal cancer, she observes that most chose not to embrace this etiology as the most persuasive framework for explaining cancer. Instead, such as in Gandie’s case, families preferred to explain cancer as the consequence of prolonged hard work and self-sacrifice. By relating Gandie’s cancer to his willingness to embrace hardship, Gandie’s family was effectively reinforcing his moral standing and social value within the household (p. 104).

Lora-Wainwright terms this process “biosociality.” Building on Arthur Klein-man’s understanding of disease as a form of social suffering, she argues that disease can be used as a way of reconstituting social bonds and negotiating social relationships. This idea is discussed in chapter 4, when Lora-Wainwright examines the gendered implications of cancer and its treatment. In Baoma village, cancer was frequently explained as the consequence of pent-up anger. This etiology was not evenly attributed to both genders, however. While men were assumed to be the victims of negative emotions—and their cancer was thus explained as the result of excessive anger—women were conversely understood to be the instigators of anger and anxiety. By attributing cancer among men to negative emotions (caused by women), villagers were implicitly reinforcing proper relationships and modes of conduct between patriarchs and their wives and daughters (p. 135). Similarly, in chapter 5, Lora-Wainwright explains why villagers generally downplay cigarette smoking and alcohol consumption as etiologies of cancer. Because these activities are considered necessary for forming social relationships (guanxi), attributing cancer to smoking and drinking would be regarded as morally...