Malignant: How Cancer Becomes Us by S. Lochlann Jain (review)

S. Lochlann Jain's ethnography/memoir Malignant: How Cancer Becomes Us is organised in a linear fashion, which gives the initial impression that the book follows an expected illness trajectory: diagnosis, treatment, recovery and the concomitant biographical interruption (Bury 1982). However, the book's contents are not linear, nor do they hinge on an individual narrative. Instead, the author deploys her own breast cancer experiences as an opening through which to explore knowledge production surrounding the cancer complex. As such, Jain traces "lines of knowledge" (155) relating to cancer causation, screening and treatment. Primary emphasis is placed on how uncertainty in these knowledge bases results in misdiagnoses and ineffective and unnecessary treatments. Jain states that "when nobody knows how to proceed (and nobody wants to admit that), certain kinds of knowledge claims come to seem most logical and therefore guide thought and action" (155). Jain's goal is to destabilise knowledge stances, as "unraveling the guiding logics of these institutions enables us to better understand who claims knowledge about cancer, and how" (5). Without this critical approach, she argues, finding new directions for the cancer complex and its accompanying "cultural containment" (221) is not possible.

Malignant begins, in Chapter 1, with the author's own diagnosis and survival prognosis. Chapter 2 centres upon maintaining one's "poker face" (46) – whether it be a "game face" (52), as in the portrayal of Lance Armstrong as a survivor in an American advertising campaign for an investment firm, or a "straight face" (65) – following diagnosis. This occurs while mediating one's own feelings of shame, confusion and fear, in addition to the expectations of the "sick role" (Parsons 1975, 257) that are thrust upon those grappling with cancer. Chapter 3 digs deeper into the cancer experience as Jain explores what it feels like to negotiate her sense of identity as a self-described "cancer butch" (67) who has undergone mastectomies to remove both breasts and decides not to have reconstructive surgery. Shortly after her last surgery to remove the remaining breast, Jain removed her shirt in a yoga class. As she strives to derive meaning from this act, she explains:

Perhaps my display was a call not for, but to, attention: a call to consider cancer as a communal event. It put into the public domain what every dimension of the cancer complex had told me should be kept private. And not public as in a magazine image – a staged photo that can be cropped, moved around, published, stared at, censored, discussed, and debated, an object that takes on its own life – but a person in a room with other people.

(77; original emphasis)

This act of "stripping" works as a metaphor for the book: S. Lochlann Jain is trying to get us to pay attention to the cancer complex, including corporate pinkwashing practices and how companies involved in these campaigns often create products that produce or contain carcinogens. This is exemplified by BMW's promotion of the "Pink Ribbon Collection" of logoed merchandise, all while gasoline and the manufacturing process of producing plastic car parts are known to emit carcinogens. Companies like BMW, while purporting to raise money for a "cure," are indeed potentially making us sick. This chapter also details successful ACT UP campaigns, which were carried out in the 1980s to bring policy change to HIV/AIDS issues in the United States. ACT UP activists were not "cheerful" or "hopeful," as pinkwashing campaigns promote that those with cancer should be; they were angry. They advocated for access to antiretroviral medication, adequate housing and medical insurance for those suffering from AIDs. They were unapologetic and made headlines with public acts such as pouring ashes on the White House lawn. As Jain puts it, "they unleashed power" (87).

In Chapter 4, Malignant delves into medical mistakes and legal malpractice frameworks in the United Sates. Jain's breast cancer was initially missed by doctors, and this experience, along with the ensuing lawsuit, provides a backdrop to the chapter. Medical malpractice...