Battling Breast Cancer

Barron H. Lerner. The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America. New York: Oxford University Press, 2001. xvi + 383 pp. Illustrations, abbreviations, glossary, sources, notes, and index. $30.00.

In 1978 the writer Susan Sontag published her now famous essay, Illness as Metaphor, detailing, she explained, "not what it is really like to emigrate to the kingdom of the ill and live there, but" rather "the punitive or sentimental fantasies concocted about that situation," "not physical illness itself but the uses of illness as a figure or metaphor." Maintaining that the tendency to rely on metaphors to discuss illness and disease was widespread in American culture, Sontag hoped through her essay to provide both "an elucidation of those metaphors, and a liberation from them." Herself a cancer patient, Sontag argued for the abandonment of metaphors in relation to disease and illness. "My point," she declared, "is that illness is not a metaphor, and that the most truthful way of regarding illness--and the healthiest way of being ill--is one most purified of, most resistant to, metaphoric thinking." Having identified Americans' attachment to metaphor in their consideration of disease, Sontag urged them to abandon this approach, citing the damage such metaphors caused in the experiences of cancer patients. ¹

Historians were quick to agree with Sontag's suggestion of the power of metaphors in American thinking about disease and medicine, and since her path-breaking work many scholars have explored the important role played by metaphorical thinking in shaping the history and contemporary experience of disease. This work has been part of a much broader evolution in the history of medicine. Since the 1970s the history of medicine has absorbed many of the sweeping changes affecting the historical discipline more generally. An earlier focus on the great leaders of medicine and a tendency toward hagiography has been replaced by a field diverse in both its subjects and its methodologies. Two trends in particular have wielded profound influences on the field. First, the work of social historians has ensured that many of the previously voiceless have become meaningful actors in the history of medicine. From female physicians to patients and their families, social historians have acknowledged the agency of those once absent from, or entirely passive in, the historical narrative. In studying these widely varied lives, social historians have produced a history of medicine that is both more complex and more sophisticated. This broader historical net has further encouraged, in turn, the trend initiated by Sontag of recognizing the role played by context in shaping American understandings and experiences of health, disease and medicine.

Closer exploration, though, has led some historians to criticize Sontag's assumption that disease, in its strict biological form, can be fully separated from its specific historical context. As Robert A. Aronowitz explained in Making Sense of Illness, "While I am sympathetic with the desire to lessen the blame and mystification that sufferers of stigmatized diseases often experience, this type of rhetoric offers up a misleading, naive, and illusory solution--that we can directly apprehend the biological core of disease unadulterated by attitudes, beliefs, and social conditions." ² Instead, Aronowitz and others have suggested, we need to investigate the powerful role played by culture in shaping our society's notions about disease, a second trend of significant importance in the history of medicine over the last couple of decades. Applying the concept of social construction to the history of medicine, this approach maintains that medicine and disease cannot be separated from their specific historical and cultural contexts. ³ The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America, a superb social and cultural history of the diagnosis and treatment of breast cancer by Barron Lerner, makes clear the rich rewards offered by these recent developments in the history of medicine.

Though covering the entire twentieth century, Lerner emphasizes his explorations of the years from 1945 to 1980, a period...