Malignant

It’s impossible to do justice to the breadth of literature that surrounds cancer. We can view cancer in a historical context through works like Siddhartha Mukherjee’s The Emperor of All Maladies. We can read reflections from the medical community in Atul Gawande’s Complications. We can see literature through the decades—like Death Be Not Proud—take on the question of how to balance art and science in practicing medicine and what might determine what we would call “good medicine.” Countless examples shape how we, as a culture, think about and make sense of cancer. And at the forefront of all cancer genres is the personal anecdote: the story of experiencing cancer either firsthand or through a family member or friend. Malignant: How Cancer Becomes Us, by S. Lochlann Jain, takes the jumbled milieu of medicine, anthropology, culture, and history and tells us how we (broadly defined) think about cancer through the lens of her experience with it.

It’s impossible to do justice to the breadth of literature that surrounds cancer. We can view cancer in a historical context through works like Siddhartha Mukherjee’s The Emperor of All Maladies. We can read reflections from the medical community in Atul Gawande’s Complications. We can see literature through the decades—like Death Be Not Proud—take on the question of how to balance art and science in practicing medicine and what might determine what we would call “good medicine.” Countless examples shape how we, as a culture, think about and make sense of cancer. And at the forefront of all cancer genres is the personal anecdote: the story of experiencing cancer either firsthand or through a family member or friend. Malignant: How Cancer Becomes Us, by S. Lochlann Jain, takes the jumbled milieu of medicine, anthropology, culture, and history and tells us how we (broadly defined) think about cancer through the lens of her experience with it.

It’s hard to not have a mental model of cancer. It’s a diagnosis. It’s a disease. It’s a status. It’s a metaphor. It’s a meme. It’s a character. It’s distinctly personal and culturally distant. Malignant gives us the framework to appreciate that the explanatory schemas that Western society has come to use to understand the disease mimic, in fact, the disease itself. The book is a rare combination of first-person experience with cancer (the author acquaints us with her condition at the beginning of the book) and scholarly reflection. Malignant is rare in that it offers intelligent yet accessible analysis of cancer. Jain takes many literatures and many experiences and “translates” those experiences to a broader audience.

However, Malignant has a darker side to it. The book is profoundly uncomfortable to read—it causes the reader to reflect and to worry about cancer and oneself. This discomfort, though, is an interesting narrative technique that forcibly invests the reader in the narrative and compels the reader to take active ownership of one’s own opinions and experiences with cancer. Jain is fully and poignantly aware that for most readers, making sense of cancer is something that we’d simply rather not do. We’d rather not think about what it means and how we engage with it. Malignant strips us of that luxury—or perhaps highlights that intellectual laziness—through its deeply personal and anecdotal stories, its medical grounding, and its dark existential rigor. This darkness is perhaps best noted in the contempt, disgust, and (perhaps?) glimmering compassion directed at the medical community and the medical machinery that is the business of knowing, diagnosing, treating, and engaging with cancer between the doctor and the patient.

Something else came to my attention while I searched for information on my treatment course. I read a trial report written by one of the doctors, a pooh-bah in the oncology world, who had misdiagnosed me. An erupting chasm seemed to physically tear the papers from my hand as I realized once in the category “diagnosed,” I was useful. I don’t mean that I became an interesting case in any way. On the contrary, I was a statistic. But as a statistic I bolstered the gravitas and significance of her world. That recognition of the gap between the counter and the counted caused the rupture.

Malignant does not dwell in darkness, but neither does it let us avoid it. The narrative voice feels like something out of a Camus short story—someone with an observation about humanity to convey with detached exhaustion. In other words, the only meaning that the world has is the meaning we give it. To that end, we feel the personal experiences of the cancer patient(s) in Malignant creating the character of cancer, just as much as we feel a broader cultural milieu (be it scientific, medical, or societal) forming a definition of “what cancer is” and “how cancer is experienced.” The book’s dark almost-nihilism of the cancer experience is not easy for the reader.

But Malignant is, fundamentally, a good book—and perhaps more significantly for the author, an important one. It does not claim to be “the” voice of cancer, but rather, an enterprise whose fundamental thesis lies in the plurality of the cancer experience. If philosopher William James wrote about cancer, one gets the feeling that he would champion something that highlighted this plurality that Jain puts to her readers. In the growing literature of intelligent, reflective analyses embedded in personal experience, Malignant is an expressive and important work.