Cancer. Two Essays.

 

The likening of cancer to a hostile enemy goes back more than a century. ‘To have a better understanding of the dread thing we know as cancer just compare it with the war,’ wrote Cleveland’s commissioner of health, R H Bishop, Jr, during the First World War. He continued: ‘Prussianism might well be called the cancerous growth that is trying to kill the other nations of Europe, for cancer, of itself, is a lawless growth of body cells which destroys life if allowed to run its course.’
 
In the early 20th century – when patients were called ‘victims’, long before remissions became tenable for many – the idea of exercising a warlike campaign against cancer gained traction among philanthropists and expert physicians. Yet in their day-to-day lives, people rarely ‘battled’ cancer. For thousands affected, fighting was not an option. Most died within a year or two of a malignant diagnosis. Cancer patients and physicians had little information, scant diagnostic tests, and few medications to consider. For the most part, people with cancer could not be helped except, for the lucky ones, by painkillers.
 
In today’s more promising climate, a ‘fighting spirit’ appeals to many people with cancer. For some cancer patients I’ve known, it’s been important to say – and for those around them to hear – that they’re trying to summon their emotional and physical powers, to do whatever they can to live longer. Some deploy combative phrases to give themselves pep talks (‘You can beat this’) as encouragement before and while receiving cancer treatment, even though they know full well that the outcome is beyond their control.
 
Yet hawkish words – talk of ‘battling’, as opposed to, say, ‘coping with’ cancer – have fallen out of favour among physicians, psychologists and patient advocates. As a practising oncologist I avoided that sort of language. War metaphors seemed inapt for describing research or cancer care. And I recognised this risk: if a treatment doesn’t work, if a tumour progresses, patients who have been led to believe that they’re supposed to put up a fight against cancer may blame themselves, mistakenly thinking that they lacked sufficient strength or will, when it’s the treatment that failed.
 
Whichever way patients and caretakers are inclined to talk about cancer, the history of pugilistic language about the disease could help inform their attitudes. To better understand why fighting words about cancer are commonplace today, and why many experts have moved away from them – concerned about their potential to burden rather than help cancer patients – it’s worth taking a look at their rise to prominence in the United States during the past century, and the debate that followed.
 
A cancer-slaying sword figures centrally in the image selected by the New York City Cancer Committee as the winner of its 1928 poster contest. Arising from a handle fashioned like a caduceus, the blade appears over the slogan ‘Fight Cancer With Knowledge’. This bold image represented the mission of the New York committee’s parent organisation, the American Society for the Control of Cancer (ASCC), which would eventually become the American Cancer Society. After receiving more than 1,000 entries, the judges of the poster contest awarded first prize and $500 to the Brooklyn artist George E Durant for his illustration. In the decades that followed, the cancer society incorporated the sword in its logo and fundraising themes.

 
When US Congress passed and the US president Franklin Roosevelt signed legislation establishing the National Cancer Institute in 1937, a Washington Post headline announced: ‘“Conquer Cancer” Adopted As Battle Cry Of The Public Health Service’, capturing the prevailing sentiment that defeating cancer warranted a warlike effort. The newest branch of the US Public Health Service would counter malignancy on two fronts, the paper reported. Researchers at the institute would investigate cancer’s causes and possible cures, while practising physicians would extend established treatments to regions where medical knowledge and facilities were limited.
 
At the time, most people with cancer sought legitimate medical care only after the disease had spread, if they did so at all. Fearing ‘the knife’, many patients delayed surgical consultation until it was too late. In the absence of effective medicines to treat cancer, quacks selling bogus ‘cures’ flourished.
 
Against this backdrop, the mantra ‘Fight Cancer With Knowledge’ referred not to cancer biology or laboratory investigations, but to the public’s understanding of disease and its proper treatments. Medical research, as we know it, was in its infancy and for the most part was not a priority for the ASCC until after the Second World War. Rather, the organisation aimed to educate people about cancer so that cases might be caught early, when established remedies – predominantly surgery and radiation – might be curative. ‘Do Not Delay’ was another go-to phrase. Experts affiliated with the cancer society emphasised that defence against malignancy rested in the public’s knowledge that cancer could be cured if treated promptly, in the recognition of symptoms (‘danger signals’), and in familiarity with appropriate care.
 
In pursuit of its mission, the ASCC sponsored the Women’s Field Army (WFA), a military-styled, grass-roots organisation that distributed anticancer literature and raised funds for the society. By 1939, led by its formidable national commander Marjorie Illig, the women’s network involved legions of territory-level, state and city commanders, deputy and vice commanders, adjutants, and majors who supervised captains, lieutenants, sergeants, corporals, and several hundred thousand ‘troops’. Each ‘recruit’ was expected to pay a $1 enlistment fee to support the cause.
 
As another world war loomed, the WFA dug into military rhetoric. In February 1938, for instance, Illig spoke with the US Congresswoman Edith Nourse Rogers in a radio segment titled ‘Women, Enlist, This Is Your War’. Mentioning the ongoing conflicts in Spain and China, Illig said:
 
“Our war is of a very different kind… We are not using bayonets or tanks or machine guns: our weapons are leaflets and lectures. We are fighting with facts and our military objectives are the putting to rout of fear and ignorance.”
 
 
As if they were at war, WFA regional commanders wore drab brown uniforms.

 
The battle metaphor stuck. From the late 1940s onward, the American Cancer Society’s annual ‘cancer crusade’ – emblemised by the sword – delivered millions in donations. As scientists sought to develop radioactive compounds for cancer therapy, newspapers trumpeted those efforts with headlines like ‘Hospital Dedicates Atom “Bomb” To Fight Cancer’. Readers absorbed the metaphor from stories such as ‘The Long, Slow Battle With Cancer’ (1952) in Harper’s Magazine and ‘New Weapons Against Breast Cancer’ (1962) in Ladies’ Home Journal.
 
The phrase ‘War on Cancer’ is often attributed to the US president Richard Nixon in connection with his signing of the National Cancer Act of 1971, although the expression antedates that by decades. Speaking at a White House ceremony in December 1971, the president compared US deaths from cancer with those lost in another war: ‘We find that more people each year die of cancer in the United States than all the Americans who lost their lives in World War Two.’ Nixon hoped the Christmastime announcement would divert public attention from the real, ongoing war in Vietnam.
 
While few at the time objected to invoking war images when discussing cancer, the writer Lucy Eisenberg wrote an article that year for Harper’s that was subtitled: ‘Guerrilla action or massive assault – which strategy for the war against cancer?’ Scientists were silently opposed to the ‘Conquest of Cancer’ legislation moving through Congress in 1971, she wrote, adding:
 
“Its proponents, who are mostly laymen, claim that breakthroughs in cancer are imminent, and that given enough money and the proper management techniques, man can conquer cancer just as he split the atom and landed on the moon. But scientists themselves dispute this assumption.”
 
Eisenberg questioned why US Congress would implement a ‘crash program[me]’– speeding the pace of federal cancer research rather than providing steadier and potentially less wasteful support for basic investigations – and answered:
 
“Congress was bewitched by words. Whipped into a rhetorical frenzy with talk of ‘universal anguish and suffering’ and of ‘overcoming an implacable foe’, it overlooked the great areas of ignorance about cancer that still remain.”
 
‘War on Cancer’ criticisms mounted after 1975, when the Columbia Journalism Review published a takedown by Daniel S Greenberg, a medical journalist. ‘With the acceleration of the so-called federal War on Cancer, now in its third year,’ the article began, ‘it is useful to contemplate certain curious and gruesome parallels that are beginning to appear between the reporting of this “war” and the early bulletins from Vietnam.’ Contrary to favourable statistics and upbeat reports distributed by the American Cancer Society, progress against cancer was slim and mainly attributable to surgical advances made before 1955, Greenberg maintained. Cancer research, while costing the government enormous sums, ‘has its own politics, vested interests, warring factions, and public-information apparatus’, he stated.

 
Nonetheless, the language of war remained popular well beyond 1978, when Susan Sontag decried it in her book Illness as Metaphor. Sontag had recently completed aggressive breast cancer treatments: a radical mastectomy, chemotherapy, and an experimental immune therapy. Figurative thinking about illness clouds patients’ rationality, she argued. Perceiving cancer as a demonic enemy supports ‘avowedly brutal notions of treatment’, she wrote, adding that if the patient’s body is ‘considered to be under attack (“invasion”), the only treatment is counterattack.’
 
Alluding to Greenberg’s perspective, Sontag wrote:
 
“It is one thing to be sceptical about the rhetoric that surrounds cancer, another to give support to many uninformed doctors who insist that no significant progress in treatment has been made.”
 
 
The truth about cancer lay between the ‘twin distortions’ of military rhetoric – the US cancer establishment’s ‘tirelessly hailing the imminent victory over cancer’, and the pessimistic specialists who talked ‘like battle-weary officers’.
 
Other influential people who’d been cancer patients embraced the language of war, finding it empowering. The Black feminist and poet Audre Lorde was explicit in her desire to be seen as a combatant against cancer: ‘Women with breast cancer are warriors,’ she wrote in The Cancer Journals (1980) after undergoing mastectomy in the late 1970s. Lorde rejected pressure to wear a breast prosthesis after surgery. In her community, cancer was often hidden. Rendering wounds invisible isolates and disempowers cancer patients, she asserted. Lorde compared her postmastectomy figure with Moshe Dayan, the Israeli leader who wore an eyepatch over his empty eye socket, a war wound. ‘Nobody tells him to go get a glass eye … The world sees him as a warrior with an honourable wound,’ she wrote. ‘I refuse to have my scars hidden or trivialised behind lambswool or silicone gel. I refuse to be reduced in my own eyes or in the eyes of others from warrior to mere victim.’
 
Lorde’s words foreshadowed the ‘silence = death’ message popularised by people with AIDS a few years later. She wrote:
 
“If we are to translate the silence surrounding breast cancer into language and action against this scourge, then the first step is that women with mastectomies become visible to each other. For silence and invisibility go hand in hand with powerlessness.”
 
Indeed, after public demonstrations by the AIDS Coalition to Unleash Power (ACT UP), some cancer patient advocates became activists, realising that they needed to fight for faster research, better care and access to treatments.
 
In the 1980s, ‘battling’ cancer came to suggest a daringly active role for patients – that they didn’t have to suffer passively, that their knowledge and choices could make a difference. When Richard Bloch, a cofounder of the tax company H & R Block, was first diagnosed with lung cancer, doctors said that his condition was hopeless. He then consulted a specialist at Houston’s MD Anderson Hospital and was fortunate; after surgery, he survived for more than two decades. Bloch coauthored a book, Fighting Cancer (1985), sponsored an information hotline, and started a foundation to help others who were affected. He encouraged all cancer patients to seek second opinions before ‘giving up’.
 
In Bloch’s view, fighting cancer involved information-seeking. As some physicians didn’t keep up to date in their knowledge, they’d recommend that people with cancer ‘go home and make themselves as comfortable as possible’, Bloch observed. ‘I’m not saying that everyone can beat cancer,’ he clarified. ‘Certainly, some people are going to die from it, no matter what they do. But … if a person doesn’t try, there is no way they can beat it.’
 
The comedian Gilda Radner, another prominent cancer fighter of this era, received gruelling chemotherapy for ovarian cancer before she died at age 42. Before Life magazine put Radner on a cover in 1988, editors sent her a photograph. ‘It looked like “coping with cancer” to me,’ she shared in her memoir, It’s Always Something (1989). ‘I didn’t want a “coping with cancer” cover because that’s not the way I was dealing with cancer,’ she wrote. ‘I wasn’t coping, I was fighting.’
 
Many doctors have objected to the use of military words in the context of illness due to the potential psychological ramifications. A person’s lack of responsiveness to cancer treatment, a relapse or death could erroneously suggest that they didn’t try hard enough, that they were ‘weak’ and somehow responsible for succumbing to their illness. A patient’s loved ones may blame them, consciously or not, if they fare poorly after a cancer diagnosis. Patients may even blame themselves.
 
Few clinical studies have examined the possibility of a relationship between cancer patients’ attitudes and their survival with any scientific rigour. In June 1985, the New England Journal of Medicine published a prospective analysis of several hundred cancer patients, conducted by the sociologist Barrie Cassileth and her colleagues at the University of Pennsylvania Cancer Center. In people with cancer, ‘the biology of the disease appears to predominate’ and ‘override the potential influence of lifestyle and psychosocial variables’ such as hopelessness, they concluded. In an editorial citing that study, Marcia Angell criticised popular notions about psychological causes of cancer and its progression, writing: ‘A view that attaches credit to patients for controlling their disease also implies blame for the progression of the disease.’ The editorial generated an enormous response, with pushback in published letters.
 
Journalists stirred the debate. In October 1985, The New York Times ran two articles about the controversy by Daniel Goleman, a psychologist and author, who wrote in that paper’s science section:
 
“Some researchers are concluding that breast cancer patients, for example, who are openly upset and show a fighting spirit – ‘I’m going to conquer this thing!’ – marshal stronger immune defences against the spread of the disease and are more likely to survive than those who suffer with quiet stoicism.”
 
His pieces drew the attention of Jimmie Holland, head of the psychiatry division at the Memorial Sloan Kettering Cancer Center in New York and the psychologist Morton Bard. A month later, in a letter to the Times, Holland and Bard stated:
 
“[P]atients with cancer are bombarded with information that ‘bad’ attitudes hasten death, and ‘good’ attitudes (sometimes hard to sustain when feeling ill) must be maintained to control disease. A fighting spirit and optimism contribute to wellbeing, to a sense of control of the situation … On the other hand, patients in whom cancer progresses seem to be blamed for not trying hard enough. This follows the well-known ideology, applied to such problems as poverty and crime, of blaming the victim when no explanation can be found.”
 
Holland, who dedicated her career to the field of psycho-oncology, spoke of the ‘tyranny of positive thinking’. Years later, she said in an interview with CBS: ‘The idea that we can control illness and death with our minds appeals to our deepest yearnings, but it just isn’t so.’
 
The issue simmered. In 1999, The Lancet reported some evidence that women with early stage breast cancer who experienced depression or scored highly on a scale measuring ‘helplessness and hopelessness’ were more likely to die within five years. Other studies, while limited, have not supported a connection between psychology and survival. Researchers with the Radiation Therapy Oncology Group, led by the psychologist James Coyne, surveyed more than 1,000 patients with head and neck cancers to study whether their emotional states, such as sadness, might affect medical outcomes. In an analysis published in 2007 by the journal Cancer, Coyne and colleagues found no relationship between cancer patients’ survival and emotional wellbeing. ‘The belief that emotional wellbeing affects survival, nonetheless, has been remarkably resilient in the face of contrary data,’ they wrote.
 
Doctors today generally caution against framing malignancy as an enemy that one must personally defeat. ‘The use of the battle metaphor implies a level of control that patients simply do not have,’ wrote the physicians Lee Ellis and Charles Blanke, and the cancer survivor and patient advocate Nancy Roach in a 2015 issue of the Journal of the American Medical Association:
 
“[W]hen we talk about the ‘battle’, we minimise the real issues faced by patients every day. Patients deal with and sometimes overcome nausea, pain, fatigue, and weight loss. They suffer the isolation that comes with a diagnosis. For those with potential curative disease, they live with the fear of recurrence and impact of chronic adverse effects.”
 
The ‘continuous urge to win the battle’ may extend to physicians, they noted. Oncologists’ desire for ‘victory’ over cancer may be detrimental to their patients if they’re inclined to prescribe inappropriately aggressive treatments. And patients, wishing to ‘beat’ cancer, may be reluctant to accept palliative or hospice care.
 
As a physician, I know there is no such thing as a tumoricidal mindset. My preference is to avoid battle language. But if someone else wants to say they’re fighting their disease, maybe that’s OK – so long as they and their doctors are clear-eyed about it, and they don’t deceive themselves into thinking they might control their outcome with an upbeat attitude or thoughts. Cancer patients have different styles and ‘philosophies’. What’s hurtful to one may be helpful to another.
 
Some years ago, while engaged as a journalist, I was invited to a fundraising event – a ‘Haymakers for Hope’ amateur boxing match – at Madison Square Garden. I’d never been to a boxing event or watched one on TV, for the violence of it. But I was drawn to the symbolism: the participants would be fighting, literally, for cancer charities of their choice. They’d been training, working out for months, to punch and knock each other out for a dear cause. Unsure if I could handle it, I contemplated Leslie Jamison’s book The Empathy Exams (2014), in which the author challenges herself, her empathy, by meeting people with behaviours and beliefs that differ from hers. At the event, I interviewed boxers who had lost friends to the disease. The ‘ring girls’, as they were called, were cancer survivors. Who was I to be critical?
 
Progress against cancer has mounted in recent decades. Whether that is attributable to the federally funded ‘War on Cancer’ launched during the Nixon administration or to the steady and incremental work of scientists over the past half-century (involving governmental, philanthropic and corporate investment that might have happened anyway), or both, is impossible to know. But the gains are undeniable. In 1975, the overall US death rate from cancers was 199 per 100,000; this rate rose until 1991, when it peaked at 215, and has since fallen steadily to 144 per 100,000 of the population overall in 2020 – a decline of 28 per cent since 1975. The US Cancer Moonshot programme, initiated in 2016, promises to support further advances. Yet some, such as Jeffrey Kluger at Time magazine, have criticised this approach, likening it to the ‘War on Cancer’.
 
Today, as better diagnostic tools, immune agents and targeted cancer therapies are becoming available, the most important thing is what we actually do, at the societal level, to help people with cancer. The question is if we’re willing to fund an all-out effort to help those affected through more inclusive research and provision of care. And here is where aggressive metaphors might be most appropriate: now that cures may be possible, it’ll take a political fight to lower cancer drug prices and assure that all patients have equal access to the treatments they need.
 
 
The war on cancer. Is it time to abandon the century-old idea that cancer is best met with a ‘fight’ from patients and their doctors alike? By Elaine Schattner. Aeon, May 9, 2023. 

Our guest is Dr. Elaine Schattner, a New York City-based journalist, cancer survivor, and physician; she's also a clinical associate professor of medicine at Weill Cornell Medical College. She joins us to discuss her new book, which is a well-researched history of how we as Americans -- from before 1900 up to the present -- talk about cancer. "From Whispers to Shouts" carefully examines public perception of cancer through stories in newspapers and magazines, social media, movies, TV shows, the world of sports, celebrities, and other avenues of popular culture. Per the noted science writer Deborah Blum: "In her innovative and insightful book...Schattner explores the ways that we tell the story of cancer -- and the ways we often fail to tell the real story of this notably complex and treacherous disease."
 
"From Whispers to Shouts: The Ways We Talk about Cancer".  Studio Tulsa, April 17, 2023

    

 
 
As soon as I woke up from the dream about two helicopters crashing onto a highway, I called my doctor’s office and asked for a mammogram.
 
Nine months earlier, a nurse practitioner had felt the lump with her gentle, cool hands and told me: “I’m not worried. You’re young. It’s most likely a cyst.”
 
“If you’re not worried, I’m not worried,” I’d said and hopped off the table.
 
The helicopter dream changed all that. I’m not certain why it gave me such a feeling of urgency, but it did. I went back in for the mammogram, then for a biopsy on the lump. Not long after that a stranger called and said: “You have cancer. Unfortunately. Someone will be in touch in the next couple of weeks.” That was August 2020. I was 36, and I’d soon be facing one life-altering decision after another in response to questions that had no medically logical answer.
 
I’m a deeply practical person. I grew up in a Scots family of farmers, coal miners, construction workers and veterinarians. I finished college one class short of a biology degree. I understand the importance of common sense and double-blind scientific studies, but at the same time, I believe that occasionally a little bit of woo-woo can’t hurt.
 
While I couldn’t tell you why two helicopters crash-landing made me certain that I had cancer, I started to take my dreams more seriously, waiting at least one night before any major medical decision. Looking back on it now, it doesn’t make sense — not exactly. But when all the rational decision-making options are bad, relying on dreams offers a different kind of logic, an emotional logic, that can be a lifesaver in its own way. The dreams helped me feel as though I wasn’t simply tossing a coin over life-and-death decisions.
 
After my diagnosis, I put on my turquoise ring for protection and flew to Boston for a second opinion. Because my cancer is hard to see, often invisible on scans, the doctor told me it was likely to be even more advanced than my other doctors thought, but we wouldn’t be sure until after my surgery. “There are nearly equally good arguments for and against doing chemo,” he said. “What do you want?”
 
That night I had a dream of soaring above a garden full of light. I woke laughing with delight, but then my laughter turned ironic — who has ecstasy dreams about chemo? Still, I took what felt to me to be the dream’s advice. I started chemotherapy.
 
I was halfway through chemo, and very bald, on the unusually cold day when I met my surgeon to talk about mastectomy. I’d forgotten my hat, so I was holding my hands over my ears trying to warm the ache out of them. When she walked in, I probably looked as if I didn’t want to hear what she had to say — and frankly, I didn’t. “You look great!” she chirped.
 
This appointment was about my “choice” between a single and a double mastectomy, and between reconstruction and no reconstruction. Double mastectomy, she said, would mean a much lower chance of developing a new breast cancer.
 
But not zero. “My sibling had a double mastectomy and then had a recurrence,” I told her, “and since the doctors don’t regularly scan double mastectomies, the recurrence was nearly missed.”
 
She made a quietly compassionate face. I’ve learned to pay attention to doctors’ silences. However, I’d already made my choice, based on the first dream I’d had in months.
 
In my apartment, flames were creeping up the blinds and down the back of the couch. I had two jugs in my hands, though only one was full of water, which I threw on the fire. I went to refill both jugs, but when I returned, the fire was already out. And so, with some relief and a laugh at the strange ways dreams communicate, I decided on a single mastectomy. One jug was enough. I didn’t tell my doctor about the dream, but I did tell her about my decision.
 
“And are you going to get reconstruction?” she asked.
 
I dreaded this question. I remembered how scared I’d been to see my mother’s scar when she had her mastectomy 20 years before. Someday, I suspected, I’d feel her strength, but right now, all I could feel was the fear. And I hadn’t had any more dreams.
 
“I think I’ll go flat,” I heard myself say. I reached out a little with my hand, almost dizzy, as if I could pull the words back. But then I imagined saying, “I guess we’ll go ahead with the reconstruction,” and I realized I’d feel the same way. There was simply no answer that felt right.
 
As the Boston doctor had predicted, during the mastectomy, they discovered that my cancer had spread deep into my lymph nodes. This put me into the category of a locally advanced cancer and lengthened my active treatment by three years. But first, I had radiation.
 
I grew to love my radiation oncologist and her team of techs. I wrote them poems and they told me jokes; we’re still in touch. But the first day was another story.
 
I was placed in a CT machine — topless, head turned to the side, arms over my head, a tough position after my recent surgery — and asked not to move for nearly 45 minutes. Then a six-person medical team came in and drew on my bare chest with a permanent marker. I hadn’t been touched by that many people simultaneously in my life, even with my clothes on. I was glad my head was turned away from them as I cried. I’ve never felt more like an object.
 
Nearly a month into radiation, my radiation oncologist found something on my scan: maybe a still-cancerous lymph node; maybe just a pocket of inflammation. If we “boosted” the radiation to kill the potential cancer, we’d be radiating through every major nerve and muscle in my arm, and I had already had nerve damage from my mastectomy. She was concerned that this could create a lifetime of pain and limited mobility. If it was cancer, this was our only opportunity to treat it, but they couldn’t do a biopsy because of its position; there was no way to know for sure.
 
“What would you do if it was your scan?” I asked. We were standing next to the radiation arm, which looked like a blunt, faceless creature.
 
She held out her hands helplessly. “I’ve been thinking about it all night,” she said, looking down. “It’s as close to 50/50 as I’ve ever seen. I would probably go for the radiation myself, but I know the damage it can do. I would struggle with the choice.”
 
That weekend, while I struggled, I had my last and strangest breast cancer dream. I saw nothing, as if I was in a dark room. A man’s voice, inflectionless, American-sounding, said, “You must continue with radiation.” It was as if my subconscious was drained of all the symbols, the stories, the irrational desires and impossibilities. The only straightforward dream of my life.
 
I did the extra radiation.
 
Today I’m nearly finished with the treatment my dreams led me to, and I’m currently N.E.D. (no evident disease). My chance for recurrence will never decrease, but I’m beginning to hope again.
 
Were my dreams infallibly correct? No. My cancer was strongly resistant to chemotherapy, but my heart was not. Shortly after radiation, at the age of 37, I was diagnosed with heart failure. My ecstatic dream of flying was replaced by the reality of a lifetime of palpitation and metoprolol. It feels a little like a betrayal. Still, if that dream helicopter hadn’t fallen to my feet in the middle of the abandoned freeway, I might have died of metastatic breast cancer. All of my doctors opened their hands, indicating with humility that science had no clear answers for me. I’m grateful that my dreams’ guidance allowed me to make choices that felt meaningful.
 
It doesn’t matter whether you “believe” in science — the earth is still round. But we are creatures who need something to believe in — stories and symbols to make meaning from a chaotic universe. Are dreams the flotsam of our waking lives, washed up on the shores of consciousness? Or are dreams, like pain, meaningful messages from our bodies?
 
Imagine my open, uncertain, freckled hands. There’s no conclusive evidence supporting either hypothesis. But when I felt betrayed by my own body, dreams gave me a feeling of meaningful connection to, and faith in, myself. I’m as grateful for that connection as I am for highly advanced medicines, and for the doctors who spend every day reckoning with the mystery that is cancer.
 
Katie Farris (@katiefar) is the author of several books, including “Standing in the Forest of Being Alive.”
 
When I Got Cancer, My Dreams Told Me What My Doctors Could Not. By Katie Farris. The New York Times, March 26, 2003.

 

 
 

Katie Farris’s work has been commissioned by MoMA and appears in American Poetry Review, Granta, McSweeneys, The Nation, and Poetry. She is the author of the chapbook A Net to Catch My Body in its Weaving, which won the 2020 Chad Walsh Poetry Award from Beloit Poetry Journal, and boysgirls, a hybrid-form book, as well as co-translator of many books of poetry. She holds degrees from UC Berkeley and Brown University. She is currently Associate Professor in Creative Writing at Georgia Institute of Technology. Standing in the Forest of Being Alive (Alice James Books, 2023) is her first book of poems. Below are excerpts from her interview with James Morehead on the Viewless Wings Poetry Podcast.
 
James Morehead: Before we talk about your poetry and your book, share a few thoughts for students considering an MFA. From the perspective of a student and, now, an Associate Professor, how should students approach an MFA to get the most out of the experience?
 
Katie Ferris: “I taught in an MFA program for about eight years at San Diego State University. I’ve also taught in low residency programs here and there, and at New England College most recently. I got my MFA from Brown University. I’ve seen the MFA experience from multiple perspectives. When students ask me what to expect, I always say the most important thing you’re going to get out of your MFA is time to write. That’s the thing you can pretty much be guaranteed. If you’re a person who needs deadlines and other people’s pressure in order to get you to succeed, then that can be really effective.
 
“Most likely you will come out of an MFA program with at least one or two good readers. If you’re lucky, you might come out of an MFA program with a mentor whom your relationship with lasts beyond those two to three years. You may come out of there with people who can write you blurbs or recommendation letters. You should be able to count on recommendation letters from faculty whose class you’ve taken, provided they don’t retire in the interim. I think a lot of people go in expecting they’re going to have a book when they get done. That may or may not be true. When I finished my MFA program, I had a book but it was not the first or second book I published. You come out with a manuscript of some kind, but it might not quite be what you expect.
 
“I also wouldn’t go into an MFA program necessarily expecting an easy job. There are jobs that you can get teaching, such as adjunct rhetoric and writing composition type classes, which are typically pretty easy to find. However, it can be quite a challenge to get into a solid tenure-track position. Some people love adjuncting and do it their whole lives, but it can be a lot of work. If you’re going into an MFA program primarily with the hope of having a university position, it will be good to talk with other people. Depending on where you are in the country and how far you’re willing to travel and how much you’re willing to teach, that may be viable, but it’s not something to count on. That’s something I’d really want students to know before they take on the debt and the time to go into an MFA program.”
 
James: “Standing in the Forest of Being Alive” interweaves your powerful experiences battling cancer at a relatively young age, and social issues, yet never preaches. Before getting it to specific poems, how, in general, do you tackle such powerful subjects without the subject overwhelming the poetry?
 
Katie: “The insurrection happened just six days before my surgery. Things were happening kind of neck and neck, and most of the poetry that I wrote during this time was totally overwhelmed by the subject matter. It was awful. It was preachy. It was frustrated. It was emotional as I was flailing around in fury and fear. Most of it was crap. Maybe 10% of it was decent. and of that maybe 5% ended up in this book. I’d like to pretend I have the magical wand that just makes good stuff come out, but in actuality, the only thing I have is the ability to distinguish what is good work from bad work, or good work from work that just doesn’t fit.
 
“One of the things I really focused on as I was writing the book was trying to incorporate humor where I could. That’s a tricky thing both with cancer and criticizing a country which I love but also which I am very critical of. I was going through poems that I accumulated during this time and asking myself if there was a touch of humor in there. I looked to see if I could pull a tease out a little bit or add some word play or some sort of linguistic strangeness that I could use to turn this on its head so that I didn’t run the risk of taking myself so seriously all the time. There’s certainly some very serious problems there, but I think providing some variety of tone was fundamentally what I was looking to do where I could.”
 
James: “A Row of Rows” is one of many poems in this book where you achieve exquisite brevity. You write,
 
"A pleasant row
of rows, little rugs
on the strings
of our love,
just enough
to pull out days
taut."
 
 
Like many poems in this book the lines are compact, just a few words, with most of the white space undisplaced. How would you describe your poetic voice and how has it developed over the years?
 
Katie: “That’s a great question. My first book consisted of short prose pieces, somewhere between prose poems, flash fiction, and short stories. Initially, I was trying to be a fiction writer, but about five or six years ago, I realized I was actually a poet. It took me 15 years to come back to poetry, where I started.
 
“When I transitioned from sentences to lines, I lost some confidence in line breaks. I began exploring metered poetry and prosody, which I enjoyed despite my initial failures. Around the time I was diagnosed with breast cancer, I had just finished reading Emily Dickinson’s entire collection. I was particularly drawn to her use of ballad meter.
 
“This shorter style, combined with writing love poems, led me to adopt a two-beat-per-line meter, which I thought of as two heartbeats together in a line. Dickinson’s alternating three- and four-beat lines also influenced my work, as I mostly write in iambic pentameter.
 
“This shift in style allowed me to think more in phrases than in long sentences, and it gave me the confidence to experiment with longer, more statement-like poems. Overall, this evolution is what led to the poetic voice present in my current work.”
 
James: “The Invention of America” experiments with repetition, with line length and word placement. Is a howl at times, longer than many poems in the collection, and is an effective shift in form, placed between two slight poems.
 
How do you approach ordering poems, the connections between poems, in particular the placement of a poem like this that stands out in form and voice?
 
Katie: “You’ve set up the context quite well. The book incorporates three major threads: love poems, cancer poems, and America poems, with some overlap between them. Ordering the book was a challenge, and I experimented with different arrangements, seeking advice from others like Jessica Jacobs and Maggie Nelson.
 
“Ultimately, I focused on tonal and textural variation. Placing a long, hard-hitting poem between two shorter, gentler ones allowed me to transition between themes, such as from love poetry to the idea of America and back. Transitions in poetry collections are perhaps less discussed than in fiction, but they’re crucial for maintaining the reader’s attention.
 
“It’s essential to give readers a break in tension if you want it to build again later. I aimed to keep the hits coming, ensuring that every poem in the book was worthy of inclusion. However, I also recognized the need for ‘sleeper hits’ – the slower, subtler poems that complement the more prominent ones. At times, I even had to revisit older poems to extract smaller, more concise pieces that could serve this purpose.
 
“The goal was to create a well-balanced collection that effectively spotlighted poems like “The Invention of America” while maintaining an engaging flow for the reader.”
 
James:  You manage to imbue this collection with humor, “Quid Pro Quo: A Dedication” you write:
 
 "You said
we could replace
our lumpy
twenty-year-old
mattress if
I wrote you
a poem.
So here's
your god-
damn
poem."
 
I read this out loud to my wife and thought it was hilarious. How do you advise poets to approach incorporating humor into their poetry, as it is deceptively difficult to do well?
 
Katie: “It’s true, incorporating humor in poetry can be difficult, partly because we might not trust it when it comes too easily. I wrote this particular poem before my cancer diagnosis as a love poem for my husband and left it on a Post-It on the refrigerator. When searching for love poems for my manuscript, I initially dismissed it as too easy, along with another poem called “Rachel’s Chair.” Surprisingly, people loved “Rachel’s Chair,” which taught me to trust their opinions and, eventually, my own instincts.
 
“Workshops are great for gathering feedback, helping you understand what works and what doesn’t. Over time, you become more objective about your own writing. Learning from my experience with ‘Rachel’s Chair,’ I realized that sometimes a straightforward, intimate sentence or two can work without needing elaborate poetic language.
 
“As for advice, I encourage poets to go for it and add humor to their work. I’d love to read more funny poetry. Trust your instincts, and don’t be afraid to experiment with different styles and tones.”
 
James: Absolutely. Billy Collins’ recent book, for example, is full of short, clever snippets, and it’s a whole collection of them. It’s a good reminder that poems don’t always have to pull from Greek history, be ten pages long, or extremely complex to resonate. Trusting your instincts and your audience is important.
 
Katie: “Definitely. Another poet who does this beautifully is Andrea Cohen, who writes very short, lyric poems. Her collections primarily consist of these compact, clever, humorous, and witty pieces, and there’s so much potential in that style.”
 
James: I love the titles of so many of the poems in this collection. One of many examples: ‘I Wake to Find You Wandering the Museum of My Body,’ a title that is a poem in itself. How do you approach the challenge of titling a poem, and what are the characteristics of an effective title?
 
Katie: “I’m honored that you like my titling, as I often struggle with it. When I was a kid, I named my stuffed animals quite literally. When titling a poem, I usually look within the poem for an unusual line. If I try to come up with a title externally, it’s often terrible. It has to surprise me and not be premeditated.
 
“An effective title, for me, can feel like a poem in itself. I ask myself, ‘Would I want to read this if it was all there was?’ Ideally, a title has a double or triple meaning, with layers of depth that can be uncovered. I love puns, wordplay, and using unexpected words because I have a passion for language.”
 
James: The poem “To the Pathologist Reading My Breast, Palimpsest” is such a powerful blending of found medical text, so dispassionate and clinical by design. The rhymes and phrases you find and amplify. Share how you approached creating this poem. 
 
Katie: “This was a tough one, as I had been trying to write my mastectomy poem for a long time. Most of the chemo and radiation poems I wrote while going through the treatments, posting about my experiences on social media. However, the surgery was particularly difficult for me, and I struggled to address it in my poetry.
 
“During that time, I was reading all the pathology reports since I have a strong interest in biology and medicine. One of the reports really shook me, and months later, I revisited it, noticing the rhyme of ‘specimen’ and ‘formalin.’ That’s when I realized that was the basis for my poem.
 
“One of the goals of my book is to demystify the experience of cancer, opening up the conversation, and letting people know that it comes with its horrors, but also, in a strange way, with its delights. I wanted to playfully address the doctor who did this work and the medical community in general, acknowledging that while some doctors may lose track of the humanity in their work, many do their best to keep it at the forefront.
 
“This poem was a way to be in conversation with the medical field, even though it gets quite sharp towards the end, especially with the irony of being ill while a dear friend was pregnant. Overall, I had a lot of love and respect for my physicians, but I also had some bad experiences in getting diagnosed and treated. This poem allowed me to express these emotions while still acknowledging the dedication of the medical community.”
 
James: I was moved by your determination to live, the thread of hope through many of the poems. In “Woman with Amputated Breast Awaits PET Scan Results” you write
 
"Help me to spell waiting? I forget. And whom
can I tell how much I want to live? I want to live."
 
And in “To the God of Radiation” you write:
 
"O God of Radiation,
let your light
like a ship pass through me,
your radiance exposing,
exposing what's inside me
like film a god takes—"
 
How do you hope your experience affects those who have been impacted directly or indirectly by cancer, and by those who haven’t?
 
Katie: “I thought a lot about this from the beginning, which is unusual for me. This is the first time I really engaged with my audience directly as the book was being written. As I shared updates about my medical condition and the poems, I struggled with how to share my experiences publicly. It was during the pre-vaccination COVID-19 era; I was alone, medically vulnerable, and couldn’t see anyone. I used this platform as a way to make connections, but I also worried about burdening others.
 
“What emerged were messages from people saying that my writing helped them understand their loved ones’ experiences or that it resonated with their own experiences with cancer. This made me realize I had a responsibility to keep going and keep hoping, not just for myself but for others as well. My writing became a way to speak with, not for, the cancer community that I had become a part of, a community that nobody wants to join.
 
“As one in two people in the world will end up with some form of cancer, my hope is that my words can help others understand, empathize, and find hope, whether they are directly or indirectly affected by the disease.”
 
James: What are you hoping to impart to your students, and what have you learned from you students?
 
Katie: “Oh, man, so much. One of the first things I’ve learned from my students is how brilliant they already are. There’s a lot of fear about producing and emphasis on the product or deliverables, which I really dislike. They want to write a good poem, but I tell them that their brilliance lies in the experimentation, process, and the act of writing itself. The deeper we go down the road of focusing on the verb of writing instead of crafting a perfect product, the better the results.
 
“It’s easy to say this to others, but harder to live by it yourself. I’ve been writing for a long time, and it’s easy to feel like you’re not successful in the arts. The biggest antidote to that feeling is to focus on doing the work, loving the work, and enjoying the work. That’s the point of this journey, at least for me.
 
“I used to say I liked having written, but now my perspective has changed, and it helps me stay sane in a world that can feel bizarre and insane, even in the poetry world. It wasn’t just me figuring this out; it was my students and me working on it together. This shift in perspective has also affected my own poetics.
 
“If my students come away believing in focusing on the process even just 5%, I will have succeeded.”

 
 
Katie Farris Battles Cancer and Insurrections with Poetic Humor and Hope in “Standing in the Forest of Being Alive”. By James Morehead. Viewless Wings, May 9, 2023.