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Breast cancer and the post-surgical body: Recovering the self
Samantha Crompvoets
ISBN: 1-403999-00-7 2006 177 pages Houndmills, Basingstoke, Hampshire: Palgrave Macmillan
Catherine Mackenzie
Department of Public Health, Flinders University, SA
This book sets out to explore the lived experience of Australian women who have had breast cancer surgery, in particular how they (re)construct and 'perform' their post-surgical bodies. The book starts from the position that women who have had breast surgery are offered no space by the dominant breast cancer culture, or by a broader sexist society, to redefine their post-surgical bodies as complete or feminine without two matching breasts. The author argues that in the prevailing cultural context, women are expected to regain two breasts by either wearing prostheses or by undergoing breast reconstruction.
The book is organised in five main chapters, followed by a concluding chapter. The literature review in Chapter One frames the rest of the book and includes helpful explanations of breast cancer incidence and contemporary medical and surgical treatments in Australia.
Featuring in Chapter One is a valuable, autobiographical account of the author's experience of what constitutes the interview process when exploring a painful topic such as women's breast cancer experiences. Researchers' accounts of interview processes are thankfully becoming part of the published literature, and this chapter highlights the need for researchers to have some form of support to enable them to cope with their own emotions.
Chapter Two sets out to explore ways in which wider social and cultural narratives are filtered through personal narratives of women who have surgical breast cancer treatment. While it is inevitable in such research that each reader will analyse narratives in their own way, I was frustrated by an absence of analytical steps in the conclusions drawn in the summaries between pieces of narrative. In several of the analyses following sections of narrative, I was left wondering whether the author was making judgements, either about the woman's character, or by seeming to 'blame' the individual woman for 'choices' that perhaps the author views as 'wrong'. For instance, the author describes one of the participants as 'positioning herself' as 'someone slightly superior', and who 'emphasises a level of self-importance' (p.30). Later, the author expresses her surprise that the same woman 'does not make a decision not to wear a prosthesis' (p.38).
Nevertheless, this chapter contains some useful analyses, for example she discusses ways in which 'positive thinking' permeates cancer discourse, particularly in relation to 'survival' (p.57). Here, the author makes good use of literature which critiques 'positive thinking' discourses to show how one of the women's narratives is reliant on such discourses, which require cancer patients to respond to their illness with optimism rather than complaint. Thus, the author analyses the narrative in the context of dominant discourses rather than her interpretation of the character of the individual woman.
The conclusion to Chapter Two draws out some interesting analyses, in particular, a tension between trust and mistrust of the medical profession, and importantly, 'a stark distinction between the ideal 'body for others' and the 'felt body' with the 'outer' being a two-breasted pretense filled out with prostheses and the 'inner' body maimed by breast cancer surgery' (p.60).
Chapter Three includes a useful history of the development of the breast cancer movement in Australia. The author discusses ways in which a range of breast cancer organisations promotes a culture supporting an assumption that regaining two-breastedness signifies full recovery and is therefore the ideal 'end-point' for women who have had breast surgery. She reveals hierarchical systems within breast cancer organisations which perpetuate this assumption, and ways in which these silence women who may challenge the dominant view by suggesting one- or no-breastedness can be equally feminine and beautiful.
Chapter Four provides an insightful analysis of 'the commodification of the post-surgical body' (p.96). The author examines advertising material produced by two prostheses companies and compares these with women's accounts of wearing and managing prostheses. This chapter provides excellent examples of how prostheses companies market their products as integral to making women feel and look beautiful, normal and free, while the realities of wearing prostheses for the women interviewed include constant fear that they could fall out or show, that they feel uncomfortable, and they mean extra work.
Chapter Five explores feminist debates about breast reconstruction, and cosmetic surgery and body image more generally. Included in this chapter is a discussion of public/private healthcare divisions that essentially mean only women who have private health insurance can afford reconstruction, as this is 'for-profit' surgery which is not covered by Medicare (national publicly funded health insurance). Also included is a sensitive analysis of women's narratives about their decisions and experiences of breast reconstruction.
Overall, I appreciate and commend the author's clarity about her theoretical and political stances. My main criticism is in the author's restatement of individual women's narratives in Chapter Two. In my view, the lived experience of the women would have emerged more authentically had the author written the women's narratives in uninterrupted form. I also felt that it would more persuasively support the overall feminist argument if the link between lived experience and the cultural constraints on choice had been more fully examined across and between the narratives, using the theories that were so well chosen by the author; rather than an analysis of particular actions or statements by individual participants. Another option would be to check conclusions with the participants, which is often a preferred approach in feminist research.
This book is a valuable adjunct to qualitative research texts for postgraduate students and early career researchers from disciplines of sociology, public health or health promotion who are interested in qualitative research. It is especially useful for those intending to use feminist theories to explore difficult, emotive or taboo research questions such as women's accounts of their bodies in the context of breast cancer or any other sensitive context. Parts of the book would also be very useful reading for individual workers and leading breast cancer organisations because it may encourage them to engage in systematic, critical reflection on how their practice may, advertently or inadvertently, influence women's 'choices' about their post-surgical bodies.
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