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book review

In her book Alanna Mitchell explores the victim-blaming that cancer patients often face.A. Elizabeth Plott/The Canadian Press

Since finding out that I have cancer, I've tried, largely unsuccessfully, to avoid books and movies that use cancer as a major plot point. I don't want to watch some "brave" character succumb to the disease that's become my constant companion. Considering how pervasive this disease feels in our society and how terrifying it is in actuality, it's an easy literary trope, an obvious metaphor for the sickness that gets inside of a relationship, for instance, or an enterprise. I understand why so many writers and filmmakers use it to deepen the experiences of their characters, directly or proximally. By using cancer as a plot point, they're tapping into society's deepest fears. In Malignant Metaphor, Alanna Mitchell explores why that is – why the very idea of cancer renders us impotent and afraid, in a way that other deadly diseases do not.

When Mitchell's brother-in-law, John, was diagnosed with cancer, and later her 21-year-old daughter, Calista, she stepped up to help in the best way she could. As a science writer, she is uniquely skilled to make plain the obtuse language of oncologists and clinical trials and skilled enough to wander deeper into the weeds than most of us can get. And the weeds are deep and thick. The information is vast, dense and ever-changing, which can make it very difficult to know which course of action is the right one instead of "pin down any given right course of action."

And so Mitchell set herself to work digging into our culture's ideas of cancer and teasing apart fact and myth, truth and metaphor.

In my experience, one of cancer's greatest tricks is that no matter how much you learn, it isn't enough. Once you unpack one concept, you'll immediately face a contradicting one. In trying to discover the source of its outsized power on our collective psyche, Mitchell quickly found herself bumping up against this very problem. She posits that the public discourse around cancer tells us that it is simultaneously inevitable, preventable and deserved, and that these three cannot logically co-exist.

It's no wonder cancer terrifies us: We're taught that the odds are that we will get cancer, that it's up to us to find the best way to prevent it and if we fail in prevention we also must have done something terrible to deserve it. But if we dig a bit deeper, the truth is we don't actually know how we get most of the 200 different types of cancer in existence.

And although cancer is one of the biggest killers in modern society, Mitchell points out that it's largely because so many other diseases have been disarmed, which means more of us are living long enough to get cancer in old age.

When Mitchell asks, "Why is the dread so pervasive? I wonder if some of that dread could be punctured if we understood cancer better," she's picking up the thread of a conversation started by Susan Sontag in 1978 with her seminal treatise Illness as Metaphor. Even though nearly 40 years have passed since Sontag first brought our society to task for blaming cancer patients for their disease, for accusing them of having a "cancer-prone personality type," it's an idea that persists today. Cancer shaming, Mitchell finds, is still prevalent in our culture. She sees messaging "veering past preventability and straight into culpability," tapping into our core fears in the interest of fundraising. When the focus is on the individual's responsibility to prevent cancer, one also has to allow for its flip side, which is culpability. We ask what a cancer patient has done wrong to deserve to have cancer, where they've failed at prevention.

As much as this book is ostensibly about defanging the malignancy of cancer as a metaphor, Mitchell can't help put forward one of her own: humans as a cancer on this planet. A science writer, most recently of the bestseller Sea Sick: The Global Ocean in Crisis, Mitchell questions how we have increased our own risk with chemicals and environmental degradation. She raises concerns about the sources of our food, the additional expense of eating organic food and the dizzying number of chemicals we're exposed to on a daily basis. "Of the 80,000 chemicals on the market in the U.S. […] only a few hundred have been tested for their cancer-causing properties." And that is testing each chemical on its own, which is not how we experience them. It would be a Sisyphean task to test them in every possible combination. "The suggestion is that it's easier to point the finger at an individual's lifestyle and choices than it is to question a widespread societal system of production and manufacturing."

And between decoding the metaphors that hang like smog around cancer, Mitchell has generously woven her own family's stories. It's these stories that give the book a human and relatable story. By sharing the fear and uncertainty her own family faced with multiple cancer diagnoses, Mitchell has crafted a book with a very easy entry point. We have all been touched by cancer in one form or another. We've all crafted our own bespoke way of coping with its impact. I think we'd all do well to approach it with the openness and candour Mitchell brings to the table.