Metastatic Cancer and Mothering

In this essay, I will explore the World Health Organization’s World Health Statistics for 2012, which highlighted the topic of noncommunicable diseases and how they are a growing threat. Of those noncommunicable diseases, I will focus specifically on cancer. I am addressing the topic of cancer from an anthropologist’s perspective by focusing on life with cancer, specifically women with metastasized cancer. I will then discuss Kirsten Bell and Svetlana Ristovski-Slijepcevic’s ethnography titled “Metastatic Cancer and Mothering: Being a Mother in the Face of a Contracted Future.” Kirsten Bell conducted the fieldwork for the ethnography by observing a support group for women with metastatic cancer held at a local cancer treatment center in western Canada between September 2007 and April 2008. I found this ethnography intriguing for it sheds light on the subjective experience of metastasized cancer, and how that reality is affected by factors such as mothering. A synthesis and juxtaposition of these two very different, yet similar works will then follow, for both works involve cancer, yet each work represents completely different views of cancer. The World Health Statistics represents cancer with figures that are completely decontextualized, whereas “Metastatic Cancer and Mothering: Being a Mother in the Face of a Contracted Future” represents cancer within a specific context.

The WHO’s World Health Statistics for 2012 included the highlighted topic of noncommunicable diseases and how they are a major health challenge for the twenty-first century. This problem is due to an increase in the population as well as a general increase in longevity. These two factors have lead to a shift of the dynamics of population ages, for there are now more middle-aged and older adults than there are children and young adults. The increase of middle-aged and older adults is directly correlated to rise of deaths due to noncommunicable diseases. “Of the estimated 57 million global deaths in 2008, 36 million (63%) were due to noncommunicable diseases (NCDs),” and the second largest portion of NCD deaths are due to cancer, a considerable twenty-one percent (WHO 2012:32). The World Health Statistics stated that the annual deaths due to cancer is projected to be 13 million in the year 2030, opposed to 7.5 million deaths that occurred in 2008 (2012:34).

Many people believe that cancer is only a problem for the developed world, the high-income countries. This idea is completely false, for “more than two thirds of all cancer deaths occur in low- and middle-income countries, with lung, breast, colorectal, stomach and liver cancers causing the majority of such deaths” (WHO 2012:36). The World Health Statistics states that there are four key behavioral risk factors for cancer tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol (2012:35). However, there are other factors that can cause cancer, like “infections such as hepatitis B and hepatitis C (both associated with liver cancer), human papillomavirus (associated with cervical cancer) and Helicobacter pylori (associated with stomach cancer) [which] cause[d] 20% of cancer deaths in low- and middle-income countries, and 9% of cancer deaths in high-income countries” (WHO 2012:36). “In sub-Saharan Africa, for example, cervical cancer is the leading cause of cancer death among women due to a high prevalence of infection with human papillomavirus. In high-income countries, the leading causes of cancer deaths are lung cancer among men and breast cancer among women” (WHO 2012:36).

In a twenty-five minute film titled “Cervical Cancer: The Real Lady Killer,” produced by PATH and Rockhopper for the BBC World’s “Kill or Cure?” series, Sarah Nyombi, a Ugandan member of parliament, is talking to a young girl named who had just been vaccinated with the HPV vaccine. The young girl has had a first hand experience of cervical cancer, for it has left her motherless. Although her mother was never formally diagnosed with metastasized cervical cancer, the symptoms experienced by her mother match those related to cervical cancer. When her mother became ill, her father took her to a local herbalist. After multiple visits to the herbalist and while following his treatment, her mother’s condition quickly deteriorated. After her mother’s death, the family learned that the cause was cervical cancer, and the herbalist’s treatment could not have helped.    This example demonstrates how cancer affects low-, middle-, and high-income countries, and is therefore a growing global health issue.

The support group Kirsten Bell observed was “small, intimate, and relatively unstructured…[They] met for one and a half hours on a fortnightly basis,” and generally had between six and twelve women present (Bell, Ristovski-Slijepcevic 2011:631). Less than half the women who attended the drop-in support group had metastatic breast cancer; the remainder had blood, colorectal, ovarian, uterine, stomach, or lung cancer as their primary tumor sites. The majority of group members were in their fifties and sixties, and many had adult children as well as grandchildren, while four of the regular group members had nonadult children ranging in ages from four to eighteen (Bell, Ristovski-Slijepcevic 2011:631). To understand this ethnography, we must take into account the reality these women live with, the context of their diagnosis. Having a diagnosis of metastasized cancer has forced these women to come to grips with the knowledge that it is not “if” their cancer will result in their death, but “when”. With that in mind, we must acknowledge that these women are living with a limited amount of time. This idea will surface again when I discuss women in the support group who have dependent children.

While attending the support group, Bell notices how an unspoken, yet constantly acknowledged “hierarchy of suffering” had developed. By unspoken, I mean that none of the attendees blatantly refer to the hierarchy, yet it is constantly implied in multiple situations because the support group attendees constantly acknowledged how the four women with nonadult children were worse off. During a session, Lara voices her concern over Sara’s well being. Sara “has just found out that she will have to have chemotherapy and that she can’t face the thought of it at the moment. She sobs that her husband and 12-year-old daughter have ‘hit the roof’ about it and she doesn’t want to go through palliative chemo again (Bell, Ristovski-Slijepcevic 2011:630). Bell and Ristovski-Slijepcevic explain how “it was her [Sara’s] 12-year-old daughter that made her story so heartbreaking. For the assembled women, it seemed that the tragedy of metastatic cancer, where life is foreshortened by disease that is largely incurable, is multiplied when the person experiencing the cancer is a mother with dependent children” (Bell, Ristovski-Slijepcevic 2011:630). Bell notes how, “Time and time again, women with adult children echoed their relief that they had not been diagnosed with metastatic cancer until after their children had grown up” (Bell, Ristovski-Slijepcevic 2011:634-635), further solidifying the acknowledgement of the hierarchy present. Bell notes,

Women in the group shared an understanding that mothers with dependent children had a claim to suffering that ‘trumped’ all other claims women might have, including physical pain (a serious issue for women with bone metastases), disabilities such as blindness, or even not having children, although this latter state entailed its own special form of suffering for other younger women in the group. For example, Bridget, a woman in her early 40s, talked about how her diagnosis had forced the realization that time had run out to do the things she wanted to accomplish in her life: “Like, I’ll never be able to have children, and I’m limited to what I can, I think, have from now to the end of my life. And that is devastating.” [Bell, Ristovski-Slijepcevic 2011:635]

This hierarchy is further defined when Jane, a woman in her sixties who was diagnosed with uterine cancer that has metastasized, attends a meeting and explains how she is very upset because she “is really worried about her granddaughters who are 7 and 9—both of her own daughters are alcoholics and she wants to be there for her granddaughters” (Bell, Ristovski-Slijepcevic 2011:635).

In this discussion, Brenda stated how much more “difficult” cancer is when there are “children in the picture.” However, although people listening to Jane’s story (including KB) were sympathetic, and although it was clear to us that Jane had a fundamental role in mothering her granddaughters, it did not have the same heart-wrenching qualities as Sarah’s. The hierarchy of suffering therefore appears to intersect with the hierarchy of mothering mentioned earlier, whereby the most appropriate person to mother a child is the biological mother rather than another family member. [Bell, Ristovski-Slijepcevic 2011:636]

            The induced hierarchy of suffering embodied by the women in the support group illustrates the current social perception that the biological mother is the best caretaker for her child. Bell and Ristovski-Slijepcevic address the cultural conceptions of mothering. They discuss how mothering has been described as both a biological and moral activity of caring, but how women become mothers and live mothering is greatly determined by larger social and cultural forces (Bell and Ristovski-Slijepcevic 2011:631). Therefore “cultural idioms such as ‘motherly love’ and ‘maternal instincts’” (Bell and Ristovski-Slijepcevic 2011:632) enforce the social perception that mothering must be done by the biological mother. This is why the mothers in the support group who have dependent children are at the top of the hierarchy of suffering; they have to deal with the reality of how much time they have to live, how much time they have with their children to be their mother. They have to juggle the role of a mother while also having to deal with the symptoms and reality of their cancer. Some group members with adult children stated how they can just stay in bed all day when they are having a bad day, or do not feel like dealing with the world. However, the mothers with dependent children do not have that luxury; they have to get out of bed and “mother” their children.

Kirsten Bell and Ristovski-Slijepcevic state that they are not surprised at how “so much of the support literature about families dealing with cancer either ignores mothers or focuses exclusively on children” (2011:636). This is what makes Bell and Ristovski-Slijepcevic’s ethnography completely different from most literature, for the fieldwork focused specifically about mothers while also taking into account their offspring. Blachman suggested that there is a cultural confusion in conceptualizing motherhood and mortality, and at that intersection, “Blachman stated that ‘[i]f being sick is generally depressing and frightening, if cancer raises the specter of death, if death is to be avoided at all costs, then seriously ill mothers of young children strike an emotional chord on an altogether different scale’” (Bell and Ristovski-Slijepcevic 2011:636). The support group members voiced their frustration with the current self-help literature that was available to them. The literature echoed how the women must make time for themselves, which was “unrealistic admonitions which women in the support group were all too aware carried their own hegemonic tendencies” (Bell and Ristovski-Slijepcevic 2011:645).

While conducting fieldwork, Kirsten Bell attacks cancer with a different approach, an approach similar to that of Gooldin’s while conducting fieldwork with anorexics in Israel. Gooldin focused on how anorexics viewed their disease and their embodiment of a heroic moral subjectivity, rather than just the medical aspect of anorexia. Kirsten Bell focuses on the subjective experience of living with metastasized cancer while having dependent children, rather than just medical aspect of metastasized cancer. This approach highlights a completely different aspect of metastasized cancer that is not represented in the WHO’s World Health Statistics. WHO acknowledges how cancer is a problem, but they solely represent it with numbers and statistics, completely free of any human-like connections. Statistics are important tools that allow us to make comparisons that make sense, but it de-contextualizes social realities. Anthropologists such as Kirsten Bell bridge that gap and connect numbers with, what I believe, is true meaning. She humanizes those with metastasized cancer, attaches a persona to those numbers. She focuses on how life with cancer is, something that is overlooked by WHO, similarly to how life with anorexia was also overlooked. 

“Metastatic Cancer and Mothering: Being a Mother in the Face of a Contracted Future” is an ethnography that unveils how having dependent children significantly affects a mother with metastasized cancer’s illness experience. It analyzes the cultural norms of mothering when applied to the biomedical diagnosis of metastasized cancer in our current time period when the context of how biological mothers are the best care takers of their children while also taking into account the subjective reality of living with metastasized cancer. Although this ethnography does not focus specifically on a better way with dealing with the global health issue of cancer, it does remind us how context is key, and how we cannot solely focus on statistics, for they “silence the experiences and voices of those with metastatic cancer—experiences and voices that require considerably more research and reflection” (Bell and Ristovski-Slijepcevic 2011:645). Statistics can also be misleading, for a large percentage of deaths are not reported, or countries do not have a system in place that allows an accurate report of statistics. For example, that young Ugandan girl whose mother died of cervical cancer was most likely not reported in the correct manner. Yet, that dependent young girl was still left motherless because of metastasized cancer. There needs to be a change in the current literature available to those living with cancer. More mothers are being diagnosed with cancer all throughout the world, and therefore there must be more alternative literature that recognizes the distinctiveness of life with metastatic cancer, as a mother with dependent children or otherwise. Because the current cultural context where motherhood is synonymous with self-sacrifice, the idea that “mothers with metastatic cancer must choose between mothering themselves and mothering their children paradigmatically connects this discourse with a much larger cultural trope on motherhood and the self: that ultimately women must make a choice between themselves (and their career) and their children” arises (Bell and Ristovski-Slijepcevic 2011:645). This ethnography further helped me to understand how cultural perceptions play a major role in our mentalities, and how although two people may be diagnosed with the same disease, their specific perception of their individual experience of suffering is subjective to other factors, such as having dependent children. 

Works Cited

Bell, Kirsten, and Svetlana Ristovski-Slijepcevic 2011 Metastatic Cancer and Mothering: Being a Mother in the Face of a Contracted Future. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 30:6, 629-649

World Health Organization - World Health Statistics 2012