waples-avatars, illness, and authority embodied experience in breast cancer autopathographics

8/17/2019 Waples-Avatars, Illness, And Authority Embodied Experience in Breast Cancer Autopathographics

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Emily Waples

Configurations, Volume 22, Number 2, Spring 2014, pp. 153-181 (Article)

DOI: 10.1353/con.2014.0011

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ABSTRACT: This essay argues that the medium of graphic illness mem-

oir, or “autopathographics,” can work to challenge the master plot

of “survival” that has circulated as part of breast cancer culture for

the past thirty years. Exploring the emergent genre of breast cancer

autopathographics through an analysis of two best-selling memoirs

published in 2006—Marisa Acocella Marchetto’s Cancer Vixen: ATrue Story and Miriam Engelberg’s Cancer Made Me a Shallower Person:

A Memoir in Comics—this essay examines the graphic in two senses:

first, it strives to enter an emergent conversation about the uses of the

visual-verbal genre of graphic memoir as a means to narrate stories

of illness and disability; further, it takes into account the popular us-

age of the word graphic to note the kind of explicitness or excess for

which illness narratives are commonly critiqued. Autopathographics

offer new possibilities for women to represent the embodied changes

occasioned by cancer in ways that register the uncertainty of the dis-ease’s temporality in the face of metastasis and terminal illness—part

of breast cancer’s epidemiological narrative that is too often ignored.

In the early weeks of 2014, a heated debate took place in the digital

public sphere regarding cancer patients’ self-representation in social

media, beginning when a provocative Guardian article by Emma

Keller asked: “What are the ethics of tweeting a terminal illness?”1

153

Avatars, Illness, and Authority:

Embodied Experience in Breast

Cancer Autopathographics

Emily Waples

University of Michigan

Configurations, 2014, 22:153–181 © 2014 by Johns Hopkins University

Press and the Society for Literature, Science, and the Arts.

1. Emma G. Keller, “Forget Funeral Selfies: What Are the Ethics of Tweeting a Terminal

Illness?” Guardian, January 8, 2014. The article has since been removed from the Guard-

ian’s website “pending investigation.”


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154 CONFIGURATIONS

2. See Lisa Bonchek Adams’s Twitter profile at https://twitter.com/AdamsLisa.

3. Bill Keller, “Heroic Measures,” New York Times, January 12, 2014. http://www.ny

times.com/2014/01/13/opinion/keller-heroic-measures.html?_r=0.

4. Katie Halper, “Former NYT editor mansplains to cancer patient to shut up and die

the right way,” Feministing.com, January 14, 2014. http://feministing.com/2014/01/14

/former-nyt-editor-mansplains-to-cancer-patient-to-shut-up-and-die-the-right-way/.

5. See “Selfies at Funerals,” December 10, 2013. http://selfiesatfunerals.tumblr.com/.

The question indeed seems sweeping in its scope, drawing together

the narrative practice of pathography, the self-publication modes af-

forded by digital media, and, apparently, “ethics.” Keller’s article is

more pointed than it might first appear, focusing solely on the testcase of Lisa Bonchek Adams, an American woman with metastatic

breast cancer who has been chronicling her treatment on Twitter:

“Doing as much as I can for as long as I can,” as Adams’s Twitter

profile reads—including, but not limited to, chemotherapy, radia-

tion, and clinical trials.2 Days after Keller’s article appeared in the

Guardian, her husband, journalist Bill Keller, weighed in with a New

York Times op-ed of his own, registering his disapproval with what

he calls Adams’s “fierce and very public cage fight with death.” As

he notes, Adams has “tweeted through morphine haze and radia-tion burn” with a candor that seems extreme, “[e]ven by contem-

porary standards of social-media self-disclosure.”3 Keller critiques

not only the “very public” nature of Adams’s relationship to can-

cer, but indeed her “fierceness,” as he goes on to wax philosophical

about the lost art of the “humane and honorable death”—or, as the

Feministing.com blog glossed it: “Former NYT editor mansplains to

cancer patient to shut up and die the right way.”4

In her Guardian article, Emma Keller self-identifies as an ardent

follower of Adams’s Twitter feed—one who is, she confesses, “em-barrassed at my voyeurism.” Keller’s own embarrassment occasions a

series of questions about what she calls the “ethics” of dying online:

“Should there be boundaries in this kind of experience?” she asks.

“Is there such a thing as TMI? Are [Adams’s] tweets a grim equivalent

of deathbed selfies, one step further than funeral selfies? Why am I

so obsessed?”5 Keller’s questions vacillate between issues of author-

ship and readership, muddling the matter of whether the “ethics” in

question relate to production or to consumption—or perhaps to a

space situated somewhere between tweeting and reading. While thetitle of Keller’s article—“What Are the Ethics of Tweeting a Terminal

Illness?”—suggests that the ethical imperative lies with the tweeter,

its motivating anxieties instead arise from her subject position as a

reader. Turning to her own audience in the Guardian thus becomes


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Waples / Breast Cancer Autopathographics 155

a way for Keller to attempt to negotiate her Schadenfreude: “Is this

educational,” she asks us, “or too much?”

The ethics of autobiographical, public self-representation have

been explored by scholars like Arthur Frank and G. Thomas Couser,who engage with illness narratives in terms of both production and

reception. Couser coins the term auto/bio/ethics in his consideration

of the bioethical implications of autobiographical, biographical, and

ethnographic practice, engaging in particular with what he calls

“vulnerable subjects”: “persons who are liable to exposure by some-

one with whom they are involved in an intimate or trust-based re-

lationship but are unable to represent themselves in writing or to

offer meaningful consent to their representation by someone else.”6

However, the vulnerable subject does not characterize Adams, whois fully capable of her own self-representation. What, then, are the

ethical issues at stake for Adams and/or her readers?

Keller’s concerns are not so much questions of ethics, I suggest,

as questions of genre. After all, the quandary that Keller faces in her

struggle to interpret Adams’s Twitter feed—and her own experience

of reading it—seems to arise less from her desire to reconcile it with

an ethical schema than from her impetus to classify it as an auto-

biographical narrative mode. Adams’s tweets, she claims, are either

“educational”—an understanding of life-writing that arguably stemsfrom Benjamin Franklin’s early incarnation of American autobiog-

raphy as a didactic practice—or else it is excessive. Per Keller, the

publication of pathography—what she deems “dying out loud”—

must be ethical, or else egotistical. Keller’s discomfort with Adams

has to do with exposure, with excess: that is, with “graphic” self-

representation of a nonpedagogical nature. “The moral imperative

of narrative ethics,” according to Frank, “is perpetual self-reflection

on the sort of person that one’s story is shaping one into, entailing

the requirement to change that self-story if the wrong self is beingshaped. Thus awareness of the general type of narrative one is tell-

ing or responding to is a crucial beginning.”7 What kind of story is

Adams telling with her tweets?

In her seminal investigation of the genre, Anne Hunsaker

Hawkins defines pathography as “a form of autobiography or biog-

raphy that describes personal experiences of illness, treatment, and

6. G. Thomas Couser, Vulnerable Subjects: Ethics and Life Writing (Ithaca, NY: CornellUniversity Press, 2004), pp. iv, xii.

7. Arthur Frank divides stories of illness into three narrative subtypes: “restitution,

chaos, or quest.” See his The Wounded Storyteller: Body, Illness, and Ethics (Chicago: Uni-

versity of Chicago Press, 1995), p. 158.


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12. Susan M. Squier, “Literature and Medicine, Future Tense: Making it Graphic ,” Lit-

erature and Medicine 27:2 (2008): 124–152, quote on p. 131 (emphasis in original).

13. Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (New York:

Oxford University Press, 1985).

14. Hillary L. Chute, Graphic Women: Life Narrative and Contemporary Comics (New York:

Columbia University Press, 2010), pp. 2–3.

relying on words, and in their juxtaposition of words and pictures,

they can also convey a far richer sense of the different magnitudes

at which we experience any performance of illness, disability, medical

treatment, or healing.”12

Building on Squier’s and others’ observa-tions about graphic media as a means of expressing or “performing”

illness, I consider the possibilities, and limitations, of graphic nar-

rative in autobiographical stories of breast cancer. How does breast

cancer in the comic form differ from its iteration in other kinds of

written, oral, visual, and digital media? What kind of relationship

does the graphic memoir forge between autobiographers and their

readerships? To employ Keller’s term, what are its representational

boundaries?

This essay will also mobilize the notion of the graphic in a secondsense: to refer not only to a written or drawn method of produc-

tion, but to connote the kind of explicitness or excess marked by

the word’s popular usage. The Kellers’ discomfort with Adams lies

not only in the sheer number of her tweets, but in their “graphic”

nature: “having her tumor genome and her cancer trial discussed

in detail,” for instance, before an audience of online strangers. The

impetus to place boundaries around some aspects of illness, but not

others, gestures toward Squier’s observation about “things that can’t

be said ” in narratives of illness. Some things can’t be said not onlybecause of their resistance to verbal representation—according to

Elaine Scarry’s theorization of pain, for instance, as actively erasing

language13—but because of the cultural stigmatization and censor-

ship of the embodied experience of illness, which is often deemed,

in Smith and Watson’s words, “abnormal, aberrant, or in some sense

pathological.” In her study of women’s graphic narratives, Hil-

lary Chute argues that comics not only “provoke us to think about

how women, as both looking and looked-at subjects, are situated

in particular times, spaces, and histories,” but also to “rethink thedominant tropes of unspeakability, invisibility, and inaudibility that

have tended to characterize trauma theory as well as our current

censorship-driven culture in general.”14 Graphic memoir—or what

Martha Stoddard Holmes has recently called graphic body studies, a

term that signals the intersection of illness and disability studies


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15. Martha Stoddard Holmes, “Cancer Comics: Narrating Cancer through Sequential

Art,” Tulsa Studies in Women’s Literature 32:2 (2014), p. 147.

16. Ariel Levy, “Sick in the City,” New York Times, October 22, 2006. http://www.ny

times.com/2006/10/22/books/review/Levy.t.html.

17. G. Thomas Couser, Recovering Bodies: Illness, Disability, and Life Writing (Madison:

University of Wisconsin Press, 1997), pp. 183, 44.

with the visual-verbal genre of comics15—accordingly pushes us to

attend differently and more closely to the relationships that exist

among embodied trauma, narrative, and visuality.

Cartoonists Marchetto and Engelberg were both in their fortieswhen they were diagnosed with early-stage breast cancer. The differ-

ences between the graphic memoirs that recount their experiences

are manifold, but the most important of these differences, I suggest,

hinge on the trauma of metastasis. In Cancer Vixen, which a New York

Times review characterized as “unflaggingly perky, “ebullient,” and

“fun,”16 Marchetto, a New York City socialite and self-proclaimed

“fabulista,” tells the story of her disease from diagnosis to recovery,

emphasizing cancer’s cosmetic challenges, particularly those that

magnify her competition with the other Manhattan women whovie for the affections of her restaurateur fiancé (later husband). Can-

cer Vixen exemplifies what Couser identifies as “the problem of the

generic convention of the comic master plot” in breast cancer nar-

ratives: the linear diagnosis-to-recovery trajectory suggests a kind

of closure that might be narratively satisfying, but ultimately disin-

genuous. “Because breast cancer is rarely considered ‘cured,’ because

having had almost always means being susceptible to recurrence,

being constantly vigilant,” he notes, “the retrospective closed-end

autobiographical narrative is always somehow false to the experi-ence.”17 As an autopathographer in remission, Marchetto offers her

readership a kind of reflectivity that distances the experience of dis-

ease.

Breast cancer’s resistance to narrative closure because of its pos-

sibility of metastasizing many years after its diagnosis renders it a

difficult disease to fit into the generic confines of the comic plot, as

Couser has observed. Engelberg, whose Stage 2 cancer metastasizes

to her bones and brain two years after her initial diagnosis, accord-

ingly cannot tell the kind of story that Marchetto does. Cancer Made Me a Shallower Person is not a strictly linear graphic narrative, then,

but rather a series of titled vignettes about the diagnosis, treatment,

recovery, and, ultimately, re-diagnosis of breast cancer. While Engel-

berg’s memoir moves with a roughly chronological temporal trajec-

tory, its end point of metastasis, rather than a return to health and


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18. Elisabeth El Refaie, Autobiographical Comics: Life Writing in Pictures (Jackson: Univer-

sity Press of Mississippi, 2012), p. 51.

“normalcy,” highlights the disease’s complicated, and terrifying, re-

lationship to temporality.

The intermediate and indeterminate spaces of illness frustrate the

kind of dichotomizing categorization that tends to mark the breastcancer memoir: their classification as either narratives of triumph or

narratives of declension. Furthermore, narratives that forefront me-

tastasis and other graphic, embodied effects of breast cancer disrupt

another of the disease’s mythologies: that the changes it wreaks on

the body are primarily cosmetic. Here, I examine the ways in which

Marchetto and Engelberg use the graphic memoir to chart embodied

change during the experience of breast cancer. Marchetto presents

her cancer as an interruption in the pursuit of somatic perfection—

an endeavor in diet, exercise, and cosmetic accessorization thatseems like a near-Darwinian necessity in the cutthroat class climate

of a fashion-mad New York City. For Engelberg, on the other hand,

breast cancer occasions confusion about what the body signifies; she

no longer knows how to accurately read her own embodiment.

I begin by situating the breast cancer graphic memoir within the

theoretical contexts of graphic narrative and autopathography, be-

fore moving on to readings of Marchetto’s and Engelberg’s graphic

memoirs. In my analysis of these texts, I explore the dual issues of

generic emplotment and what Elisabeth El Refaie calls “pictorialembodiment”—the “process of engaging with one’s own identity

through multiple self-portraits.”18 Ultimately, I argue that the me-

dium of the graphic illness memoir, or autopathographics, can work

to challenge the master plot of survival that has circulated as part

of breast cancer culture for the past thirty years. Graphic narratives

and digital media offer new possibilities for women to represent the

embodied changes occasioned by cancer in ways that register the

uncertainty of the disease’s temporality in the face of metastasis and

terminal illness—part of breast cancer’s epidemiological narrativethat is too often ignored.

Autopathographics

In their study of women’s visual/textual autobiographical prac-

tices, Smith and Watson have notably addressed “two widely held

suspicions about women’s recourse to the autobiographical in vi-

sual and performance media”—suspicions that Keller mobilizes in

her Guardian article: “that it is a transparent mirroring and that it

is narcissistic self-absorption.” As Smith and Watson remind us,


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19. Sidonie Smith and Julia Watson, eds., “Introduction: Mapping Women’s Self-

Representation at Visual/Textual Interfaces,” in Interfaces: Women, Autobiography, Image,

Performances (Ann Arbor: University of Michigan Press, 2002), pp. 8–9.

20. Hawkins, Reconstructing Illness (above, n. 8) , p. 17.

21. Frank, Wounded Storyteller (above, n. 7), p. 33 (emphasis in original).

22. Jackie Stacey, Teratologies: A Cultural Study of Cancer (London: Routledge, 1997), p.

63 (emphasis in original).

23. Virginia Woolf, On Being Ill (Ashfield, MA: Paris Press, 2002), p. 11.

the life narrative is not a mimetic representation of lived experi-

ence, nor is it necessarily an exercise in self-aggrandizing egotism.

“As a moving target, a set of shifting self-referential practices,” they

write, “autobiographical narration offers occasions for negotiatingthe past, reflecting on identity, and critiquing cultural norms and

narratives.”19 These “shifting self-referential practices” become in-

creasingly complicated when applied to the sick and dying self—a

self whose embodied figuration changes in often rapid, drastic, and

unpredictable ways during the vicissitudes of illness and treatment.

In pathographic narratives, as Hawkins has observed, “the reader is

repeatedly confronted with the pragmatic reality and experiential

unity of the autobiographical self.”20 Further, the relationship be-

tween self and body, or self as body, is a concern that underscoresautopathography. As Frank asks: “Is my body the flesh that ‘I,’ the

cognitive, ethereal I, only happen to inhabit, or is whatever ‘I’ am

only to be found as my body? Do I have a body, or am I a body?”21

In Teratologies: A Cultural Study of Cancer, Jackie Stacey highlights

the identity-bending dilemma of cancer, in particular that “cancer

is the self at war with the self. Thus, surely one’s identity is at stake

(on trial?) with the onset of such a disease.”22 Such intimations of

ontological (and oncological?) multiplicity suggest that autopathog-

raphy is always-already a vexed endeavor. Autopathography may be a relatively contemporary critical term,

but the illness narrative itself is hardly a new genre. Writers like Har-

riet Martineau and Alice James cataloged their afflictions long before

the advent of the blogosphere; we might consider Keats’s canon a

poetic series of proto-“deathbed selfies.” In her 1926 On Being Ill, Vir-

ginia Woolf reflected on the relationship between autobiographical

self-representation and the embodied realities of illness: “There is,

let us confess it (and illness is the great confessional), a childish out-

spokenness in illness,” she wrote; “things are said, truths are blurtedout, which the cautious respectability of health conceals.”23 Indeed,

the Kellers criticize Adams for precisely this kind of confessional

excess, one that they struggle to apprehend from subject positions


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24. Susan Sontag, Illness as Metaphor (London: Penguin, 1991), p. 1.

25. Neil Genzlinger, “The Problem with Memoirs,” New York Times, January 28, 2011.

http://www.nytimes.com/2011/01/30/books/review/Genzlinger-t.html?pagewanted=all.

26. Rita Felski, “On Confession,” in Women, Autobiography, Theory: A Reader, ed. Sidonie

Smith and Julia Watson (Madison: University of Wisconsin Press, 1998), p. 92.


couched in the “cautious respectability” of health. The disjunction

between the worlds that Susan Sontag famously demarcated as “the

kingdom of the well” and “the kingdom of the sick”24 can inspire

an uncomfortable visual relationship, as Emma Keller suggests. The2005 Canadian television series Terminal City has riffed on this idea

of pathological voyeurism: its breast-cancer-patient protagonist is

offered a reality television series catering to an audience that is mor-

bidly eager to witness her sickness.

As a confessional genre, autopathography inspires the kind of

critiques that hark back to the mid-twentieth-century confessional

poetry movement, which blurred the boundaries between the lyric

“I” and the autobiographical “I.” And confessionalism can prove

unpalatable. In a 2011 essay in the New York Times Book Review, forinstance, Neil Genzlinger elegized what he called “the lost art of

shutting up” in relation to autobiographical practice. “Memoirs,”

he complained, “have been disgorged by virtually everyone who

has ever had cancer, been anorexic, battled depression, lost weight.”

Accordingly, Genzlinger advocated a tightening of boundaries for

memoirists and their subject matter, offering a few words of advice

to would-be memoirists: “No one wants to relive your misery.”25

As Rita Felski observes in her essay “On Confession,” the feminist

adoption of the confessional mode is “marked by a tension betweena focus upon subjectivity and a construction of identity which is

communal rather than individualistic.” It thus “becomes neces-

sary,” she argues, “to differentiate feminist confessional discourse

from the more general fascination with ‘self-awareness’ in modern

society.”26 Autopathography, then, must be considered in relation to

the shifting cultural, scientific, and literary contexts of its produc-

tion and consumption; as Hawkins reminds us, “illness in pathog-

raphy is always experienced in relation to a particular configuration

of cultural ideologies, practices, and attitudes.” As these narrativesare “situated within the social praxis of modern medicine,”27 they

operate as commentary on the ill subject’s relationship to the tax-

onomic and disciplinary forces of the medical discourse, per Fou-

cault’s theorization of the rise of clinical medicine in the nineteenth

century, during which “the relation between the visible and the


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28. Michel Foucault, The Birth of the Clinic, trans. A. M. Sheridan Smith (New York:

Pantheon Books, 1973), pp. xi–xii.29. Couser, Recovering Bodies (above, n. 17) , pp. 27, 76, 39.

30. Felski, “On Confession” (above, n. 26), p. 93.

31. Audre Lorde, The Cancer Journals (San Francisco: Aunt Lute Books, 1980), p. 61

(emphasis added).

invisible which is necessary to all concrete knowledge changed its

structure, revealing through gaze and language what had previously

been beyond their domain.” Accordingly, Foucault insists, “we must

re-examine the original distribution of visible and invisible, insofaras it is linked with the division between what is stated and what

remains unsaid.”28 Autopathographics, in particular, alert us to this

discursive schism, as it simultaneously highlights the division be-

tween what is depicted and what remains unseen.

Autopathography became a well-established mode for American

memoir in the wake of events like the women’s health movement

of the 1970s and the AIDS crisis of the ’80s. Exemplified by texts

such as Paul Monette’s Borrowed Time (1988), Anatole Broyard’s In-

toxicated By My Illness (1992), and Lucy Grealy’s Autobiography of a Face (1994), twentieth-century illness narratives respond to the Fou-

cauldian “medical gaze” by concomitantly offering what Couser

identifies as “a form of counterdiscourse.” Breast cancer narratives

have become a particularly visible iteration of the autopathographi-

cal genre in the course of the past three decades; in his 1997 study

of illness narratives, Couser marked the emergence of breast can-

cer narratives as a “distinctive, significant, and quite coherent new

subgenre of American autobiography,” dating the emergence of this

subgenre to the 1970s and ’80s, when “various forces—especiallythe women’s movement—transformed breast cancer from a private,

even shameful, ordeal into a publicly narratable crisis.”29 Indeed, it

is by now a platitude to note that since the institution of National

Breast Cancer Awareness Month in 1985, breast cancer has become

a public disease.

Audre Lorde’s personal and political account of breast cancer,

The Cancer Journals (1980), is widely cited as the disease’s seminal

feminist text—one that, as Felski writes, “exemplified the continu-

ing importance of confessional writing as long as privatized areasof shame, fear, and guilt continue to exist in women’s lives.”30 For

Lorde, visibility is particularly at stake here: “If we are to translate the

silence surrounding breast cancer into language and action against

this scourge,” she famously asserts, “then the first step is that women

with mastectomies must become visible to each other. For silence and

invisibility go hand and hand with powerlessness.”31 Contemporary


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32. The term pinkwashing was coined by the advocacy organization Breast Cancer Ac-

tion to refer to companies that fundraise for breast cancer, while simultaneously mar-

keting products that contain toxins linked to the disease. See Gayle Sulik, Pink Ribbon

Blues: How Breast Cancer Culture Undermines Women’s Health (New York: Oxford Univer-

sity Press, 2011) , p. 370.

33. Barbara Ehrenreich, “Welcome to Cancerland,” Harper’s, November 2001, p. 52.

34. Mary K. DeShazer, Mammographies: The Cultural Discourses of Breast Cancer Narratives

(Ann Arbor: University of Michigan Press, 2013), p. 2.

35. Ellen Leopold, A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twen-

tieth Century (Boston: Beacon Press, 1999), p. 254.

36. Gillian Whitlock and Anna Poletti, “Self-Regarding Art,” Biography 31:1 (2008): v–

xxiii, quote on p. vi.

feminist critiques of the disease’s presence in the public sphere note

that the problem is, somewhat paradoxically, no longer the issue of

its invisibility, but indeed its hyper visibility. Lorde’s call for the politi-

cization of breast cancer has been mourned by critics of the disease’srelentless sentimentalization and commercialization in the public

sphere, exemplified by the twenty-first-century crisis of “pinkwash-

ing”32 in what Barbara Ehrenreich has christened the “cancer indus-

trial complex”: “the multinational corporate enterprise that with

the one hand doles out carcinogens and disease and, with the other,

offers expensive, semi-toxic pharmaceutical treatments.”33

In her recent study of postmillennial autobiographical breast can-

cer narratives, Mary DeShazer argues that such texts “constitute a

distinct testimonial and memorial tradition whose aims and strate-gies should circulate along other cultural projects of memory such

as the AIDS memorial quilt.”34 Breast cancer narratives—verbal and

visual representational modes that DeShazer collects under the ge-

neric heading of her eponymous neologism “mammographies”—in-

deed dominate the autopathographical marketplace in multifarious

forms, from traditional print memoir to digital and visual media. Yet

some consumers of the genre—like Emma Keller—have spoken back

to the autopathographical influx, questioning the extent to which

illness and death are, or should be, “publicly narratable.”How, then, do graphic memoirs satisfy what Ellen Leopold calls

the “appetite for breast cancer narratives”35 in the post-awareness

era while simultaneously negotiating the politics of the visual in a

culture that incessantly censors women’s bodies as “graphic” mate-

rial? “Critics of life narrative,” as Gillian Whitlock and Anna Poletti

explain, “are now called upon to develop more advanced visual and

cultural literacies to interpret the intersections of various modes and

media and the complex embodiments of avatar, autobiographer, and

reader/viewer gathered under the sign of autographics.”36 Whitlock


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37. Gillian Whitlock, “Autographics: The Seeing ‘I’ of the Comics,” Modern Fiction Stud-

ies 52:4 (2006): 965–979, quote on p. 966.

38. Sulik, Pink Ribbon Blues (above, n. 32), p. 9.

39. See, for example, Will Eisner, Graphic Storytelling and Visual Narrative (Tamarack, FL:

Poorhouse Press, 2004), and Comics and Sequential Art: Principles and Practice of the

World’s Most Popular Art Form (Tamarac, FL: Poorhouse Press, 2004); Scott McCloud,

Understanding Comics: The Invisible Art (Northampton, MA: Tundra Publishing, 1993);

W. J. T. Mitchell, Picture Theory: Essays on Verbal and Visual Representation (Chicago:

University of Chicago Press, 1994); and Roger Sabin, Comics, Comix and Graphic Novels:

A History of Comic Art (London: Phaidon Press, 2001).

40. See Sidonie Smith, Subjectivity, Identity, and the Body: Women’s Autobiographical Prac-

tices in the Twentieth Century (Bloomington: Indiana University Press, 1993); Jo AnnaIsaak, “In Praise of Primary Narcissism: The Last Laughs of Jo Spence and Hannah

Wilke,” in Interfaces (above, n. 19), pp. 49–68; and Stella Bolaki, “Re-Covering the

Scarred Body: Textual and Photographic Narratives of Breast Cancer,” Mosaic 44:2

(2011): 1–17.

employs the term autographics in order “to draw attention to the

specific conjunctions of visual and verbal text in this genre of auto-

biography, and also to the subject positions that narrators negotiate

in and through comics.”37

Autographic criticism thus emerges at ge-neric intersections—between, for instance, narrative theory and vi-

sual culture studies—that must also consider the cultural context of

graphic memoirs’ reception. The genre of women’s autobiographical

comics, as Chute notes, has been repositioned over the past thirty

years from an underground genre to a popular one—much as breast

cancer itself has transformed from a private disease to a pop-cultural

phenomenon wherein “the pink ribbon has become an iconic sym-

bol with the ideological power to turn breast cancer into a brand

name with a recognizable logo.”38

Critical attention to the graphicnarrative during the latter part of the twentieth century and the

early part of the present one demonstrates an evolving conversa-

tion on the visual politics of comics, one that can help to illuminate

the graphic ideologies of genre that we might, riffing on Whitlock,

deem autopathographics.39

Critics like Smith, Jo Anna Isaak, and Stella Bolaki have attended

to the use of photography in the self-documentation of breast can-

cer by artists, including Jo Spence, Matuschka, Deena Metzger, and

Hannah Wilke; the baring of the mastectomy scar, in particular, hasbecome a kind of primal image, following the circulation of im-

ages like Hella Hamid’s “Warrior” photograph of the bare-chested

Metzger, and Matuschka’s 1993 self-portrait “Beauty Out of Dam-

age.”40 More recently, David Jay’s 2011 photographic exhibition The

SCAR Project has documented the embodied experience of women


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41. David Jay, The SCAR Project , 2011. http://www.thescarproject.org/mission/. Jay’s

photographic exhibition is accompanied by a book, The SCAR Project: Breast Cancer Is

Not a Pink Ribbon (East Greenwich, RI: The SCAR Project, 2011) , as well as a documen-

tary film directed by Patricia Zagarella, Baring It All (2011).

42. “Does Facebook Allow Post-Mastectomy Photos?” 2014. https://www.facebook.

com/help/318612434939348/. See the full text of the petition by Susan (“Scorchy”)

Barrington at http://www.change.org/petitions/facebook-stop-censoring-photos-of

-men-and-women-who-have-undergone-mastectomies.

43. Marisa Acocella Marchetto, Cancer Vixen: A True Story (New York: Alfred A. Knopf,

2006), p. 1. Further references will be cited parenthetically in the text.

under age 40 by showcasing the scars of mastectomies and recon-

structive surgeries. “For these young women,” he writes, “having

their portrait taken seems to represent their personal victory over

this terrifying disease. It helps them reclaim their femininity, theirsexuality, identity and power after having been robbed of such an

important part of it.”41 As a documentary endeavor, The SCAR Project

raises a host of questions about the politics of the gaze, as a male

photographer deigns to mediate his subjects’ path to “reclaim[ing]

their femininity.” Jay’s photographs, moreover, gained special no-

tice in 2013 when they became the focus of a Facebook censorship

battle. In response to a Change.org petition to Facebook’s CEO

and COO, Mark Zuckerberg and Sheryl Sandberg, respectively, the

social-media site ultimately modified its “Warning and Blocks”feature to reflect the position that “the vast majority of [post-

mastectomy photos] are compliant with our policies,” qualifying

that “photos with fully exposed breasts, particularly if they’re un-

affected by surgery, do violate Facebook’s Terms.”42 According to

Facebook’s statement, post-mastectomy photos are acceptable in-

sofar as they serve to “raise awareness,” but tread the blurred line

of “graphic content.” Autopathographic narratives by breast cancer

patients who document the changes wrought on their own bodies,

as we shall see, raise a different set of critical concerns about agency,authority, and graphicity.

Cancer Vixen: Cosmetics, Prosthetics, and (Self-)Awareness

Marchetto begins her graphic memoir with a question to which her

readers can most likely infer the answer: “What happens,” she asks,

“when a shoe-crazy, lipstick-obsessed, wine-swilling, pasta-slurping,

fashion-fanatic, single-forever, about-to-get-married big-city girl car-

toonist (me, Marisa Acocella) with a fabulous life finds: A LUMP IN

HER BREAST?!?”43 She kicks its ass, of course—and does so in “killerfive-inch heels,” per the book’s cover illustration of Marchetto’s ava-


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44. While such critiques of a “victim” subject position “appeal to the myth of rugged

individualism, the belief that anyone can overcome obstacles and succeed in American

society,” as Carolyn Sorisio notes, such an approach often “obscures the true dynamics

of power and absolves responsibility.” See Sorisio, “A Tale of Two Feminisms: Power

and Victimization in Contemporary Feminist Debate,” in Third-Wave Agenda: Being

Feminist, Doing Feminism, ed. Leslie Heywood and Jennifer Drake (Minneapolis: Univer-

sity of Minnesota Press, 1997), p. 141.

45. For further discussion of postfeminist breast cancer narratives, see Emily Waples,

“Emplotted Bodies: Breast Cancer, Feminism, and the Future,” Tulsa Studies in Women’s

Literature 32:2 (2014), p. 47–50.

46. David B. Morris, “Un-Forgetting Asclepius: An Erotics of Illness,” New Literary His-

tory 38:3 (2007): 419–441, quote on p. 436.

47. S. Lochlann Jain, “Cancer Butch,” Cultural Anthropology 22:4 (2007): 501–538,

quote on p. 506.

tar, blonde and Barbie-thin, mid–karate kick in Christian Louboutin

stilettos. Throughout her text, Marchetto confronts her personified

cancer—rendered throughout as a cartoonish Grim Reaper—with

a sassy defiance worthy of her eponymous epithet. When, post-diagnosis, she indulges in a brief bout of desperation and self-pity,

she takes to heart the critique offered by a friend: “Instead of chang-

ing your mindset,” he suggests, “change that outfit! Sweatpants?

Sneakers? You’re the daughter of a shoe designer. You look like a

victim,” he admonishes her. “Where’s my vixen?” (p. 106).

Introducing this archetypal antithetical pairing, Marchetto seems

to gesture toward a vague postfeminist “girl power” ideology of

self-empowerment: a backlash against so-called second-wave vic-

tim feminism.44

Indeed, postmillennial breast cancer narratives likeGeralyn Lucas’s Why I Wore Lipstick to My Mastectomy abound with

feel-good triumphalism, resulting in the compulsory repetition of

a heteronormative paradigm, most often as the result of cosmetic

modification.45 David Morris, responding to the stigmatization of ill

subjects as erotically void, has praised Marchetto’s “vixen” persona,

arguing that it “replaces sexless stereotypes of the patient.”46 At the

same time, Cancer Vixen’s (re-)sexualization of the breast cancer pa-

tient can be seen to reinforce what S. Lochlann Jain has called “the

relentless hyper- and heterosexualization of the disease,” which “re-sults in something of a recursive process through which gender is

produced and policed.”47

Jain’s critique of contemporary breast cancer culture joins a host

of postmillennial feminist scholarship that waxes nostalgic for

Lorde, using her Cancer Journals as the text by which any woman’s

narrative of breast cancer must be measured. Under this rubric, then,

Cancer Vixen fails its feminist readership; Marchetto’s insistence on


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48. Lorde, Cancer Journals (above, n. 31) , p. 16.49. Diane Price Herndl, “Reconstructing the Posthuman Feminist Body Twenty Years

after Audre Lorde’s Cancer Journals,” in Disability Studies: Enabling the Humanities, ed.

Sharon L. Snyder, Brenda Jo Brueggemann, and Rosemarie Garland-Thomson (New

York: MLA, 2004), pp. 144, 153.

reproducing iconic, heteronormative femininity with commodi-

ties and cosmetics seems directly antithetical to Lorde’s critique of

“socially sanctioned prosthesis”—a category that includes both lit-

eral post-mastectomy prostheses and the kinds of cosmetic modi-fication promoted by the Look Good Feel Better program. Lorde’s

call for women with breast cancer to “become visible” in the public

sphere hinged on the argument that such prosthetic imperatives are

“merely another way of keeping women with breast cancer silent

and separate from each other,” as the embodied realities of breast

cancer become subject to a wide-scale social erasure.48

However, the question remains as to whether Lorde’s legacy of-

fers the most productive model for approaching breast cancer in

the post-“awareness” era. Diane Price Herndl, for instance, a self-identified feminist critic and breast cancer patient, has examined

her own anxiety of “not living up to Audre Lorde”—an apt encapsu-

lation of the quandary facing generational feminism. Arguing that

contemporary feminist scholarship must find new ways of engag-

ing the vexed relationship between breast cancer and embodiment,

Herndl ultimately concludes that, in the age of digital simulacra and

the posthuman, “we have come to think about bodies differently,

to see bodies as produced, as, in fact, forever alien to ourselves.” Ac-

cordingly, she continues, feminism must “find a way to understandthe difference between a postmodern, posthuman view of the body

and an earlier feminism’s view without having to regard either as

entirely wrong. Each is historically situated, responding to different

cultures, different crises in women’s embodiment.”49

To what kind of “crisis in embodiment,” then, might Cancer

Vixen be understood to respond? One way in which we can ap-

proach this question is by considering the conflation between the

medical and cosmetic connotations of “treatment”—a plurality

that Marchetto gestures toward in the illustration of her memoir’sfront page: her avatar sits in a hospital chair, simultaneously re-

ceiving chemo and applying Viva Glam lip gloss. Later, in prepa-

ration for her wedding party, Marchetto writes of getting “mani-

cured . . . brow-waxed . . . beamed . . . blonded . . . and outfitted,”

as if being “beamed”—that is, irradiated—is merely another step

in her cosmetic regimen (p. 198). On the one hand, including ra-


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50. Chute, Graphic Women (above, n. 14) , pp. 15, 26.51. Hillary Chute, “Our Cancer Year , and: Janet and Me: An Illustrated Story of Love and

Loss, and: Cancer Vixen: A True Story , and: Mom’s Cancer , and: Blue Pills: A Positive Love

Story , and: Epileptic, and: Black Hole.” Literature and Medicine 26:2 (2007): 413–429,

quotes on pp. 416–17.

diation therapy in this catalog of “treatments” seemingly trivializes

the purview of therapeutic medicine; on the other, Marchetto’s ir-

reverence indexes a particular affective relationship to the medical-

industrial complex—of ordinariness, even boredom—that seem-ingly rankles critics like the Kellers, who, while deigning to critique

Adams’s self-publicity, circuitously critique the medium through

which she achieves this publicity. Social media—blogs, Facebook

pages, and Twitter feeds, which so often serve as catalogs of minu-

tiae—render illness and death discomfitingly common.

The medium of comics also, as Chute notes, once “a countercul-

tural vehicle,” has become mainstream, burdened with associations

of pop-cultural triviality: “The underground does not exist anymore;

it collapsed, most agree, in the 1980s, if not well before.”50

Datingthe death of the underground to the era in which the breast cancer

“awareness” was born, we might thus see how texts like Cancer Vixen

respond to the historical contingencies of their production. Any cri-

tique of Cancer Vixen must beg the question: How can a breast can-

cer graphic memoir be “countercultural” when both the disease and

the medium are inescapably implicated in the mainstream?

In her review of Marchetto’s memoir, Chute deems Cancer Vixen

“an irritating book,” citing “its obsession with brand names, skin-

niness, and the ins and outs of New York celebrity/media culture,”overloading the text with superficiality and “cuteness.” Chute’s cri-

tique registers the abrasiveness of Marchetto’s “fabulista” persona:

her incessant self-positioning as the Carrie Bradshaw of the chemo

ward. “Beyond this cuteness, however,” Chute qualifies, “the book

deploys its visual form in a way that demonstrates what a visual-

verbal—as opposed to simply verbal—text can do.” For example, she

notes that Marchetto’s depiction of the core biopsy needle, dem-

onstrating its actual size in comparison to the aspirator needle, of-

fers the reader “hard, valuable information—and the presentation isnot disruptive or didactically discordant here, but flows easily in the

comics format.”51 The visual nature of the narrative, in other words,

allows multiple discursive modes to coexist. For instance, Marchetto

includes the image of her initial breast ultrasound on the opening

page of her memoir; another panel of comics are placed over a re-

production of her pathology report, juxtaposing clinical discourse


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52. El Refaie, Autobiographical Comics (above, n. 18), p. 62 (emphasis in original).53. Susan Bordo, Unbearable Weight: Feminism, Western Culture, and the Body (Berkeley:

University of California Press, 1993), pp. 246, 25.

54. Texts like Cancer Vixen can be seen to reenact what Lauren Berlant calls the “central

fantasy” of women’s culture: “the constantly emplotted desire of a complex person to

rework the details of her history to become a vague or simpler version of herself, usu-

ally in the vicinity of a love plot.” As Berlant and others have noted, however, para-

doxically, even as we may critique the operations of such narratives, we maintain our

affective attachments to them. Exploring the operations of a gendered “survival sub-

culture” in the United States, Berlant argues that “[i]n the face of the dissolution of U.S.

history by the mass culture that represents its modernity, survival seems to her like animportant victory over nature and nationality, a vital form of historicity, and material

for a critical Americana.” A culture of sentimentality , in Berlant’s terms, affords the sub-

ject a way to “endure the modern conditions of identity formation, in which the ste-

reotype, the commodity, and the history of collective pain establish a juxtapolitical

with her own visual idiom (p. 123). Such juxtaposition gestures to

the notion that multiple narratives of breast cancer exist in an array

of often interpenetrating discursive configurations.

In many ways, the graphic narrative brings the matter of embodi-ment to the fore. Readers of autographics are reminded of the nar-

rator’s subjectivity not only by the continuity of the “I,” but by the

continuity of the avatar: a perpetually reproduced image of the em-

bodied self. As El Refaie has observed, “[g]raphic memoirists are in

the unusual position of having to visually portray themselves over

and over again, often at different ages and stages of development,

and in many different situations. Thus, all autobiographical comics

artists are, in the course of their work, constantly being compelled

to engage with their physical identities.” The repeated representa-tion of the avatar —what she calls “pictorial embodiment”—high-

lights this engagement with an identity based in corporeality.52

What might seem striking about Marchetto’s avatar in Cancer Vixen,

then, is how little it changes during the course of her disease. Mar-

chetto’s memoir may, in Chute’s terms, present “hard, valuable in-

formation” for her readership insomuch as her depictions of medi-

cal apparatuses like biopsy needles conform to the representative

dictates of “reality,” and yet Marchetto assumes considerably more

artistic license with her own self-representation. If the postmod-ern body can be understood to be what Susan Bordo calls “cultural

plastic”—a term that responds, she explains, to the fantasy of “defy-

ing the historicity, the mortality, and, indeed the very materiality of

the body”53—then the avatar might be understood, for Marchetto,

as a kind of imaginative dissociation from historicity, mortality, and

materiality.54


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image of ‘democratic’ mass culture.” See Berlant, The Female Complaint: The Unfinished

Business of Sentimentality in American Culture (Durham, NC: Duke University Press,

2008), pp. 7, 97–98.

55. Ehrenreich, “Welcome to Cancerland” (above, n. 33), p. 50.

The immutability of Marchetto’s avatar visually manifests her

professed refusal to “look like a victim”: indeed, for her, any inti-

mation of embodied change—the realization, for instance, that she

may gain weight on the treatment—results in the exclamatory panicof a Cathy cartoon. Having opted for “chemo light,” she does not

lose her hair; as she explains to her oncologist, “[m]y husband owns

a restaurant where the most beautiful women go and I can’t look

like crap! And I will kill myself if I lose my hair!” (p. 132). While she

briefly grieves that she will not be able to conceive children due to

her five-year Tamoxifen treatment, the dismay over this embodied

change appears momentary and seemingly secondary to hair loss.

The one physical change that Marchetto depicts on her avatar’s

body is a relatively minor one: a bout of stress-induced eczema. “Iwoke up stippled,” she writes, “looking like a Mankoff cartoon.” In

the following frame, she picks up the telephone, crying, “I need to

see the doctor ASAP!” (p. 101). Marchetto does not run to the doctor

when she discovers the lump in her breast; the cosmetic tragedy of

red, blotchy skin, on the other hand, prompts her to seek immediate

medical attention. Moreover, wryly describing herself as a creation

of Bob Mankoff—cartoon editor of the New Yorker, a venue in which

she had previously published her work—Marchetto signals the way

in which loss of control over her body comes concomitant with lossof control over her narrative. Here, she has become the subject of

someone else’s cartoon. In order to assert authority over both her

body and her narrative, Marchetto must become another kind of

subject, then—the subject of a Marchetto cartoon.

The narrative trajectory of this subject, however, has already been

iterated by what Ehrenreich has famously called the breast cancer

“cult” in which women are compelled to reproduce a culturally em-

plotted narrative of survival. She argues that these narratives “serve

as testimonials and follow the same general arc as the confessionalautobiographies required of seventeenth-century Puritans,” nar-

ratives that move toward “the blessed certainty of salvation, or its

breast-cancer equivalent, survivorhood.”55 Cancer Vixen, however,

perhaps more recognizably reflects another prominent American

narrative model: the secular autobiographical Bildungsroman—one

that, per Franklin, champions the radical individualism of the in-


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dustrious democratic citizen. Contemporary breast cancer narratives

posit the “survivor” as the paradigm American entrepreneur who

achieves survival status through toughness, optimism, and attitude.

For memoirists like Marchetto, the “salvation” of survival occurs notthrough the intervention of an external recuperative force—such as

God’s contemporary secular equivalent, scientific medicine—but in-

stead is seen to stem from within: the will to survive.

Despite its seeming self-assertion as an exercise in radical indi-

vidualism, Marchetto’s memoir is, in fact, preoccupied with oth-

ers—specifically, with other women. In order to analyze the ways

in which Marchetto represents her own body via the medium of

graphic memoir, then, it becomes necessary to consider the ways

in which she depicts the host of women with whom she is in con-stant contact and competition. Marchetto situates herself as an ob-

ject of gossip on what she calls “the sour grapevine” (p. 50): a cabal

of young, ultra-thin, uberfashionable New Yorkers who frequent

the upscale Greenwich Village restaurant that her fiancé owns and

operates. Marchetto’s depiction of the “sour grapevine” as a cluster

of glaring green faces harks back to her initial illustration of “pos-

sible cancer cells, an artist’s rendition” (p. 4): green faces with lolling

tongues and rebelliously raised middle fingers. Both, she suggests,

are toxic: “These stick figures,” she complains, “are always hitting onmy husband” (p. 166). By describing these hypersexualized twenty-

somethings as “stick figures,” Marchetto not only hypberbolizes the

simulation of an idealized body type, but positions other women’s

bodies in a rhetorical context that she is accustomed to—cartoon-

ing. Accordingly, she elects to combat the despair of comparison

by imaginatively manipulating her competition, figuratively “Pho-

toshopping” their bodies to transform them into glaring “Gumbies”

(p. 174).

Post-diagnosis, Marchetto finds herself amid a community ofwomen who are linked not by mutual lifestyle aspirations, but

rather by mutual diagnoses; representing these women, however,

comes less easily. In the waiting room during her first appointment

with the doctor whom she deems the “it” oncologist, she works on

cancer-cartooning, depicting a bald-headed woman who says “I’m

having a bad wig day.” When, moments later, a bald woman walks

through the waiting room, Marchetto is taken aback; she depicts

herself gasping and covering her eyes while her mother notes, “[i]t’s

different when you see it” (p. 108). Seeing evidence of cancer on

other women’s bodies, Marchetto recoils. Accordingly, she does

not (in the model of many other breast cancer memoirs) seek out a


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56. See, for example, Diane Price Herndl, “Our Breasts, Our Selves: Identity, Commu-

nity, and Ethics in Cancer Autobiographies,” Signs: Journal of Women in Culture and So-

ciety 32:1 (2006): 221–245.

57. The conflation of national and personal scales of violence and suspicion recur again

in Cancer Vixen when Marchetto admits to dreaming of being “attacked by Al-Qaeda”

during her treatment (p. 235).

community of fellow patients with and through whom she can

make sense of her experience.56 Her brief interaction with another

patient in the cancer clinic centers on commodities, as a sunken-

eyed young woman momentarily brightens to exclaim, “Oh, I loveyour shoes!” (p. 160).

Inasmuch as Marchetto aims to delineate herself as an outsider

to both groups—self-segregated from both the “victim” position of

patienthood and from the prevailing milieu of urban superficial-

ity—she also reminds us that she has arrived at the subject position

of outsider with a certain deliberateness. As she informs her reader-

ship early in her memoir, “I wasn’t always the self-aware narcissist

I am today” (p. 12). Here, Marchetto marks her generic boundaries,

signaling her participation in a familiar master narrative of upwardmobility. Her tongue-in-cheek presentation of her narrative as a

journey toward “self-awareness” invokes the familiar jargon of both

self-help and breast cancer cultures, both of which hinge on a dis-

course of awareness.

Marchetto dramatizes her evolution to awareness in an illustra-

tion labeled “B.C.” (before cancer) in which she depicts herself as a

quintessential urban fashionista, in silver platforms, chasing a taxi.

An arrow directs the viewer to her avatar’s line-defined abs and jut-

ting hipbones; “Yes,” she informs us, “I really was this thin” (p. 13).Her B.C. avatar is dated August 2001; the still-standing twin towers

in the background gesture toward the significance of the date. “I was

caught up in the superficial stupid stuff,” Marchetto admits, “and

back then, who wasn’t?” (ibid.). Here, she establishes the 9/11 ter-

rorist attacks as shorthand for a crisis point in the development of

her own emotional maturity—a rather narcissistic mapping of na-

tional tragedy onto the scope of her own narrative.57 At the same

time, Marchetto’s presentation of her self-professed superficiality in

her B.C. era and the pre-9/11 national ethos as concurrent raisesa parallel between the post-9/11 rhetoric of political vigilance—per

the Department of Homeland Security’s “If You See Something, Say

Something” public awareness campaign—and the embodied vigi-

lance of the breast cancer awareness movement, both of which play

on discourses of visual suspicion in order to enact a transfer of re-

sponsibility to the individual.


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58. Rob Nixon, Slow Violence and the Environmentalism of the Poor (Cambridge, MA:

Harvard University Press, 2011).

59. Chute, Graphic Women (above, n. 14) , p. 3 (emphasis in original).

Later, Marchetto suggests that the collapse of the twin towers on

9/11 might have instigated a crisis of another kind: reflecting on

having inhaled the asbestos-laden air, she asks her diagnosing phy-

sician “the number 1 question”: “Is that why I got CANCER?!” (p.32). Considering the confluence of environmental causes that have

been demonstrated to contribute to breast cancer risk, she offers a

brief glimpse of embodied change that is noncosmetic in nature:

the incorporation of environmental risk factors. Here, momentarily,

cancer is considered not only individually, but communally as Mar-

chetto gestures toward what Rob Nixon has deemed the “slow vio-

lence” of environmental contamination.58 “What the hell are we do-

ing to ourselves?” she asks, depicting herself sitting at her drafting

table while a crowd of imagined victims of environmental “cancerclusters” implore “Don’t forget us!” (p. 36).

If the graphic memoir, as Chute suggests, operates on an “ idiom

of witness, a manner of testifying that sets a visual language in mo-

tion with and against the verbal in order to embody individual and

collective experience, to put contingent selves and histories into

form,”59 Cancer Vixen utilizes this idiom only briefly against a more

recognizable narrative of survival wherein the subject’s ultimate

aim is reincorporation into a healthy society. With its institution of

the victim versus vixen paradigm, Cancer Vixen engages in a nego-tiation of the multiple meanings and narratives of breast cancer by

suggesting that the patient must locate herself as one archetype or

the other; indeed, Marchetto constantly presents gendered scenes

of doubling, from considering the oppositional figures of the Vir-

gin Mary and Mary Poppins (whom she deems “kind of a bitch” [p.

70]), to illustrating her divided psyche as warring demonic and god-

dess characters (p. 121). In what follows, I turn to Engelberg’s Cancer

Made Me a Shallower Person in order to consider the ways in which

autographics have also opened up space for breast cancer narrativesto express liminality, plurality, and ambivalence.

Cancer Made Me a Shallower Person: Memoir, Metastasis, and

the “Path of Shallowness”

“They say hardship reveals one’s true character,” Engelberg writes

in her introduction to Cancer Made Me a Shallower Person, “and it

was clear right away that I wouldn’t be the heroic type of cancer


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60. Miriam Engelberg, Cancer Made Me a Shallower Person: A Memoir in Comics (New

York: HarperCollins, 2006). Further references will be cited parenthetically in the text.

61. Frank, Wounded Storyteller (above, n. 7), p. 115 (emphasis in original).

62. Peter Simon, “Definitely Not Upbeat,”Amazon.com , December 6, 2007. http://

www.amazon.com/Cancer-Made-Me-Shallower-Person/product reviews/0060789735

/ref=cm_cr_dp_qt_hist_one?ie=UTF8&filterBy=addOneStar&showViewpoints=0.

patient portrayed in so many television shows and movies.”60 In

other words, her “true character” is not a character—or rather, a

caricature: the archetypal hero of what Frank calls the “quest” plot.

Like the cinematic protagonists Engelberg cites, the autobiographi-cal narrators of “quest stories,” Frank explains, “meet suffering head

on; they accept illness and seek to use it.”61 If Engelberg has a quest

in her narrative of diagnosis, treatment, remission, and metastasis,

however, it is ultimately quixotic. “When I was first diagnosed,” she

reflects, “I felt pressure to become someone different—someone no-

bler and more courageous than I was.” Here, Engelberg notes the

“pressure” of the standard story of breast cancer: a narrative of per-

sonal growth and, ultimately, survival. While Marchetto also pokes

fun at this generic expectation by drawing attention to the scale ofher quest—using her illness, in Frank’s terms, as a means to tran-

sition from ordinary narcissism to “self-aware” narcissism—Engel-

berg instead admits to the complete lack of worldview-altering or

paradigm-shifting personal changes instigated by cancer. Instead, as

her title suggests, her narrative completely reverses the generic ex-

pectation of autopathography: “maybe nobility and courage aren’t

the only approaches to life with an illness. . . . Maybe the path of

shallowness deserves more attention!” (p. xiii).

For Engelberg, the “path of shallowness” is paved with pop-cultural artifacts—in particular, the TV Guide crossword puzzles that

allow her to achieve “a kind of trivia Nirvana.” This proves unpalat-

able for one Amazon.com reviewer, who pans her memoir because

it is “not upbeat” and “not a funny book.”62 The reviewer suggests

that Cancer Made Me a Shallower Person fails on two generic fronts:

as an autopathography, it does not provide a meaningful (and

“upbeat”) quest narrative; as a comic, it is not “funny” enough. “I

would give this book five stars,” another Amazon reviewer writes, “if

it were not for the sad ending—the recurrence (and progression) ofthe author’s cancer.” While this second reviewer—a self-identified

cancer patient—surely realizes that, as a memoir, the reality of the

“sad ending” is not within Engelberg’s control, she rather takes is-

sue with the iteration of this ending: “All of us going through cancer

treatment, or just finishing, know that this possibility looms in our


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63. C. Farrell, “Mixed Feelings,” Amazon.com , June 21, 2012. http://www.amazon.

com/Cancer-Made-Me-Shallower-Person/product-reviews/0060789735/ref=cm_cr_dp

_synop?ie=UTF8&showViewpoints=0&sortBy=bySubmissionDateDescending#R31KYR

QOVLONTB.

64. Judy Z. Segal, “Breast Cancer Narratives as Public Rhetoric: Genre Itself and the

Maintenance of Ignorance,” Linguistics and the Human Sciences 3:1 (2007): 3–23, quotes

on pp. 16, 4.

65. Judy Z. Segal, “Cancer Experience and its Narration: An Accidental Study,” Literature

and Medicine 30:2 (2012): 292–318, quote on p. 294.

66. This persona seems to owe much to Gilda Radner’s account of her struggle with

ovarian cancer, It’s Always Something (1989). Notably, Radner authored the memoir

when she believed she was in remission.

67. DeShazer, Mammographies (above, n. 34) , pp. 108–109.

future,” the reviewer continues; “[b]ut if you don’t want to be re-

minded of it, this book is probably not for you.”63

The master comic plot of survival placates audiences who “don’t

want to be reminded of” the threat of recurrence that hovers overevery cancer narrative. Judy Segal has launched particularly tren-

chant critiques of this culturally reified comic plot; identifying Can-

cer Vixen as one such “utterly conventional” narrative, she argues

that “[p]ersonal breast cancer stories are one means of producing

and maintaining ignorance about breast cancer.”64 Elsewhere, she

has claimed that Engelberg also reproduces this generic convention-

ality, if not via the “survival” plot, then in tone: “in promoting the

figure of the cancer-patient-with-a-sense-of-humor, [Cancer Made Me

a Shallower Person] shares some of the coercive quality of other can-cer narratives. People, especially women, with cancer are exhorted

in public discourse to be positive, strong, attractive, sexy—and

funny.” Thus Engelberg’s comics, Segal argues, “do not, in fact, un-

settle more typical stories so much as reinscribe them sideways.”65

For Segal, Engelberg’s “sideways” reinscription of the breast can-

cer narrative problematically reinforces the “cancer-patient-with-a-

sense-of-humor” persona, if not necessarily the narrative trajectory

in which she is emplotted.66 For DeShazer, on the other hand, it

is precisely Engelberg’s willingness to address metastasis from thepositionality of this persona that redeems it from the mantle of con-

ventionality. Citing Freud on “rebellious humor,” DeShazer praises

Engelberg for “choosing transgressive humor over tragic angst”

as a method for her memoir. “Themes of recurrence and metasta-

sis rarely appear in humorous breast cancer memoirs,” she notes,

“since laughter is positioned culturally as a tool of the not-dying,

and death is nothing to laugh about.”67 Engelberg’s decision to the-

matize metastasis and death in a breast cancer memoir seems es-


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68. In 2012, METAvivor Research & Support, Inc. launched the “Elephant in the Pink

Room” campaign in an effort to draw attention to metastatic breast cancer. See http://

mbcaware.org/.

69. Couser, Recovering Bodies (above, n. 17), p. 42.

pecially transgressive, perhaps, considering the cultural currency of

the word survivor— a word that Engelberg interrogates in one of her

comics. In it, a doctor leans over the bed of a bald woman, begin-

ning to pronounce her time of death. “Wait!” she cries. “I have a fewmore seconds to go. I’m still a survivor!”

Engelberg’s memoir self-consciously responds to its generic

boundaries, acknowledging the ways in which both comics and can-

cer narratives face an impetus to be funny and upbeat. She then

tests these boundaries by mapping the comic cancer patient persona

onto the tragic plot of metastasis—not for the sake of rebelliousness,

I would suggest, but instead to extend the generic logic of the cancer

narrative into the murky and rather more uncomfortable territory of

metastatic disease. In so doing, Engelberg—as evidenced by some ofher Amazon.com reviews—lays bare the seeming incongruity of her

humor: her narrative brushes against the grain of the breast cancer

memoir precisely because metastasis has largely been excised from

the cultural narrative of the disease.68

With both image and text, as well as with the paratext supplied

by Engelberg’s introduction, Cancer Made Me a Shallower Person an-

nounces its difference from the autopathographical plot, one that

tends to proceed with an optimistic chronology from diagnosis to

recovery. Indeed, even the text’s lack of pagination disrupts the no-tion of narrative linearity. “A number of topics or scenes appear in

nearly every [breast cancer] narrative,” writes Couser, “generally in

the same order.” From the detection of the “suspicious lump,” to di-

agnosis, to treatment, to “recovery and resolution in the form of fa-

vorable reports and restoration of (relative) peace of mind.” Couser

accordingly observes that “medical protocols—not the ‘progress’ of

the disease so much as the way in which it is detected, diagnosed,

and treated—would seem to dictate the basic constituents of the

master plot.”69 Rather than conform to the imperatives of this plot,then, Engelberg presents a series of what might best be termed

sketches—in both the visual and narrative senses.

As artistic sketches, Engelberg’s black-and-white illustrations offer

the impression of having been roughly and hastily produced. One

review of Cancer Made Me a Shallower Person, for instance, claims

that Engelberg’s “untutored, charmingly inept style lends an air of


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70. Ian Williams, “Cancer Made Me a Shallower Person: A Memoir in Comics,” Graphic

Medicine (n.d.). http://www.graphicmedicine.org/comic-reviews/cancer-made-me-a-shallower-person-a-memoir-in-comics/.

71. DeShazer, Mammographies (above, n. 34) , p. 103.

72. Whitlock, “Autographics” (above, n. 37), p. 976.

veracity to the work.”70 Although Engelberg is indeed a self-taught

cartoonist, if she is “charmingly inept,” it is less in her style of car-

tooning than in her attempt to try on the persona of cancer patient.

Unlike Marchetto, she is not a professional cartoonist; neither, isshe a “professional” patient, inasmuch as she resists internalizing

the kind of chronic optimism that accompanies the cultural plot

of survivorship. The kind of competition that Engelberg faces, for

instance, is not, as in Cancer Vixen, a struggle for cosmetic suprem-

acy; rather, she expresses a sense of inadequacy in the face of fellow

patients. “I felt I wasn’t keeping up with the Joneses,” she writes,

noting the incessant cheerfulness that some of the women express,

while also lamenting, “I was more depressed even before I had can-

cer!”Engelberg’s sketched aesthetic not only suggests the makeshift,

chaotic, and haphazard nature of her experience with cancer, but

it lends a kind of iconicity to her drawings; her “pictorial embodi-

ment” accordingly works to construct identification with her read-

ership. DeShazer refers to Engelberg’s avatar as “the iconic Miriam,

a black-and-white line-drawn Everywoman.”71 Indeed, as Whitlock

observes, glossing Scott McCloud’s argument in his influential Un-

derstanding Comics, “iconic drawings of the human face are particu-

larly powerful in promoting identification between reader/viewerand image, and the more cartoonish (iconic) a face is, the more it

promotes association between the viewer and image.”72 In her intro-

duction, Engelberg writes of “feeling different and alone—isolated

in a state of Miriam-ness that no one else experiences. That’s what

drew me to read autobiographical comics,” she explains, “and that’s

why I hope my comics can be of comfort to other readers that might

be struggling with issues similar to mine” (p. xiii). Her gestures, both

verbal and visual, toward commonality and mutual identification

differentiate her memoir from Marchetto’s, which insists on its iso-lation in a state of “Marisa-ness,” constantly highlighting specificity

of her situation with its “self-aware narcissism.”

From a narrative standpoint, Engelberg’s vignettes allow glimpses

into isolated aspects of her experience, particularly as she attempts

to negotiate her nascent and discomfiting identity as a breast cancer

patient. Few of Marchetto’s cartoons in Cancer Vixen, on the other


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73. As Martha Stoddard Holmes notes, Engelberg’s attention to environmental risk fac-

tors illustrates the way in which what she calls the “situatedness” of cancer comics may

be “meaningfully politicized.” See Holmes, “Cancer Comics” (above, n. 15).


hand, can be taken out of context; rather, they exist in relation to

the chronology of her narrative—a survival plot progressing from

diagnosis to recovery. Engelberg’s comics present a trenchant cri-

tique of the ways in which breast cancer is commonly emplotted:“When someone goes through hard times, friends will say, ‘You

can get through this.’ This implies a temporary state, like a Lifetime

made-for-TV-movie scenario, where the heroine comes out stronger

in the end.” Engelberg’s observation about the “made-for-TV-movie

scenario” proves to be a particularly apt assessment of breast can-

cer’s generic expectations: Lucas’s Why I Wore Lipstick to My Mastec-

tomy was adapted into a Lifetime movie in 2006; Cancer Vixen is cur-

rently under production with HBO for a made-for-TV movie starring

Cate Blanchett. “In the beginning of my relationship with cancer, Itoo viewed it as something temporary,” Engelberg admits. “I had no

idea that it would become a constant presence” (p. xii).

In Cancer Vixen, breast cancer is presented in various inimical

guises: a looming Grim Reaper, a cluster of vulgar green cells with

stuck-out tongues. For Marchetto, cancer is a villain with a thwarted

vendetta—an external agency; for Engelberg, cancer’s agency is more

complex: it does not define her, but it becomes part of her; indeed,

she realizes, it is part of her. Like Marchetto, Engelberg appeals to

the “idiom of witness” in intimating the environmental risk factorsassociated with breast cancer: from radiation, pesticides, and nitrites

to coated cookware, tap water, and cheese.73 “Everything is my en-

emy,” she decides. But when her cancer goes metastatic—becomes

a “constant presence”—she must renegotiate her “relationship with

cancer” not by personifying and externalizing it, as Marchetto does,

but rather by recognizing its permanent incorporation in her body,

and indeed her identity.

To do so, however, requires relearning how to interpret her own

embodiment. Pathography, or what Hawkins calls “our modernadventure story,”74 repositions narrative perils by highlighting the

manifold dangers located not in the external world, but contained

within the body itself. This inward turn speaks more widely to the

obsession with suspicion in the post-Ricoeurian critical climate—

what Eve Kosofsky Sedgwick has deemed “paranoid reading”: an

interpretive model that operates on suspicion, on the interplay of

surface and depth, of latent and manifest content. “The unidirec-


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75. Eve Kosofsky Sedgwick, Touching Feeling: Affect, Pedagogy, Performativity (Durham,

NC: Duke University Press, 2003), p. 130.

76. For further discussion of the concept of autobiographical endings, see Hannah Sul-

livan, “Autobiography and the Problem of Finish,” Biography 34:2 (2011): 298–325.

77. Meghan O’Rourke, “Tweeting Cancer,” New Yorker , January 13, 2014. http://www

.newyorker.com/online/blogs/culture/2014/01/tweeting-cancer.html.

tionally future-oriented vigilance of paranoia generates, paradoxi-

cally, a complex relation to temporality that burrows both backward

and forward: because there must be no bad surprises, and because

learning of the possibility of a bad surprise would itself constitutea bad surprise, paranoia requires that bad news be always already

known,” Sedgwick explains.75 This paranoiac relationship to tem-

porality helps explain the nonlinear nature of Engelberg’s narrative,

as she remains unsure how to correctly interpret embodied cues as

they may or may not signify for the larger narrative of her experi-

ence.

This ambivalence about the significance of symptomatology is il-

lustrated most clearly in a cartoon titled “Life as a Movie.” In film,

Engelberg observes, “the audience knows the character is a gonerway before [the character] figures it out.” This is the dramatic irony

of symptomatology: “In a movie it makes no sense to mention a

symptom without mentioning it later on.” However, she writes, “real

life is full of insignificant moments”—or seemingly significant mo-

ments that ultimately do nothing to further the autopathographical

plot. The instability of the embodied subject as it concerns her own

self-interpretation thus perpetually begs the question with which

Engelberg titles another cartoon: “Hypochondria or Intuition?” Her

inability to determine the answer mobilizes both her memoir’s hu-mor and its pathos.

Coda: Terminal

In life narratives and the lives they narrate, it is perhaps most dif-

ficult to conceptualize the terminal moment. The question of auto-

biographical endings is nearly always an anxiety-producing one.76

Endings, as the recent public uproar over “the ethics of tweeting

a terminal illness” evidences, tend to distress us. In her response

to the Kellers’ columns, Meghan O’Rourke writes that both authorsprovide a “stark and tone-deaf reminder of just how repressed and

ahistorical our public relationship to dying and death is today”; she

defends Adams by arguing that “there is something useful about

the disjunctiveness of posts like hers, which pop the bubble of the

social-media surfaces that we slide along, as if our time here were a

never-ending river rather than a journey that has a distinct end.”77


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78. Woolf, On Being Ill (above, n. 23) , pp. 3–4.

79. For a discussion of the inception of National Breast Cancer Awareness Month, see

Sulik, Pink Ribbon Blues (above, n. 32), pp. 123–125.

What happens in the final frame of an autopathographic text? What

140 characters or fewer will comprise Adams’s final tweet?

Given the radical differences between notions of both emplotment

and embodiment in Cancer Vixen and Cancer Made Me a Shallower Per-son, it may seem striking how similarly these texts end. The former

concludes with a symbolically convenient rainstorm, one that Mar-

chetto elects to accept calmly. Without the storm, she tells her hus-

band with dewy-eyed reflectiveness, “we wouldn’t have seen such

spectacular lightning, or witnessed that majestic fog” (p. 212). In

Engelberg’s final vignette, titled “In Perspective,” she looks back on

a memory from her college years in which looking up at the stars

inspires a brief moment during which her “anxieties seemed insig-

nificant” in comparison. “I wish I could recapture that feeling now,”she writes. Importantly, however, Engelberg’s sense of perspective is,

she admits, aspirational; her anxieties, like her metastatic cancer, are

a “constant presence.”

“Considering how common illness is,” Woolf wrote in On Being

Ill, “it becomes strange indeed that illness has not taken its place

with love and battle and jealousy among the prime themes of lit-

erature. Novels, one would have thought, would have been devoted

to influenza; epic poems to typhoid; odes to pneumonia; lyrics to

toothache.”78 Today, we have tweets that take on cancer, blogs thatchronicle chronic illness. As new media manipulate the genre of au-

topathography, our affective relationships to illness and death shift

accordingly. “There’s something very personal about telling people

you’ve had breast cancer,” Engelberg notes in the opening vignette

of Cancer Made Me a Shallower Person. She imagines a T-shirt that

would “cut to the chase,” one with a conspicuous arrow and the

words “CANCER INSIDE.” Whether T-shirt or comic, poem or Twit-

ter feed, the “personal”—that is, the conspicuously embodied, the

graphic—seems awkwardly, even irreverently at odds with the me-dium in which it is expressed. Perhaps, then, as Engelberg’s comics

seem to suggest, this speaks less to the “ethical” orientation of the

autopathographer than to the culturally established expectations of

her audience.

Engelberg’s narrative, like Adams’s, disrupts the story we want to

tell about breast cancer: that it is surmountable, codified by the cul-

tural archetype of the survivor—a subjectivity that has been relent-

lessly marketed throughout the past thirty years by breast cancer

awareness campaigns.79 Indeed, Emma Keller does not address the


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ethics of tweeting illness, broadly writ, but specifically attends to

terminal illness. “Lisa Bonchek Adams is dying,” her article begins;

it goes on to attempt to unpack the readerly affect that results from

intrusion into spaces—bodily, digital—where dying happens. Mak-ing recourse to the familiar beginnings of the breast cancer narra-

tive—“Her journey began”—Keller goes on to remark on Adams’s

“seven-year decline” as if to immediately assess Adams’s story in a

way that renders it legible generically, demarcating it as a declension

narrative—an autothanatography that inevitably moves toward a

“distinct end.” But perhaps this ending is not as distinct as we seem

to believe.

waples-avatars, illness, and authority embodied experience in breast cancer autopathographics

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