Reviewed Book
Enduring Cancer: Life, Death, and Diagnosis in Delhi. Dwaipayan Banerjee, Durham: Duke University Press, 2020, 240 pp.
Enduring Cancer: Life, Death, and Diagnosis in Delhi. Dwaipayan Banerjee, Durham: Duke University Press, 2020, 240 pp.
Saiba Varma
University of California-San Diego
In Audre Lorde’s The Cancer Journals (1980), she describes “growing up Fat Black Female and almost blind in america” as requiring “so much surviving that you have to learn from it or die” (p. 40). Lorde’s “so much surviving” offers a powerful analog to the ways mostly poor and lower-middle class people in Delhi, India experience and struggle with a range of precarities, which include, but are not limited to, cancer—the focus of Dwaipayan Banerjee’s powerful book, Enduring Cancer.
Banerjee’s ethnography takes place primarily in two settings: at the prestigious All India Institute of Medical Sciences (AIIMS) in New Delhi, and with an NGO called CanSupport, with whom Banerjee accompanied clinicians, counselors, and NGO workers to the homes of cancer patients and their families. Through deeply evocative ethnographic scenes, Banerjee’s book meditates on what it means to live beside a cancer diagnosis when the word conjures death more than life. The responses that Banerjee offers are unsettling yet revealing of tense and unpredictable worlds always already haunted by vulnerability.
Those worlds are enlivened through Banerjee’s careful attention to language: the things people say, do not say, and cannot say, about cancer. In Chapter 1, Banerjee skillfully shows how biomedical, bureaucratic, and bioethical languages and norms around disclosure and transparency are woefully inadequate to capturing the complex ways knowledge circulates in the lives of cancer patients, their families, and in regimes of care more generally. Enduring Cancer productively troubles the duality of knowing versus not knowing—a binary that corresponds to a moral map of rationality versus irrationality, modernity versus backwardness, and care versus violence—in Euro-American imaginaries. Instead, the moral axes of disclosure and its absence are, if not flipped, then productively disturbed, with broad implications beyond the case at hand. Concealing a diagnosis of cancer can convey an ethics of care, helping to “sustain possibilities of relations” (p. 7). Further, decisions about disclosure and transparency are not only about maintaining the hope of the individual patient in the face of an often-terminal diagnosis, although that is important. Rather, disclosures are less likely to enable care than they are to foreclose a wide range of relationships and possibilities for life and livelihood. Through concealment, people blunt the sharpest edges of the disease, namely, its social abandonment.
In Chapter 2, conditions of scarcity and triage reveal that cancer does not so much disrupt as reshape and interrupt “the shifting, local relational worlds within which the disease appears” (p. 44). Following CanSupport workers into the homes of patients and kin, Banerjee shows how the disease does not necessarily disintegrate marriages and families, but further fractures them, bringing old wounds and buried affects to the surface. At other moments, cancer allows gendered survivors of intimate partner violence to voice buried histories. Endurance emerges as the phenomenological and moral accompaniment to slow violence and a fast-moving disease.
In Chapter 3, Banerjee attends to an oncology palliative care unit in AIIMS staffed by anesthesiologists. This specialization, Banerjee points out, is still globally rare and is thus one of the ways AIIMS establishes itself as a prestigious global oncology institution. Following other ethnographers of cancer in the global south, Banerjee shows how cancer’s ontology in India is specific to its local and national institutional and cultural context. AIIMS employs some of India’s most well-respected doctors—some of whom appear in the pages of Enduring Cancer— and occupies an undisputed position atop the hierarchy of Indian medial education. Yet the sheer demands of outpatient care severely constrain the practical applicability of global health research that may lead to better treatment outcomes, as the AIIMS outpatient department sees 10,000 patients a day, many of whom begin queuing before dawn. Through his keen and sensitive attention, Banerjee reveals the everyday dilemmas faced by palliative care clinicians, that is, how they attend to pain while “remaining attuned to the possibility of therapeutic failure” (p. 112). These dilemmas are especially poignant in India where patients are nearly always diagnosed at late stages of disease and “pain is an overwhelming part of cancer” (p. 90).
Chapters 4 and 5 switch gears to what Banerjee describes as the “tension between lived experiences of cancer and its aesthetic representations” (p. 121). The turn away from the ethnographic to cultural texts (film, memoir) raises productive questions about the limits, failures, and possibilities of ethnography as a mode of social and ethical recognition. Chapter 4 focuses on cancer memoirs, written in a prefigurative “self-help” genre, while Chapter 5 reads popular Hindi-language films about cancer from the 1960s–2000s. Banerjee is an astute reader, so much so that some of the themes he finds in these texts spark further ethnographic curiosity in the reader. Do the moral failings so central to the genre of cancer memoirs also appear as ethnographic problems in the “register of the complaint” (Chua 2012), and if so, how? While memoirs often valorize pain as the precondition for spiritual and moral transcendence, how do cancer patients think of and theorize their own pain, and how might iconic films about cancer influence their lived experiences? While Banerjee rightfully critiques self-help memoirs for promoting a view of cancer that is predominantly about redemption rather than endurance, the films present a para-ethnographic, though heightened, world. Banerjee thoughtfully pulls out themes of sacrifice—gendered sacrifices, self-sacrifice, and sacrifice for the nation—in cancer narratives, which are often conveyed through the affect of melodrama to imagine and magnify “the stakes of ethical crises in social relations around cancer” (p. 168). These careful readings left me wondering about the sign of sacrifice in the social, emotional, and economic lives of Banerjee’s interlocutors.
This book should be widely taught and read by medical anthropologists interested in noncommunicable diseases in the Global South, particularly South Asia, as well as by public health practitioners and bioethicists. Its accessible style also makes it an excellent choice for uptake in undergraduate courses. Enduring Cancer reveals endurance to be not a singular capacity for survival, but a relational one. Banerjee’s gentle yet firm shifting of the reader’s gaze away from spectacular scene of diagnosis toward modes of dispossession that fail to breach thresholds of eventfulness is commendable. Endurance is not heroic: it does not necessarily index a journey of self-discovery, transcendence or overcoming. It is more morally ambiguous and includes necessary tactics of delay, deferral, discernment, partial revelation, and attrition in the everyday. Neither does endurance signify the absence of limitation. Endurance is forged in the crucible of constraint—of household economic struggles and macro-economic infrastructural lacks, of kin relations frayed by histories of intimate partner violence and everyday betrayals, of physical pain that is (somewhat) treatable and long festering emotional wounds that are not.
The etymology of the word endurance also contains the verb to harden. To endure is thus not a neutral act. It requires, in equal doses, lies and truths, a will to live and a will to sacrifice, to protect and let go. To endure is so much surviving—and there is only so much one can survive.
References Cited
Chua, J. L. 2012. The Register of “Complaint”: Psychiatric Diagnosis and the Discourse of Grievance in the South Indian Mental Health Encounter. Medical Anthropology Quarterly 26: 221–40.
Lorde, A. 1980. The Cancer Journals. San Francisco: Aunt Lute Books.