Abstract
Dwaipayan Banerjee’s Enduring Cancer: Life Death and Diagnosis in Delhi describes how Delhi’s urban poor live with cancer in a world where precarity and uncertainty are endemically quotidian. Enduring is an adjective that connotes something long-lasting as well as the present participle of endure, meaning to undergo hardship without giving in. Cancer, as Banerjee frames it, is slow, chronic and painful; it accretes through histories of vulnerability that take visible tolls on his interlocutors. Yet it is also an ‘ethic’, a practice through which individuals absorb the disease into their everyday lives, remaking social relations and forms of intimacy as recovery remains tenuous as best.
Enduring Cancer weaves ethnographic fieldwork, archival research, film as well as literary analysis together, making wide ranging interventions into, not only medical anthropologies of cancer, but also Science and Technology Studies and South Asian Studies writ large. Banerjee’s divergent methods afford such encompassing analyses, as they traffic between sites not often thought together in ethnographies of cancer. The first half moves between the palliative care unit in Delhi’s All India Institute of Medical Science’s (AIIMS) cancer ward, where Banerjee works as a resident, and home visits with CanSupport, an NGO that provides palliative care to low-income and terminally ill cancer patients living across the city. The second half turns to aesthetic accounts of cancer in India, predominately films and memoirs, exploring how representations of the disease give voice to or further stifle the experiences of his interlocutors. Throughout these varying sites, Banerjee chronicles how individuals experiment in living with or alongside cancer, managing a diagnosis that only sharpens long-standing vulnerabilities.
Banerjee’s notion of endurance stands in direct contrast to the promise of a biotechnological cure to cancer. A promise scholars like Jain (2014) have critiqued for distracting patients from the health-care systems that have and continue to fail them. And a promise that becomes unhinged, as Livingston (2012) has shown, in places like Botswana where innovative treatment remains out of reach for many. This promise is stifled even at AIIMS—one of the best hospitals in the country, with a palliative care unit staffed by highly trained experts wielding innovative biotechnologies. The hospital’s reputation draws upwards of 3.5 million patients from throughout India, a number that dangerously outstrips the institution’s capacity. The embodied forms of pain treated at the palliative care unit indexes this and other kinds of infrastructural failure; other public hospitals also filled to capacity, prohibitive costs of treatment, dangerously long wait times for vital forms of intervention. Banerjee carefully documents how these socioeconomic constraints manifest as embodied afflictions while charting the limits of biomedical research and treatment, which often fails to apprehend these root causes of patients’ suffering. Innovative approaches to ameliorating pain through an emphasis on spirituality and empathy, for example, bear the imprint of colonial tropes—such as a uniquely Indian capacity for metaphysical transcendence—that overlook the structural origins of patients’ suffering.
Patients, their families, and the CanSupport workers Banerjee accompanies on home visits, however, come up with other ways of managing cancer pain. Secrecy is a key practice through which patients and their loved ones negotiate the strain cancer puts on already frayed social relations. Rather than rooted in cultural stigma or misinformation, Banerjee describes these forms of non-disclosures as strategies of endurance. For some patients, whose income depends on neighbours or kinship networks, disclosing their diagnosis could lead to isolation and a loss of their means of subsistence. Secrecy then, is a mode of self-preservation. For others, concealing a diagnosis from close family members allows loved ones to continue living in the present, even if death lingers on the horizon. Secrecy, in these cases, is a practice of love. When CanSupport workers enter patient’s homes, they aid in these forms of concealment—mediating conflict between spouses, keeping illness secret from neighbours, negotiating already fraught kinship dynamics and seldom uttering the word cancer aloud. Promoting neither optimism nor transcendence, palliative care here entails continuing life amidst strained social worlds (p. 41).
Banerjee’s turn to aesthetic representations of cancer in the second half of his text builds on his ethnographic insights. Along with his work across clinical and intimate spheres, this archive foreground shows that cancer reverberates throughout India’s cultural landscape. While foregrounding the limitations of popular representations of cancer, in memoirs championing hope and perseverance, for example, other mediums open up pedagogic possibilities.
Indeed, many cancer films from the 1950s and 1960s, Banerjee argues, conform to a genre of melodrama that amplifies the stakes of cancer. Set against a backdrop of rampant inequality and the hope for social reform, films like Dil Ek Mandir (1963) and Saathi (1968), also tell the story of the ‘failed promise of decolonization, the propriety of gender roles, the decline in family values, the duties of care placed upon kin, and so on’ (p. 169). Here, male protagonists sacrifice themselves to cancer, while woman live on in a state of prolonged suffering that refuses resolution. Their embodied anguish does not simply demonstrates the limits of biomedical cures to cancer or the constraints diagnosis poses to gender roles and kinship obligations. It also gestures to how living and dying with cancer eludes any attempt to present it in coherent form. The melodramatic excess of these films emblematises precisely how, like Banerjee’s interlocutors, individuals strive to endure pain in ‘an ever-unfinished and often unrewarding struggle’ (p. 179). While the public health experts and physicians he works with at AIIMS castigate these bleak portrayals of cancer as ‘detrimental to the psychological well-being of their patients’. Banerjee argues such representations might more precisely index the stakes of living and dying with cancer in and beyond Delhi (p. 168).
Banerjee’s ethnographic writing is careful, intimate and nuanced. He describes forms of suffering and practices of persistence that not only demystify the tropes of hope and survivorship through which cancer is often apprehended in and beyond India, but also push forward expansive understandings of care. Deftly weaving between clinical contexts and intimate spheres allows readers to understand the toll living with cancer exacts long after the moment of diagnosis. Although his pivot towards aesthetic representations orients readers away from the richness of his ethnographic writing at times, his experimental methods provide a productive model for the medical humanities writ large.