Bright-Sided (3 page)

A similar reckless optimism pervaded the American invasion of Iraq. Warnings about possible Iraqi resistance were swept aside by leaders who promised a “cakewalk” and envisioned cheering locals greeting our troops with flowers. Likewise, Hurricane Katrina was not exactly an unanticipated disaster. In 2002, the New Orleans
Times-Picayune
ran a Pulitzer Prize–winning series warning that the city’s levees could not protect it against the storm surge brought on by a category 4 or 5 hurricane. In 2001,
Scientific American
had issued a similar warning about the city’s vulnerability.
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Even when the hurricane struck and levees broke, no alarm bells went off in Washington, and when a New Orleans FEMA official sent a panicky e-mail to FEMA director Michael Brown, alerting him to the rising number of deaths and a shortage of food in the drowning city, he was told that Brown would need an hour to eat his dinner in a Baton Rouge restaurant.
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Criminal negligence or another “failure of imagination”? The truth is that Americans had been working hard for decades to school themselves in the techniques of positive thinking, and these included the reflexive capacity for dismissing disturbing news.

The biggest “come-uppance,” to use Krugman’s term, has so far been the financial meltdown of 2007 and the ensuing economic crisis. By the late first decade of the twenty-first century, as we shall see in the chapters that follow, positive thinking had become ubiquitous and virtually unchallenged in American culture. It was promoted on some of the most widely watched talk shows, like
Larry King Live
and the
Oprah Winfrey Show
; it was the stuff of runaway best sellers like the 2006 book
The Secret
; it
had been adopted as the theology of America’s most successful evangelical preachers; it found a place in medicine as a potential adjuvant to the treatment of almost any disease. It had even penetrated the academy in the form of the new discipline of “positive psychology,” offering courses teaching students to pump up their optimism and nurture their positive feelings. And its reach was growing global, first in the Anglophone countries and soon in the rising economies of China, South Korea, and India.

But nowhere did it find a warmer welcome than in American business, which is, of course, also global business. To the extent that positive thinking had become a business itself, business was its principal client, eagerly consuming the good news that all things are possible through an effort of mind. This was a useful message for employees, who by the turn of the twenty-first century were being required to work longer hours for fewer benefits and diminishing job security. But it was also a liberating ideology for top-level executives. What was the point in agonizing over balance sheets and tedious analyses of risks—and why bother worrying about dizzying levels of debt and exposure to potential defaults—when all good things come to those who are optimistic enough to expect them?

I do not write this in a spirit of sourness or personal disappointment of any kind, nor do I have any romantic attachment to suffering as a source of insight or virtue. On the contrary, I would like to see more smiles, more laughter, more hugs, more happiness and, better yet, joy. In my own vision of utopia, there is not only more comfort, and security for everyone—better jobs, health care, and so forth—there are also more parties, festivities, and opportunities for dancing in the streets. Once our basic material needs are met—in my utopia, anyway—life becomes a perpetual celebration in which everyone has a talent to contribute. But we
cannot levitate ourselves into that blessed condition by wishing it. We need to brace ourselves for a struggle against terrifying obstacles, both of our own making and imposed by the natural world. And the first step is to recover from the mass delusion that is positive thinking.

ONE

T
he first attempt to recruit me into positive thinking occurred at what has been, so far, the low point of my life. If you had asked me, just before the diagnosis of cancer, whether I was an optimist or a pessimist, I would have been hard-pressed to answer. But on health-related matters, as it turned out, I was optimistic to the point of delusion. Nothing had so far come along that could not be controlled by diet, stretching, Advil, or, at worst, a prescription. So I was not at all alarmed when a mammogram—undertaken as part of the routine cancer surveillance all good citizens of HMOs or health plans are expected to submit to once they reach the age of fifty—aroused some “concern” on the part of the gynecologist. How could I have breast cancer? I had no known risk factors, there was no breast cancer in the family, I’d had my babies relatively young and nursed them both. I ate right, drank sparingly, worked out, and, besides, my breasts were so small that I figured a lump or two would probably improve my figure. When the gynecologist
suggested a follow-up mammogram four months later, I agreed only to placate her.

I thought of it as one of those drive-by mammograms, one stop in a series of mundane missions including post office, supermarket, and gym, but I began to lose my nerve in the changing room, and not only because of the kinky necessity of baring my breasts and affixing tiny X-ray opaque stars to the tip of each nipple. The changing room, really just a closet off the stark, windowless space that housed the mammogram machine, contained something far worse, I noticed for the first time—an assumption about who I am, where I am going, and what I will need when I get there. Almost all of the eye-level space had been filled with photocopied bits of cuteness and sentimentality: pink ribbons, a cartoon about a woman with iatrogenically flattened breasts, an “Ode to a Mammogram,” a list of the “Top Ten Things Only Women Understand” (“Fat Clothes” and “Eyelash Curlers,” among them), and, inescapably, right next to the door, the poem “I Said a Prayer for You Today,” illustrated with pink roses.

It went on and on, this mother of all mammograms, cutting into gym time, dinnertime, and lifetime generally. Sometimes the machine didn’t work, and I got squished into position to no purpose at all. More often, the X-ray was successful but apparently alarming to the invisible radiologist, off in some remote office, who called the shots and never had the courtesy to show her face with an apology or an explanation. I tried pleading with the technician to speed up the process, but she just got this tight little professional smile on her face, either out of guilt for the torture she was inflicting or because she already knew something that I was going to be sorry to find out for myself. For an hour and a half the procedure was repeated: the squishing, the snapshot, the technician bustling off to consult the radiologist and returning with a demand for new angles and more definitive images. In the intervals
while she was off with the doctor I read the
New York Times
right down to the personally irrelevant sections like theater and real estate, eschewing the stack of women’s magazines provided for me, much as I ordinarily enjoy a quick read about sweatproof eyeliners and “fabulous sex tonight,” because I had picked up this warning vibe in the changing room, which, in my increasingly anxious state, translated into: femininity is death. Finally there was nothing left to read but one of the free local weekly newspapers, where I found, buried deep in the classifieds, something even more unsettling than the growing prospect of major disease—a classified ad for a “breast cancer teddy bear” with a pink ribbon stitched to its chest.

Yes, atheists pray in their foxholes—in this case, with a yearning new to me and sharp as lust, for a clean and honorable death by shark bite, lightning strike, sniper fire, car crash. Let me be hacked to death by a madman, was my silent supplication—anything but suffocation by the pink sticky sentiment embodied in that bear and oozing from the walls of the changing room. I didn’t mind dying, but the idea that I should do so while clutching a teddy and with a sweet little smile on my face—well, no amount of philosophy had prepared me for that.

The result of the mammogram, conveyed to me by phone a day later, was that I would need a biopsy, and, for some reason, a messy, surgical one with total anesthesia. Still, I was not overly perturbed and faced the biopsy like a falsely accused witch confronting a trial by dunking: at least I would clear my name. I called my children to inform them of the upcoming surgery and assured them that the great majority of lumps detected by mammogram—80 percent, the radiology technician had told me—are benign. If anything was sick, it was that creaky old mammogram machine.

My official induction into breast cancer came about ten days later with the biopsy, from which I awoke to find the surgeon
standing perpendicular to me, at the far end of the gurney, down near my feet, stating gravely, “Unfortunately, there is a cancer.” It took me all the rest of that drug-addled day to decide that the most heinous thing about that sentence was not the presence of cancer but the absence of me—for I, Barbara, did not enter into it even as a location, a geographical reference point. Where I once was—not a commanding presence perhaps but nonetheless a standard assemblage of flesh and words and gesture—“there is a cancer.” I had been replaced by it, was the surgeon’s implication. This was what I was now, medically speaking.

In my last act of dignified self-assertion, I requested to see the pathology slides myself. This was not difficult to arrange in our small-town hospital, where the pathologist turned out to be a friend of a friend, and my rusty Ph.D. in cell biology (Rockefeller University, 1968) probably helped. He was a jolly fellow, the pathologist, who called me “hon” and sat me down at one end of the dual-head microscope while he manned the other and moved a pointer through the field. These are the cancer cells, he said, showing up blue because of their overactive DNA. Most of them were arranged in staid semicircular arrays, like suburban houses squeezed into cul-de-sacs, but I also saw what I knew enough to know I did not want to see: the characteristic “Indian files” of cells on the march. The “enemy,” I was supposed to think—an image to save up for future exercises in “visualization” of their violent deaths at the hands of the body’s killer cells, the lymphocytes and macrophages.

But I was impressed, against all rational self-interest, by the energy of these cellular conga lines, their determination to move on out from the backwater of the breast to colonize lymph nodes, bone marrow, lungs, and brain. These are, after all, the fanatics of Barbara-ness, the rebel cells that have realized that the genome they carry, the genetic essence of me in whatever deranged form,
has no further chance of normal reproduction in the postmenopausal body we share, so why not just start multiplying like bunnies and hope for a chance to break out?

After the visit to the pathologist, my biological curiosity dropped to a lifetime nadir. I know women who followed up their diagnoses with weeks or months of self-study, mastering their options, interviewing doctor after doctor, assessing the damage to be expected from the available treatments. But I could tell from a few hours of investigation that the career of a breast cancer patient had been pretty well mapped out in advance: you may get to negotiate the choice between lumpectomy and mastectomy, but lumpectomy is commonly followed by weeks of radiation, and in either case if the lymph nodes turn out, upon dissection, to be invaded—or “involved,” as it’s less threateningly put—you’re doomed to months of chemotherapy, an intervention that is on a par with using a sledge hammer to swat mosquitoes. Chemotherapy agents damage and kill not just cancer cells but any normal body cells that happen to be dividing, such as those in the skin, hair follicles, stomach lining, and bone marrow (which is the source of all blood cells, including immune cells). The results are baldness, nausea, mouth sores, immunosuppression, and, in many cases, anemia.

These interventions do not constitute a “cure” or anything close, which is why the death rate from breast cancer had changed very little between the 1930s, when mastectomy was the only treatment available, and 2000, when I received my diagnosis. Chemotherapy, which became a routine part of breast cancer treatment in the eighties, does not confer anywhere near as decisive an advantage as patients are often led to believe. It’s most helpful for younger, premenopausal women, who can gain a 7 to 11 percentage point increase in ten-year survival rates, but most breast cancer victims are older, postmenopausal women like myself, for whom chemotherapy adds only a 2 or 3 percentage point difference,
according to America’s best-known breast cancer surgeon, Susan Love.
1
So yes, it might add a few months to your life, but it also condemns you to many months of low-level sickness.