Cancer Narratives Evolve as Extended Memory for Healing Practice
Dr. Julie Dominic A
Abstract
Cancer is regarded as a significant cause of death worldwide, accounting for one in six deaths. The Global Cancer Observatory reports that approximately 19.3 million cancer cases were reported globally in 2020. “India ranked third after China and the United States of America. GLOBOCAN predicted that cancer cases in India would increase to 2.08 million, accounting for a rise of 57.5 per cent in 2040 from 2020” (Sathishkumar, Krishnan, et al). There is a dire need to study the various aspects of cancer as a human experience. Cancer Narratives have become the measuring scale to assess the aftermath of cancer diagnosis since it is an exposure of the cancer experience. Studies on humanities aligned with memory, as depicted in cancer narratives, could foster an advanced understanding for further analysis of the cancer experience. Such narratives are considered as extended memory storage of the self. Memory is said to be “the power or process of reproducing or recalling what has been learned and retained, especially through associative mechanisms” (Merriam-Webster Dictionary). It is the faculty of encoding, storing, and retrieving information. Memory is the cognitive function that allows the individual to store past experiences and knowledge and to further retrieve it as needed. It could be identified as a method to initiate resilience during traumatic situations. Memory helps an individual to adapt and bounce back from adversities. It benefits the individual to become more resilient and recover from challenging and critical situations easily. Learning from past experiences is considered to initiate coping strategies, create psychological resilience and cognitive flexibility, which aids the author to overcome the cancer struggle. This research paper reflects on how cancer narratives become extended memories and initiate resilience in order to help in the process of healing. The author’s cancer survival strategies in To Cancer with Love: My Journey of Joy (2015) by Neelam Kumar serve as the primary source of the study, structured within the theoretical framework of memory studies and posttraumatic growth.
Keywords: Medical Humanities, Illness Narratives, Memory Studies, Resilience, Posttraumatic Growth
Introduction
Pleasant and sorrowful life experiences find their place in literature, embellished with imagination and creativity. Life writing is a genre that generates interest since it is all about human life, presented more realistically. Life writings of trauma survivors due to illness can also motivate persons situated in similar contexts. Illness was considered the most universal experience of humans. No person can escape from illness in a lifetime. Susan Sontag writes the first lines in the work Illness as Metaphor: “Illness is the night-side of life, a more onerous citizenship. All born hold dual citizenship in the kingdom of the well and the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later, each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” (Sontag, 1977, p. 5).
The illness of cancer brings in unbearable suffering for individuals, and hence there is an urgent necessity to observe, to analyse and to learn from the struggle of cancer survivors. Cancer narratives detail these struggles and delineate the processes of survival adapted by the survivors. Further, these narratives portray the personal, social, and psychological experiences of the cancer patients from the time of their being diagnosed with cancer.
This research paper attempts to identify how cancer narratives are represented as extended memory which could initiate resilience and healing by analysing the survival process of the author Neelam Kumar in her work To Cancer with Love: My Journey of Joy (2015).
Review of Literature
A literature review on cancer narratives by women conveys the struggle they had encountered throughout the process, from the diagnosis of illness towards the treatment procedures leading to recovery and transformation of life accompanied by the fear of recurrence. Cancer as a topic of discussion was found in literary writings since the 1970s with the publishing of the work Illness as Narratives by Susan Sontag. The work discusses illness as an inevitable stage in a person’s life that is considered as another citizenship. Discussing the intricacies of illness, Sontag analyses the mythological misconceptions about cancer. Traditional ways of examining the disease closely and the expectations of being sick are also ways that hinder the personality of a sick person. Sontag tries to de-mythicise illness. It is a process of liberation, rectifying the disease concept by eliminating its metaphoric nature.
Another work that has its momenta in literature is The Cancer Journals, published in 1980 by Audre Lorde, an African American writer, lesbian feminist and activist poet who tries to change the world through writing, questioning the conventional, a revolutionary, creating a space of resistance and reformation in writing about the conditions of women and question the patriarchal notions of silencing the voice of women.
The progress of critical studies on women’s cancer narratives was explored with the publication of Fractured Borders. The book is considered the first theoretical and analytical work on various forms of autopathography by Mary K. Deshazer. It explores life writings on breast, uterine and ovarian cancer, which are more gender-specific and come up to more than forty per cent of all other cancers. The observations mainly relate to feminist literary theory, French feminism and disability theory. Deshazer argues that cancer writers observe women’s ill bodies in five images: medicalised, leaky, amputated, prosthetic, and (not) dying bodies. These images initiate an immense range of issues faced by women living with cancer, related to medicalisation to which women’s body is subjected, and also to reconceptualise the leaky body into artistic and erotic celebration.
In the article “Bollywood Stars and Cancer Memoirs: The Year in India”, Pramod K.Nayar, discusses women and body image in Bollywood. The article interprets diagnosis, staging, prognosis and protocol in celebrity narratives. A journey from cosmetic to pathologized bodies also become a discussion point in the article.
Subhrasmita and Gaur’s article, “Until the Whole World Tilts: Injustice, Coercion and Resilience in Lisa Ray’s Close to the Bone” (2022), Violence against women and illness becomes the theme. The review of the above works reveals that discussions on cancer, its metaphorical perceptions, the resistance turmoil, gender-related conflict of body and self, the medical consequences and the attitudes towards it have been discussed. It leaves scope for the discussion of cancer on memory and narrative writing which becomes a medium of resilience specially during the period of Posttraumatic Growth.
The analysed text, To Cancer with Love is a hilarious cancer memoir where the author reveals about being diagnosed with cancer twice in a lifetime. Armed with the survival kit of humour and extreme courage, Kumar appears to be a wrestler of cancer who strikes back at her strong enemy, Cancer, with sharp wit and comes out successfully twice, beating it away from the journey of life. In her struggle with cancer, Kumar portrays the story of her winning the battle that threatens to overtake her life. In the book Kumar narrates about her years of struggle, illness, financial hardships, broken relationships and death of her loved ones, which she tackles all alone with her two children, battling with her daily chores. The cancer wrestling memoir exposes the single-handed fight with the toughest of life’s paths that takes turn to hit the core of survival. This is considered as boisterous, cancer-wrestling memoir on life which also discourses about the possible side effects with tips to overcome all hitches. The paper tries to analyse how recollected memory has helped the author in creating resilience during the period of cancer survivorship leading to the condition of healing.
Research Methodology
Threats and challenges created in a person’s life because of illness, specifically cancer, have paved the way for the understanding of the various personal, psychological, social and cultural interactions and experiences that help in the process of survival by cancer patients. The qualitative method of research is applied in the study. A close reading of the Cancer Narrative To Cancer with Love: My Journey of Joy (2015) by Neelam Kumar is chosen by perusing multiple levels of survival narratives and identifying the literary devices like images, symbols, dreams, metaphors and similes used in the narration which represents past experiences. Identifying the studies conducted in cancer narratives and analysing the literature review, the research gap was considered with the attempt to contribute to the topic of analysis. The struggle and the survival procedures found in the narratives cut a path to evaluate better the concept of how narratives become an extended memory storage which initiates resilience for survival process. Theories like memory studies, post traumatic stress disorder, post traumatic growth etc. creates the theoretical framework of the study.
Memory as Healing Agent
“According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), PTSD” Posttraumatic stress disorder” is an anxiety disorder. In the International Classification of Diseases, Injuries, and Causes of Death (ICD-10, 1992), it is classified as a neurotic stress-related and somatoform disorder” (Javidi et.al, 2012, p. 3). It is seen as a psychiatric disorder which occurs among people who have witnessed any traumatic or critical events like natural disaster, accidents, threatened with death, or any serious injury.
During such horrible events, everyone thinks that their own life is in great danger and they have no control over what is happening. Anyone who has experienced a life-threatening condition can felt scared, confused, or angry. After a traumatic event, many people may develop some acute symptoms like severe anxiety, dissociative symptoms, dissociative amnesia, poor concentration, sleep disturbance, and derealization.7 However, the symptoms may not only resolve but also get worse in some of the victims, and the condition progresses to PTSD. (Javidi et.al, 2012, p. 3).
Posttraumatic Stress Disorder can affect the personality of an individual and change their lifestyle. Narrative therapy, where a person says about one’s life influence the way they perceive their experience and such expressions affect their overall well-being. “Exposure to traumatic memories and recall in the safe therapeutic atmosphere modify this associative network and create new network associations that help patients overcome their maladaptive avoidance mechanisms and prevent intense fear responses” (Minina, 2022, p. 235). As Jennings et al. say, “In the process of adapting to the stress or trauma, an individual develops new resources and capabilities, may experience a change in values and priorities, and in extreme cases develops a new sense of self or worldview” (Jennings et al. 117).
It is observed that the resilient cancer survivors get into the next phase of life, which initiates multiple doubts and queries about the future. This insecurity and confused state of mind is converted to posttraumatic growth through the survivors’ efforts and the support of family and society. In this condition, the survivors create a positive outlook towards life and develop new identities. Tedeschi et al. define “Posttraumatic Growth” (3) in Posttraumatic Growth: Theory, Research and Application (2018) as “positive psychological changes experienced as a result of the struggle with traumatic or highly challenging life circumstances” (Tedeschi et al. 2018, p. 3).
In this analysis, ‘memory’ is studied as a strategy to recognise the aspect of resilience and understand how memory helps the author to move towards the healing process during period of Posttraumatic Growth, when produced as narratives. Memory is “the power or process of reproducing or recalling what has been learned and retained, especially through associative mechanisms.” (Merriam-Webster Dictionary). It is the faculty of encoding, storing, and retrieving information. Memory is the cognitive function that allows the individual to store past experiences and knowledge and to further retrieve it as needed. Memory could be identified as becoming a medium to initiate resilience during traumatic situations. Memory also serves as a healing strategy adopted by individuals to overcome crises. Memory helps an individual to adapt and bounce back from adversities. This also helps the individual to become more resilient and recover from challenging and traumatic situations. Learning from past experiences, initiating coping strategies, creating psychological resilience, leading towards post-traumatic growth, creating cognitive flexibility, etc. could be observed as the leading factors of memory in initiating resilience among traumatic persons, helping them heal.
“Molecular neurobiology has shown that memory is largely a neuro-chemical process, which includes conditioning and any form of stored experience. On the other hand, information technology has led many to claim that cognition is also extended, that is, memory may be stored outside of the brain” (Zlotnik and Vansintjan, 2019, p. 1).
“In popular culture, memory is often thought of as some kind of physical thing that is stored in the brain; a subjective, personal experience that we can recall at will” (Zlotnik and Vansintjan, 2019, p. 1). “We now talk about memory on a hard drive, or as a chemical change between neurons” (Zlotnik and Vansintjan, 2019, p. 1). “Cognitive scientists now propose that human cognition is actually extended beyond the brain in ways that theories of the mind did not previously recognize (Clark and Chalmers, 1998; Clark, 2008). This approach is being called 4E cognition (Embodied, Embedded, Extended, and Enactive)” (Zlotnik and Vansintjan, 2019, p.3). “Science has moved far beyond a popular understanding of memory as fixed, subjective, and personal” (Zlotnik and Vansintjan, 2019, p.3).
“we carry with us through life a heavy load of disappointments, broken dreams, little tragedies and many memories. We know that forgetting is a must and a challenge. Yet, we are learning rapidly how to incorporate and use the massive amounts of data now available to us” (Zlotnik and Vansintjan, 2019, p. 4). Neelam Kumar, the author of To Cancer with Love: A Graphic Novel, is a multitalented, globally educated woman of joy who enjoys breaking conventions and stereotypical lifestyles. She explores the multidimensional skills of her personality through her writings. Kumar successfully experiments with the healing power of joy and humour which is recorded in the book successfully taken from her experiences incorporated with her past memory from childhood.
As Kandel wrote, “We are who we are in great measure because of what we learn and what we remember” (Kandel, 2007, p.10). Freud “viewed memory as a complex archive in which the individual memories are arranged in several ways: chronological order, links in chains of association, and degree of accessibility to consciousness” (Applebaum et al., 1997, p. 139).
Memory becomes a tool to initiate resilience, which helps heal specific illnesses like cancer. The three aspects, memory, resilience, and healing, become the essential components of understanding, which help the individual overcome illness and initiate new possibilities in life. Research on resilience suggests that it is crucial to identify the source of resilience and nurture it. The contextual quality and screening of memory help to generate resilience.
Memories take various forms like images, symbols, incidents, emotions and the presence of prominent individuals. “ The traumatised person may have multiple and fragmented encapsulations of the trauma, a situation which tends to push his or her dreams and fantasies toward a more disorganized state”.(Elin, 1997,p. 205), “Dreams provide a way to measure progress,…the dreamer’s symbols and representations provide important information” (Elin,1997,p. 205) and “dreams help to solidify relations between affect and memories, thereby helping to establish the unconscious emotional temperaments of individuals”(Elin,1997,p. 204) “the dreamer’s self-memory tries to make meaning through its images and symbolic representations. These images may become more and more frightening” (Elin,1997, p. 204).
Narration a Medium for Regeneration
Elizabeth Predeger, in Woman Spirit: A Journey into Healing through Art in Breast Cancer, explains, “New demands resulting from the diagnosis allow little time for reflection and expression. Art is a way of expressing these experiences” (Predeger,1996, p.48). The description of a traumatic event by a person who has experienced it can help identify PTG. Art has been a form of healing therapy for ages and continues in the contemporary situation. Expressions like painting, photography, collage and writing can be considered functional mediums that explore the process of healing. Narrative therapy promotes meaning construction and reinforces cognitive and emotional possession. It helps to generate insights and supports the fostering of PTG. “Art becomes a tool to tap inner creativity, a method of inquiry, a form of making meaning, a way of connecting and empowering and a way of knowing” (Predeger,1996, p.49). Narratives help in creating a new sense of self. The therapeutic nature of narratives helps the person reconnect and reconstruct life’s values for future living.
The narrative process has supported the enhancement of greater PTG. Studies prove that expressive writing has always been a tool for survivors to create new possibilities and plan the future by referring to their past lives. New possibilities, personal strength, and appreciation of life were enhanced through the narrative process. “Art became a pathway to healing by illuminating a changing perspective” (Predeger,1996,p.54). Old traumatized people have found the method of narrative construction to overcome their memory problems. Transcendence through courage, to move beyond oneself and to reach out to help others are the changes observed among the survivors.
Kumar says, “Courage lies in recognising the impermanence of life and challenging ourselves to create something of permanent value within it” (Kumar,2015, p. 97). Kumar tries to create her future despite the destiny created by cancer. She also conveys through her narrative that “One of the most courageous acts we can do right now is to let go of our destiny. Let’s create our own” (Kumar,2015, p.97). The narrative process also helps identify their strengths and capacity to deal with difficulty, develop a new sense of meaning and increase personal growth and self-acceptance. Therefore, Tedeschi et al. say that “reconstructing narrative can help lead to PTG experiences” (Tedeschi et al.2018, p.157).
In the referred text, the author Neelam begins the narrative where she is about to meet her mother and sister at Pune on the 13th of January with all preparations of travelling from Mumbai the next day, with childhood memories and nostalgia, after sending prayers to the heavens, asking to safeguard and never to spoil her plans. However, on that eve, she had a strange dream where she was climbing up a long winding staircase of a strange building, and frightened to see the scary images, she was afraid when the light went off at the top floor, fear peaked, and she understood that she was alone. Suddenly, she felt the presence of a tall man. As soon as she realised the presence, she put her head on her chest with fear of what he might have thought. Clutching onto him desperately, he put his arm so lovingly that she felt warmth and a glow of comfort. The Man advised her to go on a check-up of a specific body part. She couldn’t ignore the message that she got from the dream. Immediately she allowed herself to go for a check-up. Dream becomes an intuition for Neelam to go for the check-up and diagnose with a lump in her body. “Resilience is the capacity of a system to absorb disturbance and reorganise while undergoing change so as to still retain essentially the same function, structure, identity, and feedbacks” (Walker et al. 3)
It is considered that, “Language is critical to any discussion about trauma, memory, and emotion. My model sees language, syntax, and grammar as informational units on the hypercube. As informational units, words are extremely flexible and plastic” (Elin,1997, p. 208). “Some words by nature tend to have more emotion embedded into their dictionary definition than others” (Elin,1997, p. 208), words like cancer, battle fighter, survivor, etc., which are repeatedly mentioned. “A healthy self-memory system, likewise, has the capacity to ward off the minor insults and threats of daily living” (Elin,1997, p. 210)
Each self-memory system organizes life events differently. All that enters the body and mind is registered—however briefly—and is contained within the self-memory system. This process is similar to the formation of a shoreline as it is influenced by the continuous pounding of the surf. Each wave formation makes its own impression in the sand, weaving over and turning under previous currents of water which moments earlier left their own marks and etchings on the shore. From time to time, violent storms whip the waves into a pounding foam. Through repeated cycles of high and low tides, all manner of shells, sea plants, driftwood, and rocks are swept to the apron of the surf, revealing the contents of the ocean like revealing the contents of the unconscious self. With repeated pounding, the shore continuously takes on a new formation, which represents the visual and symbolic representation of the self as it has been influenced by all external and internal events. (Elin,197, p. 212)
It was the memories about Kumar’s father who taught her to be courageous at every step that made her identify the determination that she had to put to overcome a disease like cancer. Childhood memories with her father has influenced her a lot to be courageous, as she expresses an incident about the ‘landashi flower’ that she found on a snow covered morning, and her father explain about the flower as, “ That’s the landashi, or the snow flower. It survives against all odds. My child, that’s the kind of courage I want you to have.” (Kumar, 2015, p.99)
The next courageous act was her attempts to prove her teacher’s remark as wrong. When she was brought back from Russia and when she was put in an Indian fancy convent school, she was not well-versed in English, finally the teacher commented that, the girl is wood sitting on wood” (Kumar,2015, p.100). Neelam worked hard with great determination and never to be defeated, and finally, she was successful in writing four books in English, which were all Bestsellers. She obtained many Degrees and even became a Masters’ holder in Journalism from the United States of America. The courage that was instilled in her by her father was also observed when she finally signed the papers for her father’s dignified death as he was on his death bed in the most critical stage.
Memory initiates resilience by making the individual increase competence, self-determination, and self-confidence to bring in self-efficacy that is attained from a former challenging incident like the retrieval of cancer in the narrator.
Therefore, Neelam was trained well by her father and through her life experience she learnt to never give up in any critical situation. Her determination to break all obstacles that came her way and to regain a dignified life was what kept her upbeat to become a fighter of cancer. The memories of her resilient experiences made her more powerful when she was attacked by cancer the second time.
Memory has many different roles to play in the process of healing. It falls into the framework of initiating hope and self-confidence and supports the individual in creating various coping strategies and adapting methods to overcome the challenges of cancer. Past resilient incidents initiate resilience to add to the process of healing. Imagery and symbols of resilience that happened in the past life become an inspiration to cope with difficult situations in life.
Conclusion
Thus, the various situations in the text, To Cancer with Love, portrayed by Neelam Kumar, through the narration of the past events or memories that she expresses about her life and her personal experience written through her memoir directly help her to overcome cancer resiliently.
Recalling past experiences becomes a foundation for problem-solving strategies and enhances decision-making abilities. Memory about the past life can strengthen the individual to learn from the past life experiences. Memory creates psychological resilience at various stages of healing; it also gives way to Posttraumatic Growth. Literary devices like symbols, images, metaphors etc, are identified from the past which guides the author towards healing. Certain prominent characters like Father of Neelam, the teacher who created a traumatic experience are understood to initiate determination and confidence for facing persistent difficulties. It is also understood that some unforgettable incidents from the memory also become inspirations for the author to be brave and make a tool of resilience paving way towards healing.
Memory has a peculiarity in creating a narrative about any traumatic incident; it also helps create cognitive flexibility and regulate emotions. The process of narration itself is the rendering of memories that were carried along with the process of treatment from diagnosis to survival and later to the period after illness. To conclude, memories are relieved through narratives that enrich the healing process. Therefore, memories initiate resilience to overcome illness and lead to healing.
Works Cited
Comer, R. (1992). Abnormal psychology (5th ed.). New York: Worth Publishers
Elin, M. R. (1997). An integrative developmental model for trauma and memory. Trauma and memory. Clinical and legal controversies. Oxford University Press, Oxford, 188-221.
Foa, E. B. & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20-35.
Folke, C., Hahn, T., Olsson, P., & Norberg, J. (2005). Adaptive governance of social-ecological systems. Annu. Rev. Environ. Resour., 30(1), 441-473.
Jennings, P. A., Aldwin, C. M., Levenson, M. R., Spiro III, A., & Mroczek, D. K. (2006). Combat exposure, perceived benefits of military service, and wisdom in later life: Findings from the Normative Aging Study. Research on Aging, 28(1), 115-134.
Kumar, N. (2015). To Cancer, with love: My journey of Joy. Hay House, Inc.
Kandel, E. R. (2007). In search of memory: The emergence of a new science of mind. WW Norton & Company.
Minina, R. (2022). The Role of the Body and Extended Memory Systems in Working With Traumatic Memories. Ïñèõîëîãè÷íè èçñëåäâàíèÿ, 25(3), 228-239.
Predeger, E. (1996). Woman spirit: A journey into healing through art in breast cancer. Advances in Nursing Science, 18(3), 48-58.
Tedeschi, R. G., Shakespeare-Finch, J., & Taku, K. (2018). Posttraumatic growth: Theory, research, and applications. Routledge.
Vanaken L., Smeets T, Bijttebier P., Hermans D. (2021). Keep Calm and Carry On: The Relations Between
Narrative Coherence, Trauma, Social Support, Psychological Well-Being, and Cortisol Responses. Front Psychol. 2021; 12: 558044.
Walker, B., Holling, C. S., Carpenter, S. R., & Kinzig, A. (2004). Resilience, adaptability and transformability in social–ecological systems. Ecology and society, 9(2).
Zlotnik, G., & Vansintjan, A. (2019). Memory: An extended definition. Frontiers in psychology, 10, 2523.