Bright-sided: How The Relentless Promotion Of Positive Thinking Has Undermined America Part 1

BRIGHT-SIDED.

How the Relentless Promotion of Positive Thinking Has Undermined America.

by Barbara Ehrenreich.

Introduction

Americans are a "positive" people. This is our reputation as well as our self-image. We smile a lot and are often baffled when people from other cultures do not return the favor. In the well-worn stereotype, we are upbeat, cheerful, optimistic, and shallow, while foreigners are likely to be subtle, world-weary, and possibly decadent. American expatriate writers like Henry James and James Baldwin wrestled with and occasionally reinforced this stereotype, which I once encountered in the 1980s in the form of a remark by Soviet emigre poet Joseph Brodsky to the effect that the problem with Americans is that they have "never known suffering." (Apparently he didn't know who had invented the blues.) Whether we Americans see it as an embarra.s.sment or a point of pride, being positive-in affect, in mood, in outlook-seems to be engrained in our national character.

Who would be churlish or disaffected enough to challenge these happy features of the American personality? Take the business of positive "affect," which refers to the mood we display to others through our smiles, our greetings, our professions of confidence and optimism. Scientists have found that the mere act of smiling can generate positive feelings within us, at least if the smile is not forced. In addition, good feelings, as expressed through our words and smiles, seem to be contagious: "Smile and the world smiles with you." Surely the world would be a better, happier place if we all greeted one another warmly and stopped to coax smiles from babies-if only through the well-known social psychological mechanism of "mood contagion." Recent studies show that happy feelings flit easily through social networks, so that one person's good fortune can brighten the day even for only distantly connected others. 1 1 Furthermore, psychologists today agree that positive feelings like grat.i.tude, contentment, and self-confidence can actually lengthen our lives and improve our health. Some of these claims are exaggerated, as we shall see, though positive feelings hardly need to be justified, like exercise or vitamin supplements, as part of a healthy lifestyle. People who report having positive feelings are more likely to partic.i.p.ate in a rich social life, and vice versa, and social connectedness turns out to be an important defense against depression, which is a known risk factor for many physical illnesses. At the risk of redundancy or even tautology, we can say that on many levels, individual and social, it is good good to be "positive," certainly better than being withdrawn, aggrieved, or chronically sad. to be "positive," certainly better than being withdrawn, aggrieved, or chronically sad.

So I take it as a sign of progress that, in just the last decade or so, economists have begun to show an interest in using happiness rather than just the gross national product as a measure of an economy's success. Happiness is, of course, a slippery thing to measure or define. Philosophers have debated what it is for centuries, and even if we were to define it simply as a greater frequency of positive feelings than negative ones, when we ask people if they are happy we are asking them to arrive at some sort of average over many moods and moments. Maybe I was upset earlier in the day but then was cheered up by a bit of good news, so what am I really? In one well-known psychological experiment, subjects were asked to answer a questionnaire on life satisfaction-but only after they had performed the apparently irrelevant task of photocopying a sheet of paper for the experimenter. For a randomly chosen half of the subjects, a dime had been left for them to find on the copy machine. As two economists summarize the results, "Reported satisfaction with life was raised substantially by the discovery of the coin on the copy machine-clearly not an income effect." 2 2 In addition to the problems of measurement, there are cultural differences in how happiness is regarded and whether it is even seen as a virtue. Some cultures, like our own, value the positive affect that seems to signal internal happiness; others are more impressed by seriousness, self-sacrifice, or a quiet willingness to cooperate. However hard to pin down, though, happiness is somehow a more pertinent metric for well-being, from a humanistic perspective, than the buzz of transactions that const.i.tute the GDP.

Surprisingly, when psychologists undertake to measure the relative happiness of nations, they routinely find that Americans are not, even in prosperous times and despite our vaunted positivity, very happy at all. A recent meta-a.n.a.lysis of over a hundred studies of self-reported happiness worldwide found Americans ranking only twenty-third, surpa.s.sed by the Dutch, the Danes, the Malaysians, the Bahamians, the Austrians, and even the supposedly dour Finns. 3 3 In another potential sign of relative distress, Americans account for two-thirds of the global market for antidepressants, which happen also to be the most commonly prescribed drugs in the United States. To my knowledge, no one knows how antidepressant use affects people's responses to happiness surveys: do respondents report being happy because the drugs make them feel happy or do they report being unhappy because they know they are dependent on drugs to make them feel better? Without our heavy use of antidepressants, Americans would likely rank far lower in the happiness rankings than we currently do. In another potential sign of relative distress, Americans account for two-thirds of the global market for antidepressants, which happen also to be the most commonly prescribed drugs in the United States. To my knowledge, no one knows how antidepressant use affects people's responses to happiness surveys: do respondents report being happy because the drugs make them feel happy or do they report being unhappy because they know they are dependent on drugs to make them feel better? Without our heavy use of antidepressants, Americans would likely rank far lower in the happiness rankings than we currently do.

When economists attempt to rank nations more objectively in terms of "well-being," taking into account such factors as health, environmental sustainability, and the possibility of upward mobility, the United States does even more poorly than it does when only the subjective state of "happiness" is measured. The Happy Planet Index, to give just one example, locates us at 150th among the world's nations. 4 4 How can we be so surpa.s.singly "positive" in self-image and stereotype without being the world's happiest and best-off people? The answer, I think, is that positivity is not so much our condition or our mood as it is part of our ideology-the way we explain the world and think we ought to function within it. That ideology is "positive thinking," by which we usually mean two things. One is the generic content of positive thinking-that is, the positive thought itself-which can be summarized as: Things are pretty good right now, at least if you are willing to see silver linings, make lemonade out of lemons, etc., and things are going to get a whole lot better. This is optimism, and it is not the same as hope. Hope is an emotion, a yearning, the experience of which is not entirely within our control. Optimism is a cognitive stance, a conscious expectation, which presumably anyone can develop through practice.

The second thing we mean by "positive thinking" is this practice, or discipline, of trying to think in a positive way. There is, we are told, a practical reason for undertaking this effort: positive thinking supposedly not only makes us feel optimistic but actually makes happy outcomes more likely. If you expect things to get better, they will. How can the mere process of thinking do this? In the rational explanation that many psychologists would offer today, optimism improves health, personal efficacy, confidence, and resilience, making it easier for us to accomplish our goals. A far less rational theory also runs rampant in American ideology-the idea that our thoughts can, in some mysterious way, directly affect the physical world. Negative thoughts somehow produce negative outcomes, while positive thoughts realize themselves in the form of health, prosperity, and success. For both rational and mystical reasons, then, the effort of positive thinking is said to be well worth our time and attention, whether this means reading the relevant books, attending seminars and speeches that offer the appropriate mental training, or just doing the solitary work of concentration on desired outcomes-a better job, an attractive mate, world peace.

There is an anxiety, as you can see, right here in the heart of American positive thinking. If the generic "positive thought" is correct and things are really getting better, if the arc of the universe tends toward happiness and abundance, then why bother with the mental effort of positive thinking? Obviously, because we do not fully believe that things will get better on their own. The practice of positive thinking is an effort to pump up this belief in the face of much contradictory evidence. Those who set themselves up as instructors in the discipline of positive thinking-coaches, preachers, and gurus of various sorts-have described this effort with terms like "self-hypnosis," "mind control," and "thought control." In other words, it requires deliberate self-deception, including a constant effort to repress or block out unpleasant possibilities and "negative" thoughts. The truly self-confident, or those who have in some way made their peace with the world and their destiny within it, do not need to expend effort censoring or otherwise controlling their thoughts. Positive thinking may be a quintessentially American activity, a.s.sociated in our minds with both individual and national success, but it is driven by a terrible insecurity.

Americans did not start out as positive thinkers-at least the promotion of unwarranted optimism and methods to achieve it did not really find articulation and organized form until several decades after the founding of the republic. In the Declaration of Independence, the founding fathers pledged to one another "our lives, our fortunes, and our sacred honor." They knew that they had no certainty of winning a war for independence and that they were taking a mortal risk. Just the act of signing the declaration made them all traitors to the crown, and treason was a crime punishable by execution. Many of them did go on to lose their lives, loved ones, and fortunes in the war. The point is, they fought anyway. There is a vast difference between positive thinking and existential courage.

Systematic positive thinking began, in the nineteenth century, among a diverse and fascinating collection of philosophers, mystics, lay healers, and middle-cla.s.s women. By the twentieth century, though, it had gone mainstream, gaining purchase within such powerful belief systems as nationalism and also doing its best to make itself indispensable to capitalism. We don't usually talk about American nationalism, but it is a mark of how deep it runs that we apply the word "nationalism" to Serbs, Russians, and others, while believing ourselves to possess a uniquely superior version called "patriotism." A central tenet of American nationalism has been the belief that the United States is "the greatest nation on earth"-more dynamic, democratic, and prosperous than any other nation, as well as technologically superior. Major religious leaders, especially on the Christian right, b.u.t.tress this conceit with the notion that Americans are G.o.d's chosen people and that America is the designated leader of the world-an idea that seemed to find vivid reinforcement in the fall of Communism and our emergence as the world's "lone superpower." That acute British observer G.o.dfrey Hodgson has written that the American sense of exceptionalism, which once was "idealistic and generous, if somewhat solipsistic," has become "harder, more hubristic." Paul Krugman responded to the prevailing smugness in a 1998 essay ent.i.tled "American the Boastful," warning that "if pride goeth before a fall, the United States has one heck of a come-uppance in store." 5 5 But of course it takes the effort of positive thinking to imagine that America is the "best" or the "greatest." Militarily, yes, we are the mightiest nation on earth. But on many other fronts, the American score is dismal, and was dismal even before the economic downturn that began in 2007. Our children routinely turn out to be more ignorant of basic subjects like math and geography than their counterparts in other industrialized nations. They are also more likely to die in infancy or grow up in poverty. Almost everyone acknowledges that our health care system is "broken" and our physical infrastructure crumbling. We have lost so much of our edge in science and technology that American companies have even begun to outsource their research and development efforts. Worse, some of the measures by which we do lead the world should inspire embarra.s.sment rather than pride: We have the highest percentage of our population incarcerated, and the greatest level of inequality in wealth and income. We are plagued by gun violence and racked by personal debt.

While positive thinking has reinforced and found reinforcement in American national pride, it has also entered into a kind of symbiotic relations.h.i.+p with American capitalism. There is no natural, innate affinity between capitalism and positive thinking. In fact, one of the cla.s.sics of sociology, Max Weber's Protestant Ethic and the Spirit of Capitalism Protestant Ethic and the Spirit of Capitalism, makes a still impressive case for capitalism's roots in the grim and punitive outlook of Calvinist Protestantism, which required people to defer gratification and resist all pleasurable temptations in favor of hard work and the acc.u.mulation of wealth.

But if early capitalism was inhospitable to positive thinking, "late" capitalism, or consumer capitalism, is far more congenial, depending as it does on the individual's hunger for more more and the firm's imperative of and the firm's imperative of growth. growth. The consumer culture encourages individuals to want more-cars, larger homes, television sets, cell phones, gadgets of all kinds-and positive thinking is ready at hand to tell them they deserve more and can have it if they really want it and are willing to make the effort to get it. Meanwhile, in a compet.i.tive business world, the companies that manufacture these goods and provide the paychecks that purchase them have no alternative but to grow. If you don't steadily increase market share and profits, you risk being driven out of business or swallowed by a larger enterprise. Perpetual growth, whether of a particular company or an entire economy, is of course an absurdity, but positive thinking makes it seem possible, if not ordained. The consumer culture encourages individuals to want more-cars, larger homes, television sets, cell phones, gadgets of all kinds-and positive thinking is ready at hand to tell them they deserve more and can have it if they really want it and are willing to make the effort to get it. Meanwhile, in a compet.i.tive business world, the companies that manufacture these goods and provide the paychecks that purchase them have no alternative but to grow. If you don't steadily increase market share and profits, you risk being driven out of business or swallowed by a larger enterprise. Perpetual growth, whether of a particular company or an entire economy, is of course an absurdity, but positive thinking makes it seem possible, if not ordained.

In addition, positive thinking has made itself useful as an apology for the crueler aspects of the market economy. If optimism is the key to material success, and if you can achieve an optimistic outlook through the discipline of positive thinking, then there is no excuse for failure. The flip side of positivity is thus a harsh insistence on personal responsibility: if your business fails or your job is eliminated, it must because you didn't try hard enough, didn't believe firmly enough in the inevitability of your success. As the economy has brought more layoffs and financial turbulence to the middle cla.s.s, the promoters of positive thinking have increasingly emphasized this negative judgment: to be disappointed, resentful, or downcast is to be a "victim" and a "whiner."

But positive thinking is not only a water carrier for the business world, excusing its excesses and masking its follies. The promotion of positive thinking has become a minor industry in its own right, producing an endless flow of books, DVDs, and other products; providing employment for tens of thousands of "life coaches," "executive coaches," and motivational speakers, as well as for the growing cadre of professional psychologists who seek to train them. No doubt the growing financial insecurity of the middle cla.s.s contributes to the demand for these products and services, but I hesitate to attribute the commercial success of positive thinking to any particular economic trend or twist of the business cycle. America has historically offered s.p.a.ce for all sorts of sects, cults, faith healers, and purveyors of snake oil, and those that are profitable, like positive thinking, tend to flourish.

At the turn of the twenty-first century, American optimism seemed to reach a manic crescendo. In his final State of Union address in 2000, Bill Clinton struck a triumphal note, proclaiming that "never before has our nation enjoyed, at once, so much prosperity and social progress with so little internal crisis and so few external threats." But compared with his successor, Clinton seemed almost morose. George W. Bush had been a cheerleader in prep school, and cheerleading-a distinctly American innovation-could be considered the athletically inclined ancestor of so much of the coaching and "motivating" that has gone into the propagation of positive thinking. He took the presidency as an opportunity to continue in that line of work, defining his job as that of inspiring confidence, dispelling doubts, and pumping up the national spirit of self-congratulation. If he repeatedly laid claim to a single adjective, it was "optimistic." On the occasion of his sixtieth birthday, he told reporters he was "optimistic" about a variety of foreign policy challenges, offering as an overview, "I'm optimistic that all problems will be solved." Nor did he brook any doubts or hesitations among his close advisers. According to Bob Woodward, Condoleezza Rice failed to express some of her worries because, she said, "the president almost demanded optimism. He didn't like pessimism, hand-wringing or doubt." 6 6 Then things began to go wrong, which is not in itself unusual but was a possibility excluded by America's official belief that things are good and getting better. There was the dot-com bust that began a few months after Clinton's declaration of unprecedented prosperity in his final State of the Union address, then the terrorist attack of September 11, 2001. Furthermore, things began to go wrong in a way that suggested that positive thinking might not guarantee success after all, that it might in fact dim our ability to fend off real threats. In her remarkable book, Never Saw It Coming: Cultural Challenges to Envisioning the Worst, Never Saw It Coming: Cultural Challenges to Envisioning the Worst, sociologist Karen Cerulo recounts a number of ways that the habit of positive thinking, or what she calls optimistic bias, undermined preparedness and invited disaster. She quotes sociologist Karen Cerulo recounts a number of ways that the habit of positive thinking, or what she calls optimistic bias, undermined preparedness and invited disaster. She quotes Newsweek Newsweek reporters Michael Hirsch and Michael Isikoff, for example, in their conclusion that "a whole summer of missed clues, taken together, seemed to presage the terrible September of 2001." reporters Michael Hirsch and Michael Isikoff, for example, in their conclusion that "a whole summer of missed clues, taken together, seemed to presage the terrible September of 2001." 7 7 There had already been a terrorist attack on the World Trade Center in 1993; there were ample warnings, in the summer of 2001, about a possible attack by airplane, and flight schools reported suspicious students like the one who wanted to learn how to "fly a plane but didn't care about landing and takeoff." The fact that no one-the FBI, the INS, Bush, or Rice-heeded these disturbing cues was later attributed to a "failure of imagination." But actually there was plenty of imagination at work-imagining an invulnerable nation and an ever-booming economy-there was simply no ability or inclination to imagine the worst. There had already been a terrorist attack on the World Trade Center in 1993; there were ample warnings, in the summer of 2001, about a possible attack by airplane, and flight schools reported suspicious students like the one who wanted to learn how to "fly a plane but didn't care about landing and takeoff." The fact that no one-the FBI, the INS, Bush, or Rice-heeded these disturbing cues was later attributed to a "failure of imagination." But actually there was plenty of imagination at work-imagining an invulnerable nation and an ever-booming economy-there was simply no ability or inclination to imagine the worst.

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 unantic.i.p.ated disaster. In 2002, the New Orleans Times-Picayune Times-Picayune ran a Pulitzer Prizewinning 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, ran a Pulitzer Prizewinning 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 Scientific American had issued a similar warning about the city's vulnerability. had issued a similar warning about the city's vulnerability. 8 8 Even when the hurricane struck and levees broke, no alarm bells went off in Was.h.i.+ngton, 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. Even when the hurricane struck and levees broke, no alarm bells went off in Was.h.i.+ngton, 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. 9 9 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. 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 Larry King Live and the and the Oprah Winfrey Show Oprah Winfrey Show; it was the stuff of runaway best sellers like the 2006 book The Secret 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 princ.i.p.al 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 diminis.h.i.+ng job security. But it was also a liberating ideology for top-level executives. What was the point in agonizing over balance sheets and tedious a.n.a.lyses 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 wis.h.i.+ng 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 ma.s.s delusion that is positive thinking.

ONE

Smile or Die: The Bright Side of Cancer

The 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 b.r.e.a.s.t.s 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 b.r.e.a.s.t.s and affixing tiny X-ray opaque stars to the tip of each nipple. The changing room, really just a closet off the stark, windowless s.p.a.ce that housed the mammogram machine, contained something far worse, I noticed for the first time-an a.s.sumption about who I am, where I am going, and what I will need when I get there. Almost all of the eye-level s.p.a.ce had been filled with photocopied bits of cuteness and sentimentality: pink ribbons, a cartoon about a woman with iatrogenically flattened b.r.e.a.s.t.s, 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," ill.u.s.trated 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 squis.h.i.+ng, 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 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 s.e.x 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 cla.s.sifieds, something even more unsettling than the growing prospect of major disease-a cla.s.sified ad for a "breast cancer teddy bear" with a pink ribbon st.i.tched to its chest. 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 s.e.x 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 cla.s.sifieds, something even more unsettling than the growing prospect of major disease-a cla.s.sified ad for a "breast cancer teddy bear" with a pink ribbon st.i.tched to its chest.

Yes, atheists pray in their foxholes-in this case, with a yearning new to me and sharp as l.u.s.t, 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 a.s.sured 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 a.s.semblage 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-a.s.sertion, 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, a.s.sessing 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 const.i.tute 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 1 So yes, it might add a few months to your life, but it also condemns you to many months of low-level sickness. So yes, it might add a few months to your life, but it also condemns you to many months of low-level sickness.

In fact, there's been a history of struggle over breast cancer treatments. In the seventies, doctors were still performing radical mastectomies that left patients permanently disabled on the affected side-until women's health activists protested, insisting on less radical, "modified" mastectomies. It had also been the practice to go directly from biopsy to mastectomy while the patient was anesthetized and unable to make any decisions-again, until enough women protested. Then, in the nineties, there was a brief fad of treating patients whose cancers had metastasized by destroying all their bone marrow with high-dose chemotherapy and replacing it with bone marrow transplants-an intervention that largely served to hasten the patient's death. Chemotherapy, radiation, and so on may represent state-of-the-art care today, but so, at one point in medical history, did the application of leeches.

I knew these bleak facts, or sort of knew them, but in the fog of anesthesia that hung over those first few weeks, I seemed to lose my capacity for self-defense. The pressure was on, from doctors and loved ones, to do something right away-kill it, get it out now. The endless exams, the bone scan to check for metastases, the high-tech heart test to see if I was strong enough to withstand chemotherapy-all these blurred the line between selfhood and thing-hood anyway, organic and inorganic, me and it. As my cancer career unfolded, I would, the helpful pamphlets explain, become a composite of the living and the dead-an implant to replace the breast, a wig to replace the hair. And then what will I mean when I use the word "I"? I fell into a state of unreasoning pa.s.sive aggressivity: They diagnosed this, so it's their baby. They found it, let them fix it.

I could take my chances with "alternative" treatments, of course, like punk novelist Kathy Acker, who succ.u.mbed to breast cancer in 1997 after a course of alternative therapies in Mexico, or actress and ThighMaster promoter Suzanne Somers, who made tabloid headlines by injecting herself with mistletoe brew. But I have never admired the "natural" or believed in the "wisdom of the body." Death is as "natural" as anything gets, and the body has always seemed to me like a r.e.t.a.r.ded Siamese twin dragging along behind me, a hysteric really, dangerously overreacting, in my case, to everyday allergens and minute ingestions of sugar. I would put my faith in science, even if this meant that the dumb old body was about to be transmogrified into an evil clown-puking, trembling, swelling, surrendering significant parts, and oozing postsurgical fluids. The surgeon-a more genial and forthcoming one this time-could fit me in; the oncologist would see me. Welcome to Cancerland.

The Pink Ribbon Culture.

Fortunately, no one has to go through this alone. Forty years ago, before Betty Ford, Rose Kushner, Betty Rollin, and other pioneer patients spoke out, breast cancer was a dread secret, endured in silence and euphemized in obituaries as a "long illness." Something about the conjuncture of "breast," signifying s.e.xuality and nurturance, and that other word, suggesting the claws of a devouring crustacean, spooked almost everyone. Today, however, it's the biggest disease on the cultural map, bigger than AIDS, cystic fibrosis, or spinal injury, bigger even than those more prolific killers of women-heart disease, lung cancer, and stroke. There are roughly hundreds of Web sites devoted to it, not to mention newsletters, support groups, a whole genre of first-person breast cancer books, even a glossy upper-middle-brow monthly magazine, Mamm Mamm. There are four major national breast cancer organizations, of which the mightiest, in financial terms, is the Susan G. Komen Foundation, headed by breast cancer survivor and Republican donor Nancy Brinker. Komen organizes the annual Race for the Cure, which attracts about a million people-mostly survivors, friends, and family members. Its Web site provides a microcosm of the breast cancer culture, offering news of the races, message boards for accounts of individuals' struggles with the disease, and uplifting inspirational messages.

The first thing I discovered as I waded out into the relevant sites is that not everyone views the disease with horror and dread. Instead, the appropriate att.i.tude is upbeat and even eagerly acquisitive. There are between two and three million American women in various stages of breast cancer treatment, who, along with anxious relatives, make up a significant market for all things breast cancer related. Bears, for example: I identified four distinct lines, or species, of these creatures, including Carol, the Remembrance Bear; Hope, the Breast Cancer Research Bear, which wore a pink turban as if to conceal chemotherapy-induced baldness; the Susan Bear, named for Nancy Brinker's deceased sister; and the Nick and Nora Wish Upon a Star Bear, which was available, along with the Susan Bear, at the Komen Foundation Web site's "marketplace."

And bears are only the tip, so to speak, of the cornucopia of pink-ribbon-themed breast cancer products. You can dress in pink-beribboned sweats.h.i.+rts, denim s.h.i.+rts, pajamas, lingerie, ap.r.o.ns, loungewear, shoelaces, and socks; accessorize with pink rhinestone brooches, angel pins, scarves, caps, earrings, and bracelets; brighten up your home with breast cancer candles, stained gla.s.s pink-ribbon candleholders, coffee mugs, pendants, wind chimes, and night-lights; and pay your bills with Checks for the Cure. "Awareness" beats secrecy and stigma, of course, but I couldn't help noticing that the existential s.p.a.ce in which a friend had earnestly advised me to "confront [my] mortality" bore a striking resemblance to the mall.

This is not entirely, I should point out, a case of cynical merchants exploiting the sick. Some of the breast cancer tchotchkes and accessories are made by breast cancer survivors themselves, such as "Janice," creator of the Daisy Awareness Necklace, among other things, and in most cases a portion of the sales goes to breast cancer research. Virginia Davis of Aurora, Colorado, was inspired to create the Remembrance Bear by a friend's double mastectomy and told me she sees her work as more of a "crusade" than a business. When I interviewed her in 2001, she was expecting to s.h.i.+p ten thousand of these teddies, which are manufactured in China, and send part of the money to the Race for the Cure. If the bears are infantilizing-as I tried ever so tactfully to suggest was how they may, in rare cases, be perceived-so far no one had complained. "I just get love letters," she told me, "from people who say, 'G.o.d bless you for thinking of us.' "

The ultrafeminine theme of the breast cancer marketplace-the prominence, for example, of cosmetics and jewelry-could be understood as a response to the treatments' disastrous effects on one's looks. No doubt, too, all the prettiness and pinkness is meant to inspire a positive outlook. But the infantilizing trope is a little harder to account for, and teddy bears are not its only manifestation. A tote bag distributed to breast cancer patients by the Libby Ross Foundation (through places such as the Columbia-Presbyterian Medical Center) contained, among other items, a tube of Estee Lauder Perfumed Body Creme, a hot pink satin pillowcase, a small tin of peppermint pastilles, a set of three small, inexpensive rhinestone bracelets, a pink-striped "journal and sketch book," and-somewhat jarringly-a box of crayons. Marla Willner, one of the founders of the Libby Ross Foundation, told me that the crayons "go with the journal-for people to express different moods, different thoughts," though she admitted she has never tried to write with crayons herself. Possibly the idea was that regression to a state of childlike dependency puts one in the best frame of mind for enduring the prolonged and toxic treatments. Or it may be that, in some versions of the prevailing gender ideology, femininity is by its nature incompatible with full adulthood-a state of arrested development. Certainly men diagnosed with prostate cancer do not receive gifts of Matchbox cars.

But I, no less than the bear huggers, needed whatever help I could get and found myself searching obsessively for practical tips on hair loss, how to select a chemotherapy regimen, what to wear after surgery and eat when the scent of food sucks. There was, I soon discovered, far more than I could usefully absorb, for thousands of the afflicted have posted their stories, beginning with the lump or bad mammogram, proceeding through the agony of the treatments, pausing to mention the sustaining forces of family, humor, and religion, and ending, in almost all cases, with an upbeat message for the terrified neophyte. Some of these are no more than a paragraph long-brief waves from sister sufferers. Others offer almost hour-by-hour logs of breast-deprived, chemotherapized lives: Tuesday, August 15, 2000: Well, I survived my 4th chemo. Very, very dizzy today. Very nauseated, but no barfing! It's a first. . . . I break out in a cold sweat and my heart pounds if I stay up longer than 5 minutes.

Friday, August 18, 2000: . . . By dinnertime, I was full out nauseated. I took some meds and ate a rice and vegetable bowl from Trader Joe's. It smelled and tasted awful to me, but I ate it anyway. . . . Rick brought home some Kern's nectars and I'm drinking that. Seems to have settled my stomach a little bit.

I couldn't seem to get enough of these tales, reading on with panicky fascination about everything that can go wrong-septicemia, ruptured implants, startling recurrences a few years after the completion of treatments, "mets" (metastases) to vital organs, and-what scared me most in the short term-"chemo brain," or the cognitive deterioration that sometimes accompanies chemotherapy. I compared myself with everyone, selfishly impatient with those whose conditions were less menacing, s.h.i.+vering over those who had reached Stage IV ("There is no Stage V," as the main character in the play Wit Wit, who has ovarian cancer, explains), constantly a.s.sessing my chances.

But, despite all the helpful information, the more fellow victims I discovered and read, the greater my sense of isolation grew. No one among the bloggers and book writers seemed to share my sense of outrage over the disease and the available treatments. What causes it and why is it so common, especially in industrialized societies? * * Why don't we have treatments that distinguish between different forms of breast cancer or between cancer cells and normal dividing cells? In the mainstream of breast cancer culture, there is very little anger, no mention of possible environmental causes, and few comments about the fact that, in all but the more advanced, metastasized cases, it is the "treatments," not the disease, that cause the immediate illness and pain. In fact, the overall tone is almost universally upbeat. The Breast Friends Web site, for example, featured a series of inspirational quotes: "Don't cry over anything that can't cry over you," "I can't stop the birds of sorrow from circling my head, but I can stop them from building a nest in my hair," "When life hands out lemons, squeeze out a smile," "Don't wait for your s.h.i.+p to come in . . . swim out to meet it," and much more of that ilk. Even in the relatively sophisticated Why don't we have treatments that distinguish between different forms of breast cancer or between cancer cells and normal dividing cells? In the mainstream of breast cancer culture, there is very little anger, no mention of possible environmental causes, and few comments about the fact that, in all but the more advanced, metastasized cases, it is the "treatments," not the disease, that cause the immediate illness and pain. In fact, the overall tone is almost universally upbeat. The Breast Friends Web site, for example, featured a series of inspirational quotes: "Don't cry over anything that can't cry over you," "I can't stop the birds of sorrow from circling my head, but I can stop them from building a nest in my hair," "When life hands out lemons, squeeze out a smile," "Don't wait for your s.h.i.+p to come in . . . swim out to meet it," and much more of that ilk. Even in the relatively sophisticated Mamm Mamm, a columnist bemoaned not cancer or chemotherapy but the end of chemotherapy and humorously proposed to deal with her separation anxiety by pitching a tent outside her oncologist's office. Positive thinking seems to be mandatory in the breast cancer world, to the point that unhappiness requires a kind of apology, as when "Lucy," whose "long-term prognosis is not good," started her personal narrative on [http://breastcancertalk.org] breastcancertalk.org by telling us that her story "is not the usual one, full of sweetness and hope, but true nevertheless."

Even the word "victim" is proscribed, leaving no single noun to describe a woman with breast cancer. As in the AIDS movement, upon which breast cancer activism is partly modeled, the words "patient" and "victim," with their aura of self-pity and pa.s.sivity, have been ruled un-P.C. Instead, we get verbs: those who are in the midst of their treatments are described as "battling" or "fighting," sometimes intensified with "bravely" or "fiercely"-language suggestive of Katharine Hepburn with her face to the wind. Once the treatments are over, one achieves the status of "survivor," which is how the women in my local support group identified themselves, A.A.-style, when we convened to share war stories and rejoice in our "survivorhood": "Hi, I'm Kathy and I'm a three-year survivor." My support group seemed supportive enough, but some women have reported being expelled by their groups when their cancers metastasized and it became clear they would never graduate to the rank of "survivor." 2 2 For those who cease to be survivors and join the more than forty thousand American women who succ.u.mb to breast cancer each year-again, no noun applies. They are said to have "lost their battle" and may be memorialized by photographs carried at races for the cure-our lost brave sisters, our fallen soldiers. But in the overwhelmingly positive culture that has grown up around breast cancer, martyrs count for little; it is the "survivors" who merit constant honor and acclaim. At a "Relay for Life" event in my town, sponsored by the American Cancer Society, the dead were present only in much diminished form. A series of paper bags, each about the right size for a junior burger and fries, lined the relay track. On them were the names of the dead, and inside each was a candle that was lit after dark, when the actual relay race began. The stars, though, were the runners, the "survivors," who seemed to offer living proof the disease isn't so bad after all.

Embracing Cancer.

The cheerfulness of breast cancer culture goes beyond mere absence of anger to what looks, all too often, like a positive embrace of the disease. As "Mary" reports, on the Bosom Buds message board: "I really believe I am a much more sensitive and thoughtful person now. It might sound funny but I was a real worrier before. Now I don't want to waste my energy on worrying. I enjoy life so much more now and in a lot of aspects I am much happier now." Or this from "Andee": "This was the hardest year of my life but also in many ways the most rewarding. I got rid of the baggage, made peace with my family, met many amazing people, learned to take very good care of my body so it will take care of me, and reprioritized my life." Cindy Cherry, quoted in the Was.h.i.+ngton Post Was.h.i.+ngton Post, goes further: "If I had to do it over, would I want breast cancer? Absolutely. I'm not the same person I was, and I'm glad I'm not. Money doesn't matter anymore. I've met the most phenomenal people in my life through this. Your friends and family are what matter now." 3 3 The First Year of the Rest of Your Life, a collection of brief narratives with a foreword by Nancy Brinker and a share of the royalties going to the Komen Foundation, is filled with such testimonies to the redemptive powers of the disease: "I can honestly say I am happier now than I have ever been in my life-even before the breast cancer"; "For me, breast cancer has provided a good kick in the rear to get me started rethinking my life"; "I have come out stronger, with a new sense of priorities." 4 4 Never a complaint about lost time, shattered s.e.xual confidence, or the long-term weakening of the arms caused by lymph node dissection and radiation. What does not destroy you, to paraphrase Nietzsche, makes you a s.p.u.n.kier, more evolved sort of person. Never a complaint about lost time, shattered s.e.xual confidence, or the long-term weakening of the arms caused by lymph node dissection and radiation. What does not destroy you, to paraphrase Nietzsche, makes you a s.p.u.n.kier, more evolved sort of person.

Writing in 2007, New York Times New York Times health columnist Jane Brody faithfully reflected the near universal bright-siding of the disease. health columnist Jane Brody faithfully reflected the near universal bright-siding of the disease. 5 5 She gave a nod to the downside of breast cancer and cancer generally: "It can cause considerable physical and emotional pain and lasting disfigurement. It may even end in death." But for the most part her column was a veritable ode to the uplifting effects of cancer, and especially breast cancer. She quoted bike racer and testicular cancer survivor Lance Armstrong saying, "Cancer was the best thing that ever happened to me," and cited a woman a.s.serting that "breast cancer has given me a new life. Breast cancer was something I needed to experience to open my eyes to the joy of living. I now see more of the world than I was choosing to see before I had cancer. . . . Breast cancer has taught me to love in the purest sense." Betty Rollin, one of the first women to go public with her disease, was enlisted to testify that she has "realized that the source of my happiness was, of all things, cancer-that cancer had everything to do with how good the good parts of my life were." She gave a nod to the downside of breast cancer and cancer generally: "It can cause considerable physical and emotional pain and lasting disfigurement. It may even end in death." But for the most part her column was a veritable ode to the uplifting effects of cancer, and especially breast cancer. She quoted bike racer and testicular cancer survivor Lance Armstrong saying, "Cancer was the best thing that ever happened to me," and cited a woman a.s.serting that "breast cancer has given me a new life. Breast cancer was something I needed to experience to open my eyes to the joy of living. I now see more of the world than I was choosing to see before I had cancer. . . . Breast cancer has taught me to love in the purest sense." Betty Rollin, one of the first women to go public with her disease, was enlisted to testify that she has "realized that the source of my happiness was, of all things, cancer-that cancer had everything to do with how good the good parts of my life were."

In the most extreme characterization, breast cancer is not a problem at all, not even an annoyance-it is a "gift," deserving of the most heartfelt grat.i.tude. One survivor turned author credits it with revelatory powers, writing in her book The Gift of Cancer: A Call to Awakening The Gift of Cancer: A Call to Awakening that "cancer is your ticket to your real life. Cancer is your pa.s.sport to the life you were truly meant to live." And if that is not enough to make you want to go out and get an injection of live cancer cells, she insists, "Cancer will lead you to G.o.d. Let me say that again. Cancer is your connection to the Divine." that "cancer is your ticket to your real life. Cancer is your pa.s.sport to the life you were truly meant to live." And if that is not enough to make you want to go out and get an injection of live cancer cells, she insists, "Cancer will lead you to G.o.d. Let me say that again. Cancer is your connection to the Divine." 6 6 The effect of all this positive thinking is to transform breast cancer into a rite of pa.s.sage-not an injustice or a tragedy to rail against but a normal marker in the life cycle, like menopause or grandmotherhood. Everything in mainstream breast cancer culture serves, no doubt inadvertently, to tame and normalize the disease: the diagnosis may be disastrous, but there are those cunning pink rhinestone angel pins to buy and races to train for. Even the heavy traffic in personal narratives and practical tips that I found so useful bears an implicit acceptance of the disease and the current clumsy and barbarous approaches to its treatment: you can get so busy comparing attractive head scarves that you forget to question whether chemotherapy is really going to be effective in your case. Understood as a rite of pa.s.sage, breast cancer resembles the initiation rites so exhaustively studied by Mircea Eliade. First there is the selection of the initiates-by age in the tribal situation, by mammogram or palpation here. Then come the requisite ordeals-scarification or circ.u.mcision within traditional cultures, surgery and chemotherapy for the cancer patient. Finally, the initiate emerges into a new and higher status-an adult and a warrior-or in the case of breast cancer, a "survivor."

And in our implacably optimistic breast cancer culture, the disease offers more than the intangible benefits of spiritual upward mobility. You can defy the inevitable disfigurements and come out, on the survivor side, actually prettier, s.e.xier, more femme. In the lore of the disease-shared with me by oncology nurses as well as by survivors-chemotherapy smoothes and tightens the skin and helps you lose weight, and, when your hair comes back it will be fuller, softer, easier to control, and perhaps a surprising new color. These may be myths, but for those willing to get with the prevailing program, opportunities for self-improvement abound. The American Cancer Society offers the "Look Good . . . Feel Better" program, "dedicated to teaching women cancer patients beauty techniques to help restore their appearance and self-image during cancer treatment." Thirty thousand women partic.i.p.ate a year, each copping a free make over and bag of makeup donated by the Cosmetic, Toiletry, and Fragrance a.s.sociation, the trade a.s.sociation of the cosmetics industry. As for that lost breast: after reconstruction, why not bring the other one up to speed? Of the more than fifty thousand mastectomy patients who opt for reconstruction each year, 17 percent go on, often at the urging of their plastic surgeons, to get additional surgery so that the remaining breast will "match" the more erect and perhaps larger new structure on the other side.

Not everyone goes for cosmetic deceptions, and the question of wigs versus baldness, reconstruction versus undisguised scar, defines one of the few real disagreements in breast cancer culture. On the more avant-garde, upper-middle-cla.s.s side, Mamm Mamm magazine-in which literary critic Eve Kosofsky Sedgwick served as a columnist-tends to favor the "natural" look. Here, mastectomy scars can be "s.e.xy" and baldness something to celebrate. A cover story featured women who "looked upon their baldness not just as a loss, but also as an opportunity: to indulge their playful sides . . . to come in contact, in new ways, with their truest selves." One woman decorated her scalp with temporary tattoos of peace signs, panthers, and frogs; another expressed herself with a shocking purple wig; a third reported that unadorned baldness made her feel "sensual, powerful, able to recreate myself with every new day." But no hard feelings toward those who choose to hide their condition under wigs or scarves; it's just a matter, magazine-in which literary critic Eve Kosofsky Sedgwick served as a columnist-tends to favor the "natural" look. Here, mastectomy scars can be "s.e.xy" and baldness something to celebrate. A cover story featured women who "looked upon their baldness not just as a loss, but also as an opportunity: to indulge their playful sides . . . to come in contact, in new ways, with their truest selves." One woman decorated her scalp with temporary tattoos of peace signs, panthers, and frogs; another expressed herself with a shocking purple wig; a third reported that unadorned baldness made her feel "sensual, powerful, able to recreate myself with every new day." But no hard feelings toward those who choose to hide their condition under wigs or scarves; it's just a matter, Mamm Mamm tells us, of "different aesthetics." Some go for pink ribbons; others will prefer the Ralph Lauren Pink Pony breast cancer motif. But everyone agrees that breast cancer is a chance for creative self-transformation-a make over opportunity, in fact. tells us, of "different aesthetics." Some go for pink ribbons; others will prefer the Ralph Lauren Pink Pony breast cancer motif. But everyone agrees that breast cancer is a chance for creative self-transformation-a make over opportunity, in fact.

In the seamless world of breast cancer culture, where one Web site links to another-from personal narratives and gra.s.sroots endeavors to the glitzy level of corporate sponsors and celebrity spokespeople-cheerfulness is required, dissent a kind of treason. Within this tightly knit world, att.i.tudes are subtly adjusted, doubters gently brought back to the fold. In The First Year of the Rest of Your Life The First Year of the Rest of Your Life, for example, each personal narrative is followed by a study question or tip designed to counter the slightest hint of negativity-and they are very slight hints indeed, since the collection includes no harridans, whiners, or feminist militants: Have you given yourself permission to acknowledge you have some anxiety or "blues" and to ask for help for your emotional well-being? . . .

Is there an area in your life of unresolved internal conflict? Is there an area where you think you might want to do some "healthy mourning"? . . .

Try keeping a list of the things you find "good about today." 7 7 As an experiment, I posted a statement on the [http://Komen.org] Komen.org message board, under the subject line "Angry," briefly listing my complaints about the debilitating effects of chemotherapy, recalcitrant insurance companies, environmental carcinogens, and, most daringly, "sappy pink ribbons." I received a few words of encouragement in my fight with the insurance company, which had taken the position that my biopsy was a kind of optional indulgence, but mostly a chorus of rebukes. "Suzy" wrote to tell me, "I really dislike saying you have a bad att.i.tude towards all of this, but you do, and it's not going to help you in the least." "Mary" was a bit more tolerant, writing, "Barb, at this time in your life, it's so important to put all your energies toward a peaceful, if not happy, existence. Cancer is a rotten thing to have happen and there are no answers for any of us as to why. But to live your life, whether you have one more year or 51, in anger and bitterness is such a waste. . . . I hope you can find some peace. You deserve it. We all do. G.o.d bless you and keep you in His loving care. Your sister, Mary."

"Kitty," however, thought I'd gone around the bend: "You need to run, not walk, to some counseling. . . . Please, get yourself some help and I ask everyone on this site to pray for you so you can enjoy life to the fullest." The only person who offered me any reinforcement was "Gerri," who had been through all the treatments and now found herself in terminal condition, with only a few months of life remaining: "I am also angry. All the money that is raised, all the smiling faces of survivors who make it sound like it is o.k. to have breast cancer. IT IS NOT O.K.!" But Gerri's message, like the others on the message board, was posted under the inadvertently mocking heading "What does it mean to be a breast cancer survivor?"

The "Scientific" Argument for Cheer.

There was, I learned, an urgent medical reason to embrace cancer with a smile: a "positive att.i.tude" is supposedly essential to recovery. During the months when I was undergoing chemotherapy, I encountered this a.s.sertion over and over-on Web sites, in books, from oncology nurses and fellow sufferers. Eight years later, it remains almost axiomatic, within the breast cancer culture, that survival hinges on "att.i.tude." One study found 60 percent of women who had been treated for the disease attributing their continued survival to a "positive att.i.tude." 8 8 In articles