Leah Stamm

In Siddhartha Mukherjee’s novel, The Emperor of All Maladies, he explores cancer through historical research and personal case studies from his time as an oncologist. In the Author’s note, he explains how he set off to learn the history of cancer, but following the thousands of different tangents that stem from the mysterious disease, he created a biography, with cancer as the main antagonist. In this essay, I will argue that Mukherjee personifies cancer as an elusive character, more advanced and dangerous than the humans they consume with their disease.

Cancer is thought of as a primarily “modern illness” (Mukherjee 37). Before cancer, influenza in the 20s, tuberculosis throughout the first half of the 20th century, and AIDS spreading through the second half were the primary killers. However, cancer has been present throughout the history of humankind, found even in the remains of bodies buried from 2500 BC (Mukherjee 40). So why is cancer thought of as something so novel? Mukherjee claims that it is due to the modern metaphors circulating around cancer. Cellular biology is taught to students with the analogy of a machine, with the mitochondria being the powerhouse of the cell. Cancer is generated within the machine when the mitochondria is unable to control its own growth, and “thus transformed into an indestructible, self propelled automaton” (Mukherjee 37). Mukherjee uses the idea that cancer becomes more powerful than the host body it invaded to convince his readers of the extraordinary mystery and danger of this disease that humans still don’t know what causes it, or how to cure it. He goes on to describe the tipping point between normal cellular growth and how it can turn into deadly cancer: “cancer cells can grow faster, adapt better. They are the more perfect versions of ourselves” (Mukherjee 6). It is an unstoppable, villainous growth threatening to take over the body, better equipped for reproduction than the host itself.

This idea of cancer as a metaphor is apparent throughout most illness narratives. Susan Sontag, a breast cancer survivor, writer, and political activist, wrote her own narrative about the stereotypes that circulate diseases and the negative effects they have on patients. In her novel Illness as Metaphor, Sontag wanted to create a more candid feeling around talking about and living with cancer for patients, survivors, and society as a whole. There are many commonalities between what Mukerhjee and Sontag discuss, the fist being how cancer invades the body. As said before in Mukherjee’s view, cancer takes control over the body by hijacking it at its critical center. Sontag compares cancer’s “take over” to another foreign source, claiming “the patient is invaded by alien cells” (Sontag 14). Though the metaphors each author uses are different, they both have the same effect. Mukherjee characterizes cancer as this mysterious thing that is taking over the body for reasons humans don’t understand. Cancer seems to be outsmarting humankind, like a type of artificial intelligence that can manipulate the body on a cellular level. Mukherjee’s metaphor is something futuristic, creating a feeling of awe, but also resentment towards his character. Sontag’s metaphor has a similar result. She characterizes cancer as this elusive, science fictional being. Together the two works compliment each other by reinforcing a negative light onto cancer’s character. In order to find how to stop this killer character, Mukherjee delves into the medical aspects of his character, trying to find the solution at the root of the conflict.

Medical developments in cancer treatment started hundreds of years ago. Mukherjee discusses the various surgical strategies and theories behind the disease, implying the “war on cancer” started long before the term was coined. This enemy is stronger than any enemy that ever existed; “Cancer is a phenomenally successful invader and colonizer in part because it exploits the very features that makes us successful as a species or organism” (Mukherjee 39). The connotation behind Mukherjee’s word choice in this passage deepens his argument that cancer has beaten us so far, as a human race, in the war. To describe cancer as a colonizer implies all the political baggage that that word holds in connection to imperialism. In the same way the western powers had their period of colonial expansion in the 19th century, taking over Africa and parts of Asia without regard for the lives and cultures and communities they destroyed, cancer selfishly expands through its host, killing the body it invaded. As western powers looked to exploit the resources from their subjugated countries, cancer exploited the body’s materials until depletion, ironically peaking at its own self destruction. Using this metaphor deepens Mukherjee’s connection to his primarily “Western”, and probably colonizer, audience by bringing in this image of their own history they can easily understand.

In an attempt to curb the deadliness of cancer and increase surgical efficiency, a new type of approach was created by William Halsted in the late 19th century—the radical mastectomy. Instead of focusing on the localized tumors, Halsted began operating on his patients as if the entire body was the war zone and cancer had colonized it all. Beginning at the source, the breast tissue was removed; then the lymph nodes, the nodes in the neck, and even sometimes the major pectoral muscle or parts of the rib cage. Halsted would continue to strip away as far as his scalpel could reach, ignoring that he left his patients permanently deformed. His disregard for the disfigurement of his patients was accepted as “inevitable war wounds” (Mukherjee 65), something that all patients should anticipate awaiting surgery. The way that Mukhejree chose to explain Halsted’s quest to eliminate cancer from the body further developed his personification of cancer as a character. As war wounds tend to be extremely traumatic, the scars from cancer are just as bad—like soldiers of the enemy force in a war, cancer ruthlessly destroys the body.

In the long run, more surgery did not equate to a more efficient recovery. It did however start a “psychological obsession” with the idea of radicalism (Mukherjee 69). Halsted had intended the meaning of his “radical” approach to come from the latin origin root; since he was removing cancer at the root of its source. Instead, radicalism became synonymous with a new “aggressive, innovative, and brazen” way to attack the disease (Mukherjee 69). If patients were not willing to agree to this revolutionary approach, they were said to be succumbing to cancer’s death sentence without a fight. Halsted, however, was ready to be the heroic character in cancer’s story. Never one to coward away when faced with a difficult case, he was ready to “challenge cancer to duel with his knife” (Mukherjee 66). Mukherjee uses imagery to create a visual for his readers of Halsted in a medieval sword fight against an invading knight.

In another part of the world during the 19th century, the craze around Halsted’s knife transformed into a fixation on a different kind of approach,—something less tangible, but just as aggressive—radiation. Discovered by a science professor at the Würzburg Institute in Germany, radiation was quickly noticed by cancer researchers around the world as a way to kill rapidly dividing cells (Mukherjee 75). Soon enough, radiation therapy was looked at as a “benediction” for patients (Mukherjee 77). Mukherjee explains that “the vocabulary, the images, and the metaphors” around radiation convinced patients of a new atomic power (Mukherjee 76). It was advertised as openly as a new type of candy for kids, creating the same sense of urgency that the “radical mastectomy” had in America. The syntax Mukherjee uses here intensifies that urgency; the parallelism in the sentence structure creates a natural flow. Repetition of “the” followed by a noun speeds up the readability to convince the audience in one swift example that radiation would be the surprise attack needed to win the war on cancer.

Mukherjee uses his point of view as an oncologist to cover the history of cancer, the biological aspect of it, the way it controls the body it consumes, and the medical innovations throughout time. His third-person account on cancer is reliable and factual. Comparably, had it been from the first person point of view it would have been more dramaticized and personal. To analyze a related text told from the first person, turn to Arthur Frank’s “From Sick Role to Narrative Subject”. Similar to Sontag’s Illness as Metaphor, Frank explores questions of identity that cancer survivors have struggled with. He analyzes Audre Lorde’s The Cancer Journals and discusses how a cancer patient can refuse the sick role that society smothers them with by examining how Lorde reacts in her experience with breast cancer. Through her story, he shares how she overcame societal pressure and eventually accepted herself as the subject in her own narrative story.

Frank begins with the theory of the “sick role” (Frank 13). When a person is diagnosed, they feel the weight of the pressure of cancer. They are forced into a new identity as a patient to fit the “binding normative expectations” of a cancer diseased human (Frank 13). Consequently, the rest of the patient’s world would follow suit. Relatives suspend the patient’s life relieving them of any job or family obligations, and physicians validate the disease. Cancer takes on the form of an oppressor in the story, robbing the patient of all their normalcy and pushing them to take on the sick role, leaving patients bedridden and helpless. Cancer is the one facilitating this abusive relationship—similar to a manipulative partner, the focus is on keeping victims in bed with ready excuses rather than letting them reach out to others for support.

Frank then goes onto explain how Lorde rejects the sick role by accepting the physical and mental changes that come with her illness. Going further than just refusing to be obedient to her oppressor, Lorde seeks to “build a community” of other patients and survivors (Frank 14). Comparing the other fights against oppression to her fight against cancer, Frank deepens his comparison to cancer as a real person in his analysis. In the same way that Lorde has to fight for racial equality against racists, and for gender equality against misogynists, and for sexual equality against homophobes, she has to fight against cancer as another oppressor against her being.

In The Emperor of All Maladies, and the other supporting documents, there is an apparent theme of cancer being characterized as a character within each story. To understand cancer as an illness, it has to be first understood as a subject on a “more personal” level, and so, in The Emperor of all Maladies Mukherjee treated it as that (Mukherjee 39). Mukherjee realizes as he writes that what was intended to be a small project focusing on pathology, “morphed into something that resembled an individual” (Mukherjee 39). This individual was ever changing, and mysteriously unreachable. The purpose of a biography is to share the life of another person to an audience, and Mukherjee admits on page 39 that his work is less a medical journal, and more of a biography. Starting with a small mass of tissue, to its growth and development as a “desperate individual”, and its role in history as a “clonally evolving disease” Mukherjee uses the form of a novel to tell the story of cancer and its crises, exploiting cancer and its dangerous personality (Mukherjee 38-39). By doing this, Mukherjee extends his research and writing beyond other medical personnel and is able to reach a much wider audience, persuading them all of cancer’s risk and uncertainty towards the human race.

Works Cited

Frank, Arthur W. “From Sick Role to Narrative Subject: An Analytic Memoir.” Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, vol. 20, no. 1, 2015, pp. 9–21. doi:10.1177/1363459315615395.

Mukherjee, Siddhartha. The Emperor of All Maladies: a Biography of Cancer. Gale, Cengage Learning, 2012.

Sontag, Susan. Illness as Metaphor. Penguin Books, 2002.