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Emily Waples

Configurations, Volume 22, Number 2, Spring 2014, pp. 153-181 (Article)

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DOI: 10.1353/con.2014.0011

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Avatars, Illness, and Authority:

Embodied Experience in Breast
Cancer Autopathographics
Emily Waples
University of Michigan

ABSTRACT: This essay argues that the medium of graphic illness memoir, or autopathographics, can work to challenge the master plot
of survival that has circulated as part of breast cancer culture for
the past thirty years. Exploring the emergent genre of breast cancer
autopathographics through an analysis of two best-selling memoirs
published in 2006Marisa Acocella Marchettos Cancer Vixen: A
True Story and Miriam Engelbergs Cancer Made Me a Shallower Person:
A Memoir in Comicsthis essay examines the graphic in two senses:
first, it strives to enter an emergent conversation about the uses of the
visual-verbal genre of graphic memoir as a means to narrate stories
of illness and disability; further, it takes into account the popular usage of the word graphic to note the kind of explicitness or excess for
which illness narratives are commonly critiqued. Autopathographics
offer new possibilities for women to represent the embodied changes
occasioned by cancer in ways that register the uncertainty of the diseases temporality in the face of metastasis and terminal illnesspart
of breast cancers epidemiological narrative that is too often ignored.

In the early weeks of 2014, a heated debate took place in the digital
public sphere regarding cancer patients self-representation in social
media, beginning when a provocative Guardian article by Emma
Keller asked: What are the ethics of tweeting a terminal illness?1
1. Emma G. Keller, Forget Funeral Selfies: What Are the Ethics of Tweeting a Terminal
Illness? Guardian, January 8, 2014. The article has since been removed from the Guardians website pending investigation.
Configurations, 2014, 22:153181 2014 by Johns Hopkins University
Press and the Society for Literature, Science, and the Arts.

153

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The question indeed seems sweeping in its scope, drawing together

the narrative practice of pathography, the self-publication modes afforded by digital media, and, apparently, ethics. Kellers article is
more pointed than it might first appear, focusing solely on the test
case of Lisa Bonchek Adams, an American woman with metastatic
breast cancer who has been chronicling her treatment on Twitter:
Doing as much as I can for as long as I can, as Adamss Twitter
profile readsincluding, but not limited to, chemotherapy, radiation, and clinical trials.2 Days after Kellers article appeared in the
Guardian, her husband, journalist Bill Keller, weighed in with a New
York Times op-ed of his own, registering his disapproval with what
he calls Adamss fierce and very public cage fight with death. As
he notes, Adams has tweeted through morphine haze and radiation burn with a candor that seems extreme, [e]ven by contemporary standards of social-media self-disclosure.3 Keller critiques
not only the very public nature of Adamss relationship to cancer, but indeed her fierceness, as he goes on to wax philosophical
about the lost art of the humane and honorable deathor, as the
Feministing.com blog glossed it: Former NYT editor mansplains to
cancer patient to shut up and die the right way.4
In her Guardian article, Emma Keller self-identifies as an ardent
follower of Adamss Twitter feedone who is, she confesses, embarrassed at my voyeurism. Kellers own embarrassment occasions a
series of questions about what she calls the ethics of dying online:
Should there be boundaries in this kind of experience? she asks.
Is there such a thing as TMI? Are [Adamss] tweets a grim equivalent
of deathbed selfies, one step further than funeral selfies? Why am I
so obsessed?5 Kellers questions vacillate between issues of authorship and readership, muddling the matter of whether the ethics in
question relate to production or to consumptionor perhaps to a
space situated somewhere between tweeting and reading. While the
title of Kellers articleWhat Are the Ethics of Tweeting a Terminal
Illness?suggests that the ethical imperative lies with the tweeter,
its motivating anxieties instead arise from her subject position as a
reader. Turning to her own audience in the Guardian thus becomes
2. See Lisa Bonchek Adamss Twitter profile at https://twitter.com/AdamsLisa.
3. Bill Keller, Heroic Measures, New York Times, January 12, 2014. http://www.ny
times.com/2014/01/13/opinion/keller-heroic-measures.html?_r=0.
4. Katie Halper, Former NYT editor mansplains to cancer patient to shut up and die
the right way, Feministing.com, January 14, 2014. http://feministing.com/2014/01/14
/former-nyt-editor-mansplains-to-cancer-patient-to-shut-up-and-die-the-right-way/.
5. See Selfies at Funerals, December 10, 2013. http://selfiesatfunerals.tumblr.com/.

Waples/Breast Cancer Autopathographics

155

a way for Keller to attempt to negotiate her Schadenfreude: Is this

educational, she asks us, or too much?
The ethics of autobiographical, public self-representation have
been explored by scholars like Arthur Frank and G. Thomas Couser,
who engage with illness narratives in terms of both production and
reception. Couser coins the term auto/bio/ethics in his consideration
of the bioethical implications of autobiographical, biographical, and
ethnographic practice, engaging in particular with what he calls
vulnerable subjects: persons who are liable to exposure by someone with whom they are involved in an intimate or trust-based relationship but are unable to represent themselves in writing or to
offer meaningful consent to their representation by someone else.6
However, the vulnerable subject does not characterize Adams, who
is fully capable of her own self-representation. What, then, are the
ethical issues at stake for Adams and/or her readers?
Kellers concerns are not so much questions of ethics, I suggest,
as questions of genre. After all, the quandary that Keller faces in her
struggle to interpret Adamss Twitter feedand her own experience
of reading itseems to arise less from her desire to reconcile it with
an ethical schema than from her impetus to classify it as an autobiographical narrative mode. Adamss tweets, she claims, are either
educationalan understanding of life-writing that arguably stems
from Benjamin Franklins early incarnation of American autobiography as a didactic practiceor else it is excessive. Per Keller, the
publication of pathographywhat she deems dying out loud
must be ethical, or else egotistical. Kellers discomfort with Adams
has to do with exposure, with excess: that is, with graphic selfrepresentation of a nonpedagogical nature. The moral imperative
of narrative ethics, according to Frank, is perpetual self-reflection
on the sort of person that ones story is shaping one into, entailing
the requirement to change that self-story if the wrong self is being
shaped. Thus awareness of the general type of narrative one is telling or responding to is a crucial beginning.7 What kind of story is
Adams telling with her tweets?
In her seminal investigation of the genre, Anne Hunsaker
Hawkins defines pathography as a form of autobiography or biography that describes personal experiences of illness, treatment, and
6. G. Thomas Couser, Vulnerable Subjects: Ethics and Life Writing (Ithaca, NY: Cornell
University Press, 2004), pp. iv, xii.
7. Arthur Frank divides stories of illness into three narrative subtypes: restitution,
chaos, or quest. See his The Wounded Storyteller: Body, Illness, and Ethics (Chicago: University of Chicago Press, 1995), p. 158.

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sometimes death.8 The term autopathography, as Sidonie Smith and

Julia Watson explain, has subsequently been employed to refer to
personal narratives about illness or disability that contest cultural
discourses stigmatizing the writer as abnormal, aberrant, or in some
sense pathological.9 Inviting audiences into the intimate spaces of
illness, auto/pathographic narratives implicate the reader as a witness to the often uncomfortable vicissitudes of embodied experience. But Keller asks: Should there be boundaries in this kind of experience? And who decides? Yet, even autobiographical narratives
that do not take illness and death as their immediate subject are
keenly aware of its imminence, as critics like Susanna Egan suggest,
employing Nancy Millers term autothanatography to note the way in
which the spectre of death hovers over all autobiography, usually
unnamed.10 The moment of death is implied by the chronological narrative trajectory, inching ever closer as the pages grow slim
toward the end of the text: Every autobiography, Miller asserts,
is also an autothanatography.11 Every autobiography, she suggests,
moves toward the abject boundary between life and death.
By analyzing two best-selling breast cancer graphic memoirs, both
published in 2006Marisa Acocella Marchettos Cancer Vixen: A
True Story and Miriam Engelbergs Cancer Made Me a Shallower Person:
A Memoir in Comicsthis essay aims to grapple with the issues of generic boundary-building that have recently been brought to public
attention by Emma Kellers and Bill Kellers controversial treatment
of Lisa Adams. In so doing, it employs the notion of the graphic in
two senses. First, it strives to enter an emergent conversation about
the uses of the visual-verbal genre of comics as a mode of autopathography. As Susan Squier has observed, comics can show us
things that cant be said, just as they can narrate experiences without

8. Anne Hunsaker Hawkins, Reconstructing Illness: Studies in Pathography (West Lafayette,

IN: Purdue University Press, 1999), p. 1.
9. Sidonie Smith and Julia Watson, Reading Autobiography: A Guide for Interpreting Life
Narratives, 2nd ed. (Minneapolis: University of Minnesota Press, 2010), p. 261. Couser
proposes the alternate term autosomatography to address a wider autobiographical genre
of writing about what its like to have or to be, to live in or as, a particular bodyindeed, a body that is usually odd or anomalous. See G. Thomas Couser, Signifying Bodies: Disability in Contemporary Life Writing (Ann Arbor: University of Michigan Press,
2009), p. 2.
10. Susanna Egan, Mirror Talk: Genres of Crisis in Contemporary Autobiography (Chapel
Hill: University of North Carolina Press, 1999), p. 196.
11. Nancy K. Miller, Representing Others: Gender and the Subjects of Autobiography,
differences 6:1 (1994): 127, quote on p. 12.

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relying on words, and in their juxtaposition of words and pictures,

they can also convey a far richer sense of the different magnitudes
at which we experience any performance of illness, disability, medical
treatment, or healing.12 Building on Squiers and others observations about graphic media as a means of expressing or performing
illness, I consider the possibilities, and limitations, of graphic narrative in autobiographical stories of breast cancer. How does breast
cancer in the comic form differ from its iteration in other kinds of
written, oral, visual, and digital media? What kind of relationship
does the graphic memoir forge between autobiographers and their
readerships? To employ Kellers term, what are its representational
boundaries?
This essay will also mobilize the notion of the graphic in a second
sense: to refer not only to a written or drawn method of production, but to connote the kind of explicitness or excess marked by
the words popular usage. The Kellers discomfort with Adams lies
not only in the sheer number of her tweets, but in their graphic
nature: having her tumor genome and her cancer trial discussed
in detail, for instance, before an audience of online strangers. The
impetus to place boundaries around some aspects of illness, but not
others, gestures toward Squiers observation about things that cant
be said in narratives of illness. Some things cant be said not only
because of their resistance to verbal representationaccording to
Elaine Scarrys theorization of pain, for instance, as actively erasing
language13but because of the cultural stigmatization and censorship of the embodied experience of illness, which is often deemed,
in Smith and Watsons words, abnormal, aberrant, or in some sense
pathological. In her study of womens graphic narratives, Hillary Chute argues that comics not only provoke us to think about
how women, as both looking and looked-at subjects, are situated
in particular times, spaces, and histories, but also to rethink the
dominant tropes of unspeakability, invisibility, and inaudibility that
have tended to characterize trauma theory as well as our current
censorship-driven culture in general.14 Graphic memoiror what
Martha Stoddard Holmes has recently called graphic body studies, a
term that signals the intersection of illness and disability studies
12. Susan M. Squier, Literature and Medicine, Future Tense: Making it Graphic, Literature and Medicine 27:2 (2008): 124152, quote on p. 131 (emphasis in original).
13. Elaine Scarry, The Body in Pain: The Making and Unmaking of the World (New York:
Oxford University Press, 1985).
14. Hillary L. Chute, Graphic Women: Life Narrative and Contemporary Comics (New York:
Columbia University Press, 2010), pp. 23.

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with the visual-verbal genre of comics15accordingly pushes us to

attend differently and more closely to the relationships that exist
among embodied trauma, narrative, and visuality.
Cartoonists Marchetto and Engelberg were both in their forties
when they were diagnosed with early-stage breast cancer. The differences between the graphic memoirs that recount their experiences
are manifold, but the most important of these differences, I suggest,
hinge on the trauma of metastasis. In Cancer Vixen, which a New York
Times review characterized as unflaggingly perky, ebullient, and
fun,16 Marchetto, a New York City socialite and self-proclaimed
fabulista, tells the story of her disease from diagnosis to recovery,
emphasizing cancers cosmetic challenges, particularly those that
magnify her competition with the other Manhattan women who
vie for the affections of her restaurateur fianc (later husband). Cancer Vixen exemplifies what Couser identifies as the problem of the
generic convention of the comic master plot in breast cancer narratives: the linear diagnosis-to-recovery trajectory suggests a kind
of closure that might be narratively satisfying, but ultimately disingenuous. Because breast cancer is rarely considered cured, because
having had almost always means being susceptible to recurrence,
being constantly vigilant, he notes, the retrospective closed-end
autobiographical narrative is always somehow false to the experience.17 As an autopathographer in remission, Marchetto offers her
readership a kind of reflectivity that distances the experience of disease.
Breast cancers resistance to narrative closure because of its possibility of metastasizing many years after its diagnosis renders it a
difficult disease to fit into the generic confines of the comic plot, as
Couser has observed. Engelberg, whose Stage 2 cancer metastasizes
to her bones and brain two years after her initial diagnosis, accordingly cannot tell the kind of story that Marchetto does. Cancer Made
Me a Shallower Person is not a strictly linear graphic narrative, then,
but rather a series of titled vignettes about the diagnosis, treatment,
recovery, and, ultimately, re-diagnosis of breast cancer. While Engelbergs memoir moves with a roughly chronological temporal trajectory, its end point of metastasis, rather than a return to health and
15. Martha Stoddard Holmes, Cancer Comics: Narrating Cancer through Sequential
Art, Tulsa Studies in Womens Literature 32:2 (2014), p. 147.
16. Ariel Levy, Sick in the City, New York Times, October 22, 2006. http://www.ny
times.com/2006/10/22/books/review/Levy.t.html.
17. G. Thomas Couser, Recovering Bodies: Illness, Disability, and Life Writing (Madison:
University of Wisconsin Press, 1997), pp. 183, 44.

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159

normalcy, highlights the diseases complicated, and terrifying, relationship to temporality.

The intermediate and indeterminate spaces of illness frustrate the
kind of dichotomizing categorization that tends to mark the breast
cancer memoir: their classification as either narratives of triumph or
narratives of declension. Furthermore, narratives that forefront metastasis and other graphic, embodied effects of breast cancer disrupt
another of the diseases mythologies: that the changes it wreaks on
the body are primarily cosmetic. Here, I examine the ways in which
Marchetto and Engelberg use the graphic memoir to chart embodied
change during the experience of breast cancer. Marchetto presents
her cancer as an interruption in the pursuit of somatic perfection
an endeavor in diet, exercise, and cosmetic accessorization that
seems like a near-Darwinian necessity in the cutthroat class climate
of a fashion-mad New York City. For Engelberg, on the other hand,
breast cancer occasions confusion about what the body signifies; she
no longer knows how to accurately read her own embodiment.
I begin by situating the breast cancer graphic memoir within the
theoretical contexts of graphic narrative and autopathography, before moving on to readings of Marchettos and Engelbergs graphic
memoirs. In my analysis of these texts, I explore the dual issues of
generic emplotment and what Elisabeth El Refaie calls pictorial
embodimentthe process of engaging with ones own identity
through multiple self-portraits.18 Ultimately, I argue that the medium of the graphic illness memoir, or autopathographics, can work
to challenge the master plot of survival that has circulated as part
of breast cancer culture for the past thirty years. Graphic narratives
and digital media offer new possibilities for women to represent the
embodied changes occasioned by cancer in ways that register the
uncertainty of the diseases temporality in the face of metastasis and
terminal illnesspart of breast cancers epidemiological narrative
that is too often ignored.

Autopathographics
In their study of womens visual/textual autobiographical practices, Smith and Watson have notably addressed two widely held
suspicions about womens recourse to the autobiographical in visual and performance mediasuspicions that Keller mobilizes in
her Guardian article: that it is a transparent mirroring and that it
is narcissistic self-absorption. As Smith and Watson remind us,
18. Elisabeth El Refaie, Autobiographical Comics: Life Writing in Pictures (Jackson: University Press of Mississippi, 2012), p. 51.

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the life narrative is not a mimetic representation of lived experience, nor is it necessarily an exercise in self-aggrandizing egotism.
As a moving target, a set of shifting self-referential practices, they
write, autobiographical narration offers occasions for negotiating
the past, reflecting on identity, and critiquing cultural norms and
narratives.19 These shifting self-referential practices become increasingly complicated when applied to the sick and dying selfa
self whose embodied figuration changes in often rapid, drastic, and
unpredictable ways during the vicissitudes of illness and treatment.
In pathographic narratives, as Hawkins has observed, the reader is
repeatedly confronted with the pragmatic reality and experiential
unity of the autobiographical self.20 Further, the relationship between self and body, or self as body, is a concern that underscores
autopathography. As Frank asks: Is my body the flesh that I, the
cognitive, ethereal I, only happen to inhabit, or is whatever I am
only to be found as my body? Do I have a body, or am I a body?21
In Teratologies: A Cultural Study of Cancer, Jackie Stacey highlights
the identity-bending dilemma of cancer, in particular that cancer
is the self at war with the self. Thus, surely ones identity is at stake
(on trial?) with the onset of such a disease.22 Such intimations of
ontological (and oncological?) multiplicity suggest that autopathography is always-already a vexed endeavor.
Autopathography may be a relatively contemporary critical term,
but the illness narrative itself is hardly a new genre. Writers like Harriet Martineau and Alice James cataloged their afflictions long before
the advent of the blogosphere; we might consider Keatss canon a
poetic series of proto-deathbed selfies. In her 1926 On Being Ill, Virginia Woolf reflected on the relationship between autobiographical
self-representation and the embodied realities of illness: There is,
let us confess it (and illness is the great confessional), a childish outspokenness in illness, she wrote; things are said, truths are blurted
out, which the cautious respectability of health conceals.23 Indeed,
the Kellers criticize Adams for precisely this kind of confessional
excess, one that they struggle to apprehend from subject positions
19. Sidonie Smith and Julia Watson, eds., Introduction: Mapping Womens SelfRepresentation at Visual/Textual Interfaces, in Interfaces: Women, Autobiography, Image,
Performances (Ann Arbor: University of Michigan Press, 2002), pp. 89.
20. Hawkins, Reconstructing Illness (above, n. 8), p. 17.
21. Frank, Wounded Storyteller (above, n. 7), p. 33 (emphasis in original).
22. Jackie Stacey, Teratologies: A Cultural Study of Cancer (London: Routledge, 1997), p.
63 (emphasis in original).
23. Virginia Woolf, On Being Ill (Ashfield, MA: Paris Press, 2002), p. 11.

Waples/Breast Cancer Autopathographics

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couched in the cautious respectability of health. The disjunction

between the worlds that Susan Sontag famously demarcated as the
kingdom of the well and the kingdom of the sick24 can inspire
an uncomfortable visual relationship, as Emma Keller suggests. The
2005 Canadian television series Terminal City has riffed on this idea
of pathological voyeurism: its breast-cancer-patient protagonist is
offered a reality television series catering to an audience that is morbidly eager to witness her sickness.
As a confessional genre, autopathography inspires the kind of
critiques that hark back to the mid-twentieth-century confessional
poetry movement, which blurred the boundaries between the lyric
I and the autobiographical I. And confessionalism can prove
unpalatable. In a 2011 essay in the New York Times Book Review, for
instance, Neil Genzlinger elegized what he called the lost art of
shutting up in relation to autobiographical practice. Memoirs,
he complained, have been disgorged by virtually everyone who
has ever had cancer, been anorexic, battled depression, lost weight.
Accordingly, Genzlinger advocated a tightening of boundaries for
memoirists and their subject matter, offering a few words of advice
to would-be memoirists: No one wants to relive your misery.25
As Rita Felski observes in her essay On Confession, the feminist
adoption of the confessional mode is marked by a tension between
a focus upon subjectivity and a construction of identity which is
communal rather than individualistic. It thus becomes necessary, she argues, to differentiate feminist confessional discourse
from the more general fascination with self-awareness in modern
society.26 Autopathography, then, must be considered in relation to
the shifting cultural, scientific, and literary contexts of its production and consumption; as Hawkins reminds us, illness in pathography is always experienced in relation to a particular configuration
of cultural ideologies, practices, and attitudes. As these narratives
are situated within the social praxis of modern medicine,27 they
operate as commentary on the ill subjects relationship to the taxonomic and disciplinary forces of the medical discourse, per Foucaults theorization of the rise of clinical medicine in the nineteenth
century, during which the relation between the visible and the
24. Susan Sontag, Illness as Metaphor (London: Penguin, 1991), p. 1.
25. Neil Genzlinger, The Problem with Memoirs, New York Times, January 28, 2011.
http://www.nytimes.com/2011/01/30/books/review/Genzlinger-t.html?pagewanted=all.
26. Rita Felski, On Confession, in Women, Autobiography, Theory: A Reader, ed. Sidonie
Smith and Julia Watson (Madison: University of Wisconsin Press, 1998), p. 92.
27. Hawkins, Reconstructing Illness (above, n. 8), p. 18.

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invisible which is necessary to all concrete knowledge changed its

structure, revealing through gaze and language what had previously
been beyond their domain. Accordingly, Foucault insists, we must
re-examine the original distribution of visible and invisible, insofar
as it is linked with the division between what is stated and what
remains unsaid.28 Autopathographics, in particular, alert us to this
discursive schism, as it simultaneously highlights the division between what is depicted and what remains unseen.
Autopathography became a well-established mode for American
memoir in the wake of events like the womens health movement
of the 1970s and the AIDS crisis of the 80s. Exemplified by texts
such as Paul Monettes Borrowed Time (1988), Anatole Broyards Intoxicated By My Illness (1992), and Lucy Grealys Autobiography of a
Face (1994), twentieth-century illness narratives respond to the Foucauldian medical gaze by concomitantly offering what Couser
identifies as a form of counterdiscourse. Breast cancer narratives
have become a particularly visible iteration of the autopathographical genre in the course of the past three decades; in his 1997 study
of illness narratives, Couser marked the emergence of breast cancer narratives as a distinctive, significant, and quite coherent new
subgenre of American autobiography, dating the emergence of this
subgenre to the 1970s and 80s, when various forcesespecially
the womens movementtransformed breast cancer from a private,
even shameful, ordeal into a publicly narratable crisis.29 Indeed, it
is by now a platitude to note that since the institution of National
Breast Cancer Awareness Month in 1985, breast cancer has become
a public disease.
Audre Lordes personal and political account of breast cancer,
The Cancer Journals (1980), is widely cited as the diseases seminal
feminist textone that, as Felski writes, exemplified the continuing importance of confessional writing as long as privatized areas
of shame, fear, and guilt continue to exist in womens lives.30 For
Lorde, visibility is particularly at stake here: If we are to translate the
silence surrounding breast cancer into language and action against
this scourge, she famously asserts, then the first step is that women
with mastectomies must become visible to each other. For silence and
invisibility go hand and hand with powerlessness.31 Contemporary
28. Michel Foucault, The Birth of the Clinic, trans. A. M. Sheridan Smith (New York:
Pantheon Books, 1973), pp. xixii.
29. Couser, Recovering Bodies (above, n. 17), pp. 27, 76, 39.
30. Felski, On Confession (above, n. 26), p. 93.
31. Audre Lorde, The Cancer Journals (San Francisco: Aunt Lute Books, 1980), p. 61
(emphasis added).

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feminist critiques of the diseases presence in the public sphere note

that the problem is, somewhat paradoxically, no longer the issue of
its invisibility, but indeed its hypervisibility. Lordes call for the politicization of breast cancer has been mourned by critics of the diseases
relentless sentimentalization and commercialization in the public
sphere, exemplified by the twenty-first-century crisis of pinkwashing32 in what Barbara Ehrenreich has christened the cancer industrial complex: the multinational corporate enterprise that with
the one hand doles out carcinogens and disease and, with the other,
offers expensive, semi-toxic pharmaceutical treatments.33
In her recent study of postmillennial autobiographical breast cancer narratives, Mary DeShazer argues that such texts constitute a
distinct testimonial and memorial tradition whose aims and strategies should circulate along other cultural projects of memory such
as the AIDS memorial quilt.34 Breast cancer narrativesverbal and
visual representational modes that DeShazer collects under the generic heading of her eponymous neologism mammographiesindeed dominate the autopathographical marketplace in multifarious
forms, from traditional print memoir to digital and visual media. Yet
some consumers of the genrelike Emma Kellerhave spoken back
to the autopathographical influx, questioning the extent to which
illness and death are, or should be, publicly narratable.
How, then, do graphic memoirs satisfy what Ellen Leopold calls
the appetite for breast cancer narratives35 in the post-awareness
era while simultaneously negotiating the politics of the visual in a
culture that incessantly censors womens bodies as graphic material? Critics of life narrative, as Gillian Whitlock and Anna Poletti
explain, are now called upon to develop more advanced visual and
cultural literacies to interpret the intersections of various modes and
media and the complex embodiments of avatar, autobiographer, and
reader/viewer gathered under the sign of autographics.36 Whitlock
32. The term pinkwashing was coined by the advocacy organization Breast Cancer Action to refer to companies that fundraise for breast cancer, while simultaneously marketing products that contain toxins linked to the disease. See Gayle Sulik, Pink Ribbon
Blues: How Breast Cancer Culture Undermines Womens Health (New York: Oxford University Press, 2011), p. 370.
33. Barbara Ehrenreich, Welcome to Cancerland, Harpers, November 2001, p. 52.
34. Mary K. DeShazer, Mammographies: The Cultural Discourses of Breast Cancer Narratives
(Ann Arbor: University of Michigan Press, 2013), p. 2.
35. Ellen Leopold, A Darker Ribbon: Breast Cancer, Women, and Their Doctors in the Twentieth Century (Boston: Beacon Press, 1999), p. 254.
36. Gillian Whitlock and Anna Poletti, Self-Regarding Art, Biography 31:1 (2008): v
xxiii, quote on p. vi.

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employs the term autographics in order to draw attention to the

specific conjunctions of visual and verbal text in this genre of autobiography, and also to the subject positions that narrators negotiate
in and through comics.37 Autographic criticism thus emerges at generic intersectionsbetween, for instance, narrative theory and visual culture studiesthat must also consider the cultural context of
graphic memoirs reception. The genre of womens autobiographical
comics, as Chute notes, has been repositioned over the past thirty
years from an underground genre to a popular onemuch as breast
cancer itself has transformed from a private disease to a pop-cultural
phenomenon wherein the pink ribbon has become an iconic symbol with the ideological power to turn breast cancer into a brand
name with a recognizable logo.38 Critical attention to the graphic
narrative during the latter part of the twentieth century and the
early part of the present one demonstrates an evolving conversation on the visual politics of comics, one that can help to illuminate
the graphic ideologies of genre that we might, riffing on Whitlock,
deem autopathographics.39
Critics like Smith, Jo Anna Isaak, and Stella Bolaki have attended
to the use of photography in the self-documentation of breast cancer by artists, including Jo Spence, Matuschka, Deena Metzger, and
Hannah Wilke; the baring of the mastectomy scar, in particular, has
become a kind of primal image, following the circulation of images like Hella Hamids Warrior photograph of the bare-chested
Metzger, and Matuschkas 1993 self-portrait Beauty Out of Damage.40 More recently, David Jays 2011 photographic exhibition The
SCAR Project has documented the embodied experience of women
37. Gillian Whitlock, Autographics: The Seeing I of the Comics, Modern Fiction Studies 52:4 (2006): 965979, quote on p. 966.
38. Sulik, Pink Ribbon Blues (above, n. 32), p. 9.
39. See, for example, Will Eisner, Graphic Storytelling and Visual Narrative (Tamarack, FL:
Poorhouse Press, 2004), and Comics and Sequential Art: Principles and Practice of the
Worlds Most Popular Art Form (Tamarac, FL: Poorhouse Press, 2004); Scott McCloud,
Understanding Comics: The Invisible Art (Northampton, MA: Tundra Publishing, 1993);
W. J. T. Mitchell, Picture Theory: Essays on Verbal and Visual Representation (Chicago:
University of Chicago Press, 1994); and Roger Sabin, Comics, Comix and Graphic Novels:
A History of Comic Art (London: Phaidon Press, 2001).
40. See Sidonie Smith, Subjectivity, Identity, and the Body: Womens Autobiographical Practices in the Twentieth Century (Bloomington: Indiana University Press, 1993); Jo Anna
Isaak, In Praise of Primary Narcissism: The Last Laughs of Jo Spence and Hannah
Wilke, in Interfaces (above, n. 19), pp. 4968; and Stella Bolaki, Re-Covering the
Scarred Body: Textual and Photographic Narratives of Breast Cancer, Mosaic 44:2
(2011): 117.

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under age 40 by showcasing the scars of mastectomies and reconstructive surgeries. For these young women, he writes, having
their portrait taken seems to represent their personal victory over
this terrifying disease. It helps them reclaim their femininity, their
sexuality, identity and power after having been robbed of such an
important part of it.41 As a documentary endeavor, The SCAR Project
raises a host of questions about the politics of the gaze, as a male
photographer deigns to mediate his subjects path to reclaim[ing]
their femininity. Jays photographs, moreover, gained special notice in 2013 when they became the focus of a Facebook censorship
battle. In response to a Change.org petition to Facebooks CEO
and COO, Mark Zuckerberg and Sheryl Sandberg, respectively, the
social-media site ultimately modified its Warning and Blocks
feature to reflect the position that the vast majority of [postmastectomy photos] are compliant with our policies, qualifying
that photos with fully exposed breasts, particularly if theyre unaffected by surgery, do violate Facebooks Terms.42 According to
Facebooks statement, post-mastectomy photos are acceptable insofar as they serve to raise awareness, but tread the blurred line
of graphic content. Autopathographic narratives by breast cancer
patients who document the changes wrought on their own bodies,
as we shall see, raise a different set of critical concerns about agency,
authority, and graphicity.

Cancer Vixen: Cosmetics, Prosthetics, and (Self-)Awareness

Marchetto begins her graphic memoir with a question to which her
readers can most likely infer the answer: What happens, she asks,
when a shoe-crazy, lipstick-obsessed, wine-swilling, pasta-slurping,
fashion-fanatic, single-forever, about-to-get-married big-city girl cartoonist (me, Marisa Acocella) with a fabulous life finds: A LUMP IN
HER BREAST?!?43 She kicks its ass, of courseand does so in killer
five-inch heels, per the books cover illustration of Marchettos ava41. David Jay, The SCAR Project, 2011. http://www.thescarproject.org/mission/. Jays
photographic exhibition is accompanied by a book, The SCAR Project: Breast Cancer Is
Not a Pink Ribbon (East Greenwich, RI: The SCAR Project, 2011), as well as a documentary film directed by Patricia Zagarella, Baring It All (2011).
42. Does Facebook Allow Post-Mastectomy Photos? 2014. https://www.facebook.
com/help/318612434939348/. See the full text of the petition by Susan (Scorchy)
Barrington at http://www.change.org/petitions/facebook-stop-censoring-photos-of
-men-and-women-who-have-undergone-mastectomies.
43. Marisa Acocella Marchetto, Cancer Vixen: A True Story (New York: Alfred A. Knopf,
2006), p. 1. Further references will be cited parenthetically in the text.

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tar, blonde and Barbie-thin, midkarate kick in Christian Louboutin

stilettos. Throughout her text, Marchetto confronts her personified
cancerrendered throughout as a cartoonish Grim Reaperwith
a sassy defiance worthy of her eponymous epithet. When, postdiagnosis, she indulges in a brief bout of desperation and self-pity,
she takes to heart the critique offered by a friend: Instead of changing your mindset, he suggests, change that outfit! Sweatpants?
Sneakers? Youre the daughter of a shoe designer. You look like a
victim, he admonishes her. Wheres my vixen? (p. 106).
Introducing this archetypal antithetical pairing, Marchetto seems
to gesture toward a vague postfeminist girl power ideology of
self-empowerment: a backlash against so-called second-wave victim feminism.44 Indeed, postmillennial breast cancer narratives like
Geralyn Lucass Why I Wore Lipstick to My Mastectomy abound with
feel-good triumphalism, resulting in the compulsory repetition of
a heteronormative paradigm, most often as the result of cosmetic
modification.45 David Morris, responding to the stigmatization of ill
subjects as erotically void, has praised Marchettos vixen persona,
arguing that it replaces sexless stereotypes of the patient.46 At the
same time, Cancer Vixens (re-)sexualization of the breast cancer patient can be seen to reinforce what S. Lochlann Jain has called the
relentless hyper- and heterosexualization of the disease, which results in something of a recursive process through which gender is
produced and policed.47
Jains critique of contemporary breast cancer culture joins a host
of postmillennial feminist scholarship that waxes nostalgic for
Lorde, using her Cancer Journals as the text by which any womans
narrative of breast cancer must be measured. Under this rubric, then,
Cancer Vixen fails its feminist readership; Marchettos insistence on
44. While such critiques of a victim subject position appeal to the myth of rugged
individualism, the belief that anyone can overcome obstacles and succeed in American
society, as Carolyn Sorisio notes, such an approach often obscures the true dynamics
of power and absolves responsibility. See Sorisio, A Tale of Two Feminisms: Power
and Victimization in Contemporary Feminist Debate, in Third-Wave Agenda: Being
Feminist, Doing Feminism, ed. Leslie Heywood and Jennifer Drake (Minneapolis: University of Minnesota Press, 1997), p. 141.
45. For further discussion of postfeminist breast cancer narratives, see Emily Waples,
Emplotted Bodies: Breast Cancer, Feminism, and the Future, Tulsa Studies in Womens
Literature 32:2 (2014), p. 4750.
46. David B. Morris, Un-Forgetting Asclepius: An Erotics of Illness, New Literary History 38:3 (2007): 419441, quote on p. 436.
47. S. Lochlann Jain, Cancer Butch, Cultural Anthropology 22:4 (2007): 501538,
quote on p. 506.

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reproducing iconic, heteronormative femininity with commodities and cosmetics seems directly antithetical to Lordes critique of
socially sanctioned prosthesisa category that includes both literal post-mastectomy prostheses and the kinds of cosmetic modification promoted by the Look Good Feel Better program. Lordes
call for women with breast cancer to become visible in the public
sphere hinged on the argument that such prosthetic imperatives are
merely another way of keeping women with breast cancer silent
and separate from each other, as the embodied realities of breast
cancer become subject to a wide-scale social erasure.48
However, the question remains as to whether Lordes legacy offers the most productive model for approaching breast cancer in
the post-awareness era. Diane Price Herndl, for instance, a selfidentified feminist critic and breast cancer patient, has examined
her own anxiety of not living up to Audre Lordean apt encapsulation of the quandary facing generational feminism. Arguing that
contemporary feminist scholarship must find new ways of engaging the vexed relationship between breast cancer and embodiment,
Herndl ultimately concludes that, in the age of digital simulacra and
the posthuman, we have come to think about bodies differently,
to see bodies as produced, as, in fact, forever alien to ourselves. Accordingly, she continues, feminism must find a way to understand
the difference between a postmodern, posthuman view of the body
and an earlier feminisms view without having to regard either as
entirely wrong. Each is historically situated, responding to different
cultures, different crises in womens embodiment.49
To what kind of crisis in embodiment, then, might Cancer
Vixen be understood to respond? One way in which we can approach this question is by considering the conflation between the
medical and cosmetic connotations of treatmenta plurality
that Marchetto gestures toward in the illustration of her memoirs
front page: her avatar sits in a hospital chair, simultaneously receiving chemo and applying Viva Glam lip gloss. Later, in preparation for her wedding party, Marchetto writes of getting manicured...brow-waxed...beamed...blonded...and outfitted,
as if being beamedthat is, irradiatedis merely another step
in her cosmetic regimen (p. 198). On the one hand, including ra48. Lorde, Cancer Journals (above, n. 31), p. 16.
49. Diane Price Herndl, Reconstructing the Posthuman Feminist Body Twenty Years
after Audre Lordes Cancer Journals, in Disability Studies: Enabling the Humanities, ed.
Sharon L. Snyder, Brenda Jo Brueggemann, and Rosemarie Garland-Thomson (New
York: MLA, 2004), pp. 144, 153.

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diation therapy in this catalog of treatments seemingly trivializes

the purview of therapeutic medicine; on the other, Marchettos irreverence indexes a particular affective relationship to the medicalindustrial complexof ordinariness, even boredomthat seemingly rankles critics like the Kellers, who, while deigning to critique
Adamss self-publicity, circuitously critique the medium through
which she achieves this publicity. Social mediablogs, Facebook
pages, and Twitter feeds, which so often serve as catalogs of minutiaerender illness and death discomfitingly common.
The medium of comics also, as Chute notes, once a countercultural vehicle, has become mainstream, burdened with associations
of pop-cultural triviality: The underground does not exist anymore;
it collapsed, most agree, in the 1980s, if not well before.50 Dating
the death of the underground to the era in which the breast cancer
awareness was born, we might thus see how texts like Cancer Vixen
respond to the historical contingencies of their production. Any critique of Cancer Vixen must beg the question: How can a breast cancer graphic memoir be countercultural when both the disease and
the medium are inescapably implicated in the mainstream?
In her review of Marchettos memoir, Chute deems Cancer Vixen
an irritating book, citing its obsession with brand names, skinniness, and the ins and outs of New York celebrity/media culture,
overloading the text with superficiality and cuteness. Chutes critique registers the abrasiveness of Marchettos fabulista persona:
her incessant self-positioning as the Carrie Bradshaw of the chemo
ward. Beyond this cuteness, however, Chute qualifies, the book
deploys its visual form in a way that demonstrates what a visualverbalas opposed to simply verbaltext can do. For example, she
notes that Marchettos depiction of the core biopsy needle, demonstrating its actual size in comparison to the aspirator needle, offers the reader hard, valuable informationand the presentation is
not disruptive or didactically discordant here, but flows easily in the
comics format.51 The visual nature of the narrative, in other words,
allows multiple discursive modes to coexist. For instance, Marchetto
includes the image of her initial breast ultrasound on the opening
page of her memoir; another panel of comics are placed over a reproduction of her pathology report, juxtaposing clinical discourse
50. Chute, Graphic Women (above, n. 14), pp. 15, 26.
51. Hillary Chute, Our Cancer Year, and: Janet and Me: An Illustrated Story of Love and
Loss, and: Cancer Vixen: A True Story, and: Moms Cancer, and: Blue Pills: A Positive Love
Story, and: Epileptic, and: Black Hole. Literature and Medicine 26:2 (2007): 413429,
quotes on pp. 41617.

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with her own visual idiom (p. 123). Such juxtaposition gestures to
the notion that multiple narratives of breast cancer exist in an array
of often interpenetrating discursive configurations.
In many ways, the graphic narrative brings the matter of embodiment to the fore. Readers of autographics are reminded of the narrators subjectivity not only by the continuity of the I, but by the
continuity of the avatar: a perpetually reproduced image of the embodied self. As El Refaie has observed, [g]raphic memoirists are in
the unusual position of having to visually portray themselves over
and over again, often at different ages and stages of development,
and in many different situations. Thus, all autobiographical comics
artists are, in the course of their work, constantly being compelled
to engage with their physical identities. The repeated representation of the avatar what she calls pictorial embodimenthighlights this engagement with an identity based in corporeality.52
What might seem striking about Marchettos avatar in Cancer Vixen,
then, is how little it changes during the course of her disease. Marchettos memoir may, in Chutes terms, present hard, valuable information for her readership insomuch as her depictions of medical apparatuses like biopsy needles conform to the representative
dictates of reality, and yet Marchetto assumes considerably more
artistic license with her own self-representation. If the postmodern body can be understood to be what Susan Bordo calls cultural
plastica term that responds, she explains, to the fantasy of defying the historicity, the mortality, and, indeed the very materiality of
the body53then the avatar might be understood, for Marchetto,
as a kind of imaginative dissociation from historicity, mortality, and
materiality.54
52. El Refaie, Autobiographical Comics (above, n. 18), p. 62 (emphasis in original).
53. Susan Bordo, Unbearable Weight: Feminism, Western Culture, and the Body (Berkeley:
University of California Press, 1993), pp. 246, 25.
54. Texts like Cancer Vixen can be seen to reenact what Lauren Berlant calls the central
fantasy of womens culture: the constantly emplotted desire of a complex person to
rework the details of her history to become a vague or simpler version of herself, usually in the vicinity of a love plot. As Berlant and others have noted, however, paradoxically, even as we may critique the operations of such narratives, we maintain our
affective attachments to them. Exploring the operations of a gendered survival subculture in the United States, Berlant argues that [i]n the face of the dissolution of U.S.
history by the mass culture that represents its modernity, survival seems to her like an
important victory over nature and nationality, a vital form of historicity, and material
for a critical Americana. A culture of sentimentality, in Berlants terms, affords the subject a way to endure the modern conditions of identity formation, in which the stereotype, the commodity, and the history of collective pain establish a juxtapolitical

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The immutability of Marchettos avatar visually manifests her

professed refusal to look like a victim: indeed, for her, any intimation of embodied changethe realization, for instance, that she
may gain weight on the treatmentresults in the exclamatory panic
of a Cathy cartoon. Having opted for chemo light, she does not
lose her hair; as she explains to her oncologist, [m]y husband owns
a restaurant where the most beautiful women go and I cant look
like crap! And I will kill myself if I lose my hair! (p. 132). While she
briefly grieves that she will not be able to conceive children due to
her five-year Tamoxifen treatment, the dismay over this embodied
change appears momentary and seemingly secondary to hair loss.
The one physical change that Marchetto depicts on her avatars
body is a relatively minor one: a bout of stress-induced eczema. I
woke up stippled, she writes, looking like a Mankoff cartoon. In
the following frame, she picks up the telephone, crying, I need to
see the doctor ASAP! (p. 101). Marchetto does not run to the doctor
when she discovers the lump in her breast; the cosmetic tragedy of
red, blotchy skin, on the other hand, prompts her to seek immediate
medical attention. Moreover, wryly describing herself as a creation
of Bob Mankoffcartoon editor of the New Yorker, a venue in which
she had previously published her workMarchetto signals the way
in which loss of control over her body comes concomitant with loss
of control over her narrative. Here, she has become the subject of
someone elses cartoon. In order to assert authority over both her
body and her narrative, Marchetto must become another kind of
subject, thenthe subject of a Marchetto cartoon.
The narrative trajectory of this subject, however, has already been
iterated by what Ehrenreich has famously called the breast cancer
cult in which women are compelled to reproduce a culturally emplotted narrative of survival. She argues that these narratives serve
as testimonials and follow the same general arc as the confessional
autobiographies required of seventeenth-century Puritans, narratives that move toward the blessed certainty of salvation, or its
breast-cancer equivalent, survivorhood.55 Cancer Vixen, however,
perhaps more recognizably reflects another prominent American
narrative model: the secular autobiographical Bildungsromanone
that, per Franklin, champions the radical individualism of the inimage of democratic mass culture. See Berlant, The Female Complaint: The Unfinished
Business of Sentimentality in American Culture (Durham, NC: Duke University Press,
2008), pp. 7, 9798.
55. Ehrenreich, Welcome to Cancerland (above, n. 33), p. 50.

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dustrious democratic citizen. Contemporary breast cancer narratives

posit the survivor as the paradigm American entrepreneur who
achieves survival status through toughness, optimism, and attitude.
For memoirists like Marchetto, the salvation of survival occurs not
through the intervention of an external recuperative forcesuch as
Gods contemporary secular equivalent, scientific medicinebut instead is seen to stem from within: the will to survive.
Despite its seeming self-assertion as an exercise in radical individualism, Marchettos memoir is, in fact, preoccupied with othersspecifically, with other women. In order to analyze the ways
in which Marchetto represents her own body via the medium of
graphic memoir, then, it becomes necessary to consider the ways
in which she depicts the host of women with whom she is in constant contact and competition. Marchetto situates herself as an object of gossip on what she calls the sour grapevine (p. 50): a cabal
of young, ultra-thin, uberfashionable New Yorkers who frequent
the upscale Greenwich Village restaurant that her fianc owns and
operates. Marchettos depiction of the sour grapevine as a cluster
of glaring green faces harks back to her initial illustration of possible cancer cells, an artists rendition (p. 4): green faces with lolling
tongues and rebelliously raised middle fingers. Both, she suggests,
are toxic: These stick figures, she complains, are always hitting on
my husband (p. 166). By describing these hypersexualized twentysomethings as stick figures, Marchetto not only hypberbolizes the
simulation of an idealized body type, but positions other womens
bodies in a rhetorical context that she is accustomed tocartooning. Accordingly, she elects to combat the despair of comparison
by imaginatively manipulating her competition, figuratively Photoshopping their bodies to transform them into glaring Gumbies
(p. 174).
Post-diagnosis, Marchetto finds herself amid a community of
women who are linked not by mutual lifestyle aspirations, but
rather by mutual diagnoses; representing these women, however,
comes less easily. In the waiting room during her first appointment
with the doctor whom she deems the it oncologist, she works on
cancer-cartooning, depicting a bald-headed woman who says Im
having a bad wig day. When, moments later, a bald woman walks
through the waiting room, Marchetto is taken aback; she depicts
herself gasping and covering her eyes while her mother notes, [i]ts
different when you see it (p. 108). Seeing evidence of cancer on
other womens bodies, Marchetto recoils. Accordingly, she does
not (in the model of many other breast cancer memoirs) seek out a

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community of fellow patients with and through whom she can

make sense of her experience.56 Her brief interaction with another
patient in the cancer clinic centers on commodities, as a sunkeneyed young woman momentarily brightens to exclaim, Oh, I love
your shoes! (p. 160).
Inasmuch as Marchetto aims to delineate herself as an outsider
to both groupsself-segregated from both the victim position of
patienthood and from the prevailing milieu of urban superficialityshe also reminds us that she has arrived at the subject position
of outsider with a certain deliberateness. As she informs her readership early in her memoir, I wasnt always the self-aware narcissist
I am today (p. 12). Here, Marchetto marks her generic boundaries,
signaling her participation in a familiar master narrative of upward
mobility. Her tongue-in-cheek presentation of her narrative as a
journey toward self-awareness invokes the familiar jargon of both
self-help and breast cancer cultures, both of which hinge on a discourse of awareness.
Marchetto dramatizes her evolution to awareness in an illustration labeled B.C. (before cancer) in which she depicts herself as a
quintessential urban fashionista, in silver platforms, chasing a taxi.
An arrow directs the viewer to her avatars line-defined abs and jutting hipbones; Yes, she informs us, I really was this thin (p. 13).
Her B.C. avatar is dated August 2001; the still-standing twin towers
in the background gesture toward the significance of the date. I was
caught up in the superficial stupid stuff, Marchetto admits, and
back then, who wasnt? (ibid.). Here, she establishes the 9/11 terrorist attacks as shorthand for a crisis point in the development of
her own emotional maturitya rather narcissistic mapping of national tragedy onto the scope of her own narrative.57 At the same
time, Marchettos presentation of her self-professed superficiality in
her B.C. era and the pre-9/11 national ethos as concurrent raises
a parallel between the post-9/11 rhetoric of political vigilanceper
the Department of Homeland Securitys If You See Something, Say
Something public awareness campaignand the embodied vigilance of the breast cancer awareness movement, both of which play
on discourses of visual suspicion in order to enact a transfer of responsibility to the individual.
56. See, for example, Diane Price Herndl, Our Breasts, Our Selves: Identity, Community, and Ethics in Cancer Autobiographies, Signs: Journal of Women in Culture and Society 32:1 (2006): 221245.
57. The conflation of national and personal scales of violence and suspicion recur again
in Cancer Vixen when Marchetto admits to dreaming of being attacked by Al-Qaeda
during her treatment (p. 235).

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Later, Marchetto suggests that the collapse of the twin towers on

9/11 might have instigated a crisis of another kind: reflecting on
having inhaled the asbestos-laden air, she asks her diagnosing physician the number 1 question: Is that why I got CANCER?! (p.
32). Considering the confluence of environmental causes that have
been demonstrated to contribute to breast cancer risk, she offers a
brief glimpse of embodied change that is noncosmetic in nature:
the incorporation of environmental risk factors. Here, momentarily,
cancer is considered not only individually, but communally as Marchetto gestures toward what Rob Nixon has deemed the slow violence of environmental contamination.58 What the hell are we doing to ourselves? she asks, depicting herself sitting at her drafting
table while a crowd of imagined victims of environmental cancer
clusters implore Dont forget us! (p. 36).
If the graphic memoir, as Chute suggests, operates on an idiom
of witness, a manner of testifying that sets a visual language in motion with and against the verbal in order to embody individual and
collective experience, to put contingent selves and histories into
form,59 Cancer Vixen utilizes this idiom only briefly against a more
recognizable narrative of survival wherein the subjects ultimate
aim is reincorporation into a healthy society. With its institution of
the victim versus vixen paradigm, Cancer Vixen engages in a negotiation of the multiple meanings and narratives of breast cancer by
suggesting that the patient must locate herself as one archetype or
the other; indeed, Marchetto constantly presents gendered scenes
of doubling, from considering the oppositional figures of the Virgin Mary and Mary Poppins (whom she deems kind of a bitch [p.
70]), to illustrating her divided psyche as warring demonic and goddess characters (p. 121). In what follows, I turn to Engelbergs Cancer
Made Me a Shallower Person in order to consider the ways in which
autographics have also opened up space for breast cancer narratives
to express liminality, plurality, and ambivalence.

Cancer Made Me a Shallower Person: Memoir, Metastasis, and

the Path of Shallowness
They say hardship reveals ones true character, Engelberg writes
in her introduction to Cancer Made Me a Shallower Person, and it
was clear right away that I wouldnt be the heroic type of cancer

58. Rob Nixon, Slow Violence and the Environmentalism of the Poor (Cambridge, MA:
Harvard University Press, 2011).
59. Chute, Graphic Women (above, n. 14), p. 3 (emphasis in original).

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patient portrayed in so many television shows and movies.60 In

other words, her true character is not a characteror rather, a
caricature: the archetypal hero of what Frank calls the quest plot.
Like the cinematic protagonists Engelberg cites, the autobiographical narrators of quest stories, Frank explains, meet suffering head
on; they accept illness and seek to use it.61 If Engelberg has a quest
in her narrative of diagnosis, treatment, remission, and metastasis,
however, it is ultimately quixotic. When I was first diagnosed, she
reflects, I felt pressure to become someone differentsomeone nobler and more courageous than I was. Here, Engelberg notes the
pressure of the standard story of breast cancer: a narrative of personal growth and, ultimately, survival. While Marchetto also pokes
fun at this generic expectation by drawing attention to the scale of
her questusing her illness, in Franks terms, as a means to transition from ordinary narcissism to self-aware narcissismEngelberg instead admits to the complete lack of worldview-altering or
paradigm-shifting personal changes instigated by cancer. Instead, as
her title suggests, her narrative completely reverses the generic expectation of autopathography: maybe nobility and courage arent
the only approaches to life with an illness....Maybe the path of
shallowness deserves more attention! (p. xiii).
For Engelberg, the path of shallowness is paved with popcultural artifactsin particular, the TV Guide crossword puzzles that
allow her to achieve a kind of trivia Nirvana. This proves unpalatable for one Amazon.com reviewer, who pans her memoir because
it is not upbeat and not a funny book.62 The reviewer suggests
that Cancer Made Me a Shallower Person fails on two generic fronts:
as an autopathography, it does not provide a meaningful (and
upbeat) quest narrative; as a comic, it is not funny enough. I
would give this book five stars, another Amazon reviewer writes, if
it were not for the sad endingthe recurrence (and progression) of
the authors cancer. While this second reviewera self-identified
cancer patientsurely realizes that, as a memoir, the reality of the
sad ending is not within Engelbergs control, she rather takes issue with the iteration of this ending: All of us going through cancer
treatment, or just finishing, know that this possibility looms in our
60. Miriam Engelberg, Cancer Made Me a Shallower Person: A Memoir in Comics (New
York: HarperCollins, 2006). Further references will be cited parenthetically in the text.
61. Frank, Wounded Storyteller (above, n. 7), p. 115 (emphasis in original).
62. Peter Simon, Definitely Not Upbeat,Amazon.com, December 6, 2007. http://
www.amazon.com/Cancer-Made-Me-Shallower-Person/product reviews/0060789735
/ref=cm_cr_dp_qt_hist_one?ie=UTF8&filterBy=addOneStar&showViewpoints=0.

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future, the reviewer continues; [b]ut if you dont want to be reminded of it, this book is probably not for you.63
The master comic plot of survival placates audiences who dont
want to be reminded of the threat of recurrence that hovers over
every cancer narrative. Judy Segal has launched particularly trenchant critiques of this culturally reified comic plot; identifying Cancer Vixen as one such utterly conventional narrative, she argues
that [p]ersonal breast cancer stories are one means of producing
and maintaining ignorance about breast cancer.64 Elsewhere, she
has claimed that Engelberg also reproduces this generic conventionality, if not via the survival plot, then in tone: in promoting the
figure of the cancer-patient-with-a-sense-of-humor, [Cancer Made Me
a Shallower Person] shares some of the coercive quality of other cancer narratives. People, especially women, with cancer are exhorted
in public discourse to be positive, strong, attractive, sexyand
funny. Thus Engelbergs comics, Segal argues, do not, in fact, unsettle more typical stories so much as reinscribe them sideways.65
For Segal, Engelbergs sideways reinscription of the breast cancer narrative problematically reinforces the cancer-patient-with-asense-of-humor persona, if not necessarily the narrative trajectory
in which she is emplotted.66 For DeShazer, on the other hand, it
is precisely Engelbergs willingness to address metastasis from the
positionality of this persona that redeems it from the mantle of conventionality. Citing Freud on rebellious humor, DeShazer praises
Engelberg for choosing transgressive humor over tragic angst
as a method for her memoir. Themes of recurrence and metastasis rarely appear in humorous breast cancer memoirs, she notes,
since laughter is positioned culturally as a tool of the not-dying,
and death is nothing to laugh about.67 Engelbergs decision to thematize metastasis and death in a breast cancer memoir seems es63. C. Farrell, Mixed Feelings, Amazon.com, June 21, 2012. http://www.amazon.
com/Cancer-Made-Me-Shallower-Person/product-reviews/0060789735/ref=cm_cr_dp
_synop?ie=UTF8&showViewpoints=0&sortBy=bySubmissionDateDescending#R31KYR
QOVLONTB.
64. Judy Z. Segal, Breast Cancer Narratives as Public Rhetoric: Genre Itself and the
Maintenance of Ignorance, Linguistics and the Human Sciences 3:1 (2007): 323, quotes
on pp. 16, 4.
65. Judy Z. Segal, Cancer Experience and its Narration: An Accidental Study, Literature
and Medicine 30:2 (2012): 292318, quote on p. 294.
66. This persona seems to owe much to Gilda Radners account of her struggle with
ovarian cancer, Its Always Something (1989). Notably, Radner authored the memoir
when she believed she was in remission.
67. DeShazer, Mammographies (above, n. 34), pp. 108109.

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pecially transgressive, perhaps, considering the cultural currency of

the word survivora word that Engelberg interrogates in one of her
comics. In it, a doctor leans over the bed of a bald woman, beginning to pronounce her time of death. Wait! she cries. I have a few
more seconds to go. Im still a survivor!
Engelbergs memoir self-consciously responds to its generic
boundaries, acknowledging the ways in which both comics and cancer narratives face an impetus to be funny and upbeat. She then
tests these boundaries by mapping the comic cancer patient persona
onto the tragic plot of metastasisnot for the sake of rebelliousness,
I would suggest, but instead to extend the generic logic of the cancer
narrative into the murky and rather more uncomfortable territory of
metastatic disease. In so doing, Engelbergas evidenced by some of
her Amazon.com reviewslays bare the seeming incongruity of her
humor: her narrative brushes against the grain of the breast cancer
memoir precisely because metastasis has largely been excised from
the cultural narrative of the disease.68
With both image and text, as well as with the paratext supplied
by Engelbergs introduction, Cancer Made Me a Shallower Person announces its difference from the autopathographical plot, one that
tends to proceed with an optimistic chronology from diagnosis to
recovery. Indeed, even the texts lack of pagination disrupts the notion of narrative linearity. A number of topics or scenes appear in
nearly every [breast cancer] narrative, writes Couser, generally in
the same order. From the detection of the suspicious lump, to diagnosis, to treatment, to recovery and resolution in the form of favorable reports and restoration of (relative) peace of mind. Couser
accordingly observes that medical protocolsnot the progress of
the disease so much as the way in which it is detected, diagnosed,
and treatedwould seem to dictate the basic constituents of the
master plot.69 Rather than conform to the imperatives of this plot,
then, Engelberg presents a series of what might best be termed
sketchesin both the visual and narrative senses.
As artistic sketches, Engelbergs black-and-white illustrations offer
the impression of having been roughly and hastily produced. One
review of Cancer Made Me a Shallower Person, for instance, claims
that Engelbergs untutored, charmingly inept style lends an air of

68. In 2012, METAvivor Research & Support, Inc. launched the Elephant in the Pink
Room campaign in an effort to draw attention to metastatic breast cancer. See http://
mbcaware.org/.
69. Couser, Recovering Bodies (above, n. 17), p. 42.

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veracity to the work.70 Although Engelberg is indeed a self-taught

cartoonist, if she is charmingly inept, it is less in her style of cartooning than in her attempt to try on the persona of cancer patient.
Unlike Marchetto, she is not a professional cartoonist; neither, is
she a professional patient, inasmuch as she resists internalizing
the kind of chronic optimism that accompanies the cultural plot
of survivorship. The kind of competition that Engelberg faces, for
instance, is not, as in Cancer Vixen, a struggle for cosmetic supremacy; rather, she expresses a sense of inadequacy in the face of fellow
patients. I felt I wasnt keeping up with the Joneses, she writes,
noting the incessant cheerfulness that some of the women express,
while also lamenting, I was more depressed even before I had cancer!
Engelbergs sketched aesthetic not only suggests the makeshift,
chaotic, and haphazard nature of her experience with cancer, but
it lends a kind of iconicity to her drawings; her pictorial embodiment accordingly works to construct identification with her readership. DeShazer refers to Engelbergs avatar as the iconic Miriam,
a black-and-white line-drawn Everywoman.71 Indeed, as Whitlock
observes, glossing Scott McClouds argument in his influential Understanding Comics, iconic drawings of the human face are particularly powerful in promoting identification between reader/viewer
and image, and the more cartoonish (iconic) a face is, the more it
promotes association between the viewer and image.72 In her introduction, Engelberg writes of feeling different and aloneisolated
in a state of Miriam-ness that no one else experiences. Thats what
drew me to read autobiographical comics, she explains, and thats
why I hope my comics can be of comfort to other readers that might
be struggling with issues similar to mine (p. xiii). Her gestures, both
verbal and visual, toward commonality and mutual identification
differentiate her memoir from Marchettos, which insists on its isolation in a state of Marisa-ness, constantly highlighting specificity
of her situation with its self-aware narcissism.
From a narrative standpoint, Engelbergs vignettes allow glimpses
into isolated aspects of her experience, particularly as she attempts
to negotiate her nascent and discomfiting identity as a breast cancer
patient. Few of Marchettos cartoons in Cancer Vixen, on the other
70. Ian Williams, Cancer Made Me a Shallower Person: A Memoir in Comics, Graphic
Medicine (n.d.). http://www.graphicmedicine.org/comic-reviews/cancer-made-me-a
-shallower-person-a-memoir-in-comics/.
71. DeShazer, Mammographies (above, n. 34), p. 103.
72. Whitlock, Autographics (above, n. 37), p. 976.

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hand, can be taken out of context; rather, they exist in relation to

the chronology of her narrativea survival plot progressing from
diagnosis to recovery. Engelbergs comics present a trenchant critique of the ways in which breast cancer is commonly emplotted:
When someone goes through hard times, friends will say, You
can get through this. This implies a temporary state, like a Lifetime
made-for-TV-movie scenario, where the heroine comes out stronger
in the end. Engelbergs observation about the made-for-TV-movie
scenario proves to be a particularly apt assessment of breast cancers generic expectations: Lucass Why I Wore Lipstick to My Mastectomy was adapted into a Lifetime movie in 2006; Cancer Vixen is currently under production with HBO for a made-for-TV movie starring
Cate Blanchett. In the beginning of my relationship with cancer, I
too viewed it as something temporary, Engelberg admits. I had no
idea that it would become a constant presence (p. xii).
In Cancer Vixen, breast cancer is presented in various inimical
guises: a looming Grim Reaper, a cluster of vulgar green cells with
stuck-out tongues. For Marchetto, cancer is a villain with a thwarted
vendettaan external agency; for Engelberg, cancers agency is more
complex: it does not define her, but it becomes part of her; indeed,
she realizes, it is part of her. Like Marchetto, Engelberg appeals to
the idiom of witness in intimating the environmental risk factors
associated with breast cancer: from radiation, pesticides, and nitrites
to coated cookware, tap water, and cheese.73 Everything is my enemy, she decides. But when her cancer goes metastaticbecomes
a constant presenceshe must renegotiate her relationship with
cancer not by personifying and externalizing it, as Marchetto does,
but rather by recognizing its permanent incorporation in her body,
and indeed her identity.
To do so, however, requires relearning how to interpret her own
embodiment. Pathography, or what Hawkins calls our modern
adventure story,74 repositions narrative perils by highlighting the
manifold dangers located not in the external world, but contained
within the body itself. This inward turn speaks more widely to the
obsession with suspicion in the post-Ricoeurian critical climate
what Eve Kosofsky Sedgwick has deemed paranoid reading: an
interpretive model that operates on suspicion, on the interplay of
surface and depth, of latent and manifest content. The unidirec73. As Martha Stoddard Holmes notes, Engelbergs attention to environmental risk factors illustrates the way in which what she calls the situatedness of cancer comics may
be meaningfully politicized. See Holmes, Cancer Comics (above, n. 15).
74. Hawkins, Reconstructing Illness (above, n. 8), p. 1.

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tionally future-oriented vigilance of paranoia generates, paradoxically, a complex relation to temporality that burrows both backward
and forward: because there must be no bad surprises, and because
learning of the possibility of a bad surprise would itself constitute
a bad surprise, paranoia requires that bad news be always already
known, Sedgwick explains.75 This paranoiac relationship to temporality helps explain the nonlinear nature of Engelbergs narrative,
as she remains unsure how to correctly interpret embodied cues as
they may or may not signify for the larger narrative of her experience.
This ambivalence about the significance of symptomatology is illustrated most clearly in a cartoon titled Life as a Movie. In film,
Engelberg observes, the audience knows the character is a goner
way before [the character] figures it out. This is the dramatic irony
of symptomatology: In a movie it makes no sense to mention a
symptom without mentioning it later on. However, she writes, real
life is full of insignificant momentsor seemingly significant moments that ultimately do nothing to further the autopathographical
plot. The instability of the embodied subject as it concerns her own
self-interpretation thus perpetually begs the question with which
Engelberg titles another cartoon: Hypochondria or Intuition? Her
inability to determine the answer mobilizes both her memoirs humor and its pathos.

Coda: Terminal
In life narratives and the lives they narrate, it is perhaps most difficult to conceptualize the terminal moment. The question of autobiographical endings is nearly always an anxiety-producing one.76
Endings, as the recent public uproar over the ethics of tweeting
a terminal illness evidences, tend to distress us. In her response
to the Kellers columns, Meghan ORourke writes that both authors
provide a stark and tone-deaf reminder of just how repressed and
ahistorical our public relationship to dying and death is today; she
defends Adams by arguing that there is something useful about
the disjunctiveness of posts like hers, which pop the bubble of the
social-media surfaces that we slide along, as if our time here were a
never-ending river rather than a journey that has a distinct end.77
75. Eve Kosofsky Sedgwick, Touching Feeling: Affect, Pedagogy, Performativity (Durham,
NC: Duke University Press, 2003), p. 130.
76. For further discussion of the concept of autobiographical endings, see Hannah Sullivan, Autobiography and the Problem of Finish, Biography 34:2 (2011): 298325.
77. Meghan ORourke, Tweeting Cancer, New Yorker, January 13, 2014. http://www
.newyorker.com/online/blogs/culture/2014/01/tweeting-cancer.html.

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What happens in the final frame of an autopathographic text? What

140 characters or fewer will comprise Adamss final tweet?
Given the radical differences between notions of both emplotment
and embodiment in Cancer Vixen and Cancer Made Me a Shallower Person, it may seem striking how similarly these texts end. The former
concludes with a symbolically convenient rainstorm, one that Marchetto elects to accept calmly. Without the storm, she tells her husband with dewy-eyed reflectiveness, we wouldnt have seen such
spectacular lightning, or witnessed that majestic fog (p. 212). In
Engelbergs final vignette, titled In Perspective, she looks back on
a memory from her college years in which looking up at the stars
inspires a brief moment during which her anxieties seemed insignificant in comparison. I wish I could recapture that feeling now,
she writes. Importantly, however, Engelbergs sense of perspective is,
she admits, aspirational; her anxieties, like her metastatic cancer, are
a constant presence.
Considering how common illness is, Woolf wrote in On Being
Ill, it becomes strange indeed that illness has not taken its place
with love and battle and jealousy among the prime themes of literature. Novels, one would have thought, would have been devoted
to influenza; epic poems to typhoid; odes to pneumonia; lyrics to
toothache.78 Today, we have tweets that take on cancer, blogs that
chronicle chronic illness. As new media manipulate the genre of autopathography, our affective relationships to illness and death shift
accordingly. Theres something very personal about telling people
youve had breast cancer, Engelberg notes in the opening vignette
of Cancer Made Me a Shallower Person. She imagines a T-shirt that
would cut to the chase, one with a conspicuous arrow and the
words CANCER INSIDE. Whether T-shirt or comic, poem or Twitter feed, the personalthat is, the conspicuously embodied, the
graphicseems awkwardly, even irreverently at odds with the medium in which it is expressed. Perhaps, then, as Engelbergs comics
seem to suggest, this speaks less to the ethical orientation of the
autopathographer than to the culturally established expectations of
her audience.
Engelbergs narrative, like Adamss, disrupts the story we want to
tell about breast cancer: that it is surmountable, codified by the cultural archetype of the survivora subjectivity that has been relentlessly marketed throughout the past thirty years by breast cancer
awareness campaigns.79 Indeed, Emma Keller does not address the
78. Woolf, On Being Ill (above, n. 23), pp. 34.
79. For a discussion of the inception of National Breast Cancer Awareness Month, see
Sulik, Pink Ribbon Blues (above, n. 32), pp. 123125.

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ethics of tweeting illness, broadly writ, but specifically attends to

terminal illness. Lisa Bonchek Adams is dying, her article begins;
it goes on to attempt to unpack the readerly affect that results from
intrusion into spacesbodily, digitalwhere dying happens. Making recourse to the familiar beginnings of the breast cancer narrativeHer journey beganKeller goes on to remark on Adamss
seven-year decline as if to immediately assess Adamss story in a
way that renders it legible generically, demarcating it as a declension
narrativean autothanatography that inevitably moves toward a
distinct end. But perhaps this ending is not as distinct as we seem
to believe.