The incidence of cancer is rising worldwide. In 2008 it happened to be some 12.7 million new cases (7.6 million cancer-related deaths), in 2030 it could be 20.3 million cases.1 Only the means of medicine could alter this trend with a concordantly increasing number of victims.
A classical ‘conditio sine qua non’: There are also writers and poets among the ill, among the survivors, among those we lose. No wonder literature regularly offers works that present their readers the individual experience of authors confronted with disease, with cancer.
One of the most famous examples—Alexander Solzhenitsyn's ‘Cancer Ward’ of 1967. The Nobel Prize laureate of 1970 had been treated for cancer in a clinic in the Uzbekistan Soviet Republic in the 1950s. His novel describes relations and fates of a group of patients with cancer in a hospital at the end of the stalinist era. It's a picture of politics and society (The Gulag Archipelago) in the USSR. Cancer treatment in its thoroughly dark age stays in the background.
With quite another background the novel nevertheless shares similarities to Thomas Mann's ‘The Magic Mountain’ of 1924. The grandmaster of German literature in the early 20th century also presents a group of persons in a medical institution. In Mann's novel they are bourgeois tuberculosis (TB) patients in a clinic (sanatorium) in Switzerland. What TB happened to be around 1900 cancer is in the 21st century, no doubt about the demographic trends.
Let us leave undiscussed this old trick of writers to show human nature by convening individuals under some existential threat (TB, cancer) in a confined space. Anyway, whereas Solzhenitsyn's and Mann's novels also never concentrate on TB care or oncology itself as main topics another book on cancer caused an uproar in 1975. At that time, 40 years ago, the German actress and singer Hildegard Knef (1925–2002; in the US also known as Hildegarde Neff) published the second part of her biographic works: ‘The Verdict’—Knef's documentary as breast cancer patient a few years earlier (Figure 1).
Knef described the crude treatment modalities and the crude ways she was treated by her doctors. The book was almost immediately a bestseller in the German speaking countries. It was a hype. One year later it came out in English and gained Knef the Mark Twain Prize (it stood second among the bestsellers in the USA in 1976). The book was translated into 15 languages. There was discussion everywhere in the media: Should a cancer patient thus describe his/her experiences? Is such a piece of literature denouncing medicine or doctors? There was an outcry on all sides.
But maybe Knef's observations helped to pave the way for the beginning of patient empowerment in the arena of oncology. Some years later “And the Band Played On: Politics, People, and the AIDS Epidemic” by the Californian journalist Randy Shilts had a similar effect. It mobilised society against the uprising pandemic.
The German actress, singer and author would have passed 90 only a few weeks ago (born on 28 December 1925). She survived breast cancer. Her death in 2002 was not related to it. She seemed to be in frail condition for years and was like this when I interviewed her in a Viennese hotel around 1980 on her future plans.
And there is, there was, Susan Sontag with her essay ‘Illness as Metaphor’. She was being treated for breast cancer when she wrote in 1978: “Two diseases have been spectacularly, and similarly, encumbered by the trappings of metaphor: tuberculosis and cancer.”
She added: “The fantasies inspired by TB in the last century, by cancer now, are responses to a disease thought to be intractable and capricious—that is, a disease not understood—in an era in which medicine's central premise is that all diseases can be cured. (…) Now it is cancer's turn to be the disease that doesn't knock before it enters, cancer that fills the role of an illness experienced as a ruthless, secret invasion—a role it will keep until, 1 day, its etiology becomes as clear and its treatment as effective as those of TB have become.”
We have lost Susan Sontag to cancer, we still lose authors by this disease. The Swedish author, playwright and director Henning Mankell (born in February 1948) died in October 2015 from lung carcinoma. His works with a series of crimebusters have been sold in millions of copies. But Mankell also was a wonderful writer about Africa where he spent part of his life and tried to mobilise the world to fight poverty and AIDS on this continent. “Get rid of illiteracy. The gift to read and to write is the means to protect people from AIDS”, the author who spent millions for charity told me in an interview in 2010.
We lose some of the best to cancer. The Swedish author was one of them. In ‘Quicksand’ he describes how the diagnosis of cancer reminds him of one of his nightmares: to be drowned in quicksand. But Mankell also tells the reader how the arts, music, literature can help in desperate conditions and give hope and a sense of living meaningfully as long as possible.
The last example: the German writer Wolfgang Herrndorf (1965–2013). Some 10-year ago the young author and painter participated in a well-known writers’ competition—he lost but made his way.
Sadly, Herrndorf received a diagnosis of glioblastoma in 2010. A blog he first wrote for his friends and which has been made public gives evidence of his fate in a direct and unpathetic, often disturbing, sometimes self-ironic way (http://www.wolfgang-herrndorf.de/). He wants to finish a novel and knows that time is running out.
A few weeks ago the collected works by Herrndorf have been published. On this occasion a German critic wrote how Herrndorf felt trying to get his work done. There suddenly was no time to discuss whether ‘The bell gets me awake’ or ‘The ringing bell ends my sleep’ might be the better style. The diagnosis of an incurable disease had suddenly accelerated the author's life—just as it happens with all of us when we get to realise finitude …
It is clear that cancer is and will always be a topic of literature, film, plays—as TB has been (‘La Traviata’, ‘La Bohème’, ‘The Magic Mountain’) some 100 years ago. But do we have works which reflect the growing success of oncology and medicine in tackling long-standing incurable disease?
Mankell said in an interview: “I'm convinced, I might succumb to this chronic disease.” What a clear sight of present oncology's aims! The Swedish author also stressed the importance of science to fight cancer. So, what we need: Works of literature which describe the situation currently evolving—how a serious diagnosis is turned into something man can manage with a long-term perspective.
We need literature by long-term survivors. It could even be an all shocking book like Hildegard Knef's 40 years ago: How incompetent society is in accepting the patients’ needs. How badly people with cancer are treated in their professional life when they struggle to recover and regain self-confidence, job and recognition with a serious disease that has been turned into chronic illness.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
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