Social History of Medicine Vol. 27, No. 3 pp. 440–465
Before Survivorship: The Moment of Recovery in
Twentieth-century American Cancer Campaigns
David Cantor*
Summary. This paper concerns what I call “the moment of recovery,” the time when, in the 1950s,
American cancer campaigns abandoned an earlier tendency to downplay post-operative recovery in
their public education programs. This change was signalled by the emergence of new patients
groups such as Reach to Recovery (founded 1953), and by a new interest in cancer rehabilitation
among physicians, nurses, and manufacturers and sellers of equipment and clothing for patients.
My focus is on breast cancer and the nurse-patient-industrial complex that drove the new interest in
rehabilitation and recovery, but I also argue that the “moment of recovery” in breast cancer was part
of a larger “moment” in cancer more generally. Finally, I seek to distinguish the “moment of recovery”
of the 1950s from the discourses around the survivor that have emerged since the 1970s and 1980s,
what might be called the “moment of survivorship.”
Keywords: cancer; rehabilitation; survivorship; Reach to Recovery; Terese Lasser; cancer nursing;
corsetieres; prostheses; self-presentation; emotional management
Until the 1950s American cancer campaigns paid very little attention to the process of postoperative recovery in their public education programmes. The term ‘recovery’ was often
used, but it tended to refer to an outcome or goal of treatment rather than the route by
which people got to that outcome or goal. Indeed, a focus on this route was seen as a
threat to programmes of cancer control. So great was the public’s fear of cancer therapy,
cancer experts claimed, that any public discussion of the twisting, painful and uncertain
road ahead of them would dissuade people from seeking help until after the best opportunities for successful treatment had gone.
In the late 1940s, these concerns began to break down. The change was signalled by the
creation of new patient organizations such as Reach to Recovery, founded in 1953.1
* Office of History, National Institutes of Health, 1 Cloister Court, Building 60, Room 262, Bethesda, MD 20814–1460,
USA. Email: [email protected]
David Cantor is acting director of the Office of History at the National Institutes of Health, Bethesda, Maryland. He is the
editor of Reinventing Hippocrates (Ashgate, 2002) and Cancer in the Twentieth Century (Johns Hopkins University
Press, 2008), co-editor (with Christian Bonah and Matthias Dörries) of Meat, Medicine, and Human Health in the
Twentieth Century (Pickering and Chatto, 2010) and co-editor (with Edmund Ramsden) of Stress, Shock, and Adaptation in the Twentieth Century (University of Rochester Press, 2014). He is series editor (edited collections) of Studies
for the Society of the Social History of Medicine published by Pickering and Chatto.
1
There is little agreement among historians on the date
Reach to Recovery was founded. Maren Klawiter, The
Biopolitics of Breast Cancer: Changing Cultures of
Disease and Activism (Minneapolis: University of Minnesota Press, 2008), 118, and James S. Olson, Bathsheba’s Breast: Women, Cancer & History (Baltimore: Johns
Hopkins University Press, 2002), 124, claim it was
founded 1952, but this may confuse the date of Terese
Lasser’s operation with the date she founded the organisation. Lasser herself—Terese Lasser and William
Kendall Clarke, Reach to Recovery (New York: Simon
and Schuster, 1972), 46—suggests it was founded in
1953, Barron H. Lerner, The Breast Cancer Wars: Fear,
Hope and the Pursuit of a Cure in Twentieth-Century
America (New York: Oxford University Press, 2003),
143) suggests it was established ‘by 1954’ and Kirsten
Published by Oxford University Press on behalf of the Society for the Social History of Medicine 2014.
This work is written by (a) US Government employee(s) and is in the public domain in the US. doi:10.1093/shm/hkt100
Advance Access published 16 January 2014
Recovery in Twentieth-century American Cancer Campaigns
441
Sometimes labelled, ‘mutual aid’, Reach to Recovery and similar bodies were generally
established by (former) patients to help other cancer patients deal with the consequences
of therapy. Occasionally they encountered resistance from physicians, but these organizations were also established with medical encouragement. They were, in fact, part of an
emergent network or complex of patients, nurses, social workers, physicians and commercial groups concerned with post-operative recovery that also included voluntary organizations such as the American Cancer Society (ACS) and the federal government’s National
Cancer Institute (NCI). This new focus on the route to recovery is what I call the ‘moment
of recovery’. This paper is concerned with the origins of the ‘moment’. It asks why cancer
agencies tended to avoid the process of recovery in their public education campaigns
until the 1950s, and why this process came to be a subject of public discussion during
that decade.
The focus of this paper is breast cancer, but the moment of recovery in breast cancer was
part of a broader moment in cancer more generally. Similar moments emerged at about the
same time around cancers of the colon and larynx, comprising sometimes overlapping networks or complexes of physicians, nurses, social workers, patients, commercial groups and
voluntary and federal agencies.2 This paper seeks to explain what was unique about the
moment of recovery in breast cancer, why these three cancers formed the focus of the
broader moment, and how they related to an emergent interest in rehabilitation during
and after the Second World War.3 Lester Breslow and his colleagues have described
cancer as if it was the abandoned child of war-time interest in rehabilitation medicine;
fathered by the war, but ignored by most specialists who went into rehabilitation fields
other than cancer.4 This paper endorses that point, but also links the moment of recovery
to post-war concerns about cancer’s impact on the goals of suburban affluence and
married family life to which upwardly mobile Americans aspired in the 1950s, and to
issues of self-presentation, emotional management, gendered domesticity and lay
knowledge and practices regarding cancer.
A final introductory point is that the ‘moment of recovery’ should not be conflated with
the history of cancer survivorship.5 Thus while the term ‘survivor’ was occasionally used
E. Gardner, Early Detection. Women, Cancer, and
Awareness Campaigns in the Twentieth-Century
United States (Chapel Hill: University of North
Carolina Press, 2006), 148 claims it was founded ‘in
1954’. Likely it began informally, like many small
volunteer organisations, and later crystallised into a
formal institution. I have opted for Lasser’s date of 1953.
2
Lester Breslow, Daniel Wilner, Larry Agran et al.,
A History of Cancer Control in the United States, with
Emphasis on the Period 1946–1971, 4 vols (Bethesda,
MD: Division of Cancer Control and Rehabilitation,
National Cancer Institute, Bethesda; Dept. of Health,
Education, and Welfare, Public Health Service, National
Institutes of Health, National Cancer Institute, Division
of Cancer Control and Rehabilitation, 1977), Vol. 1,
ch. 8.
3
On the impact of the Second World War on rehabilitation medicine see Richard Verville, War, Politics, and
Philanthropy: The History of Rehabilitation Medicine
(Lanham, MD: University Press of America, 2009); Glenn
Gritzer and Arnold Arluke, The Making of Rehabilitation: A Political Economy of Medical Specialization,
1890–1980 (Berkeley: University of California Press,
1985). For the longer history of rehabilitation and war
see Beth Linker, War’s Waste: Rehabilitation in World
War I America (Chicago and London: University of
Chicago Press, 2011) and for a UK perspective Julie
Anderson, War, Disability and Rehabilitation in Britain:
‘Soul of a Nation’ (Manchester: Manchester University
Press, 2011).
4
Breslow et al., A History of Cancer Control, Vol. 1, ch. 8.
5
Samantha King, Pink Ribbons, Inc. Breast Cancer and
the Politics of Philanthropy (Minneapolis and London:
Minneapolis University Press, 2006); Emily K. Abel and
Saskia K. Subramanian, After the Cure: The Untold
Stories of Breast Cancer Survivors (New York and
London: New York University Press, 2008).
442
David Cantor
before the 1980s, it was not commonly deployed.6 The now contemporary portrayal of the
triumphant, happy, healthy survivor, whose life has been almost elevated by cancer, is
almost entirely absent in the 1940s and 1950s, as is the view of survivorship as providing
opportunity for physical, emotional and spiritual renewal.7 Instead of using terms such as
survivor, the public education literature of the 1940s and 1950s tended to use what, to
twenty-first-century ears, sound like more brutal expressions such as ‘breast amputee’ or
‘mastectomee’, if it used a label at all. Indeed, one of the paradoxes of the 1940s and
1950s is that alongside shocking expressions such as ‘breast amputee’ was a reticence to
give a label to women who had had a mastectomy.8 The moment of recovery was thus characterized by both discretion and descriptive bluntness.
Maren Klawiter’s study of breast cancer politics provides a valuable comparison
between the moments of ‘recovery’ and ‘survivorship’.9 She argues that while Reach to
Recovery set the stage for the emergence of the ‘survivor’, it actually embodied a very different philosophy in that it discouraged women from articulating a political identity
defined by their common experience of breast cancer and its treatment. It did this by limiting the contact between volunteer former patients and more recent mastectomees. The
volunteers were only to provide assistance during the brief period that their clients
were in recovery. After this, they were to leave them to their own devices, and Reach
to Recovery discouraged further contact between volunteers and their clients. In such
ways, the organization undermined the possibility of a broader movement around
women’s experiences of cancer. Breast cancer, in its view, was a temporary aberration
and recovery a return to ‘normality’, after which women were to go back to their lives
in the home, largely isolated from other mastectomees except as volunteers who
helped others.
Klawiter is surely right in portraying Reach to Recovery’s adjustment and recovery
approach to breast cancer in the 1950s as very different from that of today. Yet she does
not explain why cancer agencies avoided the process of recovery before the 1940s, nor
does she fully elucidate what changed in the 1940s and 1950s. This paper explores what
changed by focusing on the emergent network or complex of groups and individuals
involved in cancer rehabilitation in the 1940s and 1950s, and how and why each part of
that complex contributed to the ‘moment’. The terms complex or network are significant.
6
See for an early example of the term ‘cancer survivor’
Morton Bard and Arthur M. Sutherland, ‘Psychological
Impact of Cancer and its Treatment. IV. Adaptation
to Radical Mastectomy’, Cancer, 1955, 8, 656–72, 656.
For later uses of ‘survivor’ see Gina Kolata, ‘In One
Word, An Entire Debate on Cancer’, The New York
Times, 1 June 2004, Section A4, 14; Barbara Sills,
‘That’s Cancer Veteran, Conqueror or Activist to You’,
Los Angeles Times, 12 November 2007; Fitzhugh
Mullan, ‘Seasons of Survival: Reflections of a Physician
with Cancer’, New England Journal of Medicine,
1985, 313, 270–3; Kirsten Bell and Svetlana RistovskiSlijepcevic, ‘Cancer Survivorship: Why Labels Matter’,
Journal of Clinical Oncology, 1 February 2013, 31,
409–11. For a blurring of survivorship and recovery
see Gardner, Early Detection, 148.
7
Sharon Batt, Patient No More: The Politics of Breast
Cancer (Charlottetown, PEI: Gynergy, 1994). King, Pink
Ribbons, Inc.; Abel and Subramanian, After the Cure; Klawiter, The Biopolitics of Breast Cancer; Barbara Ehrenreich,
‘Welcome to Cancerland: A Mammogram Leads to a Cult
of Pink Kitsch’, Harper’s Magazine, November 2001,
303, 43–53.
8
In contrast to literature about ‘mastecomees’, pamphlets targeted at such women tended to avoid the
label. Terese Lasser, Reach to Recovery (New York:
Reach to Recovery, 1953); Helen B. Radler, A Handbook
for Your Recovery, rev. edn (New York: Women’s
Society for Memorial Center, 1954).
9
Klawiter, The Biopolitics of Breast Cancer, 118–21.
Recovery in Twentieth-century American Cancer Campaigns
443
Until now the tendency within the historical literature has been to stress the role of Reach to
Recovery.10 Yet, Reach to Recovery was only a part of a broader network of groups and individuals involved in the moment, and certainly not the first. This article seeks to re-evaluate its
role by focusing on its place within this network, and on how the various groups and individuals involved in this network sought to promote particular views of recovery that
served their interests.
Before the Moment
Until the 1950s, the American Society for the Control of Cancer (ASCC—the forerunner to
the ACS) tended to use the terms ‘cure’ and ‘recovery’ interchangeably. Both could refer to
an outcome of treatment, or to the path by which people came to this outcome. But, in
public cancer education campaigns the former tended to predominate. Recovery was a
state of being, a goal to be achieved or the possibility of that goal. The route by which
people arrived at this state or goal was hardly mentioned, except to acknowledge that it
involved surgery or radiation: for example, a series of advertisements in the early 1930s
announced that the probability was that surgery, X-rays and radium could ‘effect complete
recovery’ if the tumour was discovered early.11 But until the 1940s and 1950s public education programmes provided few details if any of what happened during or after surgery or
radiotherapy.12
This tendency to downplay the route to recovery was tied to efforts to reform public attitudes and behaviours towards cancer. From its creation in 1913, the ASCC argued that if
anti-cancer programmes were to work, people had to be persuaded to seek qualified
medical assistance at the first sign of what might be cancer, and from the late 1910s to
go for a regular medical check-up even if they felt well.13 The goal was to get to a physician
ideally before the onset of disease proper, or very early in its development, and to undergo
treatment the moment the disease or its possibility was identified. Thus, the ASCC developed public education programmes to teach individuals to identify the early signs of the
10
Breslow et al., History of Cancer Control Vol. 1,
ch. 8. Kirsten Gardner, James Olson and Barron Lerner
argue that Reach to Recovery was central to transforming surgeon–patient relations, women’s involvement in
(breast) cancer campaigns and to the emergence of
patient support groups in the 1950s. See especially
Gardner, Early Detection, 147–51; Olson, Bathsheba’s
Breast, 120; Lerner, The Breast Cancer Wars, 143–4.
11
See the following Metropolitan Life Insurance
Company advertisements under the heading ‘The
Majority of Cancers—In Early Stages—Can be Successfully and Completely Removed or Destroyed by
Surgery, X-rays or Radium’ in among other journals: Harper’s Magazine, 1933, 167, n.p. (advertising
section); Scribner’s Magazine, 1933, 94, n.p. (advertising section); Atlantic Magazine, September 1933,
152, 31 (advertising section); Time, 28 August 1933,
22, 21; American Magazine, September 1933, 116,
33; Review of Reviews and World’s Work, September
1933, 88, 53;. The New Movie Magazine, September
1933, 8, 69. See also the series of articles on gastric
cancer under the heading ‘The Most Common Form
of Cancer—and What you Should Know About It’,
Atlantic Monthly, March 1940, 165, opposite p. 440;
Harper’s Magazine, March 1940, 180 (advertising
section); American Magazine, March 1940, 129, 63.
For other uses of ‘compete recovery’ in public education articles see Samuel Hopkins Adams, ‘The New
Hope in Cancer’, McClure’s Magazine, May 1913,
41, 198–206, esp. 202.
12
See, for example, David Cantor, ‘Uncertain Enthusiasm: The American Cancer Society, Public Education, and the Problems of the Movie, 1921–1960’,
Bulletin of the History of Medicine, 2007, 81, 39–69;
David Cantor, ‘Choosing to Live: Cancer Education,
Movies, and the Conversion Narrative in America,
1921–1960’, Literature and Medicine, 2009, 28,
278–332.
13
Robert A. Aronowitz, Unnatural History: Breast Cancer
and American Society (Cambridge and New York:
Cambridge University Press, 2007); Lerner, The Breast
Cancer Wars; David Cantor, ‘Cancer Control and Prevention in the Twentieth Century’, Bulletin of the
History of Medicine, 2007, 81, 1–38.
444
David Cantor
disease, to go for a regular health check-up, and to seek early treatment from a recognized
physician if cancer or a pre-cancerous condition was detected.
The trouble for the ASCC was that patients often arrived in the doctor’s office long after
the best opportunities for successful treatment were gone.14 In its view, the reason for this
problem was that people were overly fearful of the disease and its treatment, and that
‘quacks’, purveyors of patent medicines, ill-educated physicians and the advice of family
and friends tended to direct people away from qualified physicians. One of the consequences of this was that its educational programmes tended to pay very little attention to what
happened between treatment and cure. In the view of the ASCC, such an emphasis could
dissuade people from seeking early detection and treatment by emphasizing the pain, disablement and mutilation caused by surgery and radiotherapy (the two main forms of treatment), and the uncertain route to recovery that followed, if recovery was possible at all. In its
view, discussion of these issues was best dealt with in the privacy of the doctor–patient relationship, where physicians could most easily deal with patients’ fears and anxieties about
cancer and its treatment. Mass public education campaigns were particularly blunt instruments for dealing with these fears and anxieties.15
If the ASCC tended to avoid discussion of the routes to recovery, it had quite a different
attitude towards recovery as a state of being after treatment or a goal to be achieved. For the
cancer organization, ‘cured’ or ‘recovered’ patients came to be crucial to the success of
cancer education, important means of encouraging others to achieve this end. As one physician put it in 1940, ‘An intelligent patient who has been entirely cured, often has more beneficial influence on cancer education in the community than the physician himself.’16 The
ASCC had used ‘intelligent’ men and especially women as recruiters to cancer control programmes since its creation in 1913, and it was institutionalized in 1937 with the creation of
the Women’s Field Army. In the view of the ASCC, one of the roles of the many women
involved in the Field Army was to enlist other women, and channel them into emergent
cancer services organized by recognized physicians. The mark of their intelligence was
their willingness to follow ASCC prescriptions for cancer control, and women who had
been successfully treated for cancer were viewed as particularly valuable. In 1939, one commentator described one such woman as an ‘animate document in evidence that the most
dreaded of all diseases is conquerable with early diagnosis and proper treatment’.17 The
key word here is ‘proper’. Animate documents in evidence served as warnings of the
dangers of quackery, and of the value of surgery and radiotherapy—when carried out by
a recognized physician—as ‘cures’ for this group of diseases.
This is not, however, to say that they were unproblematic documents. There was no guarantee that the ‘animate documents’ would tell the story that the ASCC wished them to tell,
and the Society routinely informed people that the only real experts were physicians, and
that non-physicians could only be trusted in so far as they reinforced the ASCC’s
message. Nor was it clear that the bodies of these ‘documents’ would support the
ASCC’s message. Bodies could betray aspects of surgery that the ASCC was not anxious
14
Aronowitz, Unnatural History; Lerner, The Breast
Cancer Wars; Cantor, ‘Cancer Control and
Prevention’.
15
Cantor, ‘Uncertain Enthusiasm’.
J. Richard Allison, ‘Twenty Years’ Experience With Skin
Cancer’, Southern Medical Journal, 1940, 33, 16–18,
18.
17
Isaac F. Marcosson, ‘The Cured Cancer Club’, Hygeia,
1939, 17, 694–6, 695.
16
Recovery in Twentieth-century American Cancer Campaigns
445
to discuss outside the doctor–patient relationship—pain, disability, or the absence of a body
part. For such reasons, educational programmes rarely portrayed mutilation, surgery or pain.
On the contrary, patients seemed physically no different after the operation than before,
except that perhaps they were lighter-of-foot and wider-of-smile in their relief at having
escaped the dread disease.18
Cured Cancer Club
Efforts to promote the view of cancer as a curable disease intensified in the late 1920s and
early 1930s, as cancer services expanded throughout the country.19 A 1932 symposium
‘Cancer is Curable’ organized by the American College of Surgeons sought to highlight
the growing number of people cured as a result of early diagnosis and treatment. 20 According to reports, some 8,840 Americans had survived with no recurrence for five years. Time
noted that the most ‘dramatic witness’ was Dr. Edward Loughborough Keyes, Cornell
Medical School urologist. ‘I am an example of the cure of cancer,’ he explained, ‘Three
cancers have been removed from my face by radium or actual cautery.’21
In March 1938, the ASCC’s efforts to use ‘cured’ people to promote programmes of early
detection and treatment crystallized into the Cured Cancer Club under its president,
Dr Anna C. Palmer.22 Palmer had had a breast tumour excised in the early 1920s, and
saw cancer in much the same way as the ASCC—as a disease that if caught early might
be cured. The Cured Cancer Club was to ‘show the world that cancer can be cured’, and
to help people overcome the fear of the disease.23 Time reported that the slogan of the
club was: ‘We will drive away the fear that keeps so many people from going to a physician
in time to be saved.’24 The organization claimed to have 29,000 members.25
The educational materials that accompanied this growing use of the word ‘cured’ to
promote programmes of early detection of treatment generally did not discuss convalescence after treatment. There were occasional criticisms of this neglect, but, such criticisms
seem to have had little impact on the ASCC or the ACS. Throughout the 1940s, the
ASCC/ACS’s public education programmes downplayed what happened after the operation.26 As in previous decades, it continued to hold the view that an emphasis on
See discussion of Choose to Live in Cantor, ‘Uncertain
Enthusiasm’; Cantor, ‘Choosing to Live’.
19
On cancer services see David Cantor, ‘Radium and
the Origins of the National Cancer Institute’, in Caroline Hannaway, ed., Biomedicine in the Twentieth
Century: Practices, Policies, and Politics (Amsterdam:
IOS Press, 2008), 95–146, esp. 103–4.
20
‘Symposium: Cancer is Curable’, Surgery, Gynecology
and Obstetrics, 1933, 56, 412–75; Franklin H. Martin,
‘Cancer is Curable’, American Journal of Surgery,
1933, 20, 444–50; Franklin H. Martin, The Joy of Living.
An Autobiography Vol. 1 (Garden City, New York: Doubleday, Doran & Co., 1933), 450. Marcosson, ‘Cured
Cancer Club’ argues that the publicity from this
meeting helped to stimulate the growing numbers of
clinics. Clendening suggests that the claim that cancer
was curable was a ‘half truth’. Logan Clendening,
‘Hygeia vs. Aesculapius’, American Mercury, May
1932, 26, 28–37, 34.
18
‘Cancer is Curable’, Time, 31 October 1932, 20, 32–3,
32. This quotation is not in the published version of his
paper, Edward L. Keyes, ‘Five-Year Cures of Cancer of
the Testis, Prostate, and Bladder’, Surgery, Gynecology
and Obstetrics, 1933, 56, 462–3.
22
On Palmer and the Club see Gardner, Early Detection,
147–8.
23
‘Cured Cancer Club Asks 25,000 to Join’, New York
Times, 25 March 1938, 3.
24
‘Cancer Club’, Time, 4 April 938, 31, 33–4, 34; ‘Cancer
Can be Cured’, National Bulletin of the American
Society for the Control of Cancer, July 1939, 21,
8–11. For more on the Club see W. W. Bauer, Americans, Live Longer! (Indianapolis and New York,
Bobbs-Merrill 1940), 86–111.
25
‘29,000 in Cured Cancer Club’, The Health Officer,
1939, 4, 186.
26
See, for example, the review of Choose to Live in, MSC
277, Box 4, Folder ‘Cancer 1948’, Adolf Nichtenhauser
21
446
David Cantor
convalescence and recovery in such programmes could undermine efforts to persuade
people to seek early detection and treatment. The appropriate place to discuss this was
not the public forum of the mass media, but the face-to-face encounter between doctor
and patient, where the physician could address the specific concerns of the patient in a
manner tailored to the needs of that particular patient.
The Moment of Recovery
The ACS’s tendency to downplay the process of recovery in its breast cancer public education
programmes began to break down in the 1950s. In 1957 it published a pamphlet, Help
Yourself to Recovery, for breast cancer patients, and in 1958 it released the film After Mastectomy (ACS, Oregon Branch), an instructional movie for women who had undergone the
operation.27 The movie traced the story of the fictional Kay Elliot, who has recently had a
mastectomy, and of how she recovers after the operation. It is the first public education
film to show the scar of operation: the script notes ‘CLOSE [shot] on wound with dressing
removed. Catheter is visible. Doctor’s hands palpate.’28
The roots of this transformation are commonly traced to a former cancer patient, Terese
Lasser—the wife of tax expert J. K. Lasser, author of the bestselling Your Income Tax.29 The
story goes that in 1952 her physician found a small lump in her breast, and sent her to Memorial Sloan Kettering for a biopsy. Lasser, like many women diagnosed with the disease, had
not fully appreciated what would happen, and was shocked and dismayed at the results.
‘Your hand touches your side. For the first time you are aware of the bandage’ she wrote
some twenty years later, describing the experience of waking up after the operation.30
‘Bandage? From midriff to neck, tight-wrapped as a mummy, you are bound in surgical
gauze. Somewhere deep inside you a switch is thrown and your mind goes blank. You do
not know what to think, you do not want to guess, you do not want to know.’ Lasser had
gone into hospital for a biopsy, and come out without a breast.
The shock of the operation was compounded by the manner in which she was cared for.
A sophisticated and energetic woman, the matriarch of a wealthy and well-connected
family, Lasser was not used to being patronized. Yet she found herself entirely in the
hands of her physicians—referred by her physician for a biopsy, and then rushed to
Papers, Archives and Modern Manuscripts Program,
History of Medicine Division, National Library of Medicine. See also Adolf Nichtenhauser to Louis J. Neff,
(Executive Secretary, ASCC), 22 March 1944, MSC
277, Box 4, Folder ‘Cancer 1948’, Nichtenhauser
papers. For a discussion of this movie see Cantor,
‘Uncertain Enthusiasm’, 51–4.
27
Ella Bernhardt, Terese Lasser and Helen B. Radler, Help
Yourself to Recovery (New York: American Cancer
Society, 1957). On the film see Gardner, Early Detection, 152–5.
28
I am grateful to Bill Stine at the ACS for providing me
with a copy of After Mastectomy. All references to
this film refer to the ACS copy. I am also grateful to
David Wexler for providing me with a copy of the
shooting script of the movie from the Wexler Film
archives: ‘A Film on Readjustment of the Patient
After Mastectomy’, Second Draft, Shooting Script,
Churchill-Wexler Film Prod, Inc., 801 North Seward
Hollywood, California, no date (hereafter After Mastectomy script.). A note in the Wexler archives
finding aid records that the film was honoured with
a Blue Ribbon Award from the American Film Festival. At the time of writing, the Wexler Film archives
were are held at Hollywood Vaults Inc., 742 North
Seward Street Hollywood CA 90038, <www.
hollywoodvaults.com>, accessed 27 November
2013. There are discussions to transfer the archive to
the National Library of Medicine. The scar is shown at
5 minutes, 44 seconds. The description in the script is
on p. 7.
29
For discussions of Lasser see Olson, Bathsheba’s
Breast, 120; Gardner, Early Detection, 148–151;
Lerner, The Breast Cancer Wars, 142–3; Lasser and
Clarke, Reach to Recovery.
30
Lasser and Clarke, Reach to Recovery, 19.
Recovery in Twentieth-century American Cancer Campaigns
447
radical mastectomy. Hers was a one-step operation common in the 1950s, whereby surgeons sent the biopsy to the pathologist while the woman lay on the operating table, and
operated immediately if positive results were returned, before the patient regained consciousness. In most of her publications Lasser praised the technical skills of her physicians,
but found them unable or unwilling to provide advice on rehabilitation exercises, what to
tell her children, how to resume sexual relations with her husband or how to go about
getting a prosthetic device. One day she went to the department store where she had purchased brassieres before the operation, only to find that the saleswoman fled when she discovered her missing breast.
According to the traditional story, these experiences prompted Lasser to start visiting
other women who had undergone a mastectomy. She would secretly slip into their hospital
rooms to bring them starter ‘falsies’—simulated breasts—to pin on the inside of their nightgowns; a ball, string, and instructions (which she demonstrated) for painful exercises
designed to restore arm function; and a Letter to Husbands about sex. Surgeons and hospital staff did not welcome her visits, and she was routinely escorted out of the hospital
when discovered, sometimes by the police. Lasser published a booklet Reach to Recovery
in 1953, and founded the mutual support organization Reach to Recovery, also in 1953.
The women who joined the organization—themselves mastectomees—followed her
example by visiting other women in hospital. Like Lasser, they also found themselves
escorted out of the hospital on the instructions of surgeons who opposed their visitations.
The story goes that Lasser tried to interest the ACS in the organization, but that it rejected
her overtures until 1969, when it took over Reach to Recovery.
In fact, the story is more complicated than that. Indeed, the paradox of Lasser’s story about
inadequate advice at Memorial is that the year that she underwent her operation—1952—
the hospital itself had published a short 16-page advice booklet for women who had undergone mastectomy written by Helen B. Radler—also known as Mrs Leon Radler—a volunteer
social worker at Memorial who, like Lasser, had had a mastectomy.31 A Handbook for Your
Recovery with Exercises anticipated some of the themes that would later appear in Lasser’s
more famous book.32
Thus the story of the antagonism between Lasser and the cancer establishment may
have to be revised. While there is no reason to doubt that some surgeons were very
hostile to her and her organization—the ACS admitted as much in later publications—
cancer experts were far from uniform in their attitude towards her.33 With more and
31
Radler’s other publications for Memorial included:
Helen B. Radler, Inside the Hospital (New York:
Society of Memorial Center, 1955); Helen B. Radler,
All About an Operation (New York: Society of Memorial Center, 1956).
32
It included rehabilitation exercises for patients recovering from a breast operation, and, like Lasser’s book, it
may also have included recommendations for prosthetic devices and fashion tips and sex. I use the
word ‘may’ at this point for there are two editions of
the booklet, one in 1952 and one in 1954, and I only
found copies of the 1954 edition. However descriptions of the booklet—it is not clear whether they are
descriptions of the 1952 or 1954 editions—note that
it included an insert on fashion suggestions from
leading Pattern Companies and an additional supplement, Man to Man, for husbands of women recovering
from mastectomy—an echo or anticipation of Lasser’s
Letter to Husbands. There is a copy of Man to Man in
the 1954 edition of Radler’s book. It is unknown
whether it was also included in the 1952 edition.
Helen B. Radler, A Handbook for Your Recovery with
Exercises (New York: Society of Memorial Center,
1952); Radler, A Handbook for Your Recovery, 1954
edition.
33
On the ACS’s admission of surgeons’ hostility to Lasser
and her organization, see Preface to Lasser and Clarke,
Reach to Recovery.
448
David Cantor
more women undergoing mastectomy, the ACS faced growing demand for more information on what happened after the operation. Its preference might have been for such
discussion to take place in the privacy of the doctor–patient encounter. But, the ASCC/
ACS had long complained that physicians were ignorant of the disease and its treatment, and, by extension, it also feared they were ignorant of post-operative recovery
and provided poor advice to their patients, and that public silence of the issue might
damage ACS credibility.34 Thus, the ACS’s resistance to public discussion of the postoperative consequences of cancer began to breakdown. The organization—or at least
some individuals within it—began to look for ways to provide patients with information
on this issue, and Lasser’s initiative provided one way of doing this. Lasser herself was
encouraged to publish and organize by her surgeon at Memorial, Frank Adair—the man
who Lasser criticized for providing her with inadequate advice.
Such resistance was also weakened by changing ACS attitudes towards the problem of
delay. Whereas in the 1930s, the ACS had feared that public discussion of the nature of
the treatment for cancer would undermine public willingness to seek early detection and
treatment, by the late 1940s and 1950s this began to break down with the takeover of
the organization by Mary Lasker who brought in business people and advertisers, and transformed the organization, including its public education programmes. Increasingly, subjects
which had been off-limits in such programmes began to be included, albeit somewhat cautiously. Operative scenes were included in educational films which had earlier been
excluded, as were live-action images of tumours.35 These new scenes highlight a growing
belief within the organization that the public was not as vulnerable as previously thought
to fears of cancer or its treatment, and might not delay as a result of seeing images previously
of concern. Such changes set the stage for including the process of recovery in public education programmes, albeit targeted at those who had had the operation rather than the
broader general public.
Against this backdrop, the ACS began to work with Lasser to promote her efforts. An early
suggestion of an association is an ACS advertisement—Give to Conquer Cancer—
embedded in Lasser’s first public account in 1954 of her experience of mastectomy.36
Three years later, in 1957, Lasser joined with Radler and Ella Bernhardt (the founder of Identical Form Inc., which produced bust forms for breast amputees) to co-author the ACS’s
1957 booklet, Help Yourself to Recovery, which figured prominently in the 1958 ACS
movie, After Mastectomy.37 By the end of the decade, both Radler’s and Lasser’s booklets
were regularly cited in medical and nursing texts on cancer rehabilitation.38
34
See Aronowitz, Unnatural History; Lerner, The Breast
Cancer Wars.
35
Cantor, ‘Uncertain Enthusiasm’; Cantor, ‘Choosing to
Live’.
36
Terese Lasser, ‘I had Breast Cancer’, Coronet, April
1954, 35, 109–12, 111.
37
Bernhardt, Lasser and Radler, Help Yourself to Recovery. After Mastectomy, 5 minutes, 59 seconds. After
Mastectomy script, 8.
38
On Radler’s influence on nursing literature, see Eldridge
L. Eliason, L. Kraeer Ferguson and Lillian A. Sholtis,
Surgical Nursing (Philadelphia, London and Montreal:
J.B. Lippincott, 1950), 399–407, 407; L. Kraeer Ferguson and Lillian A. Sholtis, Eliason’s Surgical Nursing (Philadelphia and Montreal: J.B. Lippincott, 1959), 519–29,
524. On Radler’s influence on publications for physicians, see ‘Cancer Clinics: Management of Carcinoma
of the Breast’, CA. A Cancer Journal for Clinicians,
1954, 4, 206–8, esp. 208; Howard Rusk with editorial
assistance of Eugene J. Taylor, Rehabilitation Medicine:
A Textbook on Physical Medicine and Rehabilitation
(St. Louis, C.V. Mosby, 1958), 439 and 445.
Recovery in Twentieth-century American Cancer Campaigns
449
Practices of Recovery
Historical accounts of Lasser’s educational efforts often credit her with inventing
the techniques that she employed—exercises for physical rehabilitation, advice on
prosthetic devices, relationships and on how to deal emotionally with the mastectomy.
Such stories have roots in Lasser’s own account of the impetus behind her efforts to
develop these exercises—the inadequate advice she received from her physician and
nurse.39 ‘Exercise of any kind,’ she recalled her nurse as saying in answer to a question
about what sort of exercises she, Lasser, should do, ‘just so that you move your arm.’40
And that was it: no supervision, no real guidance, which meant that she was forced to
rely on her own resources. Lasser was a golf enthusiast, so she tried a golf swing as an exercise, and a rubber ball she had used in the past to strengthen her golf grip, adapting these
through trial and error to her new condition. The rubber ball—but not the golf swing—later
figured in her 1953 self-help booklet, Reach to Recovery, joined by a variety of other exercises: wall climbing, clothes line, hair brushing, window, jump rope, posture and household
exercises (see Figure 1). But these rehabilitation exercises were not the simple invention of
Lasser. Both she (and Radler, who used similar techniques in her earlier publication
(Figure 1)) adapted techniques from the emergent literature on cancer nursing and rehabilitation in the 1940s and 1950s.41 In Radler’s case, a nurse—Marian Ellingwood, RN—
provided the exercises for her 1952 booklet.42
This nursing literature was the product of a small group of nurses, who were beginning to
promote cancer nursing as a specialty in the 1940s and 1950s.43 In their view, cancer nursing
was a complex field that covered all aspects of cancer care. Nurses were expected to persuade women to seek early detection and treatment, prepare patients for surgery and
39
Lasser and Clarke, Reach to Recovery, 22–7.
Ibid., 22.
41
See, for example, the wall-climbing exercise in Cancer
Nursing: A Manual for Public Health Nurses (a joint
project of the National Cancer Institute, Public Health
Service, Federal Security Agency and the New York
State Department of Health, January 1950), 48. See
also Genevieve Waples Smith, ‘When a Breast Must
Be Removed’, American Journal of Nursing, 1950,
50, 335–9, 337.
42
Marian Ellingwood RN joined the University of
Nebraska School of Nursing, Omaha, as director of
student health and instructor in public health in
1948. ‘Marian Ellingwood R.N.’, The Modern Hospital,
December 1947, 69, 164.
43
On the history of cancer nursing see Katherine Nelson,
‘The history of cancer in the nursing curriculum,
1860–1951’, in Vera Keare and Videen McGaughey,
eds, Cancer Nurses Make it Happen (Wallingford,
CT: ACS Connecticut Division, 1987), 1–9; Brigid Lusk
‘Prelude to specialization: US cancer nursing,
1920–50’, Nursing Inquiry, 2005, 12, 269–77. On the
place of nursing in PHS cancer control programmes see
for example Rosalie I. Peterson, ‘Public Health Nursing
in the Cancer Control Program of the U. S. Public
Health Service’, American Journal of Public Health,
1948, 38, 206–10. Rosalie I. Peterson and Elizabeth
40
Walker, ‘Cancer control; Integrating Nursing Service’,
Hospitals, May 1949, 23, 61. On cancer nursing in the
1940s and 1950s more generally see: Margaret
Barnett and Nancy E. Myers, ‘Nursing Care of Women
with Carcinoma of the Reproductive Organs’, American
Journal of Nursing, 1949, 49, 80–2; Mary A. Sears, ‘The
Public Health Nurse in a Cancer Control Project’, Public
Health Nurse, 1950, 42, 384–7; Lala L. Handorf and
Thyra E. Pedersen, ‘Nursing Care in Terminal Cancer’,
American Journal of Nursing, 1950, 50, 643–6; Ethel
M. Strueben, ‘Nursing Care for the Patient with an
Abdomino-Perineal Resection’, American Journal of
Nursing, 1951, 51, 226–8;. Virginia Barckley, ‘They
Like Cancer Nursing’, American Journal of Nursing,
1952, 52, 1381; Eleanor M. Lofthouse and Gertrude
A. Stokes, ‘Nursing Care of Children with Cancer’,
American Journal of Nursing, 1953, 53, 415–18;
Rosalie I. Peterson, ‘Knowledge of Cancer—Equipment
for Nursing’, American Journal of Nursing, 1954, 54,
463–6; Dorothy N. Kelly, ‘Practical Nurse Students and
the Cancer Patient’, American Journal of Nursing,
1955, 55, 454–6; Ethel Ferguson Thornton, ‘When
the ACS Nurse Comes Visiting’, American Journal of
Nursing, 1957, 57, 476–7; Renilda Hilkemeyer,
‘Nursing Care of Cancer Patients in Hospital and
Home’, CA. Cancer Journal for Clinicians, 1958, 8,
122–9; Smith, ‘When a Breast Must be Removed’.
450
David Cantor
Fig. 1 Exercises Left: Terese Lasser, Reach to Recovery (New York: Reach to Recovery, 1953). Reproduced
courtesy of the American Cancer Society. Right: Helen B. Radler, A Handbook for Your Recovery, rev. edn
(New York: Women’s Society for Memorial Center, 1954). Reproduced courtesy of The Society of Memorial
Sloan-Kettering Cancer Center.
radiotherapy, assist physicians during the operation, help with the rehabilitation of patients,
manage their pain and care for them as they died, among many other activities. As regards
rehabilitation, one of the key tasks of the nurse was to encourage breast amputees to begin
rehabilitation exercises and to continue them when they went home.
But this was not easy. Recent mastectomees were often depressed and in pain, shocked at
their loss, reluctant to begin the exercises, or to continue through the ups-and-downs of
recovery. As the narrator in the 1958 movie After Mastectomy noted, ‘physical rehabilitation
takes hard, sustained work, frequently more than it seems to the patient that she is able to
give.’44 Even the most motivated found these exercises difficult, and they had a host of questions for the nurse: Which exercises were most appropriate for them? Would the stitches on
the scar tear? How much exercise should one do? What did it mean if pain accompanied the
exercises? How long would it take to recover? How did one deal with the host of physical
problems that accompanied recovery, such as lymphedema (a swelling that often occurred
in mastectomy patients caused by a build-up of fluid in soft body tissues when the lymph
system was damaged or blocked perhaps by cancer or by the mastectomy itself)? How
did one face a lifetime of publically concealing the absence of a breast? What did ‘recovery’
mean?
44
After Mastectomy, 12 minutes 58 seconds. After Mastectomy script, 15.
Recovery in Twentieth-century American Cancer Campaigns
451
Nurses constantly had to deal with these questions for which there were often no easy
answers. Yet, like Radler and Lasser, they found a dearth of published advice for women
who had undergone mastectomy. Some turned for help to the small number of physicians
who in the 1940s and 1950s began to focus on post-operative rehabilitation, including the
psychology of post-mastectomy depression.45 But, while these physicians could provide
explanations for the ways in which mastectomy patients responded to the disease and
the operation, and advice on the process of recovery, they had little in the way of literature
to give to patients.46 In such contexts nurses were keen for anything they could give to
patients to help them begin and continue the exercises, and the new patients’ literature
was a boon. Thus when a Committee for the Care of Mastectomy Patients was established
at New York Hospital in the 1950s, it produced its own patients’ literature, and reviewed
Lasser’s and Radler’s booklets with a view to evaluating which should be distributed to
patients.47 The techniques of recovery had come full circle. If Radler and Lasser had
adapted rehabilitation exercises from the nursing literature for their booklets, by the end
of the 1950s nurses routinely handed out these booklets to cancer patients.48
Networks of Recovery
It should be clear by now that the moment of recovery in breast cancer was prompted not
only by patients such as Lasser and Radler concerned about the lack of help for mastectomy
patients, but also by nurses in the emergent field of cancer nursing. Other groups also contributed to the moment even before Lasser and Radler got involved, including the small
number of physicians interested in cancer rehabilitation. Lester Breslow and his colleagues
argue that until the 1940s and 1950s cancer rehabilitation was neglected by existing cancer
organizations such as the ACS and the NCI; that many cancer specialists were ignorant of the
subject; and that most medical and paramedical specialists entering rehabilitation medicine
after the Second World War concentrated on spinal injuries, diabetes and stroke rather than
cancer.49 In Breslow’s view, it was mutual aid organizations such as Reach to Recovery that
were crucial to turning the situation around. But this may overstate the case. While Reach to
Recovery helped to promote the work of specialists in cancer rehabilitation, these specialists
also promoted Reach to Recovery, and help set the stage for its emergence. For example, in
May 1950 a Rehabilitation Service was established at Memorial to promote a new focus on
the ‘whole patient’, and to counter growing concerns about the impact of radical surgery on
David Cantor, ‘Memorial’s Stress? Arthur M. Sutherland and the Management of the Cancer Patient in
the 1950s’, in David Cantor and Edmund Ramsden,
eds, Stress, Shock and Adaptation in the Twentieth
Century (Rochester: University of Rochester Press,
1914), 264–87.
46
Some such as Arthur M. Sutherland, the head of the
newly created Rehabilitation Service at Memorial
came to rely on Lasser’s and Radler’s literature themselves.
47
Cornell University—New York Hospital. Exercises for
Persons Who Have Had a Mastectomy. (Tentative
Draft By Nursing Committee, 30 June 1955)’, Folder
14, Virginia Dericks Papers, Center for Nursing Historical Inquiry, Claude Moore Health Sciences Library,
45
Historical Collections, University of Virginia. See also
Smith, ‘When a Breast Must Be Removed’, 337;
‘Minutes of the Committee meeting for Care of
Mastectomy Patients’, Folder 13, Virginia Dericks
Papers.
48
The 1959 edition of Surgical Nursing included a new
section on patient teaching aids and information in it
on surgery of the breast, and Radler’s and Lasser’s
booklets were included in the bibliography. This
section had not being in the previous 1950 edition.
Eliason, Ferguson and Sholtis, Surgical Nursing, 1950
edition, 407; Ferguson and Sholtis, Eliason’s Surgical
Nursing, 1959 edition, 524.
49
Breslow et al., A History of Cancer Control, Vol. 1, ch. 8.
452
David Cantor
efforts to promote early detection and treatment, and that such operations exacerbated
post-operative depression. The Service may have benefited from the creation of the
mutual aid group two years later, but Reach to Recovery also benefited from the Service.50
In addition to nurses and rehabilitation experts, there were two other groups that were
interested in mastectomees: manufacturers (of breast prostheses, and surgical bras and
corsets) and corsetieres (the women who fitted bras and corsets). Both saw the 50,000
women who underwent a mastectomy each year as a new and growing market, with
perhaps half a million women in total living with the operation.51 Yet it was a tricky
market to develop, and manufacturers and corsetieres sought to recruit nurses and patients’
groups to promote their products and services.
The growing commercial interest in breast cancer is illustrated by trade magazines such as
the Corset and Underwear Review (which during the 1950s came to include regular articles
on breast cancer awareness), and by the growing tendency of retailers to provide breast
cancer education in their lingerie departments.52 In general these educational efforts
aimed to encourage women to seek early detection and treatment, and to identify what
might be the early signs of cancer.53 But, manufacturers and retailers also focused increasing
interest on mastectomees. Thus, during the 1950s the existing trade in simulated breast
forms and bras aimed at mastectomy patients expanded substantially, while retailers—
even before Lasser’s encounter with the saleswoman who fled—began to train their staff
to work with mastectomy patients.54
As corsetieres and manufacturers turned to the mastectomee market, the process of
fitting a breast amputee with a bra became a sort of rehabilitative encounter that aimed
not only to obscure the missing breast, but also to heal the client’s psychological wounds
and help her gain confidence to face the public. ‘When you fit a customer who has suffered
a breast amputation,’ Mercy Dobell, a sales training director (and later editor of the Corset
and Underwear Review) informed her readers, ‘you must fit not only her scarred physical
tissues but also a heart that is heavy, a spirit that has been crushed and a frightened mind
that feels that she and she alone is maimed and abnormal for the rest of her life. Along
with the bust form, you must sell her a new confidence in herself and the feeling that the
rest of the world need never know about her loss.’55
The portrayal of bra fitting as a transformative, rehabilitative encounter meant that corsetieres who fitted amputees had to be specially trained. They had to understand both the
anatomy and the psychology of the mastectomee. An understanding of anatomy was
important to ensuring a comfortable fit, and the appearance of a normal bust (Figure 2);
50
51
Cantor, ‘Memorial’s Stress?’.
For histories of breast prostheses see Kirsten
E. Gardner, ‘Hiding the Scars: A History of PostMastectomy Breast Prostheses, 1945–2000’, Enterprise and Society, 2000, 1, 565–90; Kirsten
E. Gardner, ‘From Cotton to Silicone: Breast Prosthesis
before 1950’, in Katherine Ott, David Serlin and
Stephen Mihm, eds, Artificial Parts, Practical Lives:
Modern History of Prosthetics (New York and
London: New York University Press, 2002), 102–18.
See also, Ella Bernhardt, How to Fit Surgical Breast
Forms, pamphlet, (n.d.) copy in Folder 10, Virginia
Dericks papers. Originally published in Corsets and
Brassieres. The 50,000 figure comes from After Mastectomy, 7 minutes, 59 seconds. After Mastectomy
Script, 10.
52
Jane Farrell-Beck and Colleen Gau, Uplift. The Bra in
America (Philadelphia: The University of Pennsylvania
Press, 2002), 121–4.
53
‘Breast Self-Examination Film Presented’, Corset and
Underwear Review, August 1951, 109.
54
Mercy Dobell, ‘Fitting Facts. On How to Sell to Amputees’, Corset and Underwear Review, May 1951, 82–4.
55
Ibid., 82.
Recovery in Twentieth-century American Cancer Campaigns
453
Fig. 2 ‘Measure normal side from spine to center front’,Mercy Dobell, ‘Fitting Facts. On How to Sell to Amputees’,
Corset and Underwear Review, May 1951, 82–4, 83.
an understanding of psychology was necessary to manage the emotional consequences of
the operation. Corsetieres were advised never to joke with their clients about their operation; to offer kindness, but not pity.56 In the view of Mercy Dobell, women who had had
a mastectomy needed to be managed sensitively, and the corsetiere could show kindness
by seeming not to notice her condition. She was to avoid a show of over-sympathy, and
to guard against developing a hard, brittle attitude. Dobell advised corsetieres to use their
most feminine room for fitting the bra (Figure 3).
If anatomy and psychology were important to the rehabilitative aspect of bra fitting, they
were also important to its commercial aspect. A badly fitting bra would not encourage a
woman to return, and could damage the reputation of the store that sold the bra and the
manufacturer that made it. An insensitive seller could also discourage sales by failing to
take account of her client’s fragile state, or by letting her give way to an impulse to buy.
‘If you let her go on a wild buying spree,’ Mercy Dobell counselled corsetieres regarding
breast amputees, ‘she will hold it against you and will avoid you for ever more.’57 In her
view, the corsetiere should restrain her customers. She should get them to return for adjustments to ensure a good fit for the bra, and only after her final adjustment should she
56
Ibid., 82.
57
Ibid., 84.
454
David Cantor
Fig. 3 ‘Use your most feminine room for amputees’, Mercy Dobell, ‘Fitting Facts. On How to Sell to Amputees’,
Corset and Underwear Review, May 1951, 82–4, 82
encourage the customer to begin to build up her wardrobe. A central part of the ritual of
ensuring customer loyalty, to Dobell, was the moment the saleswomen offered her her
card.58
But, corsetieres worried that clients had little incentive to stay with a trained saleswoman.
Part of the issue was that whereas in the past retailers had offered complex style lines and size
configurations, they were increasingly selling brassieres with standardized chest measurements and lettered cup sizes. Such changes deskilled the work of brassiere saleswomen,
weakened their power to negotiate increased wages, and allowed retailers to sell prepackaged brassieres in department store ‘bra bars’ where customers could select merchandise without the assistance of a corsetiere.59 The consequence was that women increasingly
bought what these saleswomen regarded as cheaper throwaway competition that did not
involve the adjustments and readjustments that the corsetiere offered. The real cost, corsetieres argued, was that women had to fit into anonymous, standardized ‘figure types’. The
problem was not restricted to women who had undergone mastectomy: the cheaper standardized competition, corsetieres argued, tended to reduce all women to these types. But it
58
Ibid., 84.
59
Jill Fields, An Intimate Affair: Women, Lingerie, and
Sexuality (Berkeley: University of California Press,
2007), 102.
Recovery in Twentieth-century American Cancer Campaigns
455
was particularly significant in the market for surgical bras and corsets. Women who had had
an operation, or who were obese, or who needed a surgical bra for some other medical
reason required individualised attention. The mass produced bra or corset often did not
work on such women. They needed someone, corsetieres argued, to ensure that the bra
or corset fitted well, and to address what the fitters regarded as their fragile psychological
state. The surgical business was thus a key area where corsetieres defended their special
expertise against the threat of the mass market.60
Corsetieres’ claims to have special expertise gained support from nurses and the authors
of advice literature. Lasser urged mastectomees to go to a good corsetiere.61 Radler directed
women to department stores and specialty shops.62 And the narrator in After Mastectomy
noted that ‘Many reliable stores have specially trained saleswomen to help with the selection.’63 At the New York Hospital, the Committee for the Care of Mastectomy Patients
sought to evaluate various breast forms, worked with manufacturers to improve them,
and compiled a list of shops where prosthetics might be obtained and assessed whether
they had staff trained to deal with breast amputees.64 A budding nurse-volunteer-commercial complex began to emerge with patients groups and nurses working with manufacturers
and corsetieres in educational efforts directed at mastectomees.65 For instance, Ella Bernardt the founder of Identical Form Inc., and a former X-ray technician at a New York hospital, published articles about the rehabilitation of mastectomy patients for nurses, before
joining with Lasser and Radler to publish the ACS’s 1957 booklet for patients, Help Yourself
to Recovery.66
Nurses and patients’ groups not only worked closely with corsetieres and manufacturers,
they also echoed the industry’s assertions that women’s self-confidence was a product, at
least in part, of how they looked to others.67 The point is made clear in After Mastectomy
which explores the anxieties of breast amputees about presenting themselves in public.
The film opens with Kay Elliot reflecting on a nosy friend or neighbour who has been surreptitiously observing her to determine which breast is missing. Kay’s confidence is boosted
when she realizes that the friend or neighbour has failed to figure this problem out, and
later in the film we find out how Kay did it. When Kay is about to leave hospital after the
‘Are You a Peddler?’, Corset and Underwear Review,
December 1951, 69. ‘How to Size Up Your Patrons’,
Corset and Underwear Review, January 1952, 126;
Walter H. Lowy, ‘Electric Brains, Robots, Super
Markets will never Replace the Corsetiere’, Corset
and Underwear Review, March 1952, 69, 113; Ruby
Lucas, ‘Patience and Tact Win Successful Surgical Business’, Corset and Underwear Review, June 1952, 106.
61
Lasser, Reach to Recovery, 16.
62
Radler, A Handbook for Your Recovery, 1954 edition,
11.
63
After Mastectomy, 16 minutes, 56 seconds. After Mastectomy script, 19.
64
‘Minutes of the Committee meeting for Care of Mastectomy Patients’, Folder 13, Virginia Dericks Papers.
See also letter from Virginia C. Dericks to Ella Bernhardt, 9 November 1955, Folder 13, Virginia Dericks
papers.
60
65
At Memorial, Radler patented a simulated breast/brassiere in 1953. ‘2,717,602. Simulated Breast and Surgical Brassiere Therefor. Helen B. Radler, New York, NY.
Application 1 September 1953. Serial No. 377, 888’,
Official Gazette of the United States Patent Office,
13 September 1955, 698, 230.
66
Ella H. Bernhardt, ‘The Rehabilitation of Mastectomy
Patients’, R.N. A Journal for Nurses, October 1953,
16, 52–6; Bernhardt, Lasser and Radler, Help Yourself
to Recovery.
67
This theme of reassurance is common in articles
written by mastectomees about their experience. For
example, Charlotte George noted the reassurance
she felt after receiving an artificial breast. ‘I knew
then that the only people who need know about my
breast-removal are those I choose to tell’, Charlotte
George, ‘I’m Glad I had my Breast Removed’, Today’s
Health, August 1957, 35, 50–1.
456
David Cantor
Fig. 4 FashionsLeft: Terese Lasser, Reach to Recovery (New York: Reach to Recovery, 1953), 19. Reproduced
courtesy of the American Cancer Society. Right: Helen B. Radler, A Handbook for Your Recovery, rev. edn
(New York: Women’s Society for Memorial Center, 1954). Reproduced courtesy of The Society of Memorial
Sloan-Kettering Cancer Center.
operation, Nurse Burnford brings her a starter falsie; some cotton to fill in for her missing
breast. She tells Kay: ‘Let’s see what we can do to fool the public.’68
The theme of ‘fooling the public’ is highlighted in the iconography of Lasser’s and Radler’s
(1954) booklets, both of which deployed variants of the New Look, a fashion introduced into
the USA in 1947 (Figures 1 and 4). In both pamphlets the women who have undergone a
mastectomy have an hourglass figure: narrow waists emphasized by spreading skirts/
dresses below and busts above.69 Critics had attacked the heavy corset and padding necessary to achieve the New Look as unduly restrictive after looser war-time styles of dress, but
these pamphlets suggested that, in emphasizing the bust, the corset and heavy padding also
represented a way for a mastectomee to determine to whom they revealed the results of the
operation. In addition, where some critics saw the New Look as a regressive step after the
shorter, more revealing dresses available during the war, advocates of its look for mastectomees welcomed the concealment that the long dresses gave. Note for example the black
shawl in Figure 4 (left), which could be used to hide the lymphedema, as could the long
sleeves and high necklines in most of the images in Radler’s book. For Lasser and Radler
the New Look was a way to encourage mastectomees to overcome their fears of social
engagement and to stress the possibility of a return to domestic normality.
68
After Mastectomy, 14 minutes, 53 seconds. After Mastectomy script, 17.
69
On the relationship between corsets and the New
Look, see Valerie Steele, The Corset: A Cultural
History (New Haven: Yale University Press, 2003), 158.
Recovery in Twentieth-century American Cancer Campaigns
457
The New Look has been portrayed by some feminist historians, and indeed by Christian
Dior its creator, as representing a post-war ‘refeminization’ of women and an accompanying
return of women to their ostensibly ‘natural’ place within the home after their increased
involvement in paid work during the war.70 From such a perspective the narrow waist symbolized and reinscribed separate social spheres for men and women, and the New Look
played a role in efforts to distinguish women from paid workers in the public sphere, and
to return them to the roles of wives and mothers in the private sphere of home and
family. In practice, there were myriad versions of the New Look, as women adopted and
adapted it to their needs and desires, sometimes in ways that contradicted efforts to
return them to the private domain of the home.71
But such countervailing messages were not deployed in the iconography of Lasser’s and
Radler’s booklets. In providing ways of ‘fooling the public’, these women sought to help
others present themselves as physically ‘normal’ (at least in public) since the loss of the
breast could deprive the female body of its sexual and maternal meanings and functions,
and so symbolically threatened the post-war cultural emphasis on the role of the woman
as wife and homemaker.72 For both Lasser and Radler, these rehabilitative exercises were
also a route to a return to what in the 1950s would have been regarded as women’s domestic activities, and were represented iconographically in their booklets by women undertaking
these tasks while wearing some variant of the New Look. Indeed, these very activities—
brushing hair, opening and closing windows, and household work—were a route to recovery.73 Lasser noted: ‘Making beds, sweeping, vacuuming, ironing, cleaning windows and
mirrors, putting small things away on high shelves, cleaning the bathtub and REACHING
to its farthest corners—all these homely chores will help to achieve a lovelier you’
(Figure 1). Breast cancer and mastectomy could thus be a positive transformative experience
in the 1950s, but to Lasser, Radler and others it was one that fitted well with specific expectations of gender roles.
A final point needs to be made, which is that whereas physicians, nurses, manufacturers and corsetieres tended to emphasize the fragility of the mastectomy patient, the
advice literature designed for mastectomees tended to stress the importance of the
70
Susan Bordo, Unbearable Weight: Feminism, Western
Culture, and the Body (Berkeley: University of California Press, 1993), 181. Margaret Maynard, ‘“The
Wishful Feeling About Curves”: Fashion, Femininity,
and the “New Look” in Australia’, Journal of Design
History, 1995, 8, 43–59. Peter McNeil, ‘“Put Your
Best Face Forward”: The Impact of the Second World
War on British Dress’, Journal of Design History,
1993, 6, 283–99.
71
Angela Partington, ‘Popular Fashion and Working
Class Affluence’, in Juliet Ash and Elizabeth Wilson,
eds, Chic Thrills: A Fashion Reader (Berkeley: University
of California Press, 1992), 145–61. Chris Brickell,
‘Through the (New) Looking Glass. Gendered Bodies,
Fashion and Resistance in Postwar New Zealand’,
Journal of Consumer Culture, 2002, 2, 241–69.
72
Elaine Tyler May, Homeward Bound: American Families in the Cold War Era (New York: Basic Books,
2008). On the complex symbolic roles and functions
of the breast see Marilyn Yalom, A History of the
Breast (New York: Ballantine Books, 1997).
73
The 1957 leaflet produced by Lasser and Radler for the
ACS also treated domestic activities as a route to recovery. Several pages from the booklet are displayed in
the movie After Mastectomy which show exercises
that include: Hair brushing exercise (6 minutes, 03
seconds), Pulley Motion (6 minutes, 06 seconds), Backscratcher (6 minutes, 11 seconds), Hand wall Climbing
(9 minutes, 48 seconds and 11 minutes, 22 seconds)
and Rope Turning (11 minutes, 35 seconds). Kay
Elliot also read from the book that hanging cloths on
the line, washing windows, fixing closet shelves and
pruning bushes were equivalent to hand wall climbing
(After Mastectomy, 11 minutes, 25 seconds). Nurse
Burnford also shows Kay how to do a wall push
(After Mastectomy 13 minutes, 00 seconds). After
Mastectomy script, 13–15.
458
David Cantor
self-management of emotions as a part of the recovery process—an echo, perhaps, of the
contemporary interest in the power of positive thinking.74 As Lasser noted: ‘The first step is a
determination to face your problem with assurance and courage. Once you accomplish this,
the rest of it will be much easier.’75 For both her and for Radler the exercises, and the return to
gendered domesticity that they represented, marked a crucial part of this effort to inculcate
emotional self-management.
This is not to say that patients could attain such self-management by themselves. They
needed the help of physicians, nurses and corsetieres to heal their psychological wounds,
and they also needed the help of members of their family. The problem for physicians and
nurses was that families could be as much a hindrance as a help. As the narrator in After Mastectomy notes: ‘But the members of the family shouldn’t be overlooked. They can be a great
help, or do greater damage.’76 Particular attention focused on the husband, since his
response to the amputation was viewed as critical to the recovery of the mastectomee.
Radler’s Man to Man and Lasser’s Letter to Husbands make the point, as does After Mastectomy where there is a scene in which the husband is interviewed by the woman’s physician.
They avoid explicit discussion of sexual or physical relations, but focus more generally on the
husband’s consideration for his wife, and the debilitating impact of pity. ‘A buddy of mine
had a leg taken off by a land mine,’ the husband notes, highlighting the parallel with the
rehabilitation of the war wounded. ‘After he came out of the hospital, the worst thing
you could do was show that you felt sorry for him or try to do things for him.’77 ‘That’s
right,’ responds the Doctor, echoing the advice given by Mercy Dobell to corsetieres, and
Lasser and Radler in their pamphlets for husbands: ‘We have to be careful not to show
pity or help too much. It only makes a person feel worse.’78 And he adds: ‘She’ll need
some help and sympathetic understanding at first. But the greatest single thing you can
do to help is to let her know that your feelings towards her as a person haven’t changed
one bit.’79
Spaces of Lay Knowledge and Practice
The moment of recovery not only involved issues of self-presentation, gendered domesticity
and emotional (self) management; it also involved creating a space for lay knowledge and
practices. In Lasser’s view, recovery involved as much an act of will as an act of exercise.
But it was also something that depended on the support of others, especially other mastectomees, at least in the beginning. Mastectomees had a special form of knowledge of cancer,
she claimed, both as women and as women without breasts. It was a knowledge quite different to the knowledge a surgeon might have of the disease, something quite different too
74
Anne Harrington, The Cure Within. A History of MindBody Medicine (New York & London: W. W. Norton
2008), ch. 3.
75
Lasser, Reach to Recovery, 7.
76
After Mastectomy, 8 minutes, 34 seconds. After Mastectomy script, 11. The script has ‘great damage’
instead of ‘greater damage’.
77
After Mastectomy, 8 minutes, 40 seconds. After Mastectomy script, 11. The quotation in the script is slightly
different: ‘A buddy of mine had a leg taken off by a
land mine. After he got out of the hospital, the worst
thing you could do was show you were sorry for him
or try to do things for him.’
78
After Mastectomy, 8 minutes, 51 seconds. After Mastectomy script, 12. ‘We need to be careful not to show
pity or to help too much. It only makes the person feel
worse.’
79
After Mastectomy, 9 minutes, 06 seconds. After Mastectomy script, 12. The quotation in the script is the
same as in the film except that the doctor says
‘toward’ rather than ‘towards’.
Recovery in Twentieth-century American Cancer Campaigns
459
from the knowledge that a man might have. ‘Remember that your surgeon is a busy man
and, being a man, he cannot always foresee the many questions which beset a woman,’
Lasser wrote in 1953.80 ‘The women who inspired this booklet have lived through these
questions and we want to help you find the answers which we found.’
This gendered epistemology helped to create a space for a new form of women’s volunteer work. The ASCC/ACS had long used women volunteers to encourage women to seek
early detection and treatment, but Lasser took volunteer work in a different direction. In her
model—derived apparently from Alcoholics Anonymous—women visitors, themselves
mastectomees, would visit women in hospital soon after an operation, provide them with
emotional and practical support, and by their cheery, optimistic manner and bodily appearance help them to realise that the disease was survivable, and that it did not mean any
change in the way they were perceived by others, except those who already knew about
the operation. Crucially, this model of volunteer work depended on their special, personal
knowledge of what the loss of a breast meant to a woman, and of how women might come
to terms with it. This was a very different model to that provided by the earlier Women’s Field
Army, and marked a contrast to the work of other prominent women involved in cancer,
especially Mary Lasker. Where Lasker sought to promote research, Lasser sought to
promote recovery.
If Lasser’s epistemological rationale helped to create a space for a new form of women’s
volunteer work, it also helped to transform the idea of the ‘animate document in evidence’.
The women who joined Reach to Recovery continued to be such ‘documents’, but what they
documented had changed. They were no longer simply representations of the outcome of
early detection and treatment, goals to be achieved for those who faced mastectomy. They
also represented the means of achieving these goals. Through their words and actions, these
women portrayed cancer and mastectomy as temporary aberrations from which a return to
(something like) normality—recovery—was possible. They provided women with the exercises and attitudes they deemed necessary to achieving these goals. And, they highlighted
the importance of women’s knowledge and practices to recovery, albeit a knowledge and
practice often subservient to male surgical knowledge. Lasser urged her readers to follow
the advice of their physicians before attempting her programme of recovery, or any other.81
Lasser’s efforts to create a space for women’s knowledge received tentative endorsement
from the ACS in the 1950s, but only tentative endorsement. Despite its recent tendency to
introduce the topic of post-operative recovery into its public education programmes, the
ACS remained concerned that the topic might undermine its efforts to recruit people into
programmes of early detection and treatment by generating fears about cancer treatments,
and worried that Lasser’s efforts might make the situation worse. The organisation was
under growing criticism that it had gone too far in its post-war use of scare tactics in its
public education programmes.82 Critics argued that the organisation was fomenting
popular panic, and a growing body of psychological evidence suggested that fear-arousing
communications could easily backfire and undermine the educational messages that
80
Lasser, Reach to Recovery, 6–7.
Ibid., 6.
82
On the ACS’s growing use of fear in its advertising see
Patterson, Dread Disease, 175–6. For criticism of this
81
from alternative perspective on the ACS and scare
advertising see Charles Falkner, ‘Do Cancer Drives
Create Fear’, Bernarr MacFadden’s Health Rev.,
1950, 94, 30–1, 58–9.
460
David Cantor
they were supposed to promote.83 In such circumstances, anything that threatened to exacerbate these concerns and criticisms was a problem, and this included Reach to Recovery.
The result was that the ACS was cautious about Lasser’s efforts to create a space for
women’s knowledge, despite the help it promised for post-operative patients, and
despite Lasser’s efforts to limit and subordinate women’s knowledge to male surgical
expertise. It was too easy, the ACS felt, for things to get out of hand, and for these lay
women to do harm to patients, to dissuade others from seeking help, and to exacerbate
the existing criticism and concern about the ACS’s scare tactics by highlighting the mutilating effects of the operation—often much more mutilating than the scars shown in
After Mastectomy. Besides many ACS surgeons still felt uneasy, if not resistant, to women
volunteers trespassing on what they regarded as their territory within the hospital. For
these reasons, the ACS was cautious about Lasser’s efforts, caught between a desire to
encourage women to help each other through recovery, and a fear that it all could go
horribly wrong.
A Broader Moment
The focus of this paper has been on breast cancer, but breast cancer was only one part of a
broader moment of recovery.84 Similar moments can also be detected in other cancers, and
in particular cancers of the colon and larynx. In all of these three diseases physicians claimed
that the five-year survival rates were much higher than in other bodily sites, other than the
skin.85 All were also the subject of an increasing focus on radical surgery, and contemporary
commentators highlighted the importance in all three cancers of a substantial need for
muscle re-education, and the psychological and social adjustments to living with the
results of the surgical intervention for life.86 There were other cancers in which similar adjustments were discussed. For example, the facial disfigurement that followed a radical removal
of cancer of the jaw, mouth, eyes or neck, often required substantial plastic surgery, and
efforts to ensure that patients were not scarred emotionally as well as physically. But in
83
For psychological research which suggested that fear
arousing propaganda could backfire see: Irving L.
Janis and Seymour Feshbach, ‘Effects of Fear-Arousing
Communications’, Journal of Abnormal and Social
Psychology, 1953, 48, 78–92. Don Haefner, Some
Effects of Guilt-Arousing and Fear-Arousing Persuasive Communications on Opinion Change (Office of
Naval Research, Contract No. N6 ONR 241: Unpublished Technical Report, 15 Aug. 1956). For a report
that showed no significant differences or a mixed
outcome for essentially the same variables see
Howard Moltz and Donald L. Thistlethwaite, ‘Attitude
Modification and Anxiety Reduction’, Journal of
Abnormal and Social Psychology, 1955, 50, 231–7.
For reviews of the fear-arousing literature see
Kenneth L. Higbee, ‘Fifteen Years of Fear Arousal:
Research on Threat Appeals: 1953–1968’, Psychological Bulletin, 1969, 72, 426–44; Irving L. Janis, ‘Effects
of Fear Arousal on Attitude Change: Recent Developments in Theory and Experimental Research’, in
Leonard Berkowitz, ed., Advances in Experimental
Social Psychology, vol. 3. (New York: Academic Press,
1967), 166–224; Howard Leventhal, ‘Findings and
Theory in the Study of Fear Communications’, in
Leonard Berkowitz, ed., Advances in Experimental
Social Psychology, vol. 5 (New York: Academic Press,
1970), 119–86; Chester A. Insko, Theories of Attitude
Change (New York: Appleton-Century-Crofts, 1967),
34–43; Richard Lazarus, Psychological Stress and the
Coping Process (New York: McGraw-Hill, 1966).
84
Breslow et al., A History of Cancer Control, vol. 1,
457–62.
85
Howard A. Rusk and Eugene J. Taylor, New Hope for
the Handicapped: The Rehabilitation of the Disabled
from Bed to Job (New York: Harper & Brothers,
1949), 146–7; W. Kenneth Clark, ‘Rehabilitation and
the Cancer Patient,’ in Harry A. Pattison, ed., The
Handicapped and their Rehabilitation (Springfield, IL:
Thomas, 1957), 293–306.
86
On the history of cancer rehabilitation see Breslow
et al., A History of Cancer Control, Vol. 1, ch. 8
Recovery in Twentieth-century American Cancer Campaigns
461
the 1940s and 1950s it was the breast, colon and larynx that received most attention in terms
of rehabilitation and recovery.
If differential survival rates help to explain why cancers of the breast, colon and larynx
formed the vanguard of broader moment, so too did the emergence of similar networks
or complexes of recovery. In the case of cancers of the colon, the groundwork was laid by
the creation of earlier mutual aid organizations for ulcerative colitis. A key figure was
Edith Lenneberg, a refugee from Hitler’s Germany who settled in Boston. Diagnosed with
ulcerative colitis in the early 1950s, she underwent an ileostomy, and in 1952 helped to
found the Ostomy Association of Boston with the encouragement of physicians who
hoped it would help them manage their patients by addressing their psychological needs.
Like Reach to Recovery, the Ostomy Association began as a women only group, before
enlisting men into its ranks. It later expanded to include cancer patients, encouraging—
also like Reach to Recovery—former patients to visit new patients and provide emotional
support and practical advice, including various information pamphlets.87 There was
advice on odour control, irrigation, hygiene and care of the skin, what clothes to wear
with the bag, the process by which one regulated oneself, what equipment was needed
and where to get it, what to do in emergencies (diarrhoea), whether to use laxatives or
cathartics in the case of constipation, and diets such as the ‘low residue diet’. Much of
this advice had been developed earlier in the nursing and medical literature, and the
Ostomy Association, along with some nurses, adapted it for lay audiences. Nurses and
others eagerly sought out these pamphlets to give to their patients, investigated different
colostomy devices, and recommended manufacturers and local suppliers of equipment to
their patients. For their part, manufacturers and suppliers sought out nurses to promote
their wares and services, and a nurse-industry complex emerged, overlapping to some
extent with the similar movement around breast cancer.88
In the case of laryngeal cancers, the groundwork was laid by Lost Chord Clubs set up
before the Second World War.89 But in the 1940s and 1950s the numbers of such
87
‘The History of QT Boston / OAB Series—“In their
own words”’, <http://www.bostonoab.org/overveiw/
>, accessed 27 November 2013; Albert S. Lyons, ‘An
Ileostomy Club’, JAMA, 25 October 1952, 150, 812–3;
Edith Lenneberg, ‘QT Boston—An Ileostomy Group’,
New England Journal of Medicine, 16 December 1954,
1008–11; Manual for Ileostomy Patients (Boston:
Q. T. Boston, 1953) [1st] edn (1953), 3rd edn (1955),
4th edn (1960); The C and I Newsletter (1955–1958)
later The Cirgin (1958– ) published by the Colostomy
and Ileostomy Rehabilitation Guild, St Paul. For other literature see: Special Committee Appointed to Study the
Care of Colostomy Patients, Booklet of Instructions for
Persons with a Colostomy (New York: Cornell University,
NewYork Hospital, 1948); A Colostomy? Preparedby the
1955 Nursing Class (Kansas City, Kansas: Department of
Nursing, University of Kansas School of Medicine, 1954),
University of Kansas Medical Center Archives, School of
Nursing, Publicity Files. For a review see: Theresa
Hanlon, ‘A Booklet for Colostomy Patients’, American
Journal of Nursing, 1954, 54, 1517–18); (3) and,
American Cancer Society, Care of Your Colostomy
(New York, The Society, 1956).
88
‘Minutes of the Committee meeting for Care of Mastectomy Patients’, Virginia Dericks Papers, Folder 13;
‘Minutes of the New York Hospital Committee on
Care of Colostomy Patients’, Virginia Dericks Papers,
Folder 10; Virginia C. Dericks and Katherine
A. Robeson, ‘Problems of Colostomy Patients’, Public
Health Nursing, January 1949, 41, 16–27.
89
‘Belch-Talk’, Time, 4 December 1939, 34, 63–4;
Chevalier Jackson and Chevalier L. Jackson, The
Larynx and Its Diseases (Philadelphia, W. B. Saunders
Company, 1937); Chevalier Jackson and Chevalier
L. Jackson, ‘Cancer of the Larynx’, JAMA, 26 November 1938, 111, 1986–93; Chevalier L. Jackson, ‘The
Voice After Direct Laryngoscopic Operations, Laryngofissure and Laryngectomy’, Archives of Otolaryngology, 1940, 31, 23–37; Leo A. Kallen, ‘Vicarious Vocal
Mechanisms: The Anatomy, Physiology, and Development of Speech in Laryngectomized Persons’, Archives
of Otolaryngology, 1934, 20, 460–503; Nathaniel
Martin Levin, ‘Teaching the Laryngectomized Patient
462
David Cantor
organizations took off, many promoted by physicians interested in encouraging patients to
learn to speak again, psychosocial rehabilitation and in persuading patients who might be
hesitant about an operation that they could speak again.90 In 1952, the various lay organizations coalesced into the International Association of Laryngectomees, supported by the
ACS and the National Cancer Institute, which also provided pamphlets and films for laryngectomees.91 There was advice on how to speak again, the psychosocial problems of adjusting, the return to work and the problems of cleaning the stoma. The Associations also
promoted the Clubs as important to the exchange of ideas about appropriate clothing,
the use of stoma covers and other devices to protect the breathing tube, and how the
stoma and signs of surgery might be obscured. As with breast and colon cancers, there
seem also to have emerged a nurse/medical-industrial complex of sorts, with nurses,
speech therapists and physicians researching manufacturers and suppliers to provide information to patients, and manufacturers and suppliers seeking out the former.92
The broader moment of recovery can therefore be seen as a sort of Venn diagram, each
overlapping circle comprising its own moment and including a complex of patients, nurses,
physicians, voluntary, government and commercial groups. It is the existence of these parallel complexes that helps to explain why cancers of the breast, colon and larynx were at the
vanguard of the moment. The word complex is key here. Physicians and nurses promoted
rehabilitation in many other cancers, but medical or nursing interest by itself did not constitute a moment of recovery. What turned nursing or medical interest in (cancer) rehabilitation
into a broader moment was the existence of mutual aid organizations interested in promoting recovery discourses and practices among patients, and industries interested in the sorts
of markets that encouraged these discourses and practices. It may be that the higher lethality
of other cancers worked against the development of similar movements elsewhere: higher
mortality meant a small pool of survivors, smaller opportunities for mutual aid organizations
to flourish, and smaller long-term commercial markets for rehabilitation devices. But, mortality figures were only part of the explanation for the emergence of a moment. This emergence depended on a diverse range of contingencies that brought medical, nursing, mutual
aid and industry groups together around a particular cancer, and eventually also secured the
attention of voluntary organizations like the ACS and the Federal Government. It is the contingencies around breast cancer that have formed the core of this paper.
It is beyond the scope of this essay to fully explore in detail these other moments around
cancers of the colon and larynx, but they shared with breast cancer a common focus on treating cancer as a temporary aberration and recovery as a return to a ‘normality’ that involved
patients concealing their identities as people who had undergone cancer therapy.93 What
to Talk (Without the Aid of the Mechanical Larynx)’,
Archives of Otolaryngology, 1940, 32, 299–314; Nicholas Ehrlich, The Life of a Laryngectomee (New York:
Froben, 1937).
90
Warren H. Gardner, ‘The Laryngectomees Organize’,
Quarterly Journal of Speech, 1956, 42, 270–2;
Warren H. Gardner, ‘Problems of Laryngectomees’,
Journal of Chronic Diseases, 1961, 13, 253–60.
91
The ACS also financed its conventions, and in 1955
the ACD agreed to sponsor the programmes of the
associations’ local clubs, and its first publication IAL
News appeared in October 1955. Movies included
We Speak Again (1949), New Voices (1949), You
Can Talk Again, Post-laryngectomy Speech, and The
Irritating Angel (1959). Clark, ‘Rehabilitation and the
Cancer Patient’, 302–3; Gardner, ‘The Laryngectomees Organize’.
92
On contemporary aids see Warren H. Gardner and
Harold E. Harris, ‘Aids and Devices for Laryngectomees’, Archives of Otolaryngology, 1961, 73, 145–52.
93
Klawiter, The Biopolitics of Breast Cancer, 120.
Recovery in Twentieth-century American Cancer Campaigns
463
constituted normality differed from cancer to cancer in part because, as psychologists
argued at the time, the loss of the voice, colon or breast all had very different meanings.94
In addition, each operation offered different social challenges to patients. All of them had to
live with the possibility of discovery, but it was perhaps more difficult for a laryngectomy
patient to obscure his or her operation in public than for a mastectomee or colostomy
patient. The latter lived with the anxiety that ill-fitting equipment would release tell-tale
odours; the former lived with the anxiety that ill-fitting equipment would indicate the
missing breast.
Recovery was thus a precarious state, constantly under threat from the disease, the interventions against it, the emotional responses of patients, and the malfunctioning of equipment designed to disguise it. It could be a long process, with no assurance of a return to
full functionality, a continuing struggle to fool the public and the ever present fear of recurrence. A core set of assumptions behind the broader moment of recovery was that the anxieties associated with the disease and operation would become manageable, that people
would adapt to their new physical conditions and that cancer was curable. But sometimes
these assumptions proved false. Instead of liberating people from disease and dependency,
interventions against cancer could do quite the opposite.
The problem was further complicated when the effects of cancer on the patient’s family
were taken into account. The NCI made the point in evidence to the House Committee on
Interstate and Foreign Commerce. In its view, cancer care could be enormously expensive,
especially in the terminal stages of the disease, and could overwhelm family budgets when
the breadwinner succumbed.95 And in addition there was the loss of status or self-respect
when a family was forced to accept relief which they had never previously needed; the longterm effects on children whose mother assumed a wage earning role because of the father’s
illness; or the difficulties faced by a father who had to assume the role of caring for the children when a mother was ill. Men, in particular, faced a bleak employment outlook. ‘Most
industries refuse to employ individuals who have had cancer because of the increased risk
of compensable illness. New opportunities for creative or productive employment are difficult to find for many cancer patients, particularly males,’ noted the Institute.96 ‘Thus, there is
nearly a total socio-economic loss to the community in the case of male cancer patients, and
a substantial one with female patients, even when they have survived their initial course of
treatment for the disease.’
The NCI’s account was very different to the return to normality narrative that dominated
the moment(s) of recovery. In its view, cancer threatened families with exclusion from the
dream of post-war economic affluence. It raised the unwelcome prospect of financial hardship and the stigma of dependency and pauperism, and highlighted the fragility of the
post-war nuclear family, isolated from supportive kin in the suburbs.97 It threatened to
94
95
Cantor, ‘Memorial’s Stress?’
United States Congress, House Committee on Interstate and Foreign Commerce, Health inquiry; The toll
of our Major Diseases, their Causes, Prevention, and
Control. Preliminary Report of the Committee on Interstate and Foreign Commerce Pursuant to Section 136
of the Legislative Reorganization act of 1946, Public
law 601, 79th Congress, and House resolution 127,
83d Congress (Washington: USGPO, 1954), 102. See
also ‘Cancer: Prepared for Hearings of the House Committee on Interstate and Foreign Commerce’, 2
October 1953, NCI archives (Lion database), AR5310–003725.
96
Committee on Interstate and Foreign Commerce, Ibid.
97
May, Homeward Bound, 20.
464
David Cantor
deprive the family of its prime breadwinner (the husband in 1950s domestic ideology), not
only by killing or crippling him, but also by turning him into a liability for employers. In addition, the NCI’s comments suggest that cancer threatened the family in other ways. It disrupted the division of labour within the 1950s family, forcing men into roles that were
gendered female, and women into roles that were gendered male. And it raised the prospect
of such families producing maladjusted children, so feeding into emergent concerns about
the role of the family in producing juvenile delinquency and childhood psychic ills.98 Against
such concerns, the moment of recovery offered the comforting hope of a better future, and
the promise of knowledge and techniques by which the individual and her family might
achieve it. But, it also opened the door to blaming those same individuals for their failure
to achieve recovery, despite or because of the odds stacked against them.
Passing Moments
From the 1970s and 1980s the moment of recovery began to pass. Increasingly, Reach to
Recovery, the ACS, the NCI and a host of other organizations began to identify people as
cancer ‘survivors’, and the old labels of ‘breast amputee’, ‘mastectomee’, ‘colostomate’
or ‘larygectomee’ began to disappear. Unlike these older labels, ‘survivors’ often adopted
the new label themselves, and for life (not simply for the period of recovery), and came to
question the subordination of their own knowledge of the cancer to that of medicine.
This is not to say that the notion of recovery entirely disappeared. The idea of the cancer survivor made normal persisted, but it served different purposes.99 Whereas in the 1950s, it provided a counter-narrative to concerns about exclusion from post-war suburban affluence, in
the 1970s and 1980s it provided a counter-narrative to concerns about the economic problems, unemployment and spiralling health care costs of those decades (all of which unduly
affected cancer patients), as well as to emergent concerns about the threats posed by occupational and environmental carcinogens. In addition, with more women entering the workforce and a growing feminist movement, the domestic ideology that had helped shape the
moment in the 1950s was less relevant to the survivor made normal discourse of the 1970s
and 1980s. Commentators also identified a variety of other discourses that existed alongside, and sometimes challenged, the dominant recovery model, including portrayals of
cancer survival as an accomplishment, a quest or a descent into chaos.100
Other changes also undermined the moment of recovery of the 1950s. From the 1980s,
the older complex of commercial, professional and patients’ groups associated with the
moment of recovery was joined and displaced by a new market-driven survivorship industry
in which a variety of new corporations turned their promotion efforts to finding a cure for the
disease. Critics came to worry that this new industry overwhelmed public health prevention
efforts, undermined attempts to explore the social, economic and political causes of cancer,
98
James Gilbert, A Cycle of Outrage: America’s Reaction
to the Juvenile Delinquent in the 1950s (New York:
Oxford University Press, 1986); Deborah Weinstein,
The Pathological Family: Postwar America and the
Rise of Family Therapy (Ithaca: Cornell University
Press, 2013).
99
Christina Sinding and Ross Gray, ‘Active Aging—
Spunky Survivorship? Discourses and Experiences of
the Years Beyond Breast Cancer,’ Journal of Aging
Studies 2005, 19, 147–61.
100
A. W. Frank, The Wounded Storyteller: Body, Illness,
and Ethics (Chicago: The University of Chicago
Press, 1995); A. W. Frank, At the Will of the Body:
Reflections on Illness (Boston: Houghton Mifflin,
1991).
Recovery in Twentieth-century American Cancer Campaigns
465
and turned ‘survivors’ back into ‘animate documents’ that demonstrated the potential of
biomedicine to cure cancer and the need for more research. The patient made normal
was part of such demonstrations, but embedded in the new series of debates about survivorship. For some the term ‘survivor’ had been hijacked by the ‘survivorship industry’, which
turned the experiences of ‘survivors’ (along with the associated identity politics) to their
own corporate advantage. Others focused on its multiplicity of meanings as: indicative of
a flourishing grass roots movement; a barrier to forging a coherent political movement
around identity politics; or a label that failed to capture certain experiences of cancer. The
existence of debates and struggles around identity politics and corporate hijacking (both
absent from the debates in the 1950s) marked the beginning what might be called the
moment of survivorship and the end of the moment of recovery.
Acknowledgements
This paper began life with an invitation to participate in ‘Le Concept de Guérison à l’épreuve
du Cancer’, a meeting held at the Centre George Canguilhem, University Paris Diderot, 7
December 2007. Subsequent, versions of the paper were presented at a conference organised by CERMES also held in Paris (‘How Cancer Changed: Expanding the Boundaries of
Medical Interventions’) 2–3 April 2009 and at the Office of History, National Institutes of
Health Work-in-Progress Seminars, 6 April 2010 and 7 May 2013. The participants at all
these events helped to shape this paper, as did the work of my two research assistants,
Emily Alden and Brian Casey and the comments of the three anonymous reviewers. Needless
to say, all the problems of this paper are my own.