“Cancer’s Revelations: Malignancies and Therapies in a Recent Chinese Novel.” _Literature and Medicine_ 28.2 (Fall 2009): 351-70.

Cancer's Revelations: Malignancies and Therapies in a RecentChinese Novel

Sabina Knight

Literature and Medicine, Volume 28, Number 2, Fall 2009, pp.351-370 (Article)

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Literature and Medicine 28, no. 2 (Fall 2009) 351–370© 2010 by The Johns Hopkins University Press

Cancer’s Revelations: Malignancies and Therapies in a Recent Chinese NovelSabina Knight

In 2003, physician-turned-writer Bi Shumin 毕淑敏 published a landmark work of cancer literature, Zhengjiu rufang 拯救乳房 [Save the Breast]. In foregrounding the variety and complexity of subjective and social experience, Bi’s novel offers an account much more nuanced and realistic than many narratives and theories that explore social understandings of cancer. The novel’s perspectives on cancer, revealed through the interactions of its ten main characters, complement bio-medical conceptions of the disease. Although the novel celebrates group therapy, it implicitly challenges the individualistic psychology that often accompanies therapeutic encounters. In Save the Breast, multiple storylines, social norms, and economic contexts suggest diverse paths to healing.

The reception of Bi’s novel highlights some of the difficulties of negotiating responses to therapy cultures as American practices gain currency in China. On one hand, the novel can be read as defying the stigmatization of breast cancer and therapy culture more generally. Moreover, its focus on communicative therapies advocates for overcoming shame and speaking out not only about breast cancer but also about domestic violence, the maltreatment of prostitutes, and gender stereotyp-ing. Yet, Bi Shumin’s popularity and the novel’s large first print run of 120,000 copies sparked charges of sensationalism, particularly concern-ing the novel’s title. Though the publisher chose Save the Breast out of fear that Bi’s working title, Aizheng xiaozu 癌症小组 [Cancer Group], would frighten away readers, some critics suspected that the new title aimed to appeal to prurient readers.1 The bold cover art might also be interpreted as inviting titillation by setting a naked woman’s torso against a small white medical cross, making the figure look crucified, with arms outspread and a suspiciously prominent mastectomy scar

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Figure 1. Cover of Bi Shumin’s (毕淑敏) landmark work of cancer literature, Zhengjiu rufang 拯救乳房 [Save the Breast]. Cover image used with permission of renmin wenxue chubanshe [People’s Publishing House]

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on the woman’s right breast (figure 1). Yet for readers unaware of the photo’s provenance (a subject to which I’ll return), the Christ-like imagery might suggest that these sufferers are martyrs to wider social, economic, family, or gender dynamics, an indicator species for all those left out by market transitions and their resulting inequalities.

The novel centers on Dr. Cheng Yuanqing, a US-trained Ph.D. psychologist running a breast cancer therapy group, and her male as-sistant Zhu Qiang. Even as Dr. Cheng plans her group, fields phone inquiries, and holds initial meetings, the novel also follows the stories of the eight individuals who join her group. In presenting the back-stories of the characters, the novel underscores the extent to which the diagnosis of breast cancer has devastated their self-concepts, their gender identities, and their illusions of control. Dr. Cheng describes this psychological trauma to her benefactor, the CeO of a pharmaceuti-cal company who offers to sponsor her group: “As soon as a person comes down with cancer, it’s as if [she] gets on the conveyer belt towards death, forced to enter a black hole. Cancer is a brush fire. Grazed by it, illusions turn to ashes, happiness loses its color, gifts shatter, achievements are without light, confidence disintegrates; fear and the black stone of despair are the only remnants.”2 With terms emphasizing the characters’ “despair of finding a way out” (一筹莫

展 yi chou mo zhan, 36), the novel’s opening chapters describe their sense of helplessness, as well as the medicalization and social isolation that exacerbate their suffering. Severed from the lives they previously assumed they would live, the characters feel paralyzed, and thus, at the start, they defer to fate, to husbands, or to decisions made long ago in circumstances no longer applicable to their lives.

Although marketed as China’s first psychotherapy novel (心理

资料小说 xinli ziliao xiaoshuo), Bi’s narrative transcends a narrowly psychological perspective. even as Dr. Cheng uncritically implements many practices of ego psychology, the novel’s developments in many ways dispute a psychological approach to selfhood. For one, the delineation of the characters depends largely on the ways in which they act and communicate with others. Juxtaposed against the group members’ lived experiences, Dr. Cheng’s psychological theories about them often seem shallow, especially since they repeatedly surprise her with confessions and revelations that utterly change whatever basis she might have for analysis.

Instead of a narrowly psychological perspective, then, the novel celebrates a therapy culture grounded in communicative exercises. Though the members come from diverse subcultures and social classes,


the group dynamic provides them, in time, a sense of community. Moreover, the positive outcomes the members report testify to the therapeutic value of telling their stories in a circle of others who have experienced breast cancer: “Their hearts had opened, and they no longer feared death as they had before. Their moods were more stable, less [susceptible] to casting blame on others. They were more able to accept what was. And they were better able to experience the human world’s beauty and the preciousness of intimate feeling” (349). As they revise their personal narratives through compassionate exchanges, the characters become more than their individual afflic-tions. They begin to stand out as moral actors within what remains the medical, social, and economic context of their afflictions, but they are no longer imprisoned by those determining conditions.

Thus, in Save the Breast, the complex phenomenology of breast cancer and the suffering that accompanies it are depicted as symptoms of deep cultural discomfort.3 Following modern Chinese fiction’s long tradition of using illness for allegory, breast cancer is also a meta-phor for sickness at the heart of a nation racked by rapid social and economic change.4 As the novel shows, this sickness affects especially the nation’s women as they continue to suffer the fallout of political violence, economic restructuring, and massive rural-urban migrations. Such profound shifts affect public attitudes toward material gain, gender and sexuality, responsibilities to family members, and involvement in the public good. From lulu’s prostitution to pay for kidney dialysis for the man she loves, to Chuncao’s unemployment, to the high-level cadre’s5 loveless marriage of convenience, the group members’ predicaments are intimately connected to the gendered inequalities of China’s market transition. As Bi and other Chinese novelists confront illness and death, disability and depression, their fictional treatments allegorize the cultural distress caused by large-scale market transitions, environmental degradation, and medical interventions.

Just as fundamentally, Bi’s novel implicitly critiques detached individualism and therapy cultures that downplay interdependency. Though the novel conveys its unease with individualism more in its silences than in its explicit discourse, I highlight these tensions to contrast phenomenological approaches with the ego-psychology that underpins many therapeutic paradigms, especially therapeutic cultures imported to Chinese medical practice from America.

Several absences in the novel suggest some of the pitfalls and limitations of the therapy culture based in ego-psychology that Dr. Cheng studied in America: What happens to these women after the

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group ends? Where do recovering repressed memories and a sense of an essential self leave women if they no longer have the dynamic interaction that promotes ongoing self-cultivation and access to mean-ingful relationships? For, above all, the novel bespeaks the characters’ longing for the reassurance of acceptance, for a sense of belonging, and for the social support, as one character puts it, “to experience true [common] feeling” (356).

Malignancies

By interweaving the stories of the eight group members, Save the Breast reinforces the importance of attending to the diversity of sufferers’ experiences. Whereas the characters share profound feelings of shame, broken relationships, isolation, and initial hopelessness, their unique situations bring to light how languages, social norms, and economic contexts have shaped their illness experiences. As each character describes her breast cancer, the disease takes on multiple meanings, playing a radically different role in each life. The voice of a young graduate student, for example, articulates breast cancer’s impact on her gender identity:

From the moment I learned I had cancer, I felt that I wasn’t a girl. I’d become a strange thing, neither man nor woman. My body’s command point, my pride, my love and the good fortune I hadn’t had time to enjoy all became a terrifying abyss following the knife’s cut. I believe that what makes women called women is their in-comparably beautiful curves and the function of these curves. They aren’t only external, but internal. After [my figure] was destroyed, my dignity and courage were buried with it. (125)

As we have already seen, breast cancer is not an isolated condition in the novel. The group members’ stories emphasize the heterogeneous nature of the suffering that follows the diagnosis, to the point where speaking of the disease of breast cancer seems an example of what Whitehead called the “Fallacy of Misplaced Concreteness.”6 As biologist robert Dorit writes in addressing the question “So what makes breast cancer ‘breast cancer’?”, the answer lies at least partially in “location,” and thus could “be a superficial similarity—an address that groups together unrelated conditions and obscures connections to tumors in other parts of the body.”7


extending Dorit’s metaphor to the body politic foregrounds the novel’s insistence on presenting experiences of the disease named “breast cancer” within the context of malignancies inherent in the characters’ larger socio-economic predicaments. Finishing the novel, a reader might even conclude, as do some of the characters, that there is nothing so terrible about breast cancer itself. Instead, the corrosive malignancy is living with lies and deceptions and suffering the sense of disorder that accompanies them. For, like cancer, lies and deceptions metasta-size, and denials of human dependency and death usually entail other serious distortions. The novel represents each group member’s hopes to escape either a soul-deadening self-deception, a lie, or a deception of others. The following paragraphs offer a précis of these deceptions to introduce the characters and their predicaments.

First, despite the prerequisite that members be patients in (at least temporary) recovery, one member turns out not to have had the prescribed surgery. This ambitious high-level cadre initially rational-izes her resistance by her fear that a surgery would prevent her next promotion. later she recovers a repressed memory of having shamed her mother during the Cultural Revolution—a betrayal that led to her mother’s suicide—and realizes that she feels she deserves to die in absolution for her lack of filial piety.

A second member turns out never to have had cancer at all, but joined the group to understand her alienation from her beloved daughter, who died of breast cancer at twenty-eight. Misled about the severity of her cancer, the embittered daughter increasingly directed her anger toward her mother. This character, a retired school principal, hears that every group member would want to know the truth about her prognosis. She thus comes to understand that her daughter longed for the truth too, and that from this longing denied arose her resent-ment. “An incommunicable sadness drove a wedge between [us],” she laments. “This is more fearful than [any] cancer of the body” (284).

Hearing how this bereaved mother suffered from her estrange-ment from her daughter, another group member resolves to tell her own mother about her cancer. This young woman has concealed her disease from her family, from a series of boyfriends, and in part from her own conscious awareness. Through a sustained interactive group exercise, she practices telling each of the others that she has cancer. She thus faces her shame and overcomes her compulsion to seduce and abandon men in an attempt to use what she calls “the dark and mysterious power of sexual desire” (133) to ward off the despair she feels.

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Self-deception also fuels the nightmarish life of lulu, a group member who has four aliases and who turns out to be a high-priced prostitute. Having sold herself since adolescence to send remittances to the man she hopes to marry, lulu contracted breast cancer after having an extreme breast augmentation.8 After Dr. Cheng forces her to confront the man, and she realizes that he cares only for her money, she renounces prostitution.

A fifth member, Ying Chuncao, turns out to be the victim of persistent domestic abuse. Speaking of and to herself in the second person, she explains that “you” should meekly submit since a man wouldn’t beat “you” if “you” didn’t deserve it (316). Dr. Cheng first acknowledges the usefulness of such internal conversation for enduring violence, then stresses that it is Chuncao’s choice to bear the abuse or to change. Though Chuncao intends to answer “I can bear it,” out of her mouth comes “I want to change,” and the narrator comments that the speaker “was a different Ying Chuncao hidden within her body” (317). Dr. Cheng then has Chuncao repeat her rationalization, but in the first person. At this point Chuncao confronts the root of her sense of blameworthiness, namely that her mastectomy has left her a “maimed person” (残废人 canfeiren), “no longer a whole woman” (319).

A sixth member, Hua lan, believes her husband is having an affair, but similarly blames her breast cancer: “Having lost a breast, [she] was already incomplete as a woman. Her courage, following the excised breast, had been thrown in the garbage” (36–37). After she reclaims her courage, and her husband puts her fears to rest, the resumption of their lovemaking enables her to recover her feminine identity. Whereas mastectomies left Ying Chuncao and Hua lan feel-ing dissociated from their bodies, their husbands, and their identities as women, the group’s empathic community allows them to reclaim their voices and bodies through emotional and physical connections to others. These two cases of reclaimed self-possession reverse the biomedical model that accomplishes therapeutic cure through excision with a practice of embodiment that heals through incorporation.

And in an even more surprising turn, therapeutic embodiment does not necessarily mean eradication of the biological metastasis at all. The seventh group member makes peace with her cancer after addressing the psychological malignancy resulting from her oppressive life story. recruited as an idealistic young woman into the People’s liberation Army (PlA), her posting soon turned into an arranged marriage to a much older officer she still refers to as “the commis-sar.” When she joins the group, six years after her husband’s death,


the widow continues to heed his counsel, which she receives through his appearances in her dreams. To question her utter dependency, another group member explains that her story is like a novel, tragic and complete: “But we aren’t a novel. We’re real people” (237), the young woman tells the widow, as she urges her to let the dead hus-band’s counsel expire. Determining her own wishes turns out to be a complicated process. Initially the widow had refused all but herbal treatments on the grounds that the commissar had so advised. She had then acquiesced to biomedical intervention after caretakers convinced her traditional Chinese medicine doctor to claim that the commissar had appeared to him in a dream and so advised. Once she takes the decision into her own hands, the woman stops treatment and “let[s] nature take its course” (240).

In the most startling account, the eighth “woman” in the group turns out to be a man, a case I’ll return to below. recounting one of the later disclosures, the narration, which is presumably Dr. Cheng’s interior monologue, asks, “Why does the group have so many secrets? Why does the group have so many hoodwinkers” (骗子 pianzi)? What power did the group have that it could, one by one, reveal each secret to the light of day?” (308). The answer is implicit in group members’ interactions and in their understanding that suffering is much less personal than they imagined.

Therapies

The group members’ transformations are most evident in a scene toward the end of the novel in which Dr. Cheng joins them outside under a starlit sky. After discussing the solar system, the Milky Way, the 200 billion fixed stars, innumerable planets, and ten billion extragalactic nebulae, Dr. Cheng points out that this perspective can remind them how brief and infinitesimal each individual’s life is. “Faced with such a vast universe,” she queries, “what can we do?” (398). She hands out sheets of paper and asks each participant to draw a “lifeline” (生命线 shengmingxian), beginning with birth, noting significant life events, and adding her aspirations for the future. The members mark the major transition that the diagnosis of breast cancer occasioned as well as other life events—schooling, awards, love, marriage, childbirth. They then stop to ponder the future, and Dr. Cheng reflects on their wounds and hardships. Just as their bodies have weathered injections, excisions, and other procedures, their minds and reflections, Dr. Cheng imagines, must also have traversed “longer courses of development” (398).

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Dr. Cheng’s respect suggests that the goal of her therapy group has not been to manage the members’ suffering in order to help them be “normal people” (正常人 zhengchang ren). even if all but one of the participants began with this aim, Dr. Cheng’s approach makes therapy not a path to adjustment or conformity but an opening for her patients to become more consciously self-determining. Instead of working toward a sense of normalcy, she has counseled her group to come to terms with breast cancer in ways that expose the vulnerability and limita-tions that all mortals face.9 Additionally, by confronting together their mortality, each person relinquishes fantasies in order to take stock of what could be a good life for her. Dr. Cheng glimpses these lives as she looks at the plans sketched on their lifelines: to earn a doctorate, to become the Head of a Ministry, to have children, to write a novel. Having traveled at length with these characters, the reader is struck by their newfound ability to envision possible futures. Telling their stories among active listeners has enabled the members, along with Dr. Cheng and Zhu Qiang, to consider alternatives to the stories into which they have been socialized. In so doing, each one revises her story to allow for previously unrecognized room to maneuver.10

This outcome is all the more striking because the novel begins by depicting the characters’ sense of crushing disorder, “as if sky and earth were spinning” (天旋地转 tian xuan di zhuan, 179), that cancer may have ruined all their life plans. Bereaved about cancer-shattered dreams, many come to the group with habitual urges to recover for-mer images of themselves, most often through compulsive repetitions of self-destructive behavior.

As the novel progresses, however, each character comes to under-stand that those images were always products of fantasy, ideological mystification, and denial of death. “Actually death is peaceful and serene,” Dr. Cheng explains. “We are, after all, only temporary residents on earth” (74). Becoming realistic about mortality and the sources of their suffering, the characters cultivate a sense of meaningful moral agency. At the end, what the group has given its members, and what the novel has given its readers, is a renewed capacity of imagination and a recovery of their aspirations grounded in an expanded sense of dwelling in the world over time and with others.

The characters’ rediscovery of their aspirations is largely a story of how they move from an individual to a more social conception of selfhood. less susceptible to denial and fantasy, the social self each member develops is more experiential and phenomenological. The description of the PlA widow in the “post-commissar period” un-


derscores the importance of interpersonal communication for ending obsessive, malignant ruminations. Finally free of anxiety about obeying her deceased husband, her conversations with others help her to enjoy “thoughts thronging the mind” (浮想联翩 fuxiang lianpian, 388), and she becomes not only decisive but humorous and witty. The novel thus shifts from a medical paradigm, focusing on the individual, to a social paradigm emphasizing relational factors.

The tale of this shift exposes the characters’ internalizations of biomedical paradigms, folk wisdom, and associated symbols and metaphors. One striking feature of their evolving conceptions is that breast cancer no longer appears only “as a dysfunction of a particular body, which biomedicine [might] cure,” but also comes to serve “as a trope for a moral or spiritual condition.”11 “Humans are terrified of loneliness” (393), the narrator comments at the end of the novel, and this line points to the novel’s celebration of deepening friendships as perhaps the most crucial path for living with illness. When a nurse questions whether the group members will come to the PlA widow’s deathbed after just six months’ acquaintance, the widow responds that those six months could compensate for all her preceding decades. The group members’ attendance testifies to the importance they place on their friendships, a point reinforced by the narrator’s reflection on the widow’s success in creating a model for a dignified death: “Perhaps the significance of this death itself already surpassed the sum total of her lived months and years” (393–4).

At the same time that the novel celebrates therapeutic process, it suggests that medical control may be less important to the group’s success. What matters more is the forum the group provides for the characters to integrate their experiences and develop compassion. Mis-erable as they are at the beginning, sharing their stories at meetings opens them up to understanding and transformation. “The group is like a bonfire,” says the PLA widow. “First it warmed my hands, then my feet, and then my heart. I grew up in the group” (239).

While Bi’s novel unveils taboo issues of breast cancer, prostitu-tion, domestic abuse, and traumas of the Cultural revolution, it also depicts how sharing stories can help people develop resilience. At the same time, some of the therapeutic assumptions ostensibly celebrated by the novel appear to reinforce individualistic ideologies inimical to the development of these same capacities. A close reading reveals therapeutic paradigms that are paradoxically in tension but also in league with medical practices that the novel questions. Specifically, the novel challenges biomedical practices that implicitly equate health with

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virtue, treat illness and dependency as enemies to be conquered, and pathologize individuals rather than social and economic structures.

In detailing the characters’ anger at doctors, which one member calls “the origin of disaster” (121), and their experiences of feeling demeaned and dehumanized in hospitals, the novel presents chastened views about healing. As one character reflects on breast cancer, “the statistics include the five-year and ten-year survival rates, but no cure rate” (131). As the group members evolve, they come to accept disease and death as inevitable parts of life.

Yet, as the novel urges humility about the prospects for fighting biological malignancy, it also offers hope about the power of com-munication to improve quality of life. In this way it affirms recent studies of the health effects of group psychotherapy on breast cancer patients.12 Ultimately the reader realizes that as the group liberates its members from the isolation of their suffering, it enables them not so much to change their physical conditions (though in some cases they do) as to recast their sense of subjugation to those conditions, for Dr. Cheng encourages the group members to be as they are, vul-nerable and fallible. And in acknowledging their lack of control, the members forgive themselves for the faults they imagine brought on their cancer and grow to develop mutual affection. “everybody says that getting cancer is related to personality,” the former principal tells the PlA widow. “I think that you repressed yourself too much all these years” (237).

This incident is just one of many in which the characters attribute their cancer’s genesis to some aspect of personality. Such comments recall Susan Sontag’s concerns about psychological interpretations that associate cancer with repression, “a disease,” as Wilhelm reich saw it, “following emotional resignation—a bio-energetic shrinking, a giving up of hope.”13 The view that cancer stems from repression is widely held in China, especially as it corresponds to theories in traditional Chinese medicine that link emotional repression with the stagnation of vital energy (气 qi). The prevalence of this view makes all the more noteworthy the characters’ faith in each member’s potential to transcend her conditioned tendencies, even if it may be too late to redress the physical consequences. For some, this experience of mutual respect is a first after a lifetime of striving for basic human recognition.

The importance of not associating disease with moral failing emerges in the group’s first meeting. To model honesty, Dr. Cheng shares her own story of having interrupted her studies to support her husband as he earned his doctorate, only to have him divorce her upon


completion. When they ask if she hates him, she admits that she does and explains that, since marriage is “a woman’s second skin” (43), she feels inferior before her married patients. Feeling her inadequacy compounded by her age and her lack of first-hand experience with breast cancer, she raises the possibility that the group members might reject her. But an older member offers that neither Dr. Cheng nor the sufferers should feel inferior since “sickness isn’t a crime” (45), and another member hazards that Dr. Cheng might still come down with the disease. When the others rebuke her, she asks if they haven’t cursed Heaven and asked why others don’t have the illness, a question that allows them to both own and share the injustice they feel.

By placing intersubjective human experience at the center of the therapeutic process, Dr. Cheng’s approach supports a traditional Chinese emphasis on relationships (关系 guanxi) and moderates concerns about losing face (面子 mianzi) that might inhibit the characters from reveal-ing their histories. Once their stories emerge, the deep psychological explorations that follow may also raise misgivings about non-Chinese psychiatrists’ views of Chinese patients as somatizers.14 As the first members who bare their truths become happier, their progress encour-ages the others to risk exposing themselves. Yet despite the members’ recovery of agency, a tension remains between the novel’s celebration of the efficacy of community and Dr. Cheng’s appeals to individual responsibility, including her own responsibility for controlling the group’s therapeutic process.

Overcoming Malignant Individualism

To Dr. Cheng, her clients’ liberation from individualistic ap-proaches to their struggles is miraculous: “A part of their lives blended together,” the narrator comments, “mutually supporting and comple-menting one another. People can’t refute the way one life infiltrates another. And with this soft and silent long-term infiltration, a miracle gradually occurs” (144). This line belies the necessity of Dr. Cheng’s interventions and control. She views an inherently social process as a “miracle” because the institutional hierarchy within which she works blinds her to this therapeutic process. Dr. Cheng enjoys considerable flexibility because she is working outside of a formal institution, but in order to buttress her power, she reproduces some of the same limiting structures. However, the effectiveness of the group may depend less on her control than on the members’ willingness to participate, the

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consistency with which they carry out the exercises, and the solidar-ity they achieve.15

This presentation is complex insofar as the collective treatment is juxtaposed against an individualistic ethos. Yet the text builds up the social foundations of selfhood in contrast to what Dr. Cheng’s interior monologues profess. even the verb in the novel’s title, Save the Breast, 拯救 zhengjiu, “to save, rescue, or deliver,” indicates a collective subject, especially since a different verb can be used for self-salvation, namely 自救 zijiu “to save oneself.”

Even as the characters find hope in their solidarity, the exercise of power in the novel endangers the continuation of that solidarity. For one, the biomedical model on which the group is based depends on resources that may be precarious and that subject the group to commercial forces. At the start of the novel, the CeO of a pharma-ceutical company and former classmate of Dr. Cheng’s offers to pay her salary as a philanthropic gesture so that she can run the group free of charge to her clients. It turns out that the benefactor hopes not only to marry Dr. Cheng but to film the group to advertise his herbal cancer treatment. When Dr. Cheng refuses to involve the group in this fraudulence, he threatens not to pay her and to fire her assistant, Zhu Qiang, a long-time employee of his pharmaceutical company. They de-cide to stand by their principles, even after the group members offer to make the commercial to save Dr. Cheng’s and Zhu’s jobs.

Furious that the group’s moral scruples obstruct her filming, the commercial’s director judges that such people “deserve to get cancer” (378), and she decides simply to hire actors to make the commercial. This willingness to use deception to sell the “iris essence” recalls an earlier passage in which the pharmaceutical company promotes its herbal remedy at a sales exhibit. When angry attendees want to see a specialist doctor the company promised would be there, the sales manager dresses up a janitor to pose as the specialist.

Although such moments question the manipulation that sometimes attends the purveying of medical treatments, the novel’s focus on Dr. Cheng’s administrative role reinforces the perceived need for medical control. As desperate voices phone in response to Dr. Cheng’s initial announcement about forming the group, she explains the required selection process in detail, reasserting control whenever a candidate tries to direct the conversation. For example, when the former princi-pal recounts the breakdown of her relationship with her daughter, Dr. Cheng intervenes by asking her to articulate the most sorrowful part and adds, “People need to learn to be concise, even in the midst of


sorrow” (280). The power differential between doctor and patient is compounded by unequal residency status, as one interviewee points out when she invokes her status as a migrant to explain why she is “oversensitive” to questions about her work unit (26).

Though Dr. Cheng refers to the group as a boat that depends on each sailor’s hard work (58), she continually asserts her own need to control meetings and protocols. Dr. Cheng believes that she can help her patients pull out the “evil treasures” of suppressed memo-ries, throw them in the fire, and “let the flames weave new wings to help them fly” (59–60). This professed faith in her ability to guide her patients’ analytic process is undercut at other moments. Despite the honesty contract that Dr. Cheng asks each individual to sign, each one arrives under false pretense. At several points, Dr. Cheng marvels at her own blindness to what was in front of her, especially regard-ing the group’s cross-dresser, and at its powerful role in helping this person of split identity. Ultimately, these lapses in supervision ques-tion the hyping of human control in many therapy cultures. These moments of undermined authority also reveal the assumptions behind the American self-help exercises Dr. Cheng employs. What rings truer is Dr. Cheng’s commentary on the discipline of psychology: “People’s understanding of outer space is greater than their understanding of their inner hearts” (74).

When she does her best work, Dr. Cheng’s humility enables her to be fully present in attending to the group members. When pressured to diagnose one member’s mental health, for example, she refuses to pass judgment: “each person is an interior universe with too many mysteries and wonders. Having worked this many years as a clinical psychologist, my heart is full of reverence towards people” (243). Given her initial attempts at control, the term “group” (小组 xiaozu), for Chinese readers, could even evoke extremist factions or-ganized to harass and control people during the Mao period, yet Dr. Cheng’s group turns out to be highly self-reflective and thus achieves a benevolent mutuality consistent with feminist relational therapy.16 Dr. Cheng’s most successful practices thus challenge the members to cultivate their own moral intuition and agency.17

Dr. Cheng’s willingness to let the members confront the depth of their anger becomes clear during an exercise in which she puts a white lab coat on a chair and encourages them to speak to their doctors. Though their attacks recall the “struggle sessions” of public persecution during the Cultural revolution, Dr. Cheng offers perspec-tive when she speaks up in defense of doctors. While she legitimates

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the members’ criticisms (197), she also reminds them that doctors are protective allies, asking them to bow to the chair and acknowledging one member’s refusal to do so.

As the novel’s implications for subjectivity surpass its explicit psychological discourse, its treatment of gender surpasses its seem-ing resolution of the conflicts breast cancer poses for gender identi-ties. Beginning with Dr. Cheng’s own backstory, the novel evokes a feminist consciousness about the particular oppression of women and of gender roles more broadly. Yet Dr. Cheng’s continued reliance on individual responsibility means that gender roles are questioned less than an individual’s (in)ability to conform.

The most acute suffering is voiced by the cross-dressing group member. Cheng Muhai 成慕海 lived as a man until developing breast cancer. The humiliating discrimination he experiences over the course of his medical treatment leads him to split himself into male and fe-male personae, and he joins the group dressed in drag and using the name of his dead twin sister, Cheng Mumei 成慕梅. Muhai’s interior monologue opens the novel, but the reader only learns that he is the subject of these desperate passages after he strips off his clothes near the end of the novel.

In recurring passages, the as yet unnamed sufferer anguishes in suicidal ideation, including rationalizations for not being hasty. He plots to blow himself up in front of a dog meat restaurant both to hurt their business and to obliterate all evidence of his breast cancer. like many of the other characters, Cheng Muhai is a fascinating case study in the power of unconscious desire as he instigates several subplots. For example, he sends anonymous notes to Dr. Cheng’s assistant and telephones Dr. Cheng herself in veiled efforts to expose his deception. His aim is thwarted because Dr. Cheng and Zhu Qiang think they have already found the “fraud” each time another false identity is revealed. When he realizes that the group will soon end and that he still hasn’t found the words to confess his identity, he bares his chest to leave no uncertainty.

We might consider Cheng Muhai’s striptease, in which the group first sees his scar from the surgery and then his male pectoral muscles, as the climax of the novel, for at this moment Dr. Cheng almost loses her composure. She can’t stand feeling tricked, but she questions the legitimacy of her own anger. Here the text devotes an entire paragraph to her efforts to breathe deeply as she feels in-dignation at having been hoodwinked by this “transsexual” (變性人 bianxingren). She reflects that her ability to accept Cheng Muhai will


be a mirror for the others and that his initial deception matters less than his growth toward a more truthful existence (354). realizing the profound implications her response will have on the group’s trust, she calms herself. In this way, she subjugates her medical authority to the collective therapeutic process.

She also comes to see Muhai’s violation of the group’s honesty principle as no worse than her own violation of the rule not to dis-cuss group matters outside the group, for she has been taking phone calls from Cheng Muhai all along. He has been calling her as himself, wishing to discuss his “sister,” the group member Dr. Cheng knows as Cheng Mumei. Though she initially feels manipulated by his calls, Dr. Cheng comes to look forward to their confidences. In the end, she comes to realize the loneliness and desire for a companion that she has suppressed since her divorce many years earlier. In doing so, she too addresses her malignant individualism.

Dr. Cheng reminds herself of her commitment to the welfare of the group and of each patient, including Cheng Muhai. She thus decides to overcome her personal feelings and graciously accepts Cheng Muhai: “From now on we’ll call you Cheng Muhai” (355). (This would be the equivalent of saying to someone who had been Paula, “From now on we’ll call you Paul.”) Here, Dr. Cheng learns what her patients have already learned, namely, to avoid absolute judgments in favor of pragmatic accommodations. In a wry response to his nudity and the social awkwardness it occasions, Dr. Cheng tells Muhai to put his clothes on to avoid catching cold. With this reas-sertion of medical authority, the novel safely reintegrates Muhai into the status quo of gender binaries. He abandons female identity as a pathology the group has enabled him to overcome. Yet the reader may still be struck, like Dr. Cheng, by the depths of suffering that led to his cross-gender performance.

Conclusion

In its investigation of how biology is inextricably intertwined with social relations, Save the Breast illuminates how selfhood and belonging inform ideas about disease, intervention, and healing. Although practices delineating ideas about well-being may be more elegantly patterned in literature than in life, theorists contend that such processes also mediate people’s “basic relations to the world.”18 Readers turn to fic-tion for its powers of explanation and its capacity “to impose order” on the chaos of experience.19 However, the value of Save the Breast

367Sabina Knight

lies less in its ordering of experience than in its complex presentation of the characters’ lived experiences through a rich set of imaginings that resist a single storyline. Far from impeding the novel’s insights, the multiple storylines suggest multiple outcomes: healing through confession, empathy, acceptance, and incorporation. The novel thus supports the varieties of cultural work that Mary K. DeShazer finds prominent in contemporary women’s cancer literature. Such literature challenges stigmatization, victimization, and blame in favor of repre-senting women’s lived experiences. It also promotes women’s affilia-tion, resistance to objectification, and wisdom. And finally, it facilitates processes of healing, mourning, and commemoration.20

Through its representations of medical power, the novel offers insight into how therapy cultures can both alleviate and exacerbate local forms of suffering. Given the novel’s final sense of healing reso-lution, the cover image becomes vastly more complex than it initially appeared. As noted, the figure looks crucified, with what appears to be a mastectomy scar extremely close to Jesus’s stigma from the spear wound inflicted by a soldier to verify that he was dead. Yet one might also sense in the image an open-armed liberation, especially in the context of the novel’s scrutiny of biomedical and other forms of power. Although critiqued as the publisher’s appeal to prurience, the cover’s intent is ambiguous, and these multiple possibilities recall several of the novel’s themes. While the likeness to the martyred Jesus suggests the women’s social and economic oppression, the expression on the woman’s face could be read as one of pleasure as easily as one of pain.

As US breast cancer activists might recognize, the photo incor-porated in the cover design shows Deena Metzger, an author and holistic healer. Diagnosed with breast cancer in 1977, Metzger was on the operating table for reconstructive surgery a few days after her mastectomy when a power failure forced the surgery’s cancellation. Metzger then chose to forego the implant and instead adorned her scar with a tattoo of a sacred tree branch. Five years later she self-published a poster with her poetic colophon and her photo portrait by Hella Hammid. Metzger had hoped to use the exuberant portrait, which shows her bared body and tattoo, on the cover of her 1982 book, Tree. Yet the initial publisher would not use the image on or even in the book, and Tree had to await its 1997 edition for the now iconic photo to grace its cover.21

The poster’s free verse declares Metzger’s release from shame and celebrates her inscription of a tree on “the book of my body.”


For those familiar with the photograph of Metzger, its inclusion on the cover of Save the Breast connects the novel to 1980s feminist ac-tivism that brought images of mastectomy into public view. As the novel and its cover accomplish the same “outing” in China, a certain ironic tension emerges between the publisher’s title and the message, in both the photo and the text, about the primacy of saving the per-son. Critiquing the habit of discounting persons and viewing bodies as subjects for diagnosis, manipulation, and commercial exploitation, Bi’s novel promotes deeper appreciation of the dynamic processes of living with physical and psychological distress.

nOTeS

For helpful comments and suggestions, I wish to thank the reviewers for this journal and audiences at three presentations of earlier versions of this paper. I am particularly grateful to Brenda Schildgen and Chia-ning Chang of the University of California at Davis; Ellen Widmer, organizer of the China Gender Studies Workshop at the Fairbank Center for Chinese Studies at Harvard University; Arthur Kleinman, who served as my discussant at the Fairbank Center; and Ted Kaptchuk, organizer of my talk at the Osher research Center of the Harvard Medical School.

1. First print runs for Chinese novels generally range from 5,000–50,000 cop-ies. Jin Bo, “What’s in a name?”

2. Bi Shumin, Zhengjiu rufang, 74. All translations are my own. To the best of my knowledge, no translation of any part of this novel has yet been published. Subsequent references to the novel appear parenthetically in the text.

3. For insights into psychopathologies as “crystallizations of culture” (35), see Bordo, Unbearable Weight, especially 139–64.

4. This tradition includes lu Xun’s seminal stories “Diary of a Madman” (1918) and “Medicine” (1919).

5. In the People’s republic of China, a “cadre” (干部 ganbu) is a public functionary serving in an official and often managerial capacity within the Chinese Communist Party (CCP) power structure.

6. Whitehead, Science and the Modern World, 51.7. Dorit, “By Any Other name,” 118.8. lest the harm of such breast augmentation seem unrealistic, it is worth

noting that China “banned a breast-enlarging liquid that was injected into more than 300,000 women and caused such pain for some that they had their breasts removed.” “China Bans Popular Breast-enlarging liquid.”

9. For a critique that views Anglo-American therapeutic culture’s emphasis on emotions and emotional management as imposing a new conformity and leading people to feel powerless and ill, see Furedi, Therapy Culture.

10. The term “room to maneuver” was inspired by Chambers, Room for Maneuver.

11. On the breakdown of three paradigms, see Couser, “Paradigms’ Cost,” 22.

12. Whereas earlier studies found significant correlations between intensive group therapy and extended survival, more recent studies have found “no effect of group psychotherapy on survival time,” except in one subgroup, a finding

369Sabina Knight

that may suggest the role of improvements in treatment. Spiegel et al., “effects of Supportive-expressive Group Therapy,” 1136.

13. Quoted in Sontag, Illness as Metaphor, 23.14. See Kleinman, “Depression, Somatization and the ‘new Cross-Cultural

Psychiatry’.”15. For discussion of studies suggesting a relatively equal effectiveness of

alternative approaches to psychotherapy, often called “the Dodo effect,” see lewis, “listening to Chekhov,” 62–63.

16. On feminist relational therapy, see Stocker, “The ethics of Mutuality.”17. This characterization of feminist relational therapy draws on Stocker, “The

ethics of Mutuality,” 7.18. Wolfgang Iser, quoted in Hamilton and Schneider, “From Iser to Turner,”

645.19. Ibid., 646.20. DeShazer, Fractured Borders, 261–265.21. Metzger, “The Soul of Medicine.”

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———. “Medicine.” In Selected Stories of Lu Hsun. Translated byYang Hsien-yi and Gladys Yang. Peking: Foreign language Press, 1960, 1972. Available at http://www.coldbacon.com/writing/luxun-calltoarms.html#Medicine (accessed June 11, 2010).

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“Cancer’s Revelations: Malignancies and Therapies in a Recent Chinese Novel.” _Literature and Medicine_ 28.2 (Fall 2009): 351-70.

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