Cover by Pavilion Poetry/Liverpool University Press.
In this SPAM Cut, Jane Hartshorn looks at the sociopolitical, ethical and poetic implications of representing illness in Lieke Marsman’s poem, ‘The Following Scan Will Last Four Minutes’, whose English translation by Sophie Collins you can read here.
> Lieke Marsman’s poem ‘The Following Scan Will Last Four Minutes’ is included in her recent collection The Following Scan Will Last Five Minutes, translated from the original Dutch by poet and translator Sophie Collins.
> The book takes the form of ten poems, followed by an essay drawing on Marsman’s experience of cancer. Collins then reflects on the process of translation, written as a series of letters to Marsman.
> Marsman was influenced by Audre Lorde’s Cancer Journals, as well as Illness as Metaphor by Susan Sontag, and the themes explored in both these texts are interwoven throughout the poems. She writes, ‘The difference in the tone and approach of these two books is huge, and it gets me thinking. How will I relate to my own disease? Is this a choice?’
> The question of how to ‘relate to [one’s] disease’ is one those who have experienced prolonged illness must grapple with. Do we assimilate the disease into our sense of self, or do we reject it as an alien ‘other’? Like the abject, the disease is both ‘me’ and ‘not me’; inhabiting a liminal space between subject and object. Emerging from within us, but not completely of us, it blurs the boundary between self and other, disturbing the notion that our identity is cohesive, fixed, stable.
> Marsman herself describes this difficult and often conflicted relationship in the essay which follows the sequence, writing, ‘Sometimes I refer to my tumour lovingly as my grapefruit, while on other days I vehemently detest it and fantasise about breaking into the tissue bank where it is being stored, in strips, in minus eighty degrees centigrade.’
> This reflects Lorde’s relationship with her own tumour, in which she expresses anger at her right breast, illuminating the process of bodily dissociation illness can engender. She writes, ‘I had grown angry at my right breast because I felt as if it had in some unexpected way betrayed me, as if it had become already separate from me and had turned against me by creating this tumour that might be malignant.’ The notion of the body in revolt is one that emerges in many illness narratives, often staging the body as a battleground where wars are won or lost.
> This tension between self and other, the familiar and the unfamiliar is a theme that runs throughout the collection. For example, in ‘The Following Scan Will Last Four Minutes’, Marsman’s italicisation of ‘chondrosarcoma’, the name of her condition, gives it a dangerous power; a word only to be uttered in hushed tones. This lends it an otherworldliness, a mythic quality, and hints at its ability to threaten existence. Although receiving a diagnosis for an otherwise elusive condition can offer a sense of relief, it can also have an alienating effect. Medical discourse employs terminology that is unfamiliar to the patient, and this can estrange her from her body. The sick person loses autonomy not only through the illness, but also through the depersonalising effects of the medical establishment.
> Within the theme of defamiliarisation, the poem also explores the banality of illness. Phrases like ‘the morphinesweet unreality of the everyday’ echo Woolf’s description of becoming ill, where she writes of ‘the undiscovered countries that are then disclosed’ ‘when the lights of health go down.’ The juxtaposition of ‘unreality’ with ‘everyday’ speaks of how diagnosis, and in fact, illness itself, can be earth-shattering yet mundane. In a later poem, Marsman writes, ‘cancer is so quotidian / you hear about it on Wednesday morning / die on a Tuesday afternoon.’ And it’s the inability to perform the quotidian, such as ‘doing laundry’ or ‘balling socks’, that underpins the experience of prolonged illness. Illness is notoriously difficult to write about, and one of the reasons for this is due to its overwhelming mundanity; it cannot be dramatised, or driven by a linear narrative. Furthermore, there is often no easy resolution, or return to a pre-illness self.
> Marsman was initially misdiagnosed; the pain in her shoulder was thought to be a repetitive strain injury. Her GP suggests she could ‘get a new office chair’ or ‘set an egg timer to ensure [she] take[s] regular breaks from working’. Partly due to the negligence of a number of clinicians, she is put on a two-month waiting list for an MRI scan.
> Having ‘already inserted [her]self into the narrative of an overworked twenty-something-year-old’, Marsman initially believes she has ‘burn-out’, and the medical professionals she visits appear to encourage this self-diagnosis.
> When we become sick, we imagine it will be temporary. Within capitalism, our body is understood as a machine; one that only needs repairing in order to return to its pre-illness state. We are taught to believe that our value rests upon our level of production, or our ability to perform within a results-driven workforce. Arthur Frank explores the commodification implicit in the restitution narrative, writing, ‘what will cure the body is a commodity, whether that takes the form of a drug or a service, and however it is paid for.’
> This model of the body as machinery feeds into a larger ideology whereby the sick individual is perceived as somehow culpable for their illness, whether this is due to bad diet, unhealthy habits, or stress related factors. Sontag writes that ‘psychological theories of illness are a powerful means of placing the blame on the ill’, thus diverting attention away from possible environmental factors, or genetic disorders.
> Lorde, too, considers this culture of blaming the individual, writing, ’The idea that the cancer patient should be made to feel guilty about having had cancer, as if in some way it were all her fault for not having been in the right psychological frame of mind at all times to prevent cancer, is a monstrous distortion of the idea that we can use our psychic strengths to help heal ourselves.’
> Marsman’s own response to her diagnosis chimes with this; ‘Have I thought too often about which songs I would like played at my funeral? Should I have engaged less in Twitter feuds? Are my jokes a little on the mean side? I’m seized, now and then, by a deep, old feeling of guilt.’
> We need to be wary of discourses of health and illness that implicitly apportion blame upon the individual. Whilst remedies such as mindfulness, yoga, acupuncture can be helpful, they should not be offered as alternatives to medicine. As public health services strain under the pressure of government funding cuts, and as hospitals are increasingly understaffed and under-resourced, our health is being sold back to us as a commodifiable object.
> Marsman is also wary of this discourse, writing, ‘meditation and mindfulness are helpful in terms of alleviating pain and fatigue, but where does the pain and fatigue come from in the first place?’ She goes on to argue that relaxation techniques are often the last resort of those who have been failed by the medical establishment, whose symptoms have been incorrectly attributed to stress. The poem, too, reinforces this:
Do you know what life has to offer
or did those endless therapy sessions
and that eight-week mindfulness course
simply teach you how to tolerate suffering
that every signal in your body
can be temporarily expelled
to the rhythm of some breathing exercise?
This belief in the individual’s power to ‘cure’ themselves understands the body on mechanistic lines, placing a degree of responsibility upon the sick person for their illness, which can then manifest as guilt or blame.
> The sequence is prefaced by a quote from the Cancer Journals, in which Lorde writes,
Every once in a while, I would think, ‘what do I eat? how do I act to announce or preserve my new status as temporary upon this earth?’ and then I’d remember that we’ve always been temporary, and that I had just never really underlined it before, or acted out of it so completely before. And then I would feel a little foolish and needlessly melodramatic, but only a little.
Returning again to the question of ‘how to relate to one’s disease’, maybe, as Lorde suggests, we need to embrace this notion of temporality. If we can reframe the experience of illness, and regard it as an ongoing process of negotiation, readjustment, and management, rather than as one of loss or lacking, then maybe we can challenge the existing binary of health and sickness, and the notion of the self as a fixed, unified entity positioned at either end of the scale. Havi Carel’s concept of ‘health within illness’ is a more accurate way of describing the experience of chronic illness, as it captures its fluctuating, overlapping, non-chronological nature.
> Perhaps, then, it’s not only a question of how the individual relates to their own disease, but a matter of exploring how cultural perceptions of and attitudes towards illness shape the individual’s experience of illness.
> Marsman wonders if she is ‘experiencing this cancer as an Actual Hell because that’s how [she] genuinely feel about it, or because that is the common perception of cancer’. Both Lorde and Sontag attempt to challenge the taboos surrounding cancer in their respective texts, and I think that Marsman does the same in The Following Scan Will Last Five Minutes, critiquing the societal structures that work to ostracise and marginalise those with chronic illnesses.
> The Following Scan Will Last Five Minutes is an actively political text. Through examining her own experience of illness, Marsman situates this within a wider socio-cultural framework; she explains to us that her experience of illness has enabled her to see more clearly her position in relation to the rest of society. She deftly manages to flip the question of how to relate to one’s disease back to us, asking, how does society relate to illness, and is this a choice?
The Following Scan Will Last Five Minutes is available now, via Liverpool University Press. You can order a copy here.
Text: Jane Hartshorn