Local Histories of Cancer

Enduring Cancer: Life, Death, and Diagnosis in Delhi, Banerjee, Dwaipayan, Durham and London: Duke University Press, 2020.

Reviewed by Éva-Rozália Hölzle, Bielefeld University

Strictly speaking, cancer is not a single disease but a set of disorders and symptoms that manifest uniquely in each patient. Thus, it calls for tailored diagnostic and care practices. Not all forms of cancer amount to a speedy death following diagnosis. Early detection and specialized care increase the chances of prolonged survival. Still, in cases where treatment is possible, geographic and social position determine how long cancer death can be avoided. In his compelling book, Enduring Cancer: Life, Death, and Diagnosis in Delhi, Dwaipayan Banerjee shuns common contemporary framings of cancer in India, demonstrating that it is neither a disease of middle class Indian urbanites inclined to a Western lifestyle nor a “new epidemic” (p. 17) generated by rapid social change. Rather, cancer has a local history and affects both urban and rural dwellers in India, rich and poor – though it does so disparately. Cancer is both a personal and deeply political matter.

Early cancer diagnosis and specialized care remain beyond the reach of many impoverished urban and rural dwellers in India. The recent aggressive advancement of neoliberal programs has exacerbated this inaccessibility, and the promise of health care seems more and more like a dubious mirage to the poor. Those affected know this reality well, yet this knowledge is not synonymous with resignation. It does not mean relinquishing the desire to secure medical care post-diagnosis, even if this means descending into more dire poverty. Indeed, for destitute Delhi residents cancer detection is often the beginning of an exhausting struggle to secure care while managing the financial and emotional impact of the disease and coping with debilitating waves of pain. Banerjee walks the reader through three different perspectives as he considers the diverse ways in which the illness is experienced, how care is provided, and how palliative medical practitioners treat the symptoms of pain. He begins with the outlook of patients and their families (Chapters 1 and 2), followed by perspectives of medical doctors specialized in cancer pain (Chapter 3). Finally, Chapters 4 and 5 offer an extended analysis of literary works and movies that feature experiences of cancer.

The first three ethnographic chapters are the most compelling parts of the book. Through them, the reader is given insight into the lives and worlds of cancer patients and their families and caretakers. One of the book’s most powerful observations comes from a description of the lived experiences of cancer patients in the slums of Delhi. These individuals prefer to conceal their diagnosis from others – particularly neighbors and family members. Here, Banerjee subverts the widespread assumption that poor, uneducated people avoid accepting or disclosing their cancer status because they either do not know what it is or prefer to deny reality. The text undercuts these mistaken beliefs by showing that avoiding disclosure to others serves to protect already fragile kinship relations, which a cancer diagnosis would only further destabilize. Undoubtedly, the book’s greatest strength is its depiction of liminality: the space of preferred uncertainty or prolonged hesitance that some cancer patients and their families consciously adopt in the face of disease. Banerjee calls this space the subjunctive, or the “as if” (p. 7), a state which involves hoping, concealing, and pretending.

For some patients, disclosing a cancer diagnosis may be uncomfortable and even dangerous. Neighbors might begin lamentations before one’s death, or already volatile family relations may become more violent. Moreover, past hurts, grievances, and betrayals may suddenly resurface, reopening family wounds. Banerjee does not shy away from showing the brutality of intimate human relationships. The ethnographic chapters that highlight the subtle dangers of kinship will appeal to readers interested in insidious forms of violence deeply embedded in everyday structures.

Beyond engaging the issue of violence, the book aligns itself with an emerging trend in anthropological scholarship that has gained increasing prominence since 2015 and that considers the multiplicity of living and dying in the contemporary world. Departing from earlier works that focusing on biopolitics, this current literature decenters techniques of population management and focuses instead on alternative ways of living that exist in the fissures of capitalism. As is common in this literature, Banerjee too makes an effort to demonstrate that existential and political matters are not separate compartments of the social world, but rather become mutually entangled in the struggle for survival.

It is also notable that in this book death is not treated as the opposite of life, but as something produced by vital political processes. Banerjee refuses the neoliberal ideology that casts death as a personal failure in order to obscure the political decisions that devalue certain lives, even to the extent of pushing them into death. In this vein, the text also situates dichotomies such as pain and joy, hope and despair, and suffering and prosperity as false opposites that have plagued and limited Western thought for a long time. Most importantly, such binary distinctions create the impression that life can be appreciated without experiencing pain and suffering, while actively forgetting that life and death are existentially intertwined. Banerjee both works against such false binaries throughout the text and situates the concept of endurance at its center. Endurance captures the liminal space of cancer patients in the margins of Delhi, a place from which they “struggle to remain in the present” (p. 181). Dwaipayan Banerjee’s book is a sensitive analysis of what it means to battle cancer and poverty at the same time in contemporary Delhi. As such, it will appeal for anthropologists interested in the politics of life and death, health and disease.