Abstract

A diagnosis of breast cancer is not just life-threatening but often also disfiguring. Breast cancer research has pointedly focused on the connection between bodily loss and loss of self. We will examine the narratives of two Danish women who have been treated for breast cancer and are dealing with the consequences of their treatment. Drawing upon theories of phenomenology and literary-semiotics we demonstrate how the wom-en are negotiating their identities. In narratives of breast cancer bodily practices play a prominent role in helping or hindering the re-construction of identi-ty. We will focus on breast reconstruction as a bodily practice and seek to understand how and why breast cancer survivors either accept or reject the possibility of reconstructing their identity through breast recon-struction. We suggest that the literary-semiotic con-cept of marking can lead to a broader understanding of the connection between illness, body and identity. Breast reconstruction and the refusal of breast recon-struction can be viewed as part of a semiotic moni-toring and marking of the body that can take place in the aftermath of treatment for breast cancer.

Keywords: breast cancer; narrative; identity; breast reconstruction; phenomenology; literary-semiotic analysis

1. Introduction

Researchers focusing on the fractured identities of ill persons have done so with regard to a multiplicity of illnesses from a variety of scientific positions. They have pointed out that chronically ill persons may develop ‘disrupted lives’ characterized by a basic ‘biographical

disruption’ (Bury 1982; Becker 1997; Exley and Letherby 2001) and that they may confront ‘identity dilemmas’ (Charmaz 1995). There has been analysis of the discourses of survivorship (Little et al. 2002; Carbaugh 2007), and of the discontinuities associated with illness narratives (Williams 1984; Frank 1995).

Psycho-social cancer research has also been studying such identity dilemmas. Cancer diseases often present a challenge to the patient’s identity and sense of self (Bokhour et al. 2007; Cayless et al. 2007). Examinations, diagnosis and the short- and/or long-term side-effects of cancer treatments can affect the way in which identity issues are construed, hence a diagnosis of cancer can involve the performance of ‘identity work’ (Mathieson and Stam 1995).

This is particularly true of breast cancer since it is not just life-threatening but often also disfiguring. The mastectomied body almost claims the character of loss epitomized and breast cancer research has pointedly focused on the connection between bodily loss and loss of self (Kleinmann 1988; Langellier 2001; Manderson and Stirling 2007; Ucok 2005; 2007).1 Arthur Kleinman (1988: 22) describes breast cancer as ‘a culturally marked illness, a dominant societal symbol that, once applied to a person, spoils radically the individual’s identity and is not easily removed’.

We will examine the narratives of two Danish women diagnosed with breast cancer. The analy-sis will introduce the literary-semiotic notion of marking the body directed at grasping the relation between cancer, body and identity (Brooks 1993). We will argue that in narratives of breast cancer the bodily practices of survivors play a prominent role in helping or hindering the re-construction of identity. We will focus on breast reconstruction as a bodily practice and seek to understand how and why breast cancer survivors either accept or reject the possibil-ity of reconstructing their identity through breast reconstruction.

Communication & MedicineVolume 6(2) (2009), 143–152Copyright © Equinox Publishing LtdLondonhttp://equinoxpub.comDOI: 10.1558/cam.v6i2.143

Marked bodies and selves: A literary-semiotic perspective on breast cancer and identity

NINA HENRIKSEN AND HELLE PLOUG HANSEN

University of Southern Denmark, Odense, Denmark

144 Nina Henriksen and Helle Ploug Hansen

2. Theoretical framework: Illness, body and identity

This paper looks at the healthy and sick body and the relation between the sick body and identity from a phenomenological and literary-semiotic perspective (Leder 1990; Brooks 1993; Frank 1995). A social-constructivist perspective on the nature of identity in general informs the analysis (Williams 1984; Bruner 1986; Gergen 1991; Carbaugh 1996; Mishler 1999; Riessman 2003). This perspective considers how the self is continuously being created and recreated in context, through social relationships, over time and in discourse (Carbaugh, 2007).

2.1. ‘Dis-appearance’ and ‘dys-appearance’ of the body

In ordinary life we have a tendency to take the body for granted. The healthy body becomes an absent body, fused with the self, a dis-appearing body (Leder 1990). Man’s being in the world is characterized by the fact that the body functions as the individual’s una-voidable but at the same time naturally determined pivotal point. The body constitutes thereby our un-cognized anchor in the world. We are not continually conscious of our bodies. The healthy body functions as a blind spot in our being and, by extension, as a mute condition for our existence and our identity.

In contrast, the sick body and the body in pain become a ‘dys-appearing body’. Sickness and pain plant the seed for a body–self division, constructing another consciousness about the body. It becomes an object of consciousness (Leder 1990: 69–77). Sickness and pain turn the ‘dis-appearing body’ into a speaking body that directs attention towards itself. The ‘dys-appearing body’ can be regarded as giving voice to the body, as the individual shifts its focus from being a body to having a body. Then we become ceaselessly reminded of ‘the here-and-now body’ (Leder 1990: 76–77). The separation between the self and the body along with the accompanying objectification of the body constitute a dramatic event that affects our sense of our body and our sense of self and subsequently raises fundamental questions of identity.

2.2. ‘Dys-appearing bodies’ and selves as marked bodies and marked selves

‘Dys-appearing bodies’ can be understood as marked bodies. When people get cancer, they start on a pas-sage most often through operations, often followed by chemotherapy and/or radiotherapy. They receive

scars from surgery. Some have wounds that will not heal. Some lose their hair during chemotherapy, and their bodies can be marked by radiation and related tattoos or be radically altered by the addition of prostheses.

Bodily markings can initiate stories and become a key sign in the story of the individual (Brooks 1993: 25). The marks left by disease and treatment acquire the character of marks of truth on the body, and in that context the eyes, visibility and visuality play a particular role (Brooks 1993: 89). In this semiotic understanding, looking at the body corresponds to and expresses an urge to penetrate into the essential meaning of and truth about body and self (Brooks 1993: 89). The mark on the body performs like an opening into the body that can allow the individual access to the truth of the body and of the self (Brooks 1993: 3). And the scopophilia2 invested in looking at the body can be construed as an epistemological process, a wanting to know body and self, which at the same time is often endowed with fear, resentment and hopelessness (Brooks 1993: 96ff). The truth of body and self is evasive and difficult to decode and define (Brooks 1993: 122). The mark on the body operates as a linguistic signifier, an inscription on the body that tells a truth most often related to an awareness and admission of mortality (Brooks 1993: 102ff). The marked body signifies bodily decay, which in turn signifies death – especially in conjunction with the stigma of cancer.

3. The empirical data

The empiric material of the literature study comprises Danish first person cancer narratives published as books. The literature search was systematically con-ducted based on selected words and terms (‘cancer’ and specific types of cancer combined with ‘narra-tive’ and specific narrative genres such as ‘memoir’, ‘diary’, ‘autobiography’) using different search models (commando and chain search), different search strate-gies (based on free text and specified on topics) and different databases and search engines. This search resulted in the selection of 30 Danish cancer nar-ratives published as books between 1990 and 2008 with a variance in gender, type of cancer and age (Henriksen 2009).

3.1. The process of analysis

The process of analysis took as its point of depar-ture a registration of each narrative in an analytical schema designed and developed simultaneously with

‘Marked’ bodies and selves: A literary-semiotic perspective 145

the reading process. This schema was developed as a tool to register each narrative in detail (including quotes on the registered topics). This process of tex-tual categorization was designed as an open process not as an attempt to group the texts and specifically avoided the rigidity of coding the material into themes (Frank 2005). Accordingly, the schematization of the texts was operating strictly on an empirical, not an analytical level. On the basis of the registration salient empirical themes were chosen for analysis. In the present paper we deal with the theme of bodily appearance (looking at the body) and identity and with the connection between them as they are expressed in the two cases selected for analysis.

4. A literary-semiotic analysis of two Danish breast cancer narratives: Marked bodies and identities

The two narratives chosen exemplify a distinct con-nection between the sick body and identity. Further-more they are very dissimilar in their fundamental attitude towards the potential of bodily reconstruc-tion as a means of reconstructing identity.

In the analysis we introduce the context and the dominant formal features of the narratives. Then we look at how the connection between body and self is orchestrated in each of the narratives. Finally in the discussion we compare the narratives.

4.1. The case of Liselotte Vendelboe Andersen: Vingefang/‘Wing Span’ (2008)

Liselotte is a 41-year-old and has a BA in publishing. She is the single mother of three girls, the youngest aged seven. Liselotte has been declared terminally ill of breast cancer and is receiving life-prolonging chemotherapy.

The narrative of Liselotte is written as a non-chronological collection of moments describing and discussing different kinds of problem, anxiety and impression in relation to the diagnosis of and treatment of breast cancer and to the removal of both breasts. The narrative is written in the present tense and therefore possesses a kind of immediacy that gives the reader the sense of the immediacy of the whole situation. There is only a loose connection between paragraphs, which are also unnumbered and lack headings. The narrative is characterized by taking different moments along the trajectory of the illness without linear progression, leaping back and forth in time and repeating the same moments. This blurring

of temporal boundaries is pervasive; it prompts a similar blurring of the narrator herself.

Furthermore the narrative can be characterized more as a series of existential reflections on life and death rather than as a specific narrative about having cancer. Evident throughout is the theme of bodily appearance, of scopophilia, which is associated with the theme of identity.

Liselotte’s body is marked by cancer in several ways both visible and invisible: breasts have been removed, she has scars from radiation, and due to chemother-apy she has lost her hair and no longer menstruates. After the removal of her breasts Liselotte describes her body as follows:

As the narcosis gradually wears off and I return to the ward, I just feel like crying. It feels like I have a wide leather belt strapped around my chest. I don’t dare to look at myself. I just know that my body is disfigured forever. […] But I really don’t need to see myself. Like that. Without breasts. […] No, I wouldn’t say that was something I needed. […] Can see myself in the mirror? Pitiful. Frightening. I don’t want to see. I don’t want to meet that body positioned in the mirror. That body is mine. Even now. Disfigured. What is it I am confronted with? Who, what is it I see in the mirror? It can’t be me. (Andersen 2008: 50–51).

In this way Liselotte is testifying to an apparent ‘Dys-appearance’ of the body, a split between body and self. She is investigating herself, making a telling mix-up of ‘who’ and ‘what’ and so hinting at a certain confusion as to whether or not she resembles a human being at all. This is the first sign of her personal deconstruction that the narrative articulates.

Liselotte is afraid to look at her body, but through-out the book she describes how she persistently does precisely that:

I lose the desire for myself, my body, my sexuality. The picture I meet in the mirror every day makes me lose the desire for a future. […] I have become a freak. I have become a creature without a sex. Do I exist anymore? Does my life exist? (Andersen 2008: 56).

Throughout the narrative she returns to the con-nection between bodily loss and loss of her self, her identity.

In spite of her dislike of bodily impressions and her loathing of her body and of herself, she continually indulges in this process of gazing at her body, which seems to be as a form of reflection. She is incessantly trying to negotiate and rehearse the meaning of her marked body and, by extension, of her marked self. She is explicitly performing negotiations about her uncertain identity:

146 Nina Henriksen and Helle Ploug Hansen

I am going home to some kind of everyday life and home to be myself, […] but is that possible? Am I the same Liselotte as when I was hospitalized five days ago? (p. 34)

And

I feel so emaciated when I don’t have my own hair. It changes me. Of course it does! In a more profound way, too. Vulnerable. Naked. Without protection. I feel changed in another way not just in my looks. It is my personality that is forced to regroup. (Andersen 2008: 47).

At times she also addresses the connection between body and self:

But what about me? I am more than my body. I am also me, my personality, my spirit. (Andersen 2008: 40).

Negotiating the meaning of the connection or discon-nection between body and identity is linked to her negotiation of the meaning of motherhood:

I begin to loath my breast. I never liked the shape of my breasts, but this is completely different. I could trust my breasts when I breast-fed my children. […] Now my right breast is failing me. […] My body is failing me. But I am still a mother. It is the hardest thing I have ever put myself through. (Andersen 2008: 27).

Liselotte is striving to define what it means to be a good mother:

What is motherhood? What does it mean to be a good mother? A good mother? I ask myself again and again. Even more so now when my time left as a mother is threatened. (Andersen 2008: 102).

She is indirectly questioning whether and how her bodily deficiency is influencing her ability of being a good mother, breasts being specifically connected to motherhood. The image of her marked body trig-gers her reflection of that part of her identity that is connected to motherhood. Her determination to be a good mother is related to trying to define this role in principle and for this purpose she performs her bodily investigations, specifically investigating the site where her breasts once were.

At the same time though she is also searching for a kind of core identity beside/outside motherhood:

Are my girls my whole life? Is what I have to live and fight for something outside myself? Don’t I have something inside myself that is worth living for? My own life, pure and simple? (Andersen 2008: 25).

In her search for herself she questions the value of what she thinks is herself inherently denying the possibility of defining a separate identity or an identity at all. For all her distaste for her body and her self, both marked

by cancer, she rejects the possibility of reconstructing identity by reconstructing her body. Discussing the possibility of breast reconstruction, she says:

How could I for a moment consider breast recon-struction? To look normal? There will not be any-thing normal about the breasts I’ll end up with. […] Who am I trying to fool here?’ (Andersen 2008: 77)

Nor breast prostheses and a wig will do the trick:

I am not an actor and therefore I am not used to ‘adopt another character’ […] It is not just the hair that’s gone. The exterior ‘I’ has also gone. […] I don’t know if I can get used the picture of myself that now greets me in the mirror. Every morning I put on my breast prostheses. And now also my wig. To look normal. To look like a woman as much as possible. But it doesn’t make me feel like a woman. I don’t feel like anything at all anymore. (Andersen 2008: 78)

The articulated split between appearance and being is also manifested when she is wearing her wig and people do not recognize her in the street:

They don’t know me in my wig. I say ‘hi’ but they just pass right by. Am I that changed? Am I another person now? (Andersen 2008: 123)

Therefore on the one hand she is indirectly rejecting the connection between her bodily appearance and her identity. But on the other hand she is also probing this connection:

I feel homeless in my own body. It doesn’t say any-thing about who I am. Or maybe that’s precisely what it is saying, something about who and what I am – and that’s what I don’t like. Every morning I stand in the shower looking down at this body, so deformed that it is unbearable. (Andersen 2008: 79).

And she is testifying to the possibility that cancer is merely the accelerator of a condition that has been there all along:

With my back against the wall it seems to me like I am forced to live through all the most difficult feel-ings I know from my life. My experience of being wrong, completely wrong, about my appearance, and certainly also my being equipped with a mind and ways of thinking that are completely wrong, rolls over me again and again in this course. (Andersen 2008: 122).

Liselotte’s narrative is explicitly concerned with the discontinuity between language and the body:

Sometimes I don’t think there are enough words in the whole world. Maybe I am just being completely wrong, as with so much else. But I can’t find words to explain how it feels to stand there in front of the mirror looking at my misshapen body. (Andersen 2008: 113–114)

‘Marked’ bodies and selves: A literary-semiotic perspective 147

In this way the narrator points directly to the rep-resentational and semiotic shortcomings that occur when the body has been marked by illness. The marked body initiates the narrative because it creates a general representational need. But this lack of words is a permanent condition. No words are capable of performing the exact representation or mending the damage done by cancer to her body and to her self. But what the narrative in itself is concerned with and governed by is precisely this attempt to find the right words. Or rather problematizing the possibility of so doing.

Liselotte’s perception of body and self is a condi-tion of being that cancer does not create but rather amplifies. Cancer can be seen as the semiotic mark on her body that initiates the epistemological process of trying to define herself in body and in narrative (Brooks 1993: 96ff ). Her story is about endlessly trying to capture and express an unat-tainable image of herself, her identity. ‘Who am I’ is discussed in her ceaseless and dialogical attempts to decode bodily signs by means of looking at her body. She is striving to comprehend the body’s incompre-hensible language and thereby to define herself. But she both succeeds and surrenders in her effort to define a stable identity, to come to terms with and accept the bearings of this illness that is trying to deny her a life. Reflecting on mortality, death and dying, she says:

Is this the end of life? Cancer is about death, isn’t it? […] Cancer equals death. Cancer equals a prolonged termination of the life I thought I had plenty of. […] I am 35 years old. I have been sentenced to cancer. […] Will I turn 45? Will I see my children grow up? Shall I start saying goodbye now? (Andersen 2008: 17)

The mark on her body is interpreted as a death mark. It testifies to her coming death and for every reflection on death she reflects on her body (and vice versa):

Will I die? Yes of course I will. What an absurd question! But will it be soon? […] For the first time it strikes me fully. That I am not going to live forever. That my life, cancer or not, is limited. […] Am I afraid to die? […] I can feel the lump in my breast. It is sore. (Andersen 2008: 29)

Bodily anxiety leads her to anticipate death, to mourn, to recapitulate, returning over and again to reflect that the knowledge of impending death is robbing her of a desire to live by signalling her body as marked by death:

I lose the desire for a future with the image that meets my eye in the mirror everyday. I lose the faith that there is a future for me. (Andersen 2008: 56)

Liselotte’s body becomes the epistemological tool that communicates to her the knowledge of a life running out of time. Implicitly she recognizes that storytelling is the only way she can exist here and now. Her continuing attempt to mark her body visu-ally and in narrative becomes a way of being, a way of living with cancer. Her way of being in the world is characterized by marking and specifically defined by narrative. Questioning in itself indirectly becomes a remedy, a way she can handle the existential side-effects of terminal cancer. As in the breast cancer narrative analysed by Kristin Langellier, Liselotte describes the marked body as ‘a site of struggle over meanings’ (Langellier 2001: 145). There is no ending to her project, no final resolution, no restitution, no definitive reconstruction, no answers to all her ques-tions. Like the narrative itself, she seems decentral-ized and permanently homeless (in body, narrative and identity). Her narrative is an endless self-reflexive dialogue, intending to capture and define herself but inherently acknowledging the hopelessness of this intention.

4.2. The case of Heidi Seide Jacobsen: En helt almindelig pige i stiv modvind/‘A Perfectly Ordinary Girl against the odds’ (2008)

Heidi is 31 years old, a qualified bookkeeper and mother of 2 children aged 2 and 6. She is married to Rehne, whom she has known since they were teenag-ers. She was expecting their third child when she was diagnosed with breast cancer. The narrative unfolds in retrospect to recapture the past. Unlike Liselotte’s narrative, Heidi’s is a specific chronological recon-struction of events, even referring to specific dates. The use of photographs of herself at different stages of the illness gives the narrative a documentary quality, while visual representations of the illness experience strengthen the sense of the narrator’s dependence on a visual aesthetic. Heidi’s narrative possesses the kind of linearity that Liselotte’s lacks. It is carefully organized chronologically. The narrator is no longer a part of the chaos surrounding cancer. She is on the other side. And Heidi is even able to point to the nadir, which also represented a turning point in her recovery, namely the period immediately after the removal of both her breasts.

Heidi’s narrative bears the marks of an unbearable and radical loss, in that before the onset of surgery, radiation and chemotherapy she chose to have an abortion, and the narrative commences with the induced birth of her dead child. In the narrative this represents one of the invisible marks on her body

148 Nina Henriksen and Helle Ploug Hansen

and her self. The removal of the breasts, the radiation tattoos and the hair loss are the visible marks on her body and her self. Throughout the narrative bodily descriptions – of her appearance, her hair loss, breast prostheses and breast reconstruction – play a promi-nent role. And, as in Liselotte’s case, Heidi describes how she spends a considerable amount of time looking at herself and meditating on her identity.

At the beginning of the narrative Heidi is having difficulty accepting her image. Here she describes her looks the day after the surgery:

Good grief – what do I look like! Where my breasts used to be I am entirely flat and my belly is soft and bulging out. I am simply triangular. Completely narrow at the top and broad around the belly. Totally wrong! (Jacobsen 2008: 41)

This term ‘totally wrong’ is connected to other labels such as ‘not normal’, ‘ugly’, ‘odd’, ‘disgusting’, and throughout the narrative are contrasted to being ‘perfectly ordinary’ (also in the title of the book) and ‘normal’. Moreover this narrative makes a very strong claim as to the connection between bodily appear-ance, being and identity. Heidi is specifically using the mirror as a tool and a self-therapeutic medium meant for healing:

When I get up in the morning and there is not a single nice thing to say about my body, I look at my naked body and say out loud, ‘I am well, I am strong and fresh – and I can make it’. To look at myself in the mirror slowly makes me friends with my body again. […] my body is my friend. (Jacobsen 2008: 86)

And

‘I get more and more self-confidence by facing it every morning in the mirror.’ (Jacobsen 2008: 88)

The prostheses and the wig are important tools for administering and reducing the changes on and in herself, though she also recognizes these changes:

Nice wig and nice prostheses – I am going to get through this. It is still weird to look at myself in the mirror without clothes on. (Jacobsen 2008: 69)

Heidi is keen on the thought of recreating the look she had before the onset of cancer. In choosing a wig, she searches for an exact match with her own hair:

I ask to have a wig made that is exactly identical to my own hair. […] The hairlines will be exactly identi-cal to my own. It will simply be a faithful copy of my own hair. (Jacobsen 2008: 66)

And,

It is important to me that nobody can see that it isn’t my real hair. (Jacobsen 2008: 84)

She is specifically trying to recreate how she looked before the onset of illness. Throughout Heidi’s iden-tity is articulated as being strongly intertwined with her bodily appearance:

Rehne shaves my head completely bald. My naked head looks disgusting. It has an odd shape […] totally wrong, completely different […] I think I am ugly, ugly, ugly. […] I take a shower to wash off all the little hairs. I can see my silhouette in the shower cabinet. It looks like the man from Lord of the Rings, Gollum. Small, bald and deformed. I am Gollum! […] Put on my wig and my prostheses. I know that it is self-deceit, but it improves my mood to put it back on again. Wearing some of my new clothes I look like an ordinary girl. I am not an ordinary girl but I look like one […] in principle it is the same as dressing up, but it helps my self-confidence, and I spend some time in front of the mirror with all my gear on. Looking at myself, thinking positive thoughts. ‘I look natural’, ‘I look better than I feel’. […] I practice thinking good thoughts about myself wearing prostheses and wig. I only take it off when I go to sleep. I never walk around without the wig and the prostheses. Never. […] Only at night am I bald and without prostheses. (Jacobsen 2008: 85)

She wants to re-create her former appearance to reconstruct or maybe rather to preserve her identity. She recognizes that she has changed and that wearing wig and breast prostheses is a trick, a game resem-bling children’s play. But the imaginary recreation and the marking of this process are inextricably linked to these aids and powerfully signal a distinguishing of her identity from the illness:

I don’t wear a scarf – I think it looks so ‘cancer-like’ and to me it is important to be as normal as possible. I just want to be me, Heidi. Mother of Emil and Ida, wife of Rehne, the one with the camp site. That is my identity, not being the woman with breast cancer. (Jacobsen 2008: 88)

Heidi has no doubt what her identity is and also inherently states that she can define and determine a sort of core identity, specifically linking this core to her bodily appearance. Therefore she is determined to hide the bodily changes that the cancer treatment has brought about:

Here we are like a perfectly ordinary family and me like an ordinary girl, just three weeks from the week in hell. No one can tell what we have experienced […] I look so ordinary but I feel so different, as though I am a luminous green and have a big cross on my forehead saying, ‘She is seriously ill’. But I can tell that no one can see how I feel. (Jacobsen 2008: 56)

What is important for her is precisely the concealment of these changes from the public. On the one hand she

‘Marked’ bodies and selves: A literary-semiotic perspective 149

identifies a certain difference between body and self, but on the other hand she can handle it as long as the marks on her body remain invisible. Appearance is the key to her bodily and mentally healing.

Her choice to have a breast reconstruction is, therefore, articulated, as she visits the private clinic for plastic surgery:

I am really looking forward to getting real breasts again so I don’t have to constantly worry if anybody can tell they are fake. (Jacobsen 2008: 145)

It is striking that Heidi considers reconstructed breasts as real breasts. She specifically contrasts the prostheses she calls ‘artificial breasts’ with reconstructed breasts described as ‘real breasts’ and ‘new breasts’ (Jacobsen 2008: 156). Moreover she firmly exclaims that they will reconstruct her as ‘normal’: ‘My feelings scream “Yes, cut me normal!” ’ (Jacobsen 2008: 138). And:

I am really looking forward to have the last breast done, and then become a perfectly ordinary girl again. (Jacobsen 2008: 147)

She stresses the same point with the second reconstruction:

When I wake up again I am completely ecstatic with happiness. I look under the shirt, and there are two bumps. I am euphorically happy and grateful. Can you imagine – two breasts again! Perfectly normal! (Jacobsen 2008: 153)

Her first appointment for breast reconstruction takes place at the public hospital:

When I leave I am floating on air. My hair is almost one centimeter under the wig and I can have new breasts. I can feel that my life is calling me. A life without wig, false breasts and hospitals. A good life. Not like my old life before the illness – that was also a good life, but it is so far away from now. A new life. (Jacobsen 2008: 127)

The thought of breast reconstruction, like that of her hair growing back, is simply life-affirming and invested with a powerful existential quality. She is thrilled when the tape of the wig sticks to her own tiny new hairs: ‘It testifies to better, lighter and more normal times ahead’ (Jacobsen 2008: 115). Somehow her visual appearance and the signs of the healing body are connected to an interpretation of life in itself improving:

I discover that even though I have cancer there is still good things in life. […] I do have a life […] even though I have cancer. (Jacobsen 2008: 56)

In this way Heidi’s narrative demonstrates how the marked body can be linked to being, linked to her identity and also to the existential side of human life.

Bodily signs are read as signs of identity and of exist-ence. In Heidi’s case, a better appearance, measured against a conventional feminine ideal, equals being better and having a better life.

But meanwhile the nuances of Heidi’s narrative, as cited above, testify that her perspective on the connec-tion between appearance and identity is not a simple one. She recognizes that there has been a change in her as well as in her life. The marked body has, as in Liselotte’s case, conveyed to Heidi a consciousness about death and mortality as being a part of life:

I will never be the same again, as before I had cancer. But I have found my new feet (and breasts). I am not a poorer edition than before, just different. Most of all I have become scared. Scared to die while my children are still little. (Jacobsen 2008: 179)

By the end of the book she confirms that her identity is associated with having overcome cancer:

Cancer is something that I have had. […] It should not be allowed to frighten me or affect the way I am to live my life or give me an identity as ‘cancer patient’. I am Heidi, Emil and Ida’s mother and 32, like everyone else born in 1975. That is what I am. A perfectly ordinary girl with a perfectly ordinary life. (Jacobsen 2008: 180)

Heidi is marked by cancer but has chosen to ‘re-mark’ the body decisively, and for her definitively, by choos-ing to have a breast reconstruction. The writing of ill-ness on her body is partly overwritten by the medical writing of the breast reconstruction, which is literally ‘marked out’ when the plastic surgeon draws on her skin to demarcate the contours of the reconstructed breast before performing the surgery (Jacobsen 2008: 145). This medical process of marking reflects the instrumentality and the mechanistic view of the body that the restitution narrative outlines, and in this respect her story strongly resembles the restitu-tion story (Frank 1995: 75ff., 1994). Arthur Frank defines the restitution story as a culturally pervasive master narrative following the plot ‘Yesterday I was healthy – today I am sick – but tomorrow I’ll be healthy again’ and directed at ‘deconstructing mortal-ity’ (Frank 1995: 77). Heidi incessantly confirms her own restitution:

I can feel that I am free of cancer. […] I can feel that I am cured, completely cured. My body feels just like it felt when I was younger: light and free. And it is fantastic. (Jacobsen 2008: 55)

Being in control is unquestionably one of the key features of Heidi’s narrative. She wants to regain control of her body, of herself and her life and uses reconstruction as a powerful way of re-establishing

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that control. Her belief in the fact of her own resti-tution affects her perceptions of body and identity. By mechanically restoring the body, she is manipu-lating it into its original mould, so to speak, in an imagined approximation of a time before the onset of cancer. This is at its clearest when she enthusiasti-cally exclaims that her stomach after the TRAM-lap operation is ‘just as flat as when I was 16 years old’ (p. 147). Although aware that there has been a change in her life, she has a powerful sense of a future after recovery:

I feel my life is calling me. […] A new life. A new and happy life with my loved ones. A life where I will never forget what I have gone through, a life where I will be grateful that I was allowed to stay. (Jacobsen 2008: 127)

The marking of breast reconstruction is necessary to mark her life, to control it. For Heidi this mechanistic and restitutional manipulation of the body is also a way of manipulating death and mortality. Moreo-ver she needs this medical remarking to keep the thoughts of death at a distance:

The doctors are dedicated to their jobs, experienced, innovative – and human. […] They have saved my life. I have been branded with the fact that awful things happen. I will carry this brand forever, but I will live on and live a good life. Cancer will not get me! (Jacobsen 2008: 180–181)

Heidi’s bodily changes remind her of the presence of death, but she uses breast reconstruction to deconstruct mortality (Frank 1995: 83). Her per-sonal narrative is deeply rooted in medicine and therefore at odds with the narrative reclaiming typically performed in opposition to medicine’s claim on body and self in the quest narrative (Frank 1994, 1995).

One of the major differences between these two narratives is that Heidi’s is so strongly affiliated with the restitution narrative. The story of restitution is founded in medicine’s paradigm of restoring and controlling the body and hence in a mechanistic view of a body designed to replace defective body parts (Frank 1995: 88). Both of these characteristics are reflected in Heidi’s clarity of purpose in using breast reconstruction to reconstruct identity and even life itself. Thus Heidi’s perception of the con-nection between body and identity is significantly different from Liselotte’s. Though cancer treatment and her changed appearance are on the verge of affecting her identity, she maintains a belief in the presence of a stable inner unit of her self as ‘a perfectly ordinary girl’ and ‘the mother of Emil and Ida’.

5. Discussion: the concept of marking body and self

We have shown how both of these women manage the body’s return to their consciousness and deal with the ‘dys-appearance’ of the body. We have demonstrated how looking at the body become an action that is significant for the preservation of identity. The two women are afraid of the power of their gaze. They loathe their marked bodies but describe the perform-ance of persistently looking at it that almost takes on the character of a ritual. The narrators’ eyes physi-cally marking the body in front of the mirror (or in the bath) perform a new semiotic role. The women’s marking of their bodies, performed both in the process of observation and of narration, relates to what Frank has called a ‘reclaiming of body and self ’ (Frank 1995: 64ff). This reclaiming of body and self has to do with a resistance against the inscription ‘from the outside’ typically performed by the restitution narrative (Frank 1995: 71). Inscribing their own text on their own body corresponds to writing a self (Frank 1995: 71). This ten-dency is mirrored by the narrators’ urge to ‘find their own voice’ (Frank 1995: 71). And finding one’s voice is played out in a dialogue with the voice of mortality speaking from a body marked by death. The women negotiate the meaning of death that complicates iden-tity because it points to the ultimate end of identity.

The gesture of marking can be perceived as a form of re-claiming and contributes to it – that is to a retrieving or attempt to retrieve their bodies and selves physi-cally by looking and rhetorically by writing. But this reclamation and rediscovery of voice through marking comes about in ways that differ somewhat from Frank’s concept of reclaiming (Frank 1995: 64ff). First, in Heidi’s case the reclaiming gesture is performed with a very strong reference to the restitution narrative and therefore stands in an oppositional relationship with the quest narrative that is defined as the re-claiming narrative per se (Frank 1995: 115ff). Second, because in Liselotte’s case alongside her re-claiming act she performs a denial of the possibility of re-claiming all together. According to our interpretation, both nar-ratives describe acts of re-claiming that fall outside Frank’s definition. This is due to their perceptions of body and identity and of the intricate connections and oppositions between them.

The purposes of the women’s marking of their bodies are reflected in the empirical evidence and are interpreted here as part of a complex process of creating new meaning in relation to bodies and selves. The women’s marking and re-negotiation of identity are played out as a rhetorical process, a kind of ‘semiotization’ of body and self, which resembles a

‘Marked’ bodies and selves: A literary-semiotic perspective 151

series of ‘discursive moments’ (Carbaugh 2007: 111) and resembles a ‘narrative performance’ (Langellier 2001) directed at grasping the truth of body and self (Brooks 1993).While the women’s bodily practices unfold in contrasting ways, they imply a fundamental recurrent semiotic monitoring of the body directed at negotiating the meaning of the self.

We suggest that the concept of marking can lead to a broader understanding of the connection between illness, body and identity. The concept of marking applies both to perceptions and reflections of identity associated with a body-self being out of control and a body-self being under control. Heidi makes a strong claim to reconstruct and control both her identity and her perception, whereas Liselotte asserts the impossibility of either. But despite these differences these women are driven by the same motivation, using the same tool.

The specific choices relating to breast reconstruc-tion are influenced by perceptions of body and identity and are not just affected by questions of accepting or rejecting traditional ideals of female appearance/beauty (Ucok 2007). As shown in the empirical ma terial at hand, decisions about breast reconstruction are influenced by specific and interrelated perceptions of bodies and identities. Even though these percep-tions are affected and styled by culture, they also derive from deeply personal and rooted conviction and ought not to be submitted to value judgements when seen from different perspectives. Breast reconstruction and the refusal of breast reconstruction can be viewed as part of a semiotic monitoring and marking of the body that can take place in the aftermath of treatment for breast cancer. On the one hand the bodily practice of breast reconstruction can express a desire to refashion a ‘Dys-appearing body’ into a ‘Dis-appearing body’ (in Heidi’s case) against a perception of identity that holds a promise of identity’s reconstruction. On the other hand, seen from another perspective (in Liselotte’s case), the rejection of breast reconstruction reflects the acceptance of the impossibility of refashioning the marked body, based on a perception of identity that denies the possibility of its reconstruction. In both cases, however, the narratives testify to the role of a personal engagement in the process of healing.

Acknowledgements

We would like to thank the Danish Cancer Soci-ety and the Danish Milieu for Humanistic Cancer Research for economic support and for inspiring discussions.

Notes

1. Research has devoted considerable attention to breast cancer with regards to a number of interrelated issues, such as the process of meaning-making (Nelson 1996; Collie and Long 2005), the terminology and the genres involved in the representation of the breast cancer experience (Langellier and Sullivan 1998; Thomas-MacLean 2004; Manderson and Stirling 2007), how the meaning of breast cancer is socially and institutionally negotiated and influenced (Thorne and Murray 2000; Broom 2001; Carter 2003; Ucok 2005; Davis 2008) and how individual discourse can be conceptualized as a counter-narrative to a cultural master narrative, in some instances almost taking the form of breast cancer activism (Radley and Bell 2007; Garrison 2007).

2. Brooks refers to the classic essay by Laura Mulvey: ‘Visual pleasure and narrative cinema’ (1975). The term refers to the sensual pleasure derived from the contemplation of the body.

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Nina Henriksen is a PhD-student and holds an MA (mag.art.) in Comparative Literature. She has done research within the field of literary theory. Her MA thesis was concerned with the theoretical discussion and develop-ment of the concept of a verbal image. Currently she is researching illness narratives and in her PhD-project spe-cifically focusing on Danish cancer narratives. Address for correspondence: Research Unit (Health, Man & Society), Institute of Public Health, J. B. Winsløws Vej 9B, DK – 5000 Odense C, Denmark. Email: nihenriksen@health.sdu.dk

Helle Ploug Hansen, PhD and MA (mag.scient.), is Professor in Anthropology. She has conducted several ethnographic fieldworks in Denmark within the field of psycho-social oncology. She is author of several books and articles. Her last anthropological research is about women, cancer and rehabilitation. Scientifically she works with theories of medical anthropology, theories of commu-nication, narrativity and governmentality. She is involved in Health Technology Assessments in relation to patients’ and citizens’ issues and qualitative research. Address for correspondence: Research Unit (Health, Man & Society), Institute of Public Health, J. B. Winsløws Vej 9B, DK – 5000 Odense C, Denmark. Email: hphansen@health.sdu.dk