Do you know what hope is? It’s magic and it’s free.
It’s not in a prescription. It’s not in an IV.
It punctuates our laughter. It sparkles in our tears.
It simmers under sorrows. It dissipates our fears.
Do you know what hope is? It’s reaching past today.
It’s dreaming of tomorrow. It’s trying a new way.
It’s questioning the answer. It’s always seeking more.
It’s rumors of a break. It’s whispers of a cure.
A roller coaster ride. Of remedies, unsure.
Do you know what hope is? It’s candy for the soul.
It’s perfume for the spirit. To share it makes you whole.
Keep Hope Forever Until We Find A CURE.
—“Banners of Hope,” Sunshine after the Rain Blog
It is within disease, with its terrifying phantoms of despair and hope that my body becomes ripe as little else for encoding that which society holds to be real.
—Michael Taussig, “Reification and the Consciousness of the Patient”
Hope carries utopian promise; it offers possibilities of a “not yet,” a “to come,” and an imagining of life otherwise. Hope has often been deployed as the means to effect radical social transformation and the reinvention of reality.1 It is seen as a way of reaching beyond the stymied conditions of today by orienting toward the horizon of an alternative tomorrow. Hope is invoked as an incantation, under conditions of uncertainty, of the ability to effect change. This change can be imagined politically and economically, psychologically and corporeally. Indeed, hope is ubiquitous in contemporary culture, from then-U.S. President Barack Obama’s political memoir The Audacity of Hope to international food drives—the “Convoy of Hope”2—to biomedical understandings of illness and health. As in the preceding quotation from “Banners of Hope” (an online outreach for children with life-threatening diseases), hope is often the panacea for chronic or terminal illness.
Hope—to have hope, to show hope, to activate hope, to marshal hope—is viewed and pursued as ontologically “good,” as unquestionably the right way to be/live. Yet, in the biocultural arena, the affirmation of hope (often taking the form of a demand to hope) operates in a regulatory sense to structure subjectivities, social realities, and corporeal states. Hope incites particular behaviors, it induces certain forms of community and belonging, and it encourages us to believe in the possible transcendence of bodily limits and/or temporal constraints. In contemporary U.S. biocultures of cancer specifically, hope operates as a form of intimate governance that conditions responses to bodily vulnerability and uncertainty and manages the present for the future.3 In this chapter, we analyze how hope is articulated and employed in cancer activism and awareness campaigns, fund-raising, forms of treatment, and clinical spaces and practices to “make live.” In looking to the ways the affirmation of hope is actively made and maintained in what we call spectacles of hope, infrastructures of care, and bioethics of faith, several limitations become evident. First, we see that only certain forms of hope are validated in cancer biocultures, and in late liberalism, these dominant affective conventions of hope are increasingly commodified, routinized, and militarized.4 Second, while such dominant forms of hope orient individuals and the population at large toward life—indeed, dominant forms of hope relentlessly affirm life—the affirmation of hope also has death-effects: hope itself may not be deadly, but it can cover over death, distract us from seeing death-producing factors, and create or maintain deadly conditions for certain sectors of the population. We show that individuals who do not (or are not able to) embody dominant modes of hope—and thus fight cancer in a way that resounds in popular discourse—are framed as failed or negligent and invisibilized or abandoned within the cultural realm. Moreover, as we explore in the final part of the chapter, the insistence on hoping for the biomedical cure precludes a social justice approach that would actually apprehend the environmental, class-based, and racialized causes of cancer incidence. Hope discourse thus lets certain individuals/communities (continue to) die and can be seen to abandon individuals whose prognosis is “terminal.” We ultimately ask, how can individuals find other ways to live with and die from cancer, not through forsaking hope, but through developing and practicing alternative hope tactics—“hoping for other things”—in relation to cancer?
The Affect of Hope in U.S. Biocultures
Affect refers to affections, sentiments, perceptions, and proclivities that circulate within and are produced through social and material/environmental relations.5 Affect is actively constructed through representations, practices, and interpersonal relations: it is inextricable from social realities. Affect is socially and materially arranged and directed and is conditioned through sets of norms. These norms regarding certain affects (that regularize how to be sad, how to be happy, how to be angry, etc.) organize how we encounter one another and the world around us, and they call on us to generate and cultivate certain responses over others. As Clare Hemmings has noted, then, “affect might in fact be valuable [to criticism, to analysis] precisely to the extent that it is not autonomous.”6
Multiple affects become solidified through practices and institutions. Importantly, certain affects are valued and socially endorsed; some affects become dominant and are normalized, while others remain subjugated and devalued. Furthermore, specific understandings or responses are seen as more acceptable than others within the contours of a particular affect. Norms of a given affect constrain (or mark the limits of) knowledge and experience of that affect. These complexities call for a nuanced approach to the analysis of affect, one that takes into account the manifold social implications of affective norms and their material effects. Such an investigation is necessary because of the differential ways that norms of a given affect are productive: forming and conditioning bodies, subjectivities, and broader group identities and social relations. The stakes of conceptualizing affect as social (rather than ontological) are that politics remains embedded in embodied subjects and the practices of everyday life.
Within contemporary biocultures, hope is clearly a dominant affect. Many critical studies of biomedicine and technoscience fields have analyzed the nuanced workings of hope—its operations at individual and broader social levels: Mary-Jo Delvecchio-Good et al. have analyzed what they termed the “political economy of hope” in oncology culture; Sarah Franklin has examined new reproductive technologies as “technologies of hope”; Tiago Moreira and Paolo Palladino have investigated the tensions and mutual relations between what they call the “regimes of hope and truth”; and Carlos Novas has built on the idea of a political economy of hope by applying it to the analysis of links between corporations, individuals, and the production of biovalue. Nik Brown’s sustained attention to hope has drawn together multiple scholars working in this area of inquiry and, further, extended understandings of how hope is mediated in biomedicine, specifically in terms of biomedical expectations.7
This is not to say that other affects—such as despair, shame, fear, and anger—are unimportant: multiple affects do permeate biomedical encounters and broader collective and individual responses to illness within biocultural spheres. However, other affects are not actively fostered in biomedical engagements or in broader social articulations of disease and illness in the ways that hope is. Importantly, hope—in its dominance—operates as a form of intimate governance: it conditions particular ways of living, at the level both of the population and of the individual, and is thus both biopolitical and disciplinary. Hope works biopolitically in that it is rhetorically invoked and utilized across a broad spectrum of biomedical practices, formal biomedical institutions, and social infrastructures to orient the population toward more life. Hope operates as a form of discipline in the sense that individuals are encouraged to hope as the way to affirm their own life: hope is integral to the regulation of the self and individual bodies.
The “productivity” of hope—its uptake and its biopolitical and disciplinary effects—should not, however, be equated with widespread support for diverse forms of hope. Following on from our earlier point, like other affects, hope is conventionalized in particular ways that circumscribe what meanings or articulations of hope can exist and how hope is employed and experienced within biomedicine and contemporary biocultures. These conventions reveal the power relations at work within affective states and practices of hope: hope disciplines individuals to affirm (a circumscribed) life—to experience their biomedical subjectivity through conventions of hope and to hope as the way to live (more). One of the primary ways that hope has been conventionalized is through biomedicine itself—through biomedical encounters that condition individual feelings and responses to medical treatments and expertise. Hope affirms the “truths” that undergird biomedicine.8 These might be understood as the following: techno-utopian transcendentalism, or the possibility of transcendence of corporeal limits and ends; progress to an undefined future; a salvationary ethics that directs toward optimism; and optimization and enhancement of the human.9 By affirming these truths central to biomedicine, hope fosters life in particular ways and encourages certain ways of thinking about life (in the face of illness). The biomedical deployment of hope orients life toward these truths and, in doing so, conditions conduct and produces biomedical subjects in line with biopolitical rationalities of life-making. Importantly, however, because affect—as it operates in biocultures—is connected to broader social events, such as the economy and national policy, biocultural conventions of hope shift over time. In other words, hope becomes conventionalized in ways that delimit how hope is embodied and practiced, but these conventions (the ways hope is imagined) also shift over time in relation to economic, political, social, and scientific developments.
To explore these claims further, we turn to an analysis of hope in relation to cancer. Historically, hope has played a key role in the public address of cancer in the United States. The shame, dread, fears of contagion, and embarrassment that attended individual discoveries of cancer perpetuated its social concealment and a general repugnance to the disease.10 According to Susan Sontag, these sentiments toward cancer originated in large part because “cancer is notorious for attacking parts of the body (colon, bladder, rectum, breast, cervix, prostate, testicles) that are embarrassing to acknowledge.”11 To battle cancer’s stigma, hope was purposely cultivated and conscripted as a counteraffect to raise public awareness of cancer and rally public resources for cancer prevention and treatment. This was—and continues to be—filtered through militarized rhetoric and practice, evidenced most clearly by the historic mobilization of hope as a weapon in the “war on cancer.”12 Among the linkages between cancer and militarism (for example, chemotherapy drugs and biochemical warfare13), hope weaponry has operated in both a discursive sense and in practice through the political economy of treatment of cancer and broader public cancer campaigns and services. These militant operations of hope are more observable in some cancer activisms than others, for example, breast cancer compared to bladder cancer, but all cancers are, to some degree, managed and represented through vigilant biocultural deployments of hope—its relays and forays through biomedicine and into the public realm. In the following section, we briefly survey the rise of hope as the militant affirmation of life within cancer activism, specifically the weaponizing of hope in breast cancer culture, which dramatically emblematizes the intensified deathly potential of the contemporary pursuit of life against cancer. We consider some of the changing conventions of hope within the war on cancer to open up a broader discussion of the ways this affect governs within biocultures of cancer—both mobilizing and limiting life through various terrains of cancer activism and treatment.
Hope Weaponry in the War on Cancer
Cancer has long been considered the target of war—that which war must be waged against—with hope serving as a primary weapon to fight cancer. Hope was first deployed in biocitizenship projects relating to cancer in the late nineteenth and early twentieth centuries.14 During this time, a generalized silence accompanied the disease, and there was an overriding popular belief that a cancer diagnosis inevitably resulted in death. Despite high incidence and mortality rates, cancer received little public attention. To battle these issues and work toward the goal of the promotion of life, public education efforts and a series of social-control programs endeavored to “fight cancer with publicity” and combat the fear and silence surrounding it with hope. The American Society for the Control of Cancer (the ASCC, which became the American Cancer Society [ACS]) formally adopted the Sword of Hope symbol in 1928. The sword was used to promote the idea that vigilant detection, knowledge, and education would enable individuals to hope that they would not succumb to cancer but could instead battle it and thus make themselves live.15 Hope, in this era, was beginning to be militarized; it was considered the battle cry to wage war on cancer, and the sword rallied hope to encourage individuals to take responsibility for their own health and that of their families, and to discipline themselves with the aim of achieving national protection against cancer.16
Integral to the rising public visibility of cancer was the formation of the Women’s Field Army (WFA). Established in 1936 and initiated by the ASCC, the WFA adopted the Sword of Hope as its emblem and aimed to collectively organize “trench warfare with a vengeance against a ruthless killer.”17 Organized vertically with an officer’s corps and foot volunteers, enlisted women in this legion of volunteers wore khaki uniforms with insignias of rank and achievement. By 1943, the WFA numbered between 350,000 and 700,000 and was supported by militarized forms of hope within popular culture, such as posters that exhorted citizens to vanquish cancer by learning about it, looking for symptoms, and pursuing early diagnosis and treatment as part of a collective front against cancer.18 While various medico-technical advancements were unfolding during this time period, the strength of national health relied on individual and familial efforts to promote cancer awareness and retaliation against the disease. Cancer was seen as a disease that could be controlled by knowing its symptoms and anticipating its signs, and thus both hope and cancer’s curability relied on early detection once the disease had appeared. The aim, here, was to regularize the lives of the masses (in line with normative standards) and mitigate the risks faced by the population at large. This possibility could only be mobilized through the militancy of citizens over their own bodies and those of their families; to do otherwise meant that one failed as a citizen. The Sword of Hope was a call to arms in this enterprise, where the conquest of cancer was framed as a civic duty, a matter of honor, and a heroic endeavor that required the vigilance of the entire population.
In contemporary biocultures of cancer, hope operates differently. First, hope remains central to governing, but it now involves a heightened individual triumphalism bolstered by popular and biomedical efforts to optimize life, to make (individuals) live (more). Hope is no longer positioned as a social and collective expression of national belonging and welfare but is instead framed as something potentially embodied in one’s own biological material and facilitated by biotech advancements and corporations. Massive investment in the life sciences and biotechnologies from the 1970s onward has effectively led to a political economy of life that speculates on life and its possibilities—in contradistinction to the earlier period’s regularizing of life and collectivizing of risk. Biomedicine has extended its terrain from illness to the more all-encompassing and pervasive regime of “health”; it has increasingly customized rather than normalized the body and, through the genetic and molecular framing of life, promoted preemption and militant self-care in place of an overarching sense of national belonging and protection.19 Attendant to these biomedical shifts, hope is now marshalled as a personal—rather than primarily collective—refusal of death.
Second, fighting through hope in the war against cancer—as seen in the endless pursuit of the biomedical cure and cancer awareness campaigns—is now heavily corporatized and commodified. Breast cancer activism, in particular, has witnessed the corporatization and commercialization of hope weaponry. Breast cancer currently receives more coverage than any other type of cancer, and hope permeates almost all rhetoric and practices that surround the disease.20 Breast cancer is the disease that inspires—demands—the most hope, and such hypervisible hope has been largely achieved through the commercialization of breast cancer activism. In distinction from earlier cancer activism and control programs that emphasized civic responsibility, cancer awareness drives and fund-raising are now heavily directed through corporate sponsorship and take place in/through the market and what Barbara Ehrenreich and other critics have called the cancer–industrial complex.21 This is readily apparent in the contemporary linkages between breast cancer activism and drug manufacturers, such as AstraZeneca. This company’s predecessor, Imperial Chemical Industries, initiated National Breast Cancer Awareness Month (in 1985, in partnership with the ACS), the largest vehicle for cancer-related activism in the world. Breast cancer reveals the extent to which education, activism, and marketing have blurred under the banner of hope. For example, the pervasive color known as “breast cancer pink” allows for the expression of awareness and support for breast cancer activism through pink branding (“pinkwashing”) and consumerism. Hope is now key to making breast and other cancers palatable through the conventions of the commodity.22
The Walther P-22 Hope edition handgun captures these significant shifts of hope in biomedicine and beyond as they relate to cancer. Discount Gun Sales, a U.S. gun-manufacturing company, produced a limited number of special-edition pistols sporting a pink DuraCoat finish. They were introduced during Breast Cancer Awareness Month in 2011 with the original intention of donating a portion of the sales proceeds to the Susan G. Komen Foundation for breast cancer research.23 The gun was so successful that, in 2012, the company initiated a second production line. A Hope edition breast cancer pink handgun is merely one product in a wide array of commodities within cancer popular culture and activism wherein hope functions as an affective currency—hope is bought and sold. By buying the breast cancer handgun (or any other kind of hope paraphernalia), one participates in a market of/for hope: one buys into a system of optimism and consumer identification—an economy sponsored by corporate bodies—to show support for the cause. However, the hope gun’s death-making potential is absurdly drafted in the service of the cure for breast cancer. The gun rallies the war on cancer as a literal technology of killing that couples militant preemption with the normative femininity of pink-ribbon campaigns. While the anti–breast cancer handgun is an extreme example, it is not far afield from one of the dominant figures in contemporary U.S. breast cancer culture: the “pink warrior,” a highly individualized and triumphalist symbol of resistance to breast cancer. This militant pink hero rallies public hope and optimism to combat the threat of cancer in or through commodified images and ideas of a certain form of feminism—universalized sisterhood, self-empowerment, girl power, and so forth.24 The “princess gear” associated with this emblematic figure shows how the militarization of breast cancer operates through masculinized conventions and norms that paradoxically work to recuperate “womanness” and promotes the ideal breast cancer patient as simultaneously infantilized and militarized. The pink warrior’s call for militant hope and retaliation against breast cancer “combines with the saccharine commercial aspects of corporate breast cancer culture—the pink teddy bears, pink jelly beans, and so forth—to produce a spectacle of fanatical sugar-coated warfare.”25
Third, this militant hope in breast cancer culture—exemplified by the Hope handgun—dovetails with a more general hypervigilant biomedicalized approach to the individual body and everyday life in contemporary times.26 Advancements in biotechnology—the “march of progress” to current forms of genetic testing—have initiated new understandings of the body and practices of self-care (forms of individual discipline) that emphasize both individual genetic risk and health as a continuum. Departing significantly from the earlier era’s curative model of disease, the paradigm has now shifted from cancer’s curability after evidence of disease to a new form of life—the search for “the cure”—that involves endless detection and prediagnostic subjection to potential disease. Life, then, exists within a “pre-vivor” to “survivor” loop, and health has become an endless and hypervigilant individual enterprise. Breast cancer surveillance, in particular, through the historical mounting of biotechnologies, from the pap smear in the 1940s to the mammogram in the 1960s and genetic testing in the 1980s, has become a speculative and endless quest for the cure, to the extent that militant medical disciplining of the body through disease surveillance now traverses all stages of life. For example, there have been proposals to remove the breast buds of girl children who test positive for the BRCA1/BRCA2 breast cancer genes.27 The cure for breast cancer is, therefore, biomedically illusive, in that it defers any possibility for the “end” of cancer by enfolding persons without symptoms, along with unwanted and unknown futures, into the present in the name of cancer preemption. The idea of the cure rallies individuals around the pursuit of more life by obliging them to subject themselves to efforts of detection and optimization, thus extending the pursuit of the cure throughout everyday life. The hope gun is the ultimate fetish of this militant affirmation of life through constant preemptive action: “I will refuse death.” As a breast cancer pink–themed object, the gun’s operation now commemorates the higher purpose of breast cancer’s cause, obfuscating the terror and death associated with both the actual disease and the gun itself. In doing this, the hope gun shows the complete depoliticization of “life” under the banner of optimizing (one’s own) life; even the specter of death—via the technology of the gun—can be peddled as hope for the cure, as hope for more life.
While we do not mean to suggest that the hope gun serves as the ultimate public image for cancer or the paradigmatic icon of hope in contemporary U.S. biocultures of cancer, its existence captures the extent to which the governing of life has changed: the war on cancer and search for the cure now extend into previously untapped aspects of everyday life, and hope is militarized to such a degree that affirming life equates to pursuing and morally justifying individual security at any cost. From the hope sword of an earlier era of cancer control and prevention to a handgun that directs its preemptive violence toward “kicking cancer’s ass,” the call to hope organizes how individuals come to incorporate biomedical truths and rationalities—and biopolitical logics—in their daily lives. By incorporating these truths, individuals are not simply inert or consenting targets of biomedical power/knowledge and governance but “are always also the elements of its articulation.”28 We are now witnessing the emergence of new forms of citizenship where individuals increasingly think of themselves in relation to their biological, genetic, or corporeal status and discipline themselves accordingly.29 If life is now understood as that which can be endlessly enhanced, optimized, customized, commodified, and biologized, then hope is articulated—and comes to be embodied—as the refusal to be limited to biological capacity and the way to speculate on one’s own life, and life in general. Hope is the relentless optimism and demand for more (individual) life, the hypervigilance required of disease detection, and the militant affirmation of the endless productivity and potential of biotechnology and biomedical advancements. In the next section, we turn to the ways that conventions of hope are practiced and enacted across a diverse biocultural terrain—what we map out as spectacle, care, and faith—to explore how individuals come to incorporate biomedical truths and logics in their daily lives. By examining how hope operates within public representations of cancer, clinical settings, and encounters—across various scales of private to public, individual body to collectives, home to the clinic—we can see how the affect of hope contours life in particular ways and how such operations either obfuscate death or have deathly effects.
Spectacle, Care, and Faith: Terrains of Hope in Cancer Biocultures
Spectacles of Hope
The affirmation to hope has flourished through the proliferation of spectacles of hope within U.S. cancer biocultures of the twenty-first century. Via spectacle, biomedical rationales are endorsed and hope is continually mobilized and reenergized. This takes place through paraphernalia, in merchandizing, and in the paroxysm of mass cancer-centered events. Ultimately, such spectacles of hope structure what we should hope for in relation to cancer and how that hope should look.
Hope is most commonly turned into a spectacle via commodity items—such as the hope gun—that are adorned with imagery, branding, and slogans that represent the dominant way this affect has been conditioned in the biocultural arena. These items might be thought of as “hope paraphernalia” that enter hope into the market as a sentiment, orientation, and aesthetic that can be peddled and consumed. The spectacle embodied by these items calls on individuals to participate in the circulation of endless and affirmative hope through consumption and visual display: buying and displaying these tokens of hope come to represent an individual’s commitment to either supporting the war more generally—in line with dominant understandings of life, health, and illness—or fighting that war on the personal front through what is known as survivorship. One can purchase hope-themed cancer awareness–raising products, such as mugs decaled with the slogan “Got Hope? I Do”; dog outfits that sport the caption “Love, Hope, and Peace”; a panoply of T-shirts emblazoned with motivational maxims such as “Wish, Hope, Love, and a Cure”; and bracelets labeled with “Hope” and “Strength.” You can quite literally carry hope by buying a LeSportsac Hope Garden or Miche Premium Shell Hope handbag or wear hope in the form of a piece of eternity-symbol jewelry called the Hope Band.30 Organic life can be instrumentalized in the service of hope and the breast cancer cause through the purchase of Hope SeedBallz, which enable you to “plant an all-pink garden.”31 Moreover, the spectacle of hope has extended into the global market such that in Sweden, for instance, one can figuratively buy and gift hope to someone with cancer through purchasing the Give Hope Box—an empty box full of hope, the proceeds from which are donated to childhood cancer.32
The spectacle of hope also predominates in the slogans for cancer awareness and fund-raising, as evidenced by the basketball fund-raiser named Hoops 4 Hope,33 the art-based cancer initiative Boards of Hope (which “invites artists to transform recycled boards of all types into canvases for stunning works of art, based on the theme, Healing & Hope”34), and the Ulman Cancer Fund for Young Adults, whose beer- and wine-tasting fund-raising events are advertised under the slogan “Screw Cancer, Brew Hope.” Cancer-focused organizations equally draw from and reproduce the spectacle of hope through advertising and various initiatives. For instance, the ACS’s Relay for Life website greets the viewer with information on what the ACS calls Heroes of Hope, and Livestrong has Hope Rides and supports Fertile Hope for cancer patients. Not only evident in these arenas, the spectacle of hope (as the answer or appropriate response to cancer) has been co-opted by the broader market to become a vehicle for sales. The Breast Cancer Action group Think Before You Pink warns that, while seemingly altruistic, the “companies know that aligning themselves with ‘breast cancer awareness’ will improve the public’s perception of them and increase their profits.”35 Accordingly, an advertising campaign such as Hyundai’s Hope on Wheels—where you can buy a car and the manufacturer will supply what it calls a “hope grant” to a child with cancer—needs to be understood as a spectacle within the cancer–corporate–market nexus.36
Mass events and rallies for cancer represent perhaps the most powerful form of hope as spectacle. Of these, the Susan G. Komen Race for the Cure and the Avon Walk for Breast Cancer are conceivably the most well known and spectacular. According to Komen advertising, their race is “the world’s largest and most successful education and fundraising event for breast cancer ever created,”37 and more than 130 Komen events per year are organized globally. Avon holds walks in nine U.S. cities throughout the year and calls participants into the cause with the slogan “2 days and 39 miles of unstoppable hope.” Like other forms of cancer-hope spectacle, however, these events cannot be divorced from the commodification of cancer. They are corporate-sponsored, and as Ehrenreich has noted, “the Avon Breast Cancer Crusade . . . spends more than a third of the money raised on overhead and advertising, and Komen may similarly fritter away up to 25 percent of its gross.”38 Such events cannot be extricated from the ways these organizations may be implicated in producing deaths. For instance, Avon sponsors the Look Good . . . Feel Better program (that runs beauty workshops for women undergoing breast cancer treatment), yet more than 250 of the makeup and other products used in the program have been listed on a health risk database in the highest concern category “due to the presence of hormone disruptors, neurotoxins, and possible carcinogens.”39 And both organizations promote mammography as a first-line defense in disease detection, which many have criticized as leading to overdiagnosis and unnecessary treatment, including surgery, radiation, and exposure to potentially toxic and deadly drugs.40
Yet both of these mass events invite individuals to create an enduring spectacle of hope through various techniques: solidarity in walking/running for the cause; the adornment of pink-themed clothing, pom-poms, and other paraphernalia; and the use of anthems and theme songs. Importantly, however, it must be noted that such events enlist women who have already come to think of themselves as “citizens of breast cancer,” who have been disciplined to think of the disease as a property of their individuality, and who relate to the disease through a highly individualized framing of hope. This individualization might best be seen in one of Komen’s key slogans: “I am the cure.” Rallies, then, massify the individual militancy to hope through collective spectacle. In turn, the events become powerful conduits for and of hope, which is framed as the affect that enables one to “be energized, be inspired.”41 Thus these events operate as disciplinary technologies, in that they actively foster the dominant operations of hope as relentless optimism and future thinking. This optimism, as Ehrenreich has powerfully argued, “celebrat[es] survivorhood by downplaying mortality.”42 Indeed, it eclipses the struggle with uncertainty that is situated at the center of being diagnosed with breast cancer and obscures both death and the fact that cancer haunts society. As Dorothy Broom laments in her own account of breast cancer, “no widows weeds, no black armbands, no ritual keening, shaved heads or body paint distinguish the bereaved [in mass spectacles].”43 Sarah Polzin Schultz, a stage IV breast cancer patient, similarly remarks in her online commentary on the alienating effects of hope-as-survivorship, “The definition of ‘survivor’ is: a person who remains alive in an event where others have died. How does that apply to the incurable?”44 The spectacle of hope might, in this sense, operate as cruel optimism.45
Infrastructures of Care
It is difficult to imagine any form of cancer care not predicated on hope. The sustained marriage between care and hope constitutes the very essence of countless cancer treatment spaces and practices that regard fostering hope to be integral to providing care. The pursuit of hope as an operation of care is well established and continues to set the stage for biomedical encounters: people interface with biomedicine in/through care services that aver hope. In the contemporary era, hope is intensively fostered, and the subject governed, through architectures of care that instrumentalize interior design and customize medical services in the cause of hope—in other words, the increased efficiency and corporatization of care, combined with hope thematics. Numerous hospitals, medical centers, and cancer treatment hubs employ hope in their titles, such as City of Hope in Los Angeles, one of forty National Cancer Institute–designated comprehensive cancer treatment centers. Hope medical care titles also have a global presence, demonstrated by the numerous North American examples beyond the borders of the United States, such as the Breast Cancer Center of Hope in Manitoba, Canada, and the Oasis of Hope Cancer Hospital in Tijuana, Mexico. Many of these treatment centers strive to integrate cancer care services—blood tests, scans, chemotherapy sessions, and other support provisions—under one roof. Hope is generated through the efficiencies of a coordinated and comprehensive infrastructure of care. The integration of different offices and services reduces patient travel and allows for enhanced customization of care. Treatment centers organize doctors and medical service professionals into “care teams” that collaborate and tailor procedures according to each patient’s needs. The patient is thus treated as an individual fulcrum of hope that can be leveraged by a care team, well-organized services, and effective architecture.
Beyond teamwork tailored to each patient and the fostering of hope through architectural efficiencies, cancer care centers also seek to cultivate hope through spatial arrangements and decor. Treatment centers increasingly attempt to embody hope—hope as inspirational, calm, compassionate, and optimistic care—in their very architectural designs and interiors. For example, the Mission Hope Cancer Center in Santa Maria, California, which opened in late April 2012, offers “comprehensive compassionate cancer care” within one three-story, 44,000-square-foot building, featuring a Mediterranean-style architectural exterior with natural landscaping and vistas of the surrounding valley.46 The interior design includes external windows that pool warm, natural light; spacious seating rooms in earth tones; large ceiling portals that brighten enclosed rooms with back-lit images of blue sky; and enlarged nature photographs that serve as kiosk screens, room dividers, and window shades and that express light as natural shading. Surf photography dons many of the walls, to exude color and motivational flourishes; expansive windows overlooking the Santa Maria Valley serve as backdrop to the administration of chemotherapy on the third floor; and patients undergoing various scans and procedures can gaze on vividly back-lit, majestic landscape images that have been incorporated into the ceilings. Such hope theming, particularly the enlarged nature transparencies, creates a calming and contemplative “aquarium-bowl” effect; one potentially feels better about one’s disease or illness on viewing inspirational nature at every interface within the medical establishment. Mission Hope Cancer Center’s “nature-sanctuary” interior design conditions patients to admire nature, feel comfortable, be positive, and pursue treatment of oneself as part of the larger flourishing of life.
A second example, the University of Arkansas for Medical Sciences Winthrop P. Rockefeller Cancer Institute in Little Rock, debuted, in 2010, a twelve-story, 300,000-square-foot expansion for cancer research, treatment, and outreach. The design of the entire building was carefully considered as a means to inspire the hope of patients and their families.47 The interior holds numerous hope-themed environmental attributes: wall-displayed affirmations like “While there’s life, there’s hope,” live piano playing, and an atrium housing a garden and the Seed of Hope sculpture—the hallmark of the entire building.48 Carved from white-pearl Turkish marble and standing two feet high, this sculpture of a large seed serves as a dedicated monumental receptacle for Seed of Hope tokens.49 Such tokens, which feature the logo of the institute on one side and an impression of the interior of a seed on the other, are presented to patients on the final day of their active cancer treatment. Each patient is given two seed coins: one token is placed in the sculpture to commemorate survivorship, and the other is taken home by the patient to keep or to gift to another person as a symbol of hope.50 In this scenario, the affirmation of/to hope is symbolically minted in monetary-coin form and pressed into the service of an expansive, contemplative, timeless, and copyrighted landscape of cancer care, extending from the sculpture itself to the larger building surrounding the atrium and sculpture and to the pockets and homes of cancer patients and their relations. Such an affective economy encourages the cultural acceptance of cancer through the visually encouraging accumulation of hope; it also primes individuals to accept, internalize, and advertise corporatized forms of care.
The contemporary corporatization of cancer care—and the contradictions that attend it—can be further explored through examination of the ACS-administered Hope Lodge network. Various Hope Lodges have been built in urban centers across the United States. Each offers cancer patients and their caregivers invaluable free, temporary lodging when specialized cancer treatments are unavailable near their homes. Hope Lodges also offer many practical services and infrastructures essential to everyday life to reduce the financial and emotional burdens of cancer treatment: guest rooms and private baths, common kitchens, computer workstations, a library with educational material on hand, local transportation to and from treatment, and additional communal opportunities, including yoga, Tai Chi, and shared meals.51 Such care employs the architecture and interior environment to nurture hope, homelike comfort, private retreat, and community connection. With more than thirty locations bearing the official trademarked name, Hope Lodges serve and simulate community welfare—especially critical in the context of the U.S. market-driven health care “system,” which provides few guarantees and limited custody of those facing illness and disease. The provision of this hope network presents corporations an opportunity to articulate hope through corporate benevolence, such as AstraZeneca’s donation of $7 million for the founding of the Hope Lodge in Boston in 2006, now accordingly named the “AstraZeneca Hope Lodge Center.”52 Similar to what critics have called “greenwashing,” corporate sponsorship can strategically function as carewashing—drawing attention to corporate social responsibility in one corner, while irresponsible and harmful practices continue elsewhere.53 The parent company of AstraZeneca, for instance, manufactures carcinogenic insecticides and pesticides. AstraZeneca itself produces the breast cancer treatment drugs tamoxifen and Amiradex, and tamoxifen has been identified as a known carcinogen (causing ovarian cancer) by the U.S. National Institutes of Health. Effectively, then, such companies can harm—indeed, potentially kill—the bodies of those they are claiming to help. And rather than contributing to the marginalized research on the environmental causes of cancer, which could potentially implicate corporations like AstraZeneca and their predecessor companies, hopeful architectures and networks of care could be seen to Band-Aid over the cancer–industrial complex,54 obfuscating potential hazards and harms that commence or continue under the banner of corporate benevolence and the intensified reliance upon corporate charity as the arena and conduit for medical care.
Bioethics of Faith
Beyond being pursued and fostered in practices of spectacle and care, hope also operates in biocultures of cancer as a form of faith. U.S. oncology, most specifically, is permeated by a discourse of hope as faith in biomedicine, in the self, and in the affirmation of life.55 Such hope refuses the limits of life and calls on subjects to become active participants that instrumentalize the future, discipline themselves to be hopeful, and maintain faith in biomedical progress. While Western science and medicine historically can be seen to supersede religious truth and salvation with a telos of progress, current techno-utopian orientations toward biotechnologies, attendant to shifts within biomedicine from simply control (of disease and of populations) to customization and participation, have made hope a bioethics of faith—an ethical orientation predicated on the pursuit of salvation—that prompts subjects to internalize the pursuit of hope and marshal faith in the endless affirmation of life.
This bioethics of faith is most clearly seen in the tension that often exists between disclosure—a historically won patients’ “right to know”—and the practical need to maintain patient cooperation with treatment regimes and what has been called the “principle of respect for hope.”56 Although hope has been criticized as providing justification for paternalism, the withholding of information, and other harms within the biomedical realm, the full disclosure of diagnosis can also be interpreted as medically inappropriate if it jeopardizes hope. Prognostic ambiguity and uncertainty, then, are the grounds on which disclosing and withholding of information are negotiated in the name of securing and managing hope. Within oncology, a dedicated interest in fostering hope can subvert the medical imperative of full disclosure (at the core of medical ethics), particularly when prognoses are bleak, with “facts as the killing fields.”57 When truth is not a productive means to manage patients, oncology enlists hope as an active therapeutic tool that orients patients to the future, affirms life, and rallies faith in the pursuit of always-more medical possibilities. Some even consider the oncologist’s vocation to be instilling hope, balancing the obligation to be honest with “an equally important duty to cultivate hope.”58 Hope is understood to be transformative, potent, even capable of influencing the biological course of cancer; patients, therefore, have a right to it. The right to hope is intimately tied to U.S.-based notions of effective personhood and faith in the ability of individuals to shape life and corporeal functions through the power of will.59
This “allegiance to the efficacy of personal volition and the capacity of the self to mobilize a ‘desire for life,’ a ‘will to live’ and a ‘fighting spirit’” is evident in the development and use of hope scales since the 1970s.60 These instruments of psychometric measurement use affect for intense scrutiny, surveillance, and objectification. Specifically, they provide a means of assessing how much hope an individual has through establishing and deploying norms of acceptable levels of hope. The hope scales involve the administration of a carefully crafted series of questions that are then scored. Several scales are currently in existence, each exhibiting different nuances and backed by an expansive research network dedicated to the quantitative study of the hopeful properties of cancer patients.61 As a whole, these hope diagnostics bifurcate psyche and soma, compelling subjects to monitor and regulate the psyche in order to heal the body. They substantiate hope as central to extended survival, harmonize patients with the aspirations of treatment programs, and, by splitting the psyche and soma, foster belief in the responsibility of the individual to gather “the necessary affective resources in overcoming personalized pathology.”62 Hope, however, is essentially pathologized through such hope scales, and subjects are held accountable for hope’s absence—and disciplined to actively cultivate it.
Another way that individuals are called on to hope as a form of faith is through participating in virtual games that are designed to impart knowledge to patient-players about disease and treatments, rehearse medical protocols, and cultivate faith in self-efficacy. The nonprofit organization HopeLab, which engages in consumer-centered product development “to enhance the physical health and psychological well-being of young people with chronic diseases,” brought together video game designers, health psychologists, and cancer researchers to design a game for young people with cancer.63 The intention was to create and market a game that equipped patient-players with motivational and transformative affective experiences in order to practice vigilant self-care through virtually battling their disease. The result was a Microsoft Windows–based, third-person shooter game—Re-mission—released in 2006 with twenty-plus levels of gameplay. Re-mission immerses players within the complex, microscopic world of cancer-ridden bodies in an epic battle against cancer, wherein one’s weapons are upgraded and more life is achieved by adhering to protocols of prescribed medications, timely symptom reporting, and side-effect management.64 In the game, patient-players pilot a sassy nanobot named Roxxi through the cellular level of teenaged cancer patients to investigate symptoms, destroy cancer cells, stop metastases, and activate patients into “chemo compliance.”65 Players live out the contingencies of treatment in the game’s virtual organic proving grounds. For example, if a patient skips chemotherapy doses, then Roxxi’s chemo-concentrating blaster misfires every third shot and the cancer cells survive and become drug resistant. Considered a flagship for the health-gaming movement, with reportedly more than 185,000 copies distributed free of charge across eighty-one countries, the game has undergone controlled trials to measure its impact on patient behavior, and, based on these results, is said to have stimulated an increase in positive cancer-related attitudes by “transforming mundane medication into bullets to kill the enemy cells, and by changing the humdrum routine of swallowing pills into a heroic act.”66 Essentially, subjects internalize the dominant conventions of hope through the game’s rehearsal of highly militaristic and individualistic self-care. By playing the game, subjects rally faith in biomedicine and, through techno-utopian transcendence, affirm life, the power of the self, and martial values. Re-mission activates a powerful exercise of militarized faith in self-efficacy and, in doing so, secures both the individualized disciplining of hope and the biopolitical optimization (of a certain form) of living.
Spiritual guidance around cancer treatment is a third area where hope as faith proliferates, as a joint venture of medical and religious communities. The integration of various spiritual diagnostics and services in the formal clinical process of treatment—what is often referred to as a holistic approach—increasingly dominates the field of cancer care. Regardless of the faith-based religious content at work in different cases, the biomedical protocol of oncology to foster hope and affirm life interestingly dovetails with religious practice. For example, research has been under way on the hypothesis that individuals with spiritual struggle have greater mortality, and the reverse, that spirituality heals and faith is “medicine’s neglected spirit.”67 While biomedicine could be said to use religion to generate hope, the reverse could also be asserted. Religious communities have been engaged in biomedicine throughout the history of health care in the United States. Religiously affiliated hospitals and treatment centers, for instance, have a long-standing formal presence, especially Christian-oriented care and charity. What is new, however, are the explicit promotional claims and niche businesses of customized spiritual medical care that are taking place within the competitive health care market. The Cancer Treatment Centers of America (CTCA) emblematizes this significant trend, advertising their provision of “mind–body medicine,” spiritual guidance, and a “mother standard of care,” along with cutting-edge biotechnologies and treatment programs.68 CTCA’s “care that never quits” slogan asserts interminable care as the means to enduring hope, and its highly visible marketing strategy emphasizes the integration of medical faith and spiritual custodianship—that spiritual faith is vital to battling cancer.69
A related though less readily apparent facet of the CTCA is its Our Journey of Hope spiritual-support program, which advocates the communion of faith in care and healing with faith in God.70 This salvationary enterprise, which portends to establish relations between medical and spiritual communities (“when religion and medicine embrace”), not only indicates a competitive strategy within the neoliberal marketplace of health care—the niche of serving spiritual hope and guidance—but also structures individual relations with biomedicine in such a way that patients have an opportunity to be born again through biomedical encounters, to heal themselves through relations with God and renewed Christian faith and optimism.71 This extends individual self-care beyond the biological foundations of the human to vigilance through God. Religion compounds the biomedical affirmation of life to proliferate hope: if biomedical faith is hope in biomedicine to affirm biological life, then its combination with faith in God expands hope’s telos beyond life and death. This expansion of affirmation beyond life and death, however, means that individuals now bear intensified moral and social responsibility to get healthy through God, matched with biomedical advancements. An article posted in the resources section of the CTCA’s Our Journey of Hope website, “Don’t Waste Your Cancer,” implores readers to see their illnesses as a productive enterprise of faith: “you will waste your cancer if you do not believe it is designed for you by God. . . . You will waste your cancer if you believe it is a curse and not a gift. . . . You will waste your cancer if you seek comfort from your odds rather than from God. . . . You will waste your cancer if you grieve as those who have no hope.”72 To do otherwise—“to waste your cancer”—is not mere failure to enhance and optimize one’s life; it is the fault of individuals—and individuals are deserving of death—for not attending to spiritual care, for not having faith in God, for not allowing cancer to teach them how to be hopeful. The title of another CTCA-posted article alludes to this final judgment and the anathema that is death under the evangelical biomedical banner of endless hope: “Atheist Doctors More Likely to Hasten Death.”73
Hoping for Other Things: Alternative Hope Tactics
As evidenced through the various practices of spectacle, care, and faith, the affect of hope (and affirmation to hope) has a pervasive governing function in U.S. biocultures of cancer. It is deployed in ways that support the biopolitical focus on affirming and enhancing the life of the population and increasingly structures the way that individuals are governed. This claim is clearly substantiated through the example of cancer culture, wherein hope directs an optimistic orientation to the future and to life, often predicated on militant organization and consumption. Hope is promoted and pursued and comes to function as a regulatory affect, disciplining social engagements with and individual responses to cancer: it affirms life, and this affirming relentlessly circumscribes the kind of life that can be lived and the forms of hope that are socially celebrated and endorsed.
This affirmation of life through hope is an intervening into life, a promoting of life. However, not all forms of life are fostered equally. Race, class, and sexuality—as they intersect with gender—heavily condition disease incidence and survival rates for cancer: economically disadvantaged, nonheterosexual, and racial and ethnic minorities are diagnosed later, receive disparities in care, and experience higher mortality rates in relation to cancer.74 Moreover, the pursuit of well-being and optimal health has largely become a privatized concern dependent on social status, including educational background, financial means, and racially and ethnically stratified access to care and resources. According to the National Cancer Institute’s race/ethnic categorizations, African Americans/blacks, Asian Americans, Hispanics, American Indians, Alaska Natives, and underserved whites are more likely than the general population to have higher incidence and death statistics for certain types of cancer, largely due to lack of medical coverage, barriers to early detection and screening, unequal access to improvements in cancer treatment, and a combination of hazardous occupations and degraded living conditions where exposure to environmental toxins has intensified the risk of developing and decreased the chances of surviving cancer.75 Discrepancies in survival are particularly evident at the intersections of race and gender: the highest death rate from cervical cancer is among African American women, and while white women have the highest incidence rate for breast cancer, African American women are most likely to die from the disease and experience—at a younger age—aggressive tumors that are poorly detected (due to unequal access to early screening and medical coverage) and less responsive to standard cancer treatments.76 African American men have the highest incidence rate for prostate cancer and are more than twice as likely as white men to die of the disease.77
The affect of hope plays a specific role in obfuscating these deaths—and such obfuscation can itself lead to excess deaths, precisely because the causes of racialized and classed-based cancer incidence are not adequately addressed. In cancer culture, hope works to obscure the political character of the disease—for example, in the lack of attention directed toward cancer-causing toxicity and pollution and differential access to healthy environments, food choices, and the biomedical embrace. In this regard, there are “hope haves” and “hope have-nots.” While the Patient Protection and Affordable Care Act was signed into law in 2010 to remedy health disparities and eradicate this “hope divide,” universal health care access remains highly uneven, particularly in cancer-related care and health outcomes.78 As the racial/ethnic and gender differences in the financial hardships of medical debt indicate, no amount of hoping for the biomedical cure for cancer will resolve the linkages between health status differences and other structural inequalities especially related to homeownership, insurance, environmental location and conditions, poverty, and so forth.79
The deployment of hope also eclipses the realities of the disease by refusing a space to address fear, precarity, uncertainty, and pain; for S. Lochlann Jain, “that politics and suffering is more easily black-boxed behind chipper wrapping paper.”80 The affect of hope is constructed as militantly positive and future oriented, and the disease can only be approached as something to be overcome, surmounted, or vanquished. This kind of hope is what is called on as the acceptable and, indeed, the only possible response to cancer diagnosis and treatment, because it is this kind of hope that facilitates the triumphant march onward—to more life. The problem here is obviously not hope in and of itself but the particular conventions of hope that are normalized within biocultures of cancer and the reality that only certain kinds of life can be affirmed and hoped for—positive, ongoing life. The affirmation of life, conditioned through the conventions of hope that we have analyzed, leaves little room to meditate on death or the collateral damage of living under the shadow of imminent death, and it renders invisible those individuals who can be said to “live out” the let-die component of biopolitics. The vulnerability of the subject with cancer does not, cannot, register. These are the other lives, ones that fail to achieve “life” as it is known in dominant knowledge systems and/or those lives abandoned, truncated, or elided in the social sphere.
In short, hope is not inherently “good,” nor is the affirmation of life. Rather, hope, as it operates in the biomedical arena and broader social sphere in relation to cancer most specifically, has an ominous quality, with pernicious effects. Hope obscures the regulatory and political–economic nature of the affirmation of life and circumscribes social responsibility and ethics. It places the onus on the individual as an agent for life and fosters a limited approach to that life. In the context of these conventions of hope, precious few alternative expressions or tactics of hope and life in relation to cancer exist. Such alternative imaginings are generally overshadowed—or risk being deemed pathological—because of their failure to assemble and reflect acceptable responses to the disease. Despite this, we conclude with several key examples that imagine hope otherwise. These “hopeful” alternatives show how hope might be understood not as militant affirmation but as practices that attend to death and precarity through recognition of vulnerability. In these alternative imaginings, what is hoped for is more tangible, modest, and immediate than triumphant survival.
The Beautiful and Bald Movement, for instance, began a public campaign in 2011 to convince toy maker Mattel to mass-produce a bald Barbie doll called “Hope,” “in support of children living with hair loss due to chemotherapy, alopecia, trichotillomania and other auto-immune diseases.”81 This demand for the Hope Barbie took the form of social-networking activism, operating primarily on Facebook, and has had overwhelming public support, with more than 135,000 fans as of March 2016.82 A prototype of the doll that Mattel did produce sported a magnificent diamante-encrusted, black ball-gown, a pink stole, and a tiara on her proudly displayed bald head. Such a doll offers an alternative to the contemporary “makeover” imperative that compels cancer to be hidden through the maintenance of normative femininity, which is largely signified through hair, and instead actualizes the public display of cancer in its depiction of the harsh physical effects of treatments. Had it been released on the mass market, this doll could have potentially provided children with hope for other models of femininity. While still working within the commercial hope culture and representing dominant norms of female embodiment, Hope Barbie could have simultaneously subverted those norms by resignifying hair loss, reimagining beauty, and depicting a tantalizing drag or glam superhero version of Barbie—with cancer.83 The possibility of such a doll, however, was resisted by Andrew Becker, director of media relations for the ACS, who stated that the Hope Barbie would “do more harm than good for kids and parents” and that children “could . . . end up being terrorized by the prospect of it [cancer] in a far outsized proportion to their realistic chances [of developing the disease].”84 Hope Barbie, for Becker (and by extension the ACS), would lead to the evacuation of hope, presumably due to the realities that the doll would embody.
A second example of alternative imaginings of hope is at work in the organization called Hope Cancer Ministries (HCM).85 This nonprofit, faith-based ministry provides practical care and assistance for patients, caregivers, and families living with cancer by offering services like transportation, meals, home handymen, housekeeping, and financial support for critical needs (for example, utility bills). These services attend to the day-to-day needs and the hard realities of those affected by cancer and its accompanying treatments when, for instance, the need for a ride to chemotherapy or childcare is often more immediate than hope for the cure. In the absence of a custodial state that might attend to the concerns of those living with illness, HCM presents a necessary safety net. It moves away from individualistic framings of hope and instead deploys faith in the service of a practical community of health. While such practices might be criticized for offering only a compromised hope that fails to address the social and political inadequacies of the health care system, ultimately, hoping for help in the daily practice of living with and possibly dying of cancer represents a revised vision of hope: as that which must be continually reoriented. In this sense, the hope offered by HCM dovetails with palliative care ideology and practice that, rather than reproducing the endless “hope through treatment” and “hope in the cure,” faces death by focusing on caring—not curing—and giving credence to the possibility of dying well. By promoting nonhospitalized care at the end of life, palliative care and HCM provide the dying with hope for more quality time with loved ones, pain and symptom management, emotional or spiritual support in approaching death, and, ultimately, a good death.
Finally, Bob Carey’s photographic series The Tutu Project gestures toward more modest and tentative forms of hope in relation to cancer culture—wherein, as Jain has stated, “hope and exceptionalism pervade . . . like a shrill thread, everyone hanging on for dear life and yet still dangling.”86 In this whimsical set of images, Carey photographs himself in various locales—cornfields, barren hilltops, hanging on to a climbing wall, in the middle of a street in the snow—wearing only a scant pink tulle tutu. Inspired initially by Carey’s wife’s diagnosis of breast cancer, the project raises awareness and funds for breast cancer research and might be said to stage an implicit critique of dominant breast cancer conventions. A man wearing a pink tutu calls into question the feminization of breast cancer culture; a man frolicking, prancing, bounding, or standing as a diminutive figure in an unexpected landscape (a deserted subway station, a darkened parking lot, a cow paddock) conveys a playfulness that highlights the conservatism of cancer politics; and Carey’s lone and near-naked body stands at odds with the mass spectacle of cancer in the broader public sphere. Through depicting Carey’s lone figure, his face generally turned from the viewer, in often absurd locations and scenarios, these alternative renderings also introduce melancholy and vulnerability into the representation of cancer and thus push away hope as relentless optimism and the conviction to survive. Instead, hope emerges as a subtle, even solitary—though not an individualistic—subjunctive possibility and as a sharing of humor in times of distress and fear. As Carey has stated, “cancer has taught us that life is good, dealing with it can be hard, and sometimes the very best thing—no, the only thing—we can do to face another day is to laugh at ourselves, and share a laugh with others.”87 His articulations do not prioritize the commercialization of hope, thus enabling the politics of cancer to be foregrounded. They do not represent hope as unencumbered triumphalism but instead seek space for dealing with messiness, fragility, absurdity, and loss and attempt to foster creative and even playful forms of persistence. In one particular image, Carey stoops against a barbed-wire fence on what appears to be the deserted edges of a city. Rubbish gathered around the fence surrounds him, while a Goodyear blimp floats in the sky above. Such an image might be said to ironically juxtapose the concept of elevation and the vision of the horizon (and the hope for a good year?) with limits (the barbed-wire fence), abandonment, solitude, and the detritus of daily life. Hope, here, is a practice of “artful endurance.”88
Taken together, these alternative articulations of hope still affirm life, but they do not necessarily frame that life as exclusive of death. Moreover, these other ways of hoping perform the difficult and often painful labor of persisting within the realities of cancer and the fear that can accompany it. Instead of marshaling militant hope, these kinds of hope are fragile; they show forms of mourning, maintenance work, and humor. Rather than being predicated on future orientation, they focus on grappling with the present. Ultimately, these articulations might be said to operate as critiques of the dominant conventions of hope: they intervene into and redirect the ways that hope has come to operate and be deployed to govern populations, communities, and senses of self in relation to cancer. Here critique operates as “an instrument for those who fight, resist, and who refuse what is. . . . It is a challenge directed to what is.”89 It signals a refusal to be governed “like that and at that cost”90 and advances an incitement to hope otherwise.