Article Review

ORIGINAL ARTICLE

Symbols and Meanings in Breast Cancer Awareness Campaigns

VENKE FREDERIKE JOHANSEN*, THERESE MARIE ANDREWS**, HALDIS HAUKANES† & ULLA-BRITT LILLEAAS‡

*University of Agder, Faculty of Health and Sport, Kristiansand, Norway; **Nordland Research Institute,

Bodø, Norway; †Faculty of Psychology, University of Bergen, Bergen, Norway; ‡University of Agder, Center

for Gender and Equality, Kristiansand, Norway

ABSTRACT This article examines symbols and meanings in breast cancer awareness campaigns, and the ways in which multifarious actors draw attention to the disease. We discuss what the various campaigns and initiatives can indicate, above and beyond creating breast cancer awareness. Our data stem from sources such as printed material, the Internet, and events. From these sources we have singled out and explored objects, text, and visual expressions, looking in particular for metaphors and symbolic aspects. In this article we present six “images” indicating the underlying patterns that we found. We have called the images Re-enchantment of femininity, Infantilization, Corporate profit-making, Objectification, Transgression of boundaries, and Exhibition of deviation. These are further discussed in the light of perspectives drawn from the social sciences and feminist theories. One of the article’s key arguments is that breast cancer campaigns, to a great extent, build upon and reinforce traditional, stereotypical gender roles.

Introduction

In recent decades there has been an increase in efforts to raise awareness of breast cancer. In many ways this is positive. But the increased attention also carries problematic aspects, as this article reveals. Until the 1960s, people were generally silent about breast cancer (Olson 2002; Leopold 2006). To the extent that it was discussed, it was usually couched in metaphors with connotations of punishment, war and death, for example victim, crusade, attack, invasion, or malign infiltration, or it was spoken of with euphemisms in order to avoid naming the disease, for example The Big C (Sontag 1978; Clarke & Everest 2006). During the 1960s, however, certain famous American women began making it publicly known that they had breast cancer. They prepared the ground for others, who started telling their breast cancer

q 2013 The Nordic Association for Women’s Studies and Gender Research

Correspondence Address: Venke Frederike Johansen, Associate Professor. Email: [email protected]

NORA—Nordic Journal of Feminist and Gender Research, 2013 Vol. 21, No. 2, 140–155, http://dx.doi.org/10.1080/08038740.2013.797024

stories, first in books, newspapers, and magazines (see, e.g., Stacey 1997; Potts 2000;

Olson 2002; Leopold 2006), then also on radio and television, and now online (Pitts

2004; Orgad 2005). Grassroots-based organizations have also created tremendous

awareness of breast cancer. The largest of these, the Susan G. Komen Breast Cancer

Foundation, started in the United States in 1982, and Pink Ribbon, founded in 1992,

also originated in the United States. Both organizations operate globally. They raise

awareness, lead fund-raising campaigns, and use the month of October for

collaborative initiatives. Many other organizations help to direct attention to breast

cancer, and include charities, sports clubs, the fashion and entertainment industries,

and, not least, the business community. These multifarious actors draw attention to

the disease through visual expressions, advertising campaigns, organized marches,

sporting events, and by selling a wide array of products. Public and private-sector

health organizations have also become involved. Few other diseases—if any—have received as much public attention as breast

cancer. Yet it is not the prodigious attention itself but the startling ways and means by

which it is achieved that compelled us to examine the various activities more closely.

In our research, it soon became clear that the ways in which breast cancer initiatives

are promoted today are unprecedented, not only in the context of cancer but in the

context of disease in general. It also became clear that these means are gendered—

and this is not surprising given that breast cancer is a woman’s disease. We wanted to

study the ways in which they are gendered, and what this can indicate above and

beyond creating breast cancer awareness. We have therefore looked for the

underlying meanings and contexts of meaning—the “symbolic gender structure”—

(see, e.g., Solheim 2002) to see how the symbols used in the campaigns gain meaning

through being contextualized, and how they transfer meaning from one domain

to another—in principle, in an infinite chain of transference—often without our

awareness. To gain deeper insight into these contexts, we studied the techniques and ideas now

used to publicize breast cancer, focusing especially on complex and ambiguous

symbols and metaphors. As we know from Levi-Strauss (1963) and others, symbols

are infinite in their complexity, but simple in their rules. According to Solheim (2002),

they are able to generate new chains of meaning-transfer and can shed new light on

original meanings. First and foremost, symbols give us meaning in life, help us to

structure life, and make us belong to a group of people—often in ways that cause us

to take them for granted. This may be why symbols tend to be so effective within their

native culture. On the same level as symbols, metaphors are pervasive in thought and

action and structure our perception and understanding in everyday life (Lakoff &

Johnson 1980). To cover the breadth and multitude of breast cancer campaigns today, our data

material encompasses colour, artefacts, visual expressions, and activities. The

analysis shows how certain discourses of life are entangled in different truth regimes,

some of which are gendered. These are saturated with relations of power that are

structured in complex ways. The specific findings are discussed in the light of various

theoretical perspectives drawn from the social sciences and feminist theories.

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Method

The data for this article consist of a selection of means currently used to promote breast cancer initiatives in Norway and other countries, mainly the US and Canada. This selection is intended to reflect how widely and diversely breast cancer awareness is promoted today and also to underline the striking similarities found in campaigns across countries. The two largest organizations, Susan G. Komen Breast Cancer Foundation and Pink Ribbon, operate internationally, and many of their means are directed towards an international public, aided by the fact that the general availability of the Internet has erased national boundaries when it comes to the spreading of information. Thus, we have not distinguished between the different campaigns on the basis of nationality or place of origin. We do, however, often make reference to specific data sources in our presentation, and highlight particular events, which mirror distinctive features of Norwegian campaigns.

Data collection took place over a five-year period (2007–2011), in the early phase somewhat unsystematically in connection with data gathering for a larger project, of which this present study is a part (see Johansen, Andrews & Haukanes 2009; Johansen, Andrews, Haukanes & Lilleaas submitted). A more systematic search for data began in 2009 with regular readings of a selection of Norwegian and international newspapers and magazines (including the Norwegian subscription magazine Athene, published for breast cancer sufferers), Internet searches, direct observations of “real-life” events, and Internet-based observations of “October events”.

In the printed materials we examined everything we came across concerning public breast cancer initiatives. On the Internet we studied products sold through Internet boutiques, among others Breast Cancer Awareness Shop, Pink Ribbon Shop, Ta-Tas Brand Clothing, Healingbaskets.com, Save the Ta-Tas, Etsy, and Zazzle. Product advertisements often appeared in pop-up windows while we were surfing breast- cancer-related websites. Internet material also includes films and video advertise- ments. For this article we have selected three films: Save the Boobs, by ReThink Breast Cancer; Tarzan and Jane, produced by SHOPBreastCancer.com; and the music video Pink Glove Dance, launched by Providence St. Vincent Medical Center in Portland, Oregon, USA. Two entertainment initiatives geared towards raising awareness and soliciting funds for breast cancer research also stem from the Internet: Ha-Ha’s for Ta-Ta’s; and Boobyball, sponsored by ReThink Breast Cancer. Also studied were “kick-off” arrangements in connection with the annual breast cancer awareness month, October, such as pink parades, pink lighting of buildings, and bra exhibitions. Information about these activities stems from different sources, including direct observations and first-hand narratives of events, literature, and the Internet.

The analysis proceeded in three phases, which ran more or less in parallel. Firstly, we classified the data material into four categories: objects, text, visual expressions, and events. In phase two we looked for word choices, metaphors, colours, and other qualities of “objects” or “features” across the first four categories, and categorized and recategorized these. In phase three we progressed to greater reflection and deeper insight by using various theoretical perspectives for interpreting the material. One

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striking preliminary finding was the role played by gendered signification systems and a market-orientation in the way breast cancer initiatives are promoted. These and other aspects represent characteristics of breast cancer campaigns which we have grouped into what we call “images”, presented under the following six headings: Re- enchantment of femininity, Infantilization, Corporate profit-making, Objectification, Transgression of boundaries, and Exhibition of deviation.

(1) Re-enchantment of femininity

The most visually striking aspect of situations where breast cancer has been themed is the colour pink. One can buy lace underwear, outer clothing, shoes, bathroom articles, tableware, decorative objects, and gardening tools, all in shades of pink. On sale are pink baskets with diverse contents, for instance the Pink Warrior Breast Cancer Basket containing an inspirational book, a “warrior cap”, a handmade soap, a candle, sugar-free drops for queasiness, soft socks, and three “courage stones”.

In addition to pink products, “pink activities” are held in many countries, in particular in the USA: Pink Seminars, Pink Ribbon Runs & Sport, and Walk for the Cure—a parade and walk in pink lasting several days in many American states. On the Internet, pink is used almost without exception when breast cancer is the focus of attention. One example is the website Pink Page Ladies, where “survivors” tell their stories and share advice. Most breast cancer blogs are also decorated with pink, and sports teams wear pink as a way of supporting breast cancer initiatives. During the month of October, famous landmarks have been strung with pink lights: the Eiffel Tower, Sydney Opera House, the Empire State Building, Niagara Falls, the Arch of Constantine, Tokyo’s Rainbow Bridge, the water in 18 of Kansas City’s fountains, and Fløien Restaurant in Bergen, Norway.

The colour pink was introduced with a ribbon, and formed the name of the organization called Pink Ribbon. The charity was launched in 1992, by the women’s magazine Self, in collaboration with cosmetics giant Estée Lauder. Despite the ribbon having already been used by others in connection with breast cancer awareness campaigns, in retrospect, Self and Estée Lauder are often credited with introducing the idea of the pink ribbon (Fernandez 1998; Wagner 2005). As Moore (2008) points out, the ribbon in general is one of the most widely known symbols in the world, and the pink ribbon is outstanding in that respect. Wagner (2005) suggests that pink’s playful, life-affirming, and reassuring connotations can partly explain why it was chosen as the signal colour for breast cancer organizations, given the optimism it brings to an otherwise depressing theme.

First and foremost, pink symbolizes femininity (Wagner 2005; Ambjörnsson 2011). This has, however, not always been the case: in the early twentieth century, little boys were dressed in pink and little girls in blue. Not until the 1950s did pink become a girl’s colour (Paoletti & Kregloh 1989; Ambjörnsson 2011). Because pink is a leitmotif in almost everything related to breast cancer, and has become a globalized brand for the sake of breast cancer initiatives, concerning both the ways in which these are marketed and all the products that are made, we call this “pinkification”.

Since pink obviously has a symbolic impact beyond raising awareness about breast cancer and is also the female colour, we interpret “pinkification” in breast cancer

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campaigns as a re-enchantment of femininity. The concept of re-enchantment is used by George Ritzer (2010), who asserts that the means used by consumer culture are re- enchanting the world. Now more than ever, Ritzer claims, we buy objects and experiences to signal extravagance, luxury, romance, and identity. Ritzer takes as his starting-point Max Weber’s concept of “disenchantment”. For Weber, “the disenchantment of the world” denoted the way in which magic, spontaneity, and wonderment were lost in the transition to an industrialized, rational, and bureaucratized society.

In our study, we expand the concept of disenchantment to include the idea of lost femininity as a consequence of breast cancer. Because it affects the breast and the woman’s appearance, the disease’s primary aspect is in some cases seen as a loss of femininity (Abend & Williamson 2002; Wagner 2005). We claim that focusing on the loss of a breast and what some interpret as a loss of attractiveness results in the disenchantment of femininity, but that femininity becomes re-enchanted, or efforts are made to that end, by deploying the colour pink.

In a parallel vein, lost femininity is the focus of the Look Good Feel Better charity (LGFB), a globally established collaborative project involving 40 cosmetics companies. Under the slogan “Smiling through Cancer”, we read that “Cancer can rob a woman of her energy, appetite and strength, but it doesn’t have to take away her self-confidence.” Through a tailor-made programme, women who have been operated on for breast cancer can receive help to revitalize their appearance and hide traces of the disease. Cancer negatively affects one’s appearance, the advertisement emphasizes, but LGFB offers the help needed to correct the problem. On LGFB’s website, several women express their thanks for the help they have received.

Like “pinkification”, the LGFB concept can be interpreted as a means of re- enchanting femininity, based on the assumption that appearance is integral to feminine identity, and that this identity is weakened or strengthened through whatever affects appearance.

(2) Infantilization

Despite the fact that breast cancer only impacts adults, many gift items for sufferers contain childish elements. The Cancer Awareness Shop sells several products with childish associations; for instance, the Breast Cancer Teddy Bear, which wears a cap as a sign that it is also undergoing chemotherapy. Some text fragments on breast cancer websites actually are baby talk. The Internet shop Save the Ta-Tas sells baby rompers with the slogan “Be vewy vewy quiet I’m hunting ta-tas”. Other websites express a different sort of immaturity by selling dog T-shirts with slogans like “Take your top off! Get a mammogram!” or “I have breast cancer. Not cooties!” Returning to the Pink Warrior Breast Cancer Basket, one could interpret it as infantilizing cancer sufferers through the renaming of everyday items: Warrior Cap, Courage Candle, Queasy Candy Drops, Softest Socks, and Courage Stones. The products above seem to reflect the attitude that women with breast cancer have reverted to a childish stage and should be comforted in the same manner as sick children.

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Several products acquire a childish expression simply through the colour pink, examples being gardening tools, tableware, balloons, and the party supply package Celebrate in Pink. The childishness is clearly manifested through the marketing of pink products for little girls, be they clothes, toys, school supplies, or bedroom furniture (Jeong Mee Yoon 2009; Ambjörnsson 2011). The use of pink childish products in breast cancer campaigns shows a similarity with the Japanese Kawaii phenomenon, which includes clothing cut in a childish style and produced in a shade of pink that underscores childishness. Ambjörnsson (2011) interprets Kawaii as a denial of being a responsible, accountable adult.

(3) Corporate profit-making

Another aspect of the colour pink is the ways in which it is used in marketing. In the mid-1980s, US corporations introduced a technique called cause-related marketing. The basic principle is to boost sales by associating products with good causes, and breast cancer is one of the causes receiving the most attention (King 2006). The number of companies supporting cancer research is growing steadily—airlines, car manufacturers, food conglomerates, clothing companies, cosmetics franchises, shoe manufacturers, electric companies, and restaurants. They appeal to the public through slogans and pink ribbons. One example is the Ford Motor Company, maker of the Mustang: “Winning the race against breast cancer is going to take a whole lot of horsepower”. Under the slogan “Warriors in pink”, the company has equipped the car with pink seats and décor. Another example is the fast-food chain Kentucky Fried Chicken; in April 2010 it painted its stores pink and donated 50 cents per chicken bucket to Susan G. Komen for the Cure. Not to be outdone, cosmetics giant Avon sells pink Kiss Goodbye to Breast Cancer Lipstick; the yoghurt producer Yoplait advertises its products with the slogan “Save Lids to Save Lives”; the vacuum cleaner producer Eureka Co. advertises with “Clean for the Cure”. Through slogans, the companies sometimes appeal to ideas of healing, for instance, that breast cancer will disappear as soon as the product is purchased (“warriors in pink”, “kiss goodbye to breast cancer”, and “clean for the cure”). Researchers analysing cause-related marketing phenomena all agree: breast cancer is one cause it pays to support, because it casts a favourable light on companies and helps increase sales (King 2006).

Companies such as those mentioned above are accused of “pinkwashing”. They give the impression of doing charity work but are actually using breast cancer to generate goodwill in the market and increase their own profits (see Fernandez 1998). Besides, it is often unclear how much money from each purchase actually goes to the cause. King (2006) points out the paradox of linking products to breast cancer initiatives: every company wants to use the initiatives to draw attention to its own products, to distinguish them from the welter of other products on the market, but the massive linkage to breast cancer campaigns causes the products to disappear into the crowd. Sulik (2011) holds that the primary function of pink ribbon culture is now to keep the money flowing. This is in line with Moore (2008), who claims that the pink ribbon is used to promote products more than to improve women’s chances of detecting breast cancer.

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(4) Objectification

It is no surprise that the attention devoted to breast cancer often centres on the theme of breasts. Apart from a few exceptions, all of which concern baby clothing, attention is directed towards sexualized breasts. Here, as elsewhere in society, a woman’s identity is often linked to having a perfect body, which again presupposes perfect breasts. The sexualized significance of breasts is reflected in films, entertainment, art, literature, newspapers, magazines, the Internet, and advertisements for almost any product one can imagine (Yalom 1999). Saywell, Henderson, and Beattie (2000) assert that the marketing of breast cancer is often built around breasts imaged as icons. An early example of the sexualized undertone of breast cancer initiatives appeared in 1996, when The New York Times Magazine declared of breast cancer: “This Year’s Hot Charity”. The article was illustrated with a picture of supermodel Linda Evangelista who, with a mixed expression of embarrassment and “come hither”, was using one hand to partly cover her perfect, naked, and intact breasts. Today’s charities commonly resort to sexualized techniques to raise funds and awareness. One example is the Internet store for Ta-Tas Brand Clothing, which sells over 50 different T-shirts for men and women with slogans such as “My wife has great ta-tas”, “Save a life, grope your wife”, “Caught you lookin’ at my ta-tas”, “I love my big ta-tas”, “They are new, and they are bigger and better”, and “Cancer babe”. The general message of these T-shirts is that the disease is first and foremost about breasts, that it has a dramatically negative impact on attractiveness. Early diagnosis is important in order to avoid amputation. But if amputation is unavoidable, the woman can still be a babe—even a cancer babe—thanks to technology’s ability to assist nature. Drawing on Franklin, Lury, and Stacey (2000), we interpret the T-shirts telling us “They are new, and they are bigger and better” as examples of “seconding nature”. This means that the amputated breast is re- naturalized by means of cosmetic surgery, but that is not all; the new, “natural” look exceeds the original nature. As Franklin, Lury, and Stacey (2000) state, nature and culture mimic each other, but the difference between them is precisely what makes the substitution desirable.

YouTube offers many film clips on the breast cancer theme. In some of these, the camera’s focus is what film theorists call “the male gaze”: portraying women as sexual objects with a “to-be-looked-at-ness” (Mulvey 1999). One example is the 45- second film Tarzan and Jane. To the music of Beethoven’s Fifth Symphony, a buxom Jane in skimpy tiger skin struts before Tarzan. The screen flashes with “Tarzan like Jane!” and “Jane hot!!” The screen then goes dark and we read “2 mastectomies later”. Jane returns wearing the same attire, but the tiger skin now lies flat over her chest. She looks sad. With the symphony in the background, we read “Jane sorry” and “Tarzan sorry too”. Tarzan is sitting on the ground and does not even look at Jane. One interpretation of this film could be that we should feel sorry for men who have wives or lovers with breast cancer because their women have lost their sexual attractiveness. Another example of sexualized breast cancer initiatives is the public service announcement Save the Boobs, produced by the organization ReThink Breast Cancer. The film clip shows a young, voluptuous, bikini-clad woman at a pool party, strutting to “strip club” music. Also here, the camera lens zooms in with the

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“male gaze”. In slow motion, the woman walks by the waiter and other party guests, all of whom follow her with their eyes. The film alternates between camera zooms of her bulging, bouncing breasts and her viewers’ facial expressions. We read three short texts: “You know”, “You like them”, and “Now it’s time to save the boobs”. The film ends with a last close-up of the breasts as the woman leans over a young man lying on a pink pool raft. The public does not see her bared breasts, for as she removes her top, a text covers them: “Breast cancer is the leading cause of cancer death in young women aged 25 to 49.” Like the products mentioned above, this film can be interpreted as objectifying the female body. It reinforces established patterns of gender roles by assuming that a woman’s attractiveness is linked to her bodily appearance. Breast cancer is thus linked to the idea of a mutilation that threatens feminine worth (see Saywell et al. 2000).

Since Mary Wollstonecraft (2003/1792), feminists have criticized the assumption that a woman’s primary duty is to be attractive for a man (see also Beauvoir 1983/1949). Howson (2004), for instance, claims that a woman’s body is under constant surveillance, both by the one who owns the body and by others. This, it would seem, has now extended to the sick body.

(5) Transgression of boundaries

A common phenomenon in breast cancer campaigns is the tit cake, a cake shaped like breasts, auctioned off at shopping malls in connection with breast cancer campaigns, or served at such events. The Internet has dozens of websites where individuals, associations, and businesses sell the cakes for breast cancer benefits. One contribution from Australia is the Dolly Parton cupcakes for breast cancer, sold in pairs in decorative boxes. From the United States, there is Baking for Breast Cancer Awareness Round Up! Among the contributions are peach-flavoured Jello Boobs with the text: “They wiggle, They jiggle, They wobble, They even bobble, BUT They should never come off! Get a mammogram once a year. Fight for a cure!” Turning to Norwegian and American contributions, there are also specially designed tit soaps, resembling amputated, shapely, light-pink breasts. Along with the cakes and soap, in Norway it has become common to collect used bras for the designated breast cancer month of October. The bras decorate stands, flutter from trees, garland walkways and city squares, and are used in art exhibitions at shopping centres.

The cakes and soaps demonstrate ways in which food and hygiene products are used to represent a sick bodily organ. Through being used in these ways, such artefacts are placed in a new context, which, in line with Mary Douglas’s work (2002/1966), indicates that boundaries are being transgressed. In all societies, boundaries are constructed to separate “purity” and “danger” as well as “normal” and “abnormal”. This categorization into “safe” and “unsafe” helps ensure order in life and engenders a sense of security. The examples we have given illustrate the violation of boundaries that Douglas claims are important for distinguishing between danger and safety. Formerly separate categories are now mixed. The cakes and soaps recalling breast amputations are expressive means of fusing together danger and safety, or, one might say, of moving the features from one side of the dichotomy to the other. Traditionally, cake is a food product symbolizing celebration and pleasure;

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soap symbolizes cleanliness and well-being; used pink bras symbolize intimacy and femininity. In other words, cake, soap, and bras symbolize things that are life- affirming, safe, and attractive, whereas sickness, especially cancer, triggers ideas of suffering and death.

Boundaries are also transgressed when entertainment becomes a medium for promoting breast cancer initiatives. In this case, something carefree—harmless—is mixed with something dangerous. One example is Ha-Ha’s for Ta-Ta’s, an American group of stand-up comedians who put on shows and donate money to breast cancer awareness and research. On the website, they call themselves the Cupcake Mafia, a kind of metaphor used to express the idea of being indomitable fighters defending breasts. In contrast to the grave war metaphors discussed by Sontag (1978), for example invasion, attack, and battle, the Cupcake Mafia uses the element of humour. Their slogan—“Save the cupcakes. Check the boobies”—can be interpreted as an attempt to make breast examination funny. On their Facebook page, women who have been cured tell their stories: laughter and a good sense of humour were indispensable to the cure. Another humorous contribution is the Pink Glove Dance, performed with pink latex gloves. In the music video, surgeons and nurses dance in their gowns wearing stethoscopes and flower wreaths; janitors dance with dust mops in hospital corridors, kitchen staff bump and grind between stoves and serving counters—all to the rhythm of “Baby are you down, down, down, down? . . . so baby don’t worry, even if the sky is falling down . . . I wanna see you lose control . . . ”

Yet another example from the world of entertainment is the Boobyball, a club in Toronto, Canada, that markets itself as a “high-profile club for young philanthropists”. Its stated goal is to create a future without cancer. The club’s website advertises its main fundraising event as a ball aboard a cruise ship. “The destination? Clear sailing into a future full of healthy bikini-clad breasts . . . ” A photo gallery shows well-dressed guests drinking sparkling pink wine. In the video, cancer is staged in a world of luxury, glamour, and pleasure, but with the message that breast cancer does not belong in this world.

(6) The exhibition of deviation

In 1993 The New York Times Magazine presented a cover photo showing the artist and model Matuschka wearing a tight white dress which revealed that her right breast had been amputated. The caption was “You Can’t Look Away Any More: The Anguished Politics of Breast Cancer” (Ferraro 1993). In Norway as well, several women, some well-known, have been pictured in the mass media with mastectomy scars. In 2002, for example, the newspaper Dagbladet’s weekend magazine ran a cover story on the former actress Julie Ege, showing that she now had but one breast. Other newspapers have printed similar pictures. In 2005 Verdens Gang, Norway’s largest newspaper, ran a front-page story on 10 women affected by breast cancer. Most were photographed with bare upper torsos revealing scars, amputations, and reconstructed breasts. Several local newspapers, weeklies, and monthly magazines have carried similar stories. Prior to this, however, pictures of women who had undergone breast cancer surgery had already appeared in art-institutional contexts. One famous example is the photograph of Jo Spence from 1982: “I framed my breast

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for posterity”. The picture is carefully arranged and shows Spence naked from the waist up with a bandage on her left breast (Radley & Bell 2007). In 2004, Norwegian women with breast cancer featured in a photo exhibition at the gallery Kunstnernes hus in Oslo. The phenomenon recurred in 2010, in the travelling exhibition Livsdans (Dance of Life). Moving from the art gallery to the public outdoors, during October 2010, fifty Oslo city buses were swathed in monumental black and white photos of postoperative women revealing their breast cancer scars and amputations. Another “show window” is the Women & Cancer Walk, which was launched in San Francisco, USA. In contrast to the pink survivors in Walk for the Cure, many of the participants in Women & Cancer Walk revealed that they had undergone breast amputation and chemotherapy. They wore no breast prostheses or wigs (Klawiter 2000).

Picturing disease is of course nothing new (Blom 2002; Radley 2009). In the eighteenth and nineteenth centuries it was tuberculosis that was the focus of visual attention. But while pictures of women with tuberculosis harmonized with the reigning aesthetic, pictures of women who have suffered breast cancer do not. The photos of women with amputated breasts have received mixed reviews. Supporters praise the women’s beauty and lionize them for their bravery in helping to undermine breast cancer taboos. Critics deem the pictures vulgar and humiliating (Matuschka 1993). Depicting abnormality can illustrate what Featherstone (2007) calls the “aesthetization of everyday life”, one aspect of which is to turn life into an art project; here: life with breast cancer. Radley and Bell (2007) maintain that one important potential for artwork dealing with the theme of breast cancer is to create an intellectual space for debate.

In the intersection of art, medicine, and social action, however, the performance of sickness is problematic, as it compels the audience to have compassion. This makes it difficult to scrutinize the pictures critically (Radley 2009). Goffman (1963) and Sennett (2003) argue that depicting deformation turns the viewer into a voyeur. The practice, Goffman explains, only works to re-emphasize conceptions of normality. Sennett, for his part, stresses the thin line between empathy and curiosity and points to Plato’s awareness of the human tendency to gawk at suffering. Thomson (2005) supports this point; all disabled people experience being stared at. The abnormal body also triggers a “to-be-looked-at-ness”, like the perfect female body mentioned earlier. Yet Sandahl and Auslander (2005) see something positive about displaying abnormality—to the extent that it can be a way of gaining control over the voyeur’s gaze. For instance, exposing surgery scars and amputated limbs can be interpreted as a protest against the pressure for technological redesign and reconfiguration of the (female) body (see Smelik & Lykke 2008). Exposing breast cancer through the showing of scars can simply be a way of saying “I accept myself; it is up to society to catch up”, and, in other words, it could be a way of diminishing taboos.

Discussion

The images we have described show that several contemporary breast cancer campaigns present women as being weak and breast cancer as a disease that robs a woman of her attractiveness. Affected women are also placed in an inferior position by means of marketing products that contain childish elements. Most campaigns

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reflect strategies drawn from consumer marketing, and the general use of positively loaded metaphors and symbols in the first five images is also striking. For instance, “survivor”, “Walk for the cure”, and pictures of smiling people are more promising than “victim”, “crusade” (see Sontag 1978), and serious-looking faces. Even war or underworld metaphors, which signal that cancer is nothing to joke about, have been mixed with humour—the “Cup Cake Mafia” being a case in point. Yet we also found what may be interpreted as the antithesis of childishness, objectification, commercialization, and humour—namely, campaigns using breast-cancer-affected women showing “the naked truth”. This kind of self-revelation may have merit in terms of immediate benefits to the women involved. One woman who was portrayed with naked upper torso said in an interview that she wanted to tell a positive story about breast cancer, and that it also resulted in credit and support from other people (Johansen, Andrews, Haukanes & Lilleaas submitted). The pictures of naked torsos may have political potential as “visual arguments” in the debate about reconstruction; they may be one of many long-term efforts to eradicate breast cancer from the population; or they may, as Klawiter (2000) asserts, challenge the beauty ideal and diminish taboos. Yet picturing illness is problematic because it compels the audience to exercise compassion and thus makes it difficult to examine critically the matter at hand (see Radley & Bell 2007).

Notwithstanding the serious tone that we have shown in the sixth image, we believe that many of today’s breast cancer campaigns build on and reproduce traditional, stereotypical understandings of gender. Featherstone’s work (1982; 2010) is useful for reflecting on this, as he argues that the body industry has created a world of vulnerable individuals who constantly monitor themselves for physical defects, thus becoming ready customers for the cosmetics market. This especially pertains to women. For the most part, this industry has focused on the healthy body’s flaws, such as wrinkles, fat, and other deviations from the current beauty ideal. Through the means now being used to bring breast cancer into the limelight, it turns out, according to our analysis, that the sick body has also become a focus for this industry. This comes to expression, in part, through the sale of pink products and slogans such as “smiling through cancer”. In product advertisements, the idea is that breast cancer negatively affects attractiveness, self-appreciation, and female identity, but that this can be repaired, that is, re-enchanted, in a pink universe and with the correct make-up. The expressed idea confirms expectations about women needing to look good and be positive (Howson 2004; Sulik 2011), now even when they are sick. Under the cloak of attractiveness and pleasure, there is an undertone confirming health consciousness as an ideal vehicle for the performance of femininity (Moore 2010); one of the consequences of this is that “doing health” may become a means of “doing gender”.

Through the preponderance of commercialization, objectivization, humour, and so forth, breast cancer stands apart from all other diseases inasmuch as it seems almost unthinkable to use such means in other disease-related contexts. Aside from T-shirts aiming to raise awareness of other types of cancer, it seems unthinkable to host a dance against colon cancer, or for a car company to devote attention to lung cancer. Who would make cakes in the shape of any other diseased or amputated body part? It also seems unthinkable to adorn public streets with men’s underwear to

150 V.F. Johansen et al.

promote awareness of prostate cancer. It may be argued that the phenomena we are discussing show that the breast cancer movement is up-to-date by using modern methods and exploiting its unique marketing potential—female breasts—assuming that this will benefit the cause by increasing awareness. But one can also argue that what we are witnessing demonstrates the continued expectation for women to submit to rules for how to be women, rules coinciding with Wollstonecraft’s (2003/1792) and Beauvoir’s (1983/1949) claim that the prized characteristics of women are weakness and beauty. Such objectification reflects a theme running throughout history: the relation between dominance and submission. It shows that women are expected to discipline their bodies, even in cases where it limits development and well-being; from bound feet, corsets, emaciation, and coquettish fainting, to cosmetic surgery and breast implants that inhibit the feeling of being touched. Now add to this the demand for the sick body to look pretty and fresh.

Although ideals of beauty are constantly changing (Connell 2009: 54–55) and most Western women are no longer raised to be docile creatures for the man’s sake, the importance of a woman’s appearance per se seems to endure in Western culture. Several Foucauldian studies on the semiotics of gender show how gendered bodies are produced through social disciplining (Connell 2009: 49–51). This disciplining seems to be changing in the current world of cosmetic surgery (Isaksen & Bjelland 2002) and other interventions, be they hormone-, carbon-, or silicon-based (see McNeil 2007; Roberts 2007; Smelik & Lykke 2008).

It may initially seem that the “means of culture” have come to nature’s rescue. Yet it is possible that culture itself makes demands on nature. When breast cancer strikes, the cosmetics industry, disguised as a benefactor, hurries to the woman’s aid. In other words, the female body is controlled and shaped by cultural demands and the constant perceived need to maintain a young and perfect body. The merging of nature and culture seems to be so common that we often forget to ask critical questions about how culture is practised—how it affects the body, how we perceive the body, and, not least, questions on the level of meaning.

There are, however, good arguments for seeking help to revitalize one’s appearance, in other words, to re-enchant the disenchanted. Many women would say this promotes a sense of mastery (Abend & Williamson 2002; Johansen, Andrews & Haukanes 2009). The counter-argument is that the smiling, pink-clad survivor, who tends to be the front figure for breast cancer campaigns, may function normatively for cancer sufferers, as seen in the heroic cancer narratives referred to by Stacey (1997) and Sulik (2011). The extent to which this is problematic only sufferers themselves can say. But what can happen is for breast cancer to be reduced to being seen as a disease affecting attractiveness, rather than primarily an existential threat.

The emphasis on appearance and weakness builds on and perpetuates traditional assumptions about gender roles. Examples are Walk for the Cure, Pink Glove Dance, Ha-Ha’s for Ta-Ta’s, and the Boobyball. As we can see, some activists have adapted to the positive thinking trend by promoting awareness in an up-beat, cheerful context. According to Ehrenreich (2009), the entertainment aspect of breast cancer initiatives has become a distinct business concept in the USA, with roots in the positive thinking ideology that spread throughout North America, starting in the nineteenth century. According to Featherstone (1982) and Stacey (1997), optimism as

Symbols and Meanings in Breast Cancer Awareness Campaigns 151

a creed has developed through the flourishing trade in motivational and self-

help books in American consumer culture. It has also gained a foothold in academia

through positive psychology, serving to strengthen the argument that a positive

attitude is the best medicine (Seligman 2002). Ehrenreich’s (2009) concern, then, is

about what happens when a positive attitude does not lead to what is promised—full

recovery. The stricken individual is confronted with self-reproach; her lack of healing

is her own fault, which in turn confirms the myth that cancer strikes people with

repressed emotions (see Sontag 1978). This can be interpreted as a means of

suppressing reactions such as anger and frustration, but it can also stifle important

questions about why there has been a tremendous increase in the number of women

with breast cancer. It may prove ultimately to reproduce a reactionary attitude to

women’s diseases. The new life-affirming, humorous devices for creating breast cancer awareness

mean that the disease is now often seen in a new context. Over a very short period,

and to a very great extent, it went from a context of concealment, suffering, and

death, to a context traditionally associated with prosperity, pleasure, and vitality,

thus crossing a boundary (Douglas 2002/1966) or moving from one context into

another where it does not traditionally belong. The colour pink, for example, as a

symbol of something life-affirming, feminine, and childish, now also becomes a

colour associated with breast cancer. Sulik (2011) maintains that the colour pink also

functions to make breast cancer palatable for public presentation (see also Moore

2008). The question is whether the traditional symbolism of pink helps to conceal

or cheer up an otherwise gloomy disease, or whether the colour pink is on the verge

of gaining expanded meaning. If the latter is the case, pink may become a colour

associated with both the beginning and end of life. Rather than symbolizing

something cheerful and life-affirming, it could eventually come to symbolize the

evanescence of life. This would confirm the ability of symbols to absorb new

meanings and to shed light on earlier meanings. Although Sontag (1978) asserts that illness is best handled when presented in as

plain a language as possible, she admits that language dealing with illness cannot be

metaphor-free (Sontag 1988). Stacey (1997) also states that cancer metaphors are

unavoidable in spite of being frightful and gloomy. Hence, achieving a metaphor-free

language for dealing with disease is not only impossible, it is probably not even

useful. A more important task is to scrutinize the metaphors being used. There is,

after all, a huge gap between raising breast cancer awareness through the colour pink,

femininity, childish or humorous devices, cakes, and soaps, and directing attention to

it through picturing topless postoperative women. None of these devices are devoid

of symbolism and metaphors, but while the former render the disease a “hot charity”,

the latter reveal “the naked truth”. “You can’t look away anymore” is a message

directed at a society experiencing an enormous increase in breast cancer cases. The

black and white pictures of postoperative women contrast starkly with pictures of

smiling, pink-clad “survivors”. To stand up and smile can communicate optimism,

but it can also distort perceptions of the disease. This is something Stacey (1997)

criticizes certain heroic cancer narratives for doing. Standing up and showing the

naked truth of amputation can be a means to “re-route” oneself—from being

152 V.F. Johansen et al.

perceived as an object for a charity, to being a critical medium for proclaiming that breast cancer is a serious disease about which there are many unanswered questions.

Concluding comments

This article gives no answers to the question of whether the means we have analysed have a positive or negative effect, and it says nothing about how breast-cancer- affected women experience this type of marketing. Neither does it say whether the new methods of focusing attention on the disease can help to improve diagnosis, treatment, or research.

Our main aim has been to show the breadth and diversity of the ways in which breast cancer initiatives are promoted and to capture underlying meanings. We believe that our approach, and the selection of breast cancer awareness campaigns we have studied, has expanded our understanding of this phenomenon. Nevertheless, additional data, including data from additional contexts, may add to the picture we have drawn, as may studies employing other theoretical perspectives. We find for instance that many campaigns resort to consumer marketing strategies, and that these strategies in exceptional ways move breast cancer across boundaries from “danger” to “purity”. One of the article’s key findings is, however, that breast cancer campaigns, to a great extent, build on and reinforce traditional, stereotypical gender roles. Across the images, we demonstrate the ways in which various campaigns present women as objects. Women’s attractiveness is linked to bodily appearance and especially perfect, intact, sexualized breasts. Women are also presented as weak, inferior, and dependent, through a number of artefacts and slogans, and to a certain degree through the colour pink. Basically these aspects substantiate our idea that many campaigns carry a message indicating that women should first and foremost be attractive, even when they are sick.

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Symbols and Meanings in Breast Cancer Awareness Campaigns 155

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