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CHAPTER 2

Poker Face

Gaming a Lifespan

When my partner’s sister showed up at our house all bald after her chemotherapy, I demonstrated my unvarnished social aptitude with the ridiculous joke, “Hey, you could totally be a lesbian!” I had picked up the culture of stigma, and this prevented me from genuinely recognizing her, even a few years later as she sat in a wheelchair shortly before her death. When my cousin Elise was undergoing chemotherapy treatment while in her early thirties, I couldn’t even mention cancer, couldn’t (wouldn’t, didn’t) say I was sorry or ask her how she was doing—even though it was so obviously what was going on. I was thirty-five, for God’s sake, a grown-up, yet cancer was so unthinkable that I couldn’t even acknowledge her disease. Whatever rationalizing spin I try to give it, I sucked in all the ways I had to deal with later when others made similar dumbish comments.

I don’t blame people for not knowing how to engage with a person with cancer. How would they? I obviously didn’t. Despite the fact that each year 72,000 Americans between the ages of fifteen and forty are diagnosed with the disease—double the incidence of thirty years ago—many of my friends in their thirties had no personal experience with cancer.

Everyone who has “battled,” “been touched by,” “survived,” “become a shadow of a former self,” or otherwise inhabited cancer clichés has been asked to live as a caricature. As poets recognize, clichés shut down meaning. These turns of phrase allow us not to think about what we are describing or hearing about. If we know roses are red and violets are blue, why would we bother to take a close look? News articles, TV shows, detection campaigns, patient pamphlets, high-tech protocol-driven treatments, hospital organizations, and everyday social interactions force people with cancer to live in and through these clichés. These venues overlap to form a broader network of ways we think, and refuse to think, about a revolting way to die.

I’m not opposed to social grace. A quick “You look good” followed by “Oh, thanks” offers a mutually welcome segue to the next discussion topic and enables propriety to mask the confusion about how disease should be acknowledged. It saves us from getting snot on a work shirt or accidently oversharing an existential crisis with a mere acquaintance. Still, the awkwardness—no, the devastating denial—contained in these conversations offers a window into the larger social confusion about how illness fits in with the broader economic and political infrastructures that contour American ideas, even ideologies, of a lifespan.

It’s no wonder shame is such a common response to diagnosis. As usual, the Oxford English Dictionary helps—shame: “the painful emotion arising from the consciousness of something dishonouring, ridiculous, or indecorous in one’s own conduct or circumstances . . . or of being in a situation which offends one’s sense of modesty or decency.” We know cancer will happen, yet when it does, it seems dishonoring or indecorous. I don’t refer to its side-effects here; the physical breakdown of the body virtually epitomizes “indecorousness.” Judgments about proper decorum (be a survivor, wear a wig, look good!) can help illuminate the ugly downside of America’s will to health.

My economic class, my age, and certainly my nationality buffered me from thinking about survival until I was suddenly the one who might be survived. Diagnosis beckoned me to attend retreats, camps, and support groups. Diagnosis made me share an infusion room—do all kinds of things, really—with many people who didn’t live for much longer. Diagnosis accompanied me in reading their obituaries, attending their memorial services, going to the garage sales of their things, writing on their memorial websites.

To be sure, diagnosis (as opposed to death or just plain old life) comes with its benefits. I got a kayak, albeit with a leak, as well as two weeks of adventure camp where I learned how to use it, all for free thanks to a group that offers young adult cancer “fighters” an experience designed to empower them to “climb, paddle, and surf beyond their diagnoses, defy their cancer, reclaim their lives and connect with others doing the same thing.”¹ Even so, things can go bad. During down moments, I think about how at least my life insurance could pay for some cool things for my kids, or that maybe I don’t have to worry about saving for a down payment for a house, since in order for a home to be a good investment one should really plan to live in it for five years. I can look down from a superior place at all the people scurrying around on projects I have determined do not matter—and then go and do the laundry or shop for groceries just as everyone else does. Like Bette Davis’s character dying of a brain tumor in the 1939 movie Dark Victory, one can consider oneself the lucky one, not having to survive the deaths of those one loves.

(Sometimes one can’t help but devolve into a self-centered, unremitting fear. To ground myself in my ordinariness, I like to keep in mind what a driver once told me when I asked him what it was like to chauffeur celebrities such as Oprah Winfrey around New York. He fingered the St. Christopher amulet hanging from his rearview mirror and declared, “They like to think they are important. But after every funeral I’ve been to, people do the saaaaame thing. They eat.”)

The child survives the parent, the doctor survives the patient, the healthy survive the sick. But how have we come to take this mode of lifespan and survivorship for granted, as something to which we are entitled? Even a century ago, some—heck, many—of us would have died youngish, in childbirth or of some illness. Devastating though it may have been, people weren’t shocked. Even in the present, we don’t exactly live in medical nirvana. The United States is not in the top ten for the longevity of its population. According to some studies, it’s not even in the top forty.² Yet despite such statistics, the United States spends more on healthcare than any other nation. Part of Americans’ dismal life expectancy results from the broad lack of access to healthcare as well as documented discrimination against the usual suspects: African Americans, women, younger people, and queers (not to mention those groups that remain not so well documented). Other factors affect even those with excellent access to excellent care: high levels of toxins in the environment, and in turn in human and animal bodies; cigarettes; guns; and little safety oversight of food, automobiles, and other products. Physician Peter Pronovost lists medical error after heart disease and cancer as the third largest killer in the United States.³

In short, despite the insistent rhetoric, American economies simply do not prioritize health. No particular logic demands that a population’s general health should trump other national concerns. So what do we get when we notice that it doesn’t?

The anxious dissonance between the bleak median state of health in America and the upper and middle classes’ general sense of entitlement to health and longevity plays out in the different, even contradictory, modes of time in which we each must live. On the one hand, lives correlate to a greater and lesser extent with a standardized, assumed timeline: birth; marriage; children; working, saving, paying taxes; kids’ college bills; retiring; dying. On the other hand, we have various links with immortal systems. The state, for example, underpins our expectations of a lifespan by helping some of us if we die early through various forms of financial aid to those it understands as legitimate dependents. In this sense, the immortal state (or an employer) can take the part of linking our “survivors” to the immortal timeline of capital. Still, enough people drop out of line with this standard story that a pervasive insecurity shores up a uniquely American security state.

Unpacking the dissonance offers insights into how notions of health are shored up and made to seem like an entitlement, when health is in fact the unspoken tenet of a lifespan, one that is often cast aside as an externality. No one feels this more baldly or sees it more starkly than those who have slipped off the bandwagon at the peak of the party onto the cold, hard cement.

CANCER BURDEN

If the organ that first harbors a cancer provides one way to chalk up numbers, age offers another vector through which to analyze the social dimensions of the disease. One of the most delightful characteristics of youth—that you are indestructible (until you’re not)—is one of its greatest risk factors, as well. Cancer is the largest disease killer of adults under forty. One in forty-nine young American women and one in sixty-nine young men are diagnosed with invasive cancers.⁴ The numbers are far from insignificant, especially given the social costs of the number of years of life (read, productivity) lost. Yet until about five years ago virtually no oncological attention was given to this demographic.

While cancer survival rates have steadily, if haphazardly, improved for children and older adults, they remain historically static for young adults. Adults under forty don’t undergo regular screening, and as students or temporary employees, they often don’t have access to regular healthcare. In cases where they do seek out care, younger adults have little experience advocating for a definitive diagnosis. Furthermore, doctors often work under the misguided assumption that cancer is a disease of older people, leading to an immorally high number of delayed diagnoses and, in turn, the large proportion of late-stage cancers. This misinterpretation of cancer carries enormous financial and personal costs, costs that are more often dismissed as individual misfortune—an act of God, perhaps—than as problems with the diagnostic process and access to healthcare.

Alison, age forty-one, spoke before she died of her months of being misdiagnosed by a pulmonologist at University of California, San Francisco, who claimed that she must have asthma rather than a metastasis to the lung of a cancer that she had been treated for three years prior. Afterward, she was confounded by her doctor’s “lack of curiosity,” but she said she didn’t advocate too hard because she didn’t want to hear that she had a metastasis.⁵ Petra initially went to her ob-gyn to have a hard spot checked out when she was thirty-six. The doctor thought it was nothing but promised to keep tabs on it. The next year she went to the office again, though the original doctor was not available. The new doctor ordered a mammogram, ultrasound, and core biopsies; the ultrasound found nothing, and the day after a core biopsy located an eight-centimeter malignant tumor, the mammogram results came in: negative.⁶

Gene, twenty-eight, found out in 2004 that a brain tumor recurrence had been growing since 2000, yet no one had passed along the information. He has those original radiology reports, but the doctor left the practice. Jess’s doctor pulled a silicone “practice” breast from the cupboard to show her the difference between a hard lump and a soft lump, diagnosed hers by feel as a benign cyst, and delayed diagnosis by over a year. A freshly minted thirty-three-year-old lawyer I spoke to had waited for six months until the insurance that came with a new job would cover her visit to a doctor. She was diagnosed with metastatic cancer and died six years later.⁷

Compounding these problems, younger people suffer from an intense “cancer burden.” Often they have few savings on which to draw during long treatments; have young children to support; face job discrimination and job loss; and, if they survive, suffer from a chronic condition that may cost thousands of dollars a year even with insurance. Furthermore, the stereotypes about cancer lead to the profound alienation of young adults, who, often the youngest people in the chemotherapy room, need to cope with the inexperience and misinformation of their friends, family, communities, and at times, even physicians. Few clinical trials focus on young adults, and overall they have poorer outcomes than the older and younger groups with treatments standardized for those demographics.

As with the cancer category more generally, it barely makes sense to consider cancer in this demographic as one disease. Mean five-year survival rates for young adults (15–39) exceed 94 percent for Hodgkin lymphoma, thyroid carcinoma, and testicular tumors. Notable improvement has taken place in acute leukemias, while survival rates for numerous other cancers remain intractably low, particularly when controlling for stage at diagnosis. With metastasis, mean five-year survival in this age group slips to 89.7 percent for thyroid carcinomas, 86.7 percent for Hodgkin lymphoma, 73 percent for testicular cancer, 47.8 percent for ovarian, 31.6 percent for breast, 18.9 percent for colorectal, and 5.9 percent for lung.⁸ (I examine various aspects of cancer and young adults in other parts of Malignant.)

The nearly complete lack of socioeconomic support that presses those with catastrophic illness entirely out of the system bears some examination, especially given the pivotal role young adults play economically. Having to watch the economy of accumulation from the outside—to decide whether to return to work or stay on Social Security disability, for example—might give new insight into the justifying logics of mortal lifespans in immortal systems.

Cancer itself parodies the capitalist ideal of accrual through time, and people with cancer inhabit its double consciousness. In the cancer complex, the relations among cell division, financial accumulation, and deferred gratification are anything but linear. For each postdiagnosis individual, the story will go one of two ways: You will have a recurrence, or you will not. You will die of cancer, or you will not. You will be ill for a long time, or you will not. If you defer your spending for too long, you won’t get to enjoy it. But if you don’t defer . . . well, what if you survive but have spent all your money on a new kayak and a trip down the Grand Canyon? What if you want to go back to work but can’t because your employer found out you had cancer and fired you? What if you can’t get insurance because of preexisting illness? What if your small business didn’t survive the time you had to take off for treatments?

When I was in college, my dad offered me ten dollars to read a book called The Wealthy Barber.⁹ In this book I learned the value of starting to save early in one’s life. The book claimed that the barber or secretary who began working and saving at age twenty was far better off than the teacher or nurse who began working at thirty or the lawyer who spends all her money on Pebble Beach vacations. That extra ten years of working and saving, even with a low salary, adds up some forty years later to a princely sum on which to retire. The book aimed to show how people who live for seven or eight decades can hook into market systems that grow for a couple of centuries to their advantage. These systems value modest barbers who know how to play the system more than spendy lawyers who don’t bother. The trick lies in time—specifically, in having a lot of it during which to watch one’s savings grow inside the market.

The morass of young adult cancer, the confusion and dislocation, can be read as a collision in modes of time. In an aspirational, personal, and normative timeline, one supports one’s kin. In losing one’s relation to that, an immortal timeline ticks by as one misses the chance to put aside savings and get that promotion. These two temporal modes can compete and destroy each other with even the smallest trip-up in their assumed alliance.

The idea of lifespan justifies the pressure on young adults. After all, when else would one save for retirement or have young kids? The obviousness of this question indicates the centrality of the larger social fantasy that holds together the economic necessity of one’s “productive years” in which one is assumed to be the most attractive, the most fit, the most able-bodied of one’s life. Yet precisely when people have to drop out of those years because of the brute bad luck of illness, one finds, instead of the expected social supports, people holding their own fundraisers or websites auctioning massages and hula hoop lessons to pay for chemotherapy. As one twenty-nine-year-old who has been living in the cancer complex for fifteen years put it, “A fundraiser is where you invite people to a big fun event, serve great drinks, and do everything possible for them not to think about cancer.”¹⁰ You do want people to feel good and strong so that they will open their wallets, and who doesn’t like good clean fun?¹¹

GAME FACE

When it comes to interpretive rubber meeting the symbolic road, nothing beats an advertisement featuring cyclist Lance Armstrong (fig. 5). Armstrong inspired a generation of cancer survivors through his charisma, his cycling victories, and by pouring millions of dollars into his nonprofit, typographically loud, LIVESTRONG organization. To be sure, he cuts an ambivalent figure, both having played the cancer card in extremis to veer attention away from the numerous performance-enhancing exploits that led to his being stripped of seven Tour de France victories, and having funded needed cancer research. Armstong and cancer cultivated a mutually beneficial relationship, partly demonstrated by the willingness of many cancer survivors to support him even in his fall.

FIGURE 5. In 2006, American Century Investments partnered with Lance Armstrong to create a series of widely advertised Live Strong term funds. The company continues to maintain the Live Strong funds, despite Armstrong’s ignominy over performance-enhancing drug use.

In 2006, American Century Investments (ACI), a private firm managing more than $100 billion in assets, entered into a partnership with LIVESTRONG in which ACI donates to the charity part of the profits from a series of life-cycle mutual funds, “in which the type of investments vary according to the age of the investor.”¹² As ACI boasts on its website, “LIVESTRONG Portfolios make investing for retirement . . . as easy as identifying the approximate date you plan to begin withdrawing your money.”¹³ The pun of “life-cycle” aside, the magazine ad highlights Armstrong’s role as a translational figure for the nexus of industry, cancer, and humanitarianism.

Armstrong claims survivorship as a key identity, reiterating continually that his greatest success and pride lie in his having survived testicular cancer. In his autobiography, It’s Not about the Bike, Armstrong describes his active search, when diagnosed in 1996, for the best care available to overcome his prognosis.¹⁴ He settled on a doctor who offered a then-new regimen that revolutionized treatment for testicular cancer, turning it from a high-risk disease into a largely curable one, even in its metastatic iteration. The coincident timing of his diagnosis and this new treatment underpins what he portrays as his own agency in finding medical care—another inspirational aspect of his cancer survival story. Armstrong’s story is misleading, however, in that it overemphasizes the role of patient agency in the success of cancer treatment, a view that correlates with the advertising messages of cancer centers and, well, banks. It also overestimates the curative potential of treatments for most cancers, though we’d all like to believe in these inflated claims. And it propagates the myth that everyone has the potential to be a survivor, deaf to the reality that “survivor” implies, in the final analysis, “dier.”

The Armstrong story comes with real social costs for many people surviving with and dying of cancer. Like so many cancer narratives, Miriam Engelberg’s graphic novel Cancer Made Me a Shallower Person ends abruptly with the recurrence of her disease and her subsequent death. In one frame she holds a placard stating, “Lance Armstrong had a different form of cancer!” (fig. 6).¹⁵ Her friends’ and colleagues’ comparison of her situation with Armstrong’s offered only a terrifying denial of her actual situation.

The ACI advertisement summons you to gaze into the close-up image of a determined-looking Armstrong, and after thinking to yourself, What the fuck? you read that “to put your Lance face on . . . means taking responsibility for your future. . . . It means staying focused and determined in the face of challenges.” Control over one’s future weaves cancer survival, Tour de France victories, and smart investing into a common thread. But all this unravels, much as his own cycling success has, in the tiny hedge at the bottom of the ad: “Past performance is not a guarantee of future results. . . . It is possible to lose money by investing.” Even the Lance Face can’t see the future.

This warning, necessary by law, echoes a skill essential for capitalism. In a study of financial risk, Caitlin Zaloom finds that a market trader “must learn to manage both his own engagements with risk and the physical sensations and social stakes that accompany the highs and lows of winning and losing. . . . Aggressive risk-taking is established and sustained by routinization and bureaucracy; it is not an escape from it.”¹⁶ The ACI ad’s conflation of Armstrong as athlete and cancer survivor proffers the ideal personification of market investing, since capitalism requires a valorization of focused determination and responsibility for one’s future, even as one risks one’s savings. By now a truism, liberal economic and political ideals require citizens to place themselves within a particular masochistic relationship toward time: we save money now for imagined pleasures and security in the future. Without this ethos of deferred gratification, banks couldn’t remain solvent.

FIGURE 6. Cartoonist Miriam Engelberg captures the confusing, misleading, and sometimes undermining ideas about cancer and survivorship in light of Lance Armstrong’s iconic status as a cancer survivor. (From Cancer Made Me a Shallower Person [New York: Harper, 2006], n.p.)

In Armstrong, age, class, gender, and a curable cancer along with his brilliantly choreographed cheating, masochistic training schedule, and dazzling marketing skill combined to form an icon of cancer survivorship. His status overshadows a simple fact: cancer can completely destroy your finances and your family’s future. Sixty percent of personal bankruptcies in the United States result from the high cost of healthcare.¹⁷ Cancer can be a long, expensive disease, paid for over generations. When your financial planner asks, semi-ironically, how long you plan to live, he calls up the paradox of survivorship. Middle- and upper-class Americans plan for an assumed longevity, and to be sure, a properly planned lifespan combined with a little luck comes with its rewards. But in times of trouble, the language of financial service starts to ring hollow, even for healthy youngish people. In a meeting with a Fidelity representative about my decreasing retirement account—and the decreasing value of virtually all of Fidelity’s offerings—he kept saying, “As your retirement plan grows.” When I pointed out that it had, in fact, shrunk by 45 percent, he stared at me blankly. When I asked him about people who don’t make it to the age of sixty-five, he pleaded: “You really need to think about it as a retirement plan.” In his training, the age of the investor offered the proxy for lifespan prognosis.

An implied lifespan grounds many economic benefits: you work now, we’ll pay you later. Social Security benefits are based on how much you put into the system over years, and they last until you or your survivors are no longer eligible. Middle-class jobs often include not only salaries, but also “deferred payments” such as pensions, penalty-free retirement savings, and, for some academics, tuition breaks for children’s college education.

If you croak early, some of these contributions may revert back to your estate, others are disbursed to qualifying survivors, and still others are recycled into plans that pay for the education of your colleagues’ children. As with any insurance policy, the state or the employer calculates averages over the whole workforce and offers a salary package as a financial bet on your mortality. If you get paid a certain amount when you’re old, it’s because some died young. It’s nothing personal; this is actuarial time.

Wait—I take that back. There is little more personal than your sex life, your orientation, and your marriage status, which greatly affect your survivorship. That is, if you say you are sleeping with one person and one person only, and if that person is of the opposite sex (as of this writing!), you are over a certain age, and you have sealed the deal with the court, your cancer card will play more lucratively. If you fill these criteria, you can pass on your benefits and enable your loved ones to pay off some of your medical debts or live out a more comfortable life in spite of your absence (and sometimes because of it).

Every American worker pays Social Security taxes in accordance with income rather than by the type of support they will be withdrawing from the system. Thus, the surplus skimmed from the nearly half of American adults who choose not to live with, sleep with, or bicker with someone over eighteen of the opposite sex—or at least to do so, by choice or exclusion, under the radar—underwrites the benefits that others receive. (Actuarially speaking.)

A Social Security check is one of the few dependable modes of retirement income now, in the insecure world of private investment for retirement (given that there are not many guaranteed pension programs left). The quarterly slip of paper that tells each working person how much money their spouse and dependents will receive each month if the worker dies or becomes disabled offers different measures of security. To some it will offer a sense of relief that her main “peeps” will be taken care of, and to others it generates an awareness of disenfranchisement, a reminder that his labor will not result in the same benefits for his social support systems and the folks who depend on him. With its two categories—married or unmarried—the quarterly chart offers the trappings of democracy: any adult can join the institution, and once you do, more cash is available to you. But in fact, those who join the system rely on the exclusion of benefits and the financial contributions of those who don’t sign up.¹⁸

Several friends of mine have found a way around this status quo. One young man described the reasoning behind his recent gender change: he can now legally convert his girlfriend into a wife, legally bring her into the country, and offer her the protections of Social Security. For the same reasons, my lawyer advised me to marry a man, so that my husband could give the survivor-cash to my girlfriend. But the question is both more and less one of who can marry whom—regardless of who fits in the box, it’s still an exclusive relationship with benefits, reliant on those buttressing it from the outside.

Health is not just physical, but social and institutional, and the currency of survivor street-cred varies. Capital and kinship legitimate and augment each other in ways that require a fair amount of massaging to seem logical. The economic rewards and costs that underpin these notions of survivorship remind me of an idea common a few generations ago, which is that cancer results from a degenerate lifestyle (fig. 7). Few people would still argue outright that remaining single or living in sin counts as degenerate, though certain demographics still cling to the idea that same-sex couples deserve to burn in hell. But the systematic privileging of marriage results in an increased vulnerability for others, no matter how it is justified. More important to my argument here, the benefit structure encourages us to expect a certain lifespan. You expect to live until the children grow up; you put money away that you will have access to when you turn fifty-nine and a half. Lifespan becomes a financial and moral calling, one that the state will partially subsidize in disability and death for all citizens who fulfill its principles of economic and sexual responsibility.

All this rests on a basic premise: time and accumulation go together. You need the former to get the latter; in theory, the older you get, the more stuff you have. No wonder people want to freeze themselves. Cryonics offers an obvious strategy to maximize capitalist accumulation. On my salary, I’ll be able to pay for my kids’ college tuition in one hundred and fifty years. If I could freeze my family and let my savings grow that whole time, I’d come back to life after all the work of accumulation is done, taking full advantage of both the deferral and the gratification. This may sound ludicrous, but it’s the logical next step in the current situation. People already freeze their gametes in order to maintain their fertility until they’ve gained the financial security that education and accumulation (are supposed to) bring.

FIGURE 7. A 1930s car advertisement portrays the wise man as investing “his money in a handsome car . . . whereas his foolish neighbour invests his money in a wife and children.” In reality, argues John Cope in his book Cancer: Civilization: Degeneration—The Nature, Causes, and Prevention of Cancer, Especially in Its Relation to Civilization and Degeneration (London: H. K. Lewis & Co., 1932), “The luxurious car brings with it the evils which arise out of inadequate exercise of the muscles. . . . In the end, the man who walks and marries is the gainer. He is healthier and in every way better for the exercise, and both he and his wife are less likely to become cancerous” (299.) These conservative notions of family continue to gain otherwise unjustifiable (in a free market economy) social support.

In its offensive use of disease to create business, the ACI ad bestows a comforting ideal of survivorship. As one woman wrote about giving Armstrong’s autobiography to her dying mother, “I wanted her to be a courageous ‘survivor’ too. I think we find it less creepy or at least difficult when people assume the role of survivor, where they pretend they’re going to live an easy and long life.”¹⁹ I get the appeal, I really do. The survivorship metaphor captures the ache of seeing someone sick and feeling completely unable to help. You want them to fight; you want to climb inside of them and join in when they can’t anymore. But the throbbing desires that the term survivor captures do not leave room to recognize the structures of cultural and economic survival in which physical survival dwells. These underwrite a uniquely American insecurity and the fact that, every day, people lose medical insurance by losing a job or partner, and that many Americans can and will lose everything with a single diagnosis. And not because they didn’t work hard enough.

STICKY FACE

In a series of experiments in the 1960s and ’70s, Stanford psychology professor Walter Mischel and his colleagues undertook what would become known informally as the Stanford Marshmallow Experiments.²⁰ The research intended to figure out how attention could be strategically allocated, enabling a subject to delay gratification. Each experiment contained several control groups and differing situations, but for the sake of brevity, I’ll explain the most general protocol. Experimenters gave each of several preschoolers a marshmallow (or pretzel or cookie) and asked the child to sit in a room that was either empty or contained various distractions. Once the adult left, the youngster could go ahead and enjoy the treat he had been given, and the adult would come back. Or he could wait, not eating the snack, until the adult returned and have both the initial treat and another treat. Behind a one-way mirror, Mischel’s team sat back to watch the torment as each child sniffed his marshmallow, poked it, held it up to the light, sat on her hands, tapped his feet, chewed her lips, sang a song, or, glancing both ways, took a teeeeny tiiiiny lick. Many couldn’t resist. Others waited an astonishing hour, shattering the myth that little ones can’t wait. Years later, Mischel found that the children’s ability to wait for their reward correlated to their life success.

Typical interpretations of this experiment maintain it demonstrates that deferral of gratification is a skill that can be learned, can be learned early on, and pays off. Arguably, though, in testing a practice that our political and economic system often rewards—deferring gratification—the experiment also naturalizes this political, psychosocial, and economic skill as unquestionably allied with success. Given that grade-school education does not specifically teach students how to strategically allocate attention, the fact that a child who has this skill can parlay it into success in a system that values it, while significant, is not particularly surprising. For that very reason, the experiment gives insight into how we take for granted the bond between time and accumulation.

Obvious pitfalls prevent us from taking the connection of experiment and real-world success too literally. For example, anyone living in a major city would have been better off buying a small house in the 1980s or early ’90s than tucking away their dimes in Citibank or ill-fated stock to save for a larger house. In other words, we can’t really know until a decade or so later whether buying a home will equal eating or saving the marshmallow. Money saved has to go somewhere other than your mattress to keep up with inflation, and if it does, it goes directly into what the economist Susan Strange so aptly described as “casino capitalism.”²¹

The marshmallow-equals-deferred-gratification-equals-success translation to real life can fail by several routes. You may have excellent deferred gratification skills that don’t carry a big payoff. For example, the market may crash, leaving you to wish you’d bought that new car, so you’d at least have something. In this case, the means of deferral—the market—failed you. In the terms of the experiment, it would be as if the adult never came back with the extra reward. Skill at waiting matters here, but the practice of deferral also requires faith in both the process and the authority figures that do the distributing.

Or, the rendition from skill to success can fail this way: you did so well at school that you spent twelve years in grad school to become a research biologist, while your little brother, who barely slogged through high school, became much wealthier as an adman than you dare dream about. In other words, he found a better way to get marshmallows than allocating his attention into whistling a mournful tune waiting for the experimenter to come back. Or, the equation can fail because just as the experimenter returns, you topple over and die of excitement while using your marshmallow to sop up the mouth-watering juices pouring down your chin. In this case, you got to enjoy neither the marshmallow you already had nor the immortally deferred one.

The design of the experiment hinders its ability to do any more than gesture to these bigger issues. Its use of insubstantial snack foods, for example, nudges the interpreter to think about material gains rather than other kinds of satisfaction that could result from an ability to concentrate. (The experiment might have focused on an ability to learn math or fall asleep.) Its time limit of a few minutes and the lack of data on the home lives of the children render the possible failures detailed above not only into externalities, but as somewhat ridiculous. But they aren’t. Too close an extrapolation from the experiment obscures the critical fact that what you do, when you do it, and how these things magically converge for some people all relate to a world beyond one’s control—including the chance to have a home situation that enabled trust to begin with. When read in this light, the experiment reminds us that the stipulation to defer gratification, for a life-cycle retirement account, say, offers merely the opportunity to enter a routinized casino bureaucracy, not a means to show off an individual propensity toward managing the frustrative effects of delay.

Above all, let us never forget that without marshmallow eaters, the marshmallow business would go broke and we’d live in a dim, s’moreless world. The noneaters need the eaters, as much as vice versa, just as the married workers depend on the unmarried ones, and the heroic survivors depend on those not so lucky.

If wealth rots the soul, accreting tumors rot the host. Cancer just grows, sometimes as a tumor you should have noticed but didn’t, sometimes as a tumor you can’t help but notice but can’t have removed. It may just live there; you may touch it each day. It may disappear, or it may wrap its way around your tongue. Its changing size may make it seem to be living or dying. Described by words such as apoptotic and runaway, cancer inhabits a competing version of time—not yours, not the one in which savings, Rice Krispie squares, and retirement exist.

Alas, the Lance Face can’t look in the eye the cancer survivors whose bodies experience these fissures. Unlike many people who calculate their odds and cash out their retirement policies after diagnosis, unlike the friends of mine who told me that I was the inspiration for them to live in the moment and renovate their homes (not dead yet!), unlike those ads in Cure magazine that offer to buy the life insurance policies of people with cancer in exchange for a percentage, the Lance Face returns our focus to future thinking through sheer determination. The ACI ad applies this notion of cancer survivorship to banking products for its own ends, pulling the wool over all of our eyes.

BABY FACE

From cashing in the retirement savings to hours spent in the waiting room, from the prognosis to the too quickly dividing cells, cancer is always about time. But if cells reproduce, so do people, and if anything can provide a foil for cancer’s temporality, it’s the children—new ones who arrive as fast as the prior ones exit. Both the child and early detection campaigns work with embedded ideas of temporality that reflect back on the bald insistence behind representations of lifespan. Recently, the American Cancer Society (ACS) played on the tropes of both in a widely distributed campaign intended to draw attention to the high number of Americans without health insurance (fig. 8).

FIGURE 8. An American Cancer Society Cancer Action Network (ASC CAN) advertisement, circa 2009.

The ad at once builds on a century of emphasis on early detection and implicitly critiques the logic of accumulation that I have been outlining. It presents a simple enough message: acting now by seeing a doctor means saving cash in the long run. Stuck between registers of accumulation, the ad cautions us to be careful what we defer.

Early-detection campaigns have always walked a knife-edge: they aim to provoke sufficient fear that people take symptoms seriously, but not so much that they bury their heads in the sand. An ad needs to inspire some confidence that medicine can work on the cancer (when diagnosed early), but not so much that a person thinks treatment will work if cancer is caught later on. Likewise, an ad needs to impart enough anxiety that the patient makes sure the doc does the test, but not so much that she doesn’t go to the doc in the first place or that she pesters the doctor with benign symptoms.

Based on the current theory that cancer starts in one area of the body and may spread to distant organs, early detection encourages people to take advantage of the brief window of opportunity offered by even a small tumor. Early-detection narratives, suggesting future and past counterfactuals, seek to break the deeply held association between cancer and death with one simple directive: You won’t die if you just see your doctor! The directive has a foreboding undertone: It could have been different. We can change the course of history—and if we can’t now because we waited too long, we could have before.

The ACS ad highlights the key mechanisms of early-detection campaigns. A simple cost-benefit analysis maintains that it is cheaper to “keep his mother healthy” now, for $700, than it will be to “try to keep her alive” later, for $200,000. Early detection means saving money and saving lives: it’s win-win.²² The ad also relies on the myth that if you find and treat cancer later, you could probably have found it sooner, with the additional promise that cancer death rates and overall cancer expenditure could go down. The small print informs the reader that “60% of cancer deaths could be prevented” and urges “access to prevention and early detection. For all Americans.”²³ The gap between “keeping” and “trying to keep” the mother healthy is unsettlingly similar to the hedge at the bottom of the American Century Investments ad: “Past performance is not a guarantee of future results.” Like financial accumulation, cancer treatment offers only uncertainty.

To whom is the ACS message—money and lives are being lost—addressed? In other words, who cares? The difference between $700 and $200,000 might in fact invite incredulity. While there may be investments that increase twenty-five-fold over some unspecified amount of time, as a financial wager it’s dubious, especially since it’s unclear how the various pockets will lose and gain coin. Thus the ad must cite not only the Market, but also the other key referent of the future, the Child who stands to lose his mother.

English professor Lee Edelman has argued that the Child holds a critical rhetorical place in American politics.²⁴ The wide-eyed face of the Child has ideologically justified everything from marriage with its unequal distributions of wealth to the Patriot Act. Mothers used their children to curb drunk driving in the 1980s, and after the deaths of hundreds of gay men, only the presexual child Ryan White finally brought AIDS to national attention. From Megan’s Law to denying gay marriage to expelling gay school teachers, political action has harnessed the power of the Child. The Child gains his potency in his abstract permanence and his winsome innocence, in his asexuality, in his disconnection from the market and his prepolitical sensibility.²⁵ This Child, not as a person but as fetishized ideal, plays a critical role in laying out expectations about life course.

Without portraying a child and referencing its archetype, the ad would uneasily tangle with the “who cares?” question, since the state doesn’t generally care about any individual’s health. Such is the premise of the private insurance system and the reason that some forty-five million Americans remain uninsured, with sixty million more underinsured. Even given recent legislation that may change this for the moment, to ask the state to care for any particular individual using a market logic can’t work. Not only does the pre- and postcancer money come from different, incommensurate pockets, but with only a few exceptions, health insurance, we’ve decided, is not a benefit to be distributed by the state. The ad needs, then, to appeal to another logic: humanitarianism.

While his mother might be blamed for not getting insurance, this boy has done nothing to deserve losing her. The young woman on her own may generate resistance (why doesn’t she have a [better] job?), yet children remain outside the market exigencies that underlie the moral economy of who has healthcare. The ad purveys the message that “we” owe him, if not his mother, at least the initial $700, while it also assures the self-interest of saving ourselves $200,000. The “who cares?” question is both artfully raised and clunkily avoided.

Such ads can easily be understood as rhetoric, mere attempts to lacquer political ideals onto a ruse of sentimental innocence. Had the ACS portrayed a person of color, a homeless person, or a childless queer person, the ad would certainly have been less palatable. If strategic reference to children’s safety achieves a broader goal, then so be it. But the representational power of the Child is especially potent, for none of the other cast of uninsured characters would help us make the rhetorical and political leap toward a cancerless future.

In bringing our attention, justly, to the huge effect that insurance has on mortality rates and pointing the way to a future fantasy in which all Americans have insurance, the ad diverts attention from the way statist ideologies justify the market distribution of medical insurance. Indeed, in an internal contradiction it supports, rather than challenges, these same ideologies.²⁶ The ad, ultimately, recants the ways in which the ideology of the Child denies benefits to huge swaths of the population (as in the justifications for marriage benefits) and forecloses a more earthy discussion of who has insurance and who does not and why both insurance and healthcare are so expensive.

STRAIGHT FACE

The Young Adult, too, holds a critical rhetorical place in U.S. politics. Years ago at a funeral I attended for a grad school colleague who had died of leukemia at thirty-three, her cousin comforted herself in a speech with the idea that Chaney had been lucky, for she would not have to experience the horrific event of turning forty, as the cousin recently had. Chaney would not have to pass that invisible, ineluctable birthday that drew the speaker one step closer to disposability. Virtually any comment at a funeral gets a special pass, but this remark is telling for its unashamed embrace of the fetishization of Young Adulthood, of the person at the height of intellectual potency and reproductive fertility, with boot-strapping promise, still marching up the sunny incline of the hill.

Like the Child and the Cancer Survivor, the Young Adult cuts a high-stakes ideal that can be exploited, as Lance Armstrong’s vast empire demonstrated. Still, the fetishization of Young Adulthood is all the more insistently enforced given the lack of, or finely parsed distribution of, social support. As heirs to these ideals of a lifespan, the best, and worst, young unmarried survivors can do is to fail our families by leaving parents to survive us (a crime against nature) or leaving our dependents without support. Regardless of who is listed as kin in the last line of an obituary (“. . . is survived by . . .”), those relationships are local. The broader economy, miraculously, has protected itself from being failed or survived by the illnesses of it citizens.

Legitimate, financially supported survivorship relies on kinship models. Specifically, marriage entitles one to benefits, some of which I have mentioned already: insurance, or increased odds of insurance, through a spouse’s employer; survivors’ benefits for the spouse, such as Social Security; and government and employer benefits for children. Quite distinct from individual success and hard work, these selective gifts result not from performance but from kinship. They also shore up the notion that some lives are more worth living than others and some lifespans more worthy of completion (if only by proxy). To put it coldly and without ascribing intent, not everyone deserves to survive or to be survived.

The early-detection trope routes the promise of a cancerless world through the fetishized child and the market (pay now, save later) and consolidates the notion that the problem of cancer can be solved through these ideals, rather than seeing them as part of the problem. The ACS ad shrugs off the same questions that all early-detection ads do: about missed cancers (especially in this mother’s age group), about the expense of treatment, about the causes of the disease. It also describes cancer as white and straight, and early detection as a duty of individuals and in the interests of the state. Given the conservatism of the ACS (some of the country’s top industrialists have served on its board of directors), one would not expect something so radical as a prevention statement that focused on the chemical, industrial, and medical causes of cancer. Still, the ad does more than not make waves; it erases the underlying politics of the disease.

The market relies on a notion of the future, which in turn drives ideas about expected lifespan. Retirement and children, the two carrots of futurity, are the key symbols of a life well lived. The productive reproductive young adult takes center stage in these ideals. Early-detection campaigns also play on some version of the defining market ideology of “pay a little now, save a lot later,” coming close to promising that, despite everything, we can succeed against cancer, both as individuals and as a society. But the disease also enables a unique insight into the disparities in the distribution of goods underwritten by the fantasies of fairness that justify the market.

Despite cancer culture’s nearly panicked generation of future thinking, the disease places futures radically in danger. In the United States, the redistribution that cancer entails—the massive expenses incurred and the mammoth profits made—puts the whole system at risk of failure. Lance’s poker face shamefacedly disguises the cancer that threatens the underwriting ideologies and promises of the market (lifespan, futurity, deferral). A culture may not have cells that can divide, but cancer has it by the pocketbook.