Resistance to Cancer Diagnosis

In the contexts of discussing disease and health, age is thought to be a key index in the natural course of physical health development. Under this natural course, people have normative expectations of the stage of physical health development each age group corresponds to. For example, it is normally expected that the health condition of elderly people will become weaker and weaker day by day (Coupland et al. 1989), so their physical disease and frailty is explainable by the fact of aging. The stage of physical health development the young adults in the age group of 20 to 29 corresponds to is normally

thought to be developing or on the climax of maturity rather than on the way to collapsing or even death. This normative expectation about physical health development can also be reflected by the statistics about the number of cancer patients gathered by the Department of Health in Taiwan. Take the statistics in 2010 (cf. Table 5.1) for example: age and the number of cancer patient are in direct proportion. That is to say, the older the age group, the greater the number of cancer patients. The total number of cancer patients from the age group 20 to 29 is 4,206, which made up 0.1% of the total number of people (3,473,436) in that age group and 1.3% of the total number of cancer patients in that year.

Table 5.1

Total number of people and total number of cancer patients in 2010 in Taiwan.

Age

We normally think that young adults are on the way to achieving their ideals and dreams. For many young adults, being in the age group of 20 to 29 is just the time for them to finish their studies and start their careers. However, they have no choice but to be the 1.3 out of 100 people. (e.g. ‘為甚麼會是我？我才 27 歲！！家裡沒有遺傳，我也不符合高 危險群，為甚麼會是我？！/Why me? I am only 27!! It is not hereditary in my family and I am not from high-risk populations. Why me?!’) Nurmi (1992) investigated the life goals and life concerns people in different age groups and found that people in different age groups have different life goals. Moreover, these life goals can reflect the main

developmental tasks each age group corresponds to. According to the research by Nurmi (1992), compared to the people from older age groups, young adults from the age group of 19 to 34 more often mention the life goals related to future education, family and marriage.

We also recognize that young adults from the age group of 19 to 34 are normally thought to be at the age of receiving education and preparing to have their own family. These kinds of life goals are filled with hope, happiness and ideals and the unexpected cancer diagnosis disrupts their opportunities to realize their dreams and ideals, as one of the patient members said: ‘事業才剛要起步就被迫中斷/My career is just going to start and it is now forced to be interrupted.’ They may, therefore, worry that their life goals are unable to be achieved (e.g. ‘目前最怕︰再次復發及結婚生子問題/the thing I fear the most now: to have recurrence and the question of getting married and having children’). Thus, it is even harder for them to accept cancer diagnosis.

We have mentioned that the non-neutral pattern for age-disclosure was presented in full sentences and their appearances were related to the context because they belonged to the description of patient members’ stories. Along with disclosing age, patient members may also mention the current status or memorable life events surrounding the event of receiving the cancer diagnosis or the posting of the self-introduction itself. The characteristic in common of these status and life events is that they all belong to important stages in life, such as, ‘休學/temporary suspension of schooling,’ ‘畢業/graduation,’ ‘生日 /birthday,’ ‘青春年華/being in the prime of youth’ and ‘三十而立/at thirty I take my stand.’ There is no need for them to provide the status they were in if they merely wanted to give an account for their age. Now that they purposely chose to mention the stage of life they were in, the meaning they would like to convey was that getting cancer diagnosis was really an influential event in their life journey. Moreover, it threw their life journey into confusion, as one of the patient members said: ‘十月初，我的人生道路拐了個大彎/at the

beginning of October, the road of my life made a big turn.’ Another patient member even directly spoke of the helplessness of having a disrupted life because of getting cancer at young age:

我總覺得 20-30 真是個生病的尷尬年紀

‘I always think that it is embarrassed to get ill at the age of 20 to 30’

接受的教育也差不多告一個段落卻還來不及有自己的事業

‘The received education is almost finished but there is not enough time to have one’s own career.’

正值青春洋溢的年紀但就算擁有也只是一段沒有未來的戀情

‘Being exactly in the prime of youth but even if we held a relationship, it has no future’

‘but there is not enough time to have one’s own career’ and ‘even if we held a relationship, it has no future’ directly pointed out the hopelessness of life stages and life's journey being disrupted.

Besides, the research by Kübler-Ross (1970) talked about the five stages of mental status patients may go through when they are diagnosed with a serious illness. When patients are told that they are diagnosed with a serious illness, they may deny the diagnosis in the first place and therefore go to another place for a second diagnosis because they do not want to trust the first doctor. After they are able to accept their illness identity, they may start to feel angry about their fate and thus bring up the question ‘Why me?’ Then, they may enter the stage of bargaining. In this stage, they may pray for some more days to live in order to accomplish the things they want to do. After they find that they are gradually losing everything, they may start to feel depressed, the fourth stage. In the last

stage, patients then accept everything with a peaceful mind. In modern society, medical treatment has made great progress and there are many cases of recovering from cancer to prove that cancer is not an incurable disease. Nonetheless, according to the statistics gathered by the Department of Health in Taiwan, malignant tumor, the so-called cancer, has been the number one cause of death for as long as 30 years. Thus, it is not hard to imagine that getting cancer diagnosis is just like getting the death penalty for cancer patients, especially for young cancer patients. There is no exception for the young cancer patients in KDD cancer board. Some patient members mentioned how they felt when they were informed of their cancer diagnosis, such as, ‘為甚麼會是我？我才 27 歲！！家裡沒 有遺傳，我也不符合高危險群，為甚麼會是我？！/Why me? I am only 27!! It is not hereditary in my family and I am not from high-risk populations. Why me?!’ They are still very young so getting cancer diagnosis is totally out of their expectation, as one patient member said: ‘原本覺得怎麼會讓這種病發生在這個年紀’ ‘originally I thought that how come I would get cancer at this age’ and thus they were angry about their destiny.

Presenting one’s own age when making inquiry indicates that getting a virulent disease at a young age is the reason they could not face the fact and also the cause of their anger.

We can also see patient members’ resistance to cancer diagnosis because of their being young through their use of non-neutral patterns for age-disclosure. Some non-neutral patterns for age-disclosure contained evaluative adverbs to convey the patients’ emotion and attitude toward getting cancer diagnosis. Those evaluative adverbs include ‘才/only,’

‘就/an auxiliary stressing the following verb,’ ‘剛/just,’ ‘值/be exactly in,’ and ‘竟 /unexpectedly,’ as in the following examples:

為甚麼會是我？我才 27 歲！！

‘Why me?’ I am only 27!!’

大家都驚訝這麼年輕(25)就罹癌

‘Everybody is surprised that I got cancer in such a young age (25).’

78 年次剛滿 23 歲

‘Born in 1989 and just over 23 years old’

第一次發現此病時，正值青春年華的 24 歲

‘When it was first found, I was 24 years old and was exactly in the prime of my youth.’

但 23 歲的我竟也得了

‘I, being 23 years old, unexpectedly get (cancer).’

When these adverbs appeared in the above examples, they were used to convey the idea of ‘counter-expectation.’ We have a further discussion about the emotion and attitude the use of ‘才/only’ conveys because it is the most common usage found in our collected data. Li (1997) made a research on ‘才/only’ in Taiwanese (ciah) and brought up two of its usages: being used as a linking element and being used as a limiting element. According to Li (1997), the basic meaning of ‘ciah’ is only or just when it is used as a linking element.

When its basic meaning interacts with the Maxim of Manner (the content of speaking should be clear and brief) and the Maxim of Relevance (the content of speaking should be relevant to the situation and its context) proposed by Grice it gets an expectation-denying function (Lin 1996 cited in Li 1997). The data analyzed by Li (1997) is in Taiwanese but Lin (1996 cited in Li 1997) mentioned that its counterpart ‘才/only’ in Mandarin (cai) also has the same function. We also analyze our collected data with this point of view. In terms of Maxim of Manner, the information patient members provided is clear enough without the use of an additional ‘才/only’ if they just wanted to neutrally present their age. That is,

‘I am 27 years old’ without an ‘only’ before 27 is clear enough. Their choice of adding an

‘才/only’ before their age indicated that they did not want to neutrally present their age but wanted to draw support from the function of counter-expectation provided by the use of

‘才/only’ to highlight their resistance to cancer diagnosis because of their young age. In the process of buying and selling, buyers may say ‘How come it is so expensive, the other vendor only sell it for 500’ in order to make a bargain with sellers. The use of additional

‘才/only’ here is to show their attitude that they do not want to accept the price so would like to make a bargain with the seller. The same with buyers who want to make a bargain, patient members used an additional ‘才/only’ to show their attitudes that they did not want to accept the fact of getting cancer diagnosis, so they would like to make a bargain with their destiny, just as a patient member said when presenting his/her age: ‘大家都驚訝這麼 年輕(25)就罹癌’ ‘everybody is surprised that I got cancer in such a young age (25).’

In terms of Maxim of Relevance, young patient members’ emphasis on their being

‘only XX years old’ further strengthened their notion that they should not have gotten cancer at their age. The fact of getting cancer made others think that they should be older than their real age. This idea also pointed out the notion of age being a key index in the natural course of physical health development as mentioned earlier in the present study.

The stages of physical health development to which young age groups correspond are normally hard to be associated with virulent disease. Moreover, we think that patient members’ use of ‘才/only’ plus their age indicates their belief that the fact of getting cancer vastly disconnected with the normative expectation associated with their age group. This is because they encountered something people in their age group are not thought to encounter.

They are in a young age group, but the thing they encountered is normally associated with middle or old age groups. For young patient members, their stages in life are switching too fast, so they use the additional ‘才/only’ to emphasize their being young and not belonging to the age group normally associated with getting cancer.

In fact, we also found that there were three non-patient members using additional ‘才 /only’ when mentioning their age in their self-introduction postings (cf. Examples 1 to 3 in Table 5.2). We have mentioned earlier that there were only 26 (24%) out of the 108 non-patient members who mentioned their age-related information within self-introduction posting. Although they also belonged to young age groups, with the average age of 25, these 26 non-patient members did not try to avoid telling their age, which is a sensitive topic in social contexts. Why? We think their spontaneous reference to age shows their resistance to the cruel fact that their relatives and friends got cancer diagnosis when they were still young. For most people, losing family members, especially patients, is something they should encounter when they get older. Some non-patient members are still under age and need to be looked after by parents (17 years old, cf. Table 5.2). However, they cannot be looked after by their patients because their parents get cancer. They even need to take on the role of parents or face with the possibility of losing parents. Thus, their stages in life are also switching too fast, just like young patient members. This proves that the use of ‘才 /only’ plus their age shows young people’s resistance to their own cancer diagnosis or their relatives and friends’ cancer diagnosis because they are still young.

Table 5.2

Examples of the use of ‘才/only’ plus own age from the self-introduction postings by non-patient members.

  Examples Their age when relatives

and friends got cancer

‘I am only 27 years old and have not get married. My younger sister has graduated from college and just

father gets cancer when he/she is 27 years old

starts to find a job.’

3 本人才高二升高三

‘I am only going to be in my third year of senior high school.’

mother gets cancer when he/she is 17 years old