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UBC Theses and Dissertations

Four discourses about breast cancer : a broader view McEwan, Colleen


Breast cancer has become a modern day epidemic. Over 19,000 women will be diagnosed with breast cancer this year in Canada, and over 5,000 will die. Health care providers and the public need to find better ways to understand the complexity of this disease. Universal explanations for such phenomena are no longer acceptable. Multiple "other" views must be recognized. To seek out truth it is necessary to make the invisible, visible. This thesis is an attempt to reveal competing discourses that construct breast cancer. Models help us see the world in different ways. The four world-view model is a tool that recognizes four different ways of thinking about phenomena. These four viewpoints (functionalism, humanism, radical functionalism and radical humanism) encompass ontological differences (subjectivity versus objectivity) and extant power relations differences (challenge versus reinforcement). Functionalists view reality objectively, and assume that society is stable and status quo is maintained. Humanists also view society as stable and status quo as acceptable, but reality is subjectively constructed. Both radical functionalists and radical humanists believe that there are deep-seated conflicts between the elite and the underclasses and change is needed. Radical functionalists view the world objectively and believe that the underclasses are controlled via information and material constraints, while radical humanists view the world from a subjective viewpoint and believe superstructures disempower the underclasses. In this study breast cancer literature was reviewed to find examples that illustrate the four perspectives of the four world-view model. Each article, book, and website was "questioned" using an interview guide based on the four world-view model. Samples were selected to reflect several issues that were relevant to each perspective. The goal of this study was to use the four world-model as a framework for creating a broad and complex description of breast cancer. The intent was never to create an exhaustive description of breast cancer. By using the four world-view model to describe various perspectives of breast cancer, a broader discourse has been uncovered. Multiple viewpoints have been recognized. For many years breast cancer has been defined from a functionalist perspective. Biology defined breast cancer. Research identified various aspects of breast cancer; how cells multiply and grow, what treatments best halt the spread of cancer, and what treatments do not affect the growth and recurrence of breast cancer. The humanist perspective explores the personal stories of breast cancer. Breast cancer has been described in many ways, sometimes as enemy, challenge and opportunity for transformation. Each way of experiencing breast cancer needs to be recognized and honored for its truthfulness and legitimacy. According to the radical functionalist perspective, large corporations and physicians, the elitist members of society, have been responsible for determining how breast cancer is researched and treated. These powerful groups controlled material resources and information, ensuring their needs for prestige and profits are met, with little regard for the needs of women with the disease. Women's lack of societal power has had a significant effect on the treatment patterns for this disease. Many women have undergone disfiguring surgical procedures and drug research trials without their informed consent. Often decisions have been made regarding breast cancer treatment to continue the power and profitability of physicians and corporations, not to best meet the needs of women with breast cancer. The radical humanist perspective also illustrates how social structures and privileged elites have influenced breast cancer. Society has blamed and shamed women into silence. Women have been convinced that it is necessary to hide breast cancer behind prosthesis and augmentation surgery to ensure their desirability and value. By staying silent about breast cancer, women have fulfilled their role as mother and partner, putting their needs behind the needs of their family. Breast cancer continues to be a taboo subject; this has created a silence. This silence has ensured that breast cancer is viewed as a personal tragedy, only spoken about in family circles, instead of as a preventable health care crisis. By looking at breast cancer through the four lenses of the world-view model, a broader discourse of breast cancer unfolds. Breast cancer is no longer just a biological issue that is treated with surgery, radiation and chemotherapy. It is a personal tragedy for the women with the disease, changing their lives forever. It is also a social phenomenon where society has influenced how it is treated, researched and experienced by the women with it. If truth is sought, which can be defined as absence of concealment, it is necessary to make the invisible visible and not to reject particular ways of knowing. By using the four world-view model to describe the different perspectives of breast cancer new and diverse ways of seeing breast cancer are uncovered. This broader description of breast cancer can be used to inform decisions made by healthcare teams as well as guide educational planning for health care professionals and the public. The four world-view model creates space for alternative viewpoints, which is can lead to a more comprehensive and complex understanding of disease. Healthcare teams can incorporate this broader understanding into their planning, potentially developing creative programs that address a variety of needs for people with disease. The four world-view model can also be used as a guide for educational planning for health care professionals, students and the public. The broad definition of disease that is created through the use of the four world-view model can be represented at conferences, in classrooms and in public information documents. This broader description provides space for the personal experience of disease as well as how society has an impact on how disease is experienced and treated.

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