Not long after she was diagnosed with breast cancer in 1994, Christine Clifford walked into her local Barnes and Noble with a simple request: "I'd like to see all of your humorous books about cancer."
The clerk shot her a dirty look: "That's sick."
Undaunted by a severe scarcity of titles — she could find only two — Clifford went on to write her own cancer cartoon books and to deliver her sassy brand of tumor humor to increasingly large audiences, including 700 people who turned up for a recent women's health fair in tiny Wadena, Minn. (pop: 4,000).
"Cancer patients want to find humor in their situations," Clifford says.
"It's a long journey. It's usually a minimum of a year, by the time people have had surgery, and chemotherapy and radiation therapy, and possibly adjunct therapies. My whole push has been, let's help cancer patients get back into the mainstream of life, and I think humor is a great way to do that. It makes you feel like your life is normal."
Much has been made in recent weeks of stand-up comic Tig Notaro's "Hello, I have cancer" performance, praised by comedian Louis C.K. as one of a handful of "truly great, masterful stand-up sets" he's seen in 27 years in the business. But while Notaro's take on the topic, delivered when she was still reeling from the shock of her diagnosis, broke new ground, it also occurred in the broader context of shifts in attitudes toward cancer humor.
Fifty years ago, cancer was "The Big C," a disease so terrible many Americans dared not speak its name, much less joke about it publicly.
In her book "The Human Side of Cancer," psychiatrist Jimmie Holland writes about working at Memorial Sloan-Kettering Cancer Center in the late 1970s: "A taxi driver once refused to drive me to Memorial saying, 'No, ma'am, that place is for The Big C. I drive all the way around it."
In the mid-1990s, when Clifford went searching for cancer humor, her local librarian took her deep into the bowels of the library and pointed to a single book on a shelf too high to reach.
But due in part to declining cancer death rates, an increase in the number of support groups and the breast cancer movement, all of which have brought survivors together and affirmed their experiences, along with factors such as increasing openness in both society and comedy, cancer humor — long an unofficial part of the patient experience — is coming out of the closet.
"Survivors are now a recognized and honored group," Dr. Richard Penson, clinical director of gynecologic oncology at Massachusetts General Hospital, said in an email exchange. "That and the commitment to maximize quality and quantity of life factors into both joy and humor. It is a celebration and a coping strategy."
Dialing up the humor
In recent years, we've seen the rise of humorous greeting cards ("I'm Having a No Hair Day"), T-shirts ("Save the Ta-Tas") and books ("Cancer Vixen" by Marisa Acocella Marchetto).
"Sex and the City" tested the TV waters with Samantha's breast cancer storyline in 2004, and now we have the dramedy "The Big C" with Laura Linney. Last year Seth Rogen co-starred in "50/50, "(tag line: "It takes a pair to beat the odds"), an irreverent big-screen comedy about a young man with cancer.
On the Internet, blogs such as igotthecancer.blogspot.com fight for the right to laugh with posts such as "Ain't no party like a PET scan party" and Amazon.com lists more than 50 cancer humor titles. At MyBreastCancerTeam, a social network for women with breast cancer, Ida Rosenberg of Agoura Hills, Calif., recently posted a "Scarf Fashion Show" featuring her post-chemo headgear.
"I could find humor in almost any situation, and breast cancer is no exception," says Rosenberg, 55, who notes that she was diagnosed in May, the day before her dog died, and four days before her birthday.
When Rosenberg found out that she didn't have enough body fat to have breast reconstruction surgery done to her exact specifications, she saw the irony: "For the first time in my life I didn't have enough fat — there's no justice in life!"
"You have to laugh," she says. "These are funny moments. That is my nature, to find humor in things. There will be the person who's like, 'Oh my God, am I supposed to think that's funny?' Get over it! I'm the one who's going through cancer, not you."
The use of humor by cancer patients has generally been uncontroversial, but in recent months feminist bloggers have taken issue with popular breast cancer slogans such as "Save the Ta-Tas," arguing that they emphasize sex appeal over survival.
"Focusing on breasts and breasts alone obscures the reality and the faces of the people who are at the center of the fight against breast cancer," wrote Jessica Luther in Flyover Feminism. "They may have beaten the cancer but they lost their breasts, the things everyone seems to actually care about."
Laughter as medicine
Research on the health effects of laughter is in its infancy, according to a 2010 review of medical studies in the journal Alternative Therapies.
The article's author, Ramon Mora-Ripoll of the Organizacion Mundial de la Risa in Barcelona, Spain, found that well-designed randomized controlled trials, the gold standard in medical research, have not yet been performed. But less conclusive studies do indicate that laughter has psychological benefits such as reducing stress and elevating mood, Mora-Ripoll writes, and the potential downside of laughter is small.
Clifford, the author of "Not Now ... I'm Having a No Hair Day" and "Cancer has its Privileges," says her experience with cancer actually began when she was 15, and her mother was diagnosed with breast cancer.
Her mom lived for only four more years, she says, and when she herself was diagnosed at age 40, she assumed the worst.
"I thought I'm going to get depressed, crawl into bed and die," she recalls.
But then, shortly after she got back from the hospital, the doorbell rang.
"Mom!" her 8-year-old son called out: "More flowers for your breast!"
"That was the first time I laughed in eight days. I thought, 'Oh my gosh, I can laugh again. This feels good,'" she said.
Cancer humor sources
An audio recording of Tig Notaro's now-famous set, performed shortly after she learned she had Stage 2 breast cancer, can be purchased at iTunes. For great excerpts, check out "This American Life," Episode 476 ("What Doesn't Kill You") at thisamericanlife.org.
T-shirts are at available at zazzle.com, ("Don't Let Cancer Steal Second Base") and Edition.
For younger, edgier cancer humor ("Top Ten Signs You've Joined a Cheap HMO"), check out the "Cancertainment" section of planetcancer.org.
Blogs with a strong humor element include igotthecancer.blogspot.com and cancerissofunny.blogspot.com.
Zazzle.com sells greeting cards ("I'm having a no hair day," "My oncologist does my hair.")
Popular books include "Cancer on Five Dollars a Day" by Robert Schimmel and Alan Eisenstock, "Cancer Made Me a Shallower Person" by Miriam Engelberg and "Cancer Schmancer" by Fran Drescher.Copyright © 2014, The Baltimore Sun