Thursday Book: A novel way to cope with cancer

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A SIMPLIFIED history of writing about illness in the 20th century might chart a line of development from illness-as-metaphor, exemplified in works such as Thomas Mann's The Magic Mountain and Solzhenitsyn's Cancer Ward, to recent accounts of illness-as-experience by journalists such as Martyn Harris, Ruth Picardle and now John Diamond. The turning point would be the publication in 1978 of Susan Sontag's Illness As Metaphor, which challenged the metaphorical uses made of illnesses, in particular tuberculosis and cancer, and paved the way for the current crop of experiential writing.

But actual processes are never quite so neat. W N P Barbellion's The Journal of a Disappointed Man and A E Ellis's The Rack both trace the course of an illness (respectively, multiple sclerosis and TB) experientially rather than metaphorically. They predate Sontag's famous essay, although both authors hide behind pseudonyms and adopt the fictional mode.

John Diamond's encounter with throat cancer, and the painful treatments and operations he has had to undergo, both to remove the well-concealed primary tumour at the base of his tongue and to prevent the spread of the disease, will already be partly familiar to readers of The Times. This is journalism, not fiction, but the two are more closely related than we are generally prepared to admit. Diamond chooses to tell his story as a journey from hypochondria to real illness, from not being able to breathe as a result of a panic attack to almost choking to death from a blocked windpipe.

Another novelistic theme adds density to what seems, on the face of it, a straightforward report from the cancer ward. This is the symbolic, as well as literal, silencing of a fluent - not to say facile - speaker, a representative of the chattering classes and a regular voice on the airwaves.

After the operation on his tongue, Diamond finds himself unable to speak and requires the services of a speech therapist to relearn the art of talking, just as accident or stroke victims may need a physiotherapist to teach them the art of walking again. He writes, "To say I lived by my voice would be overstating the case, but not by much". He could no longer broadcast, of course, and was limited even in the kind of articles he could write, since anything that wasn't about himself would involve phoning people and asking them questions.

So his professional life was seriously stunted. But what worried him more was what his honking and drooling, as he calls it, did to his self- image: "Like a page three girl who believes that she is described entirely by her breasts, so I believe my personality to be almost entirely manifest in what I say and the way I say it, that people respond to me not because I am good or kind or have a face which encourages response, but because of the words I speak. There is part of me which believes, for instance, that I have never taken a woman to bed but that I talked her there, that I have never got a job but that I talked my way into it."

"The fact is," he goes on, "that I am talking: talking is what I do." To be deprived of the ability to express himself in the way that gives his life meaning is a deeply painful personal experience but a rich artistic opportunity.

Where the book parts company with fiction is in the bathos of the conclusion. Diamond has dramatised himself as a character undergoing draconian treatment for cancer, but he is both too close to the experience and too uncertain of the outcome to be able to assess its impact on his life.

Yet, because he is writing a book, he feels obliged to offer some sort of summary, in which the journalistic fizz of his earlier writing gives way to ponderous and banal remarks about learning a lot about himself and how "the bad [side of the experience] has outweighed the good a millionfold".

There are other problems relating to the switch from the journalistic sprint to the long haul of book writing. Diamond rightly ridicules the stereotype of the brave sufferer and passionately castigates the inanities of alternative medicine (causing the Sunday Telegraph to invite him to contribute a weekly column on the subject). But his provocative views, while perfectly suited to the demands of the 1,000-word column, can seem a trifle shrill in book form. The reader may wonder if he is not - like the atheist obsessed with the follies of religion - already halfway down the road to Damascus.

These are, of course, literary cavils. In human terms, Diamond has written as honest and clear-eyed account of experiencing cancer as one could ask for. He approaches the subject with something of the dandyish bravado the poet Keith Douglas brought to the war in the North African desert. And that is high praise indeed.