Synaptic

This piece was written in Fall 2020 for COMM 276: Communicating Health & Illness. The assignment was to select a narrative that focuses on the personal or family experience of an illness and analyze that narrative from a health communication perspective, bringing the narrative into dialogue with health communication theory and research. I nominate this piece for the sophisticated analysis it offers as it expertly brings together health communication theory and this portrayal of lived experience. In addition, the author does an excellent job of providing informed insight into the complex cultural perspectives enacted in the narrative. I think we often view practices of people from other cultural traditions — such as those portrayed in the film under analysis — with perplexity, or even judgment. In this analysis, Harrington artfully uses theory to enlighten perspectives and cultivate (inter) cultural understanding.

– Dr. Linda Laine

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Nai Nai, along with most of Billi’s other relatives, still live in China. Billi’s parents inform her that they are planning a trip to China to see Nai Nai, but the family has decided not to tell Nai Nai about her own cancer diagnosis due to cultural and personal reasons. Billi disagrees with her family’s decision and struggles to cope with Nai Nai’s illness (especially while in Nai Nai’s presence). Through these external and internal conflicts, the film examines the unique challenges illness poses to an entire family within a specific cultural context, focusing on the various roles family members can perform during illness through the concepts of social support and the Voice of Lifeworld. The film also showcases the social construction of illness through narration, particularly through the narrative functions of asserting control and transforming identities.

Perhaps most central to The Farewell is the questions it raises about the appropriate role family plays in supporting a loved one who is terminally ill. To what extent family should be involved in another’s health care decisions is unclear and often culturally relative, as is which people are considered “family” (du Pré, 2017). In the case of the Wang family, many people are involved in the decisions about Nai Nai’s health—including her siblings, children, and grandchildren. Billi’s uncle (Nai Nai’s son) explains to her the reason for such widespread involvement in keeping Nai Nai’s cancer a secret from her by saying, “You want to tell Nai Nai the truth because you don’t want to take responsibility for her, because it’s too big of a burden. It’s our duty to carry this emotional burden for her.” Their perceived role is to experience the emotional toll of Nai Nai’s cancer themselves so that Nai Nai does not experience that toll at all. This rationale reflects a culture- centered approach to health that emphasizes the “intersection of culture, structure, and agency” where “purifying the mind is intertwined with taking care of the body” and “maintaining the harmony of the mind and the body is central to the delivery of health” (Dillard et al., 2014, to treatment, so the family believes they must safeguard her mental harmony by keeping her cancer a secret from her.

The family’s choice to take on the role that they do reflects the concept of social support. Barnes and Duck (1994) define social support as, “behaviors that, whether directly or indirectly, communicate to an individual that she or he is valued and cared for by others” (p. 176). The family indirectly shows Nai Nai social support by keeping her cancer from her. Doing so is meant to erase Nai Nai’s fear about her eventual death. The lie itself stems from their deep care for Nai Nai’s emotional state, even though Nai Nai does not realize she is being supported in this way. The family’s means of social support is later affirmed by Nai Nai’s doctor. He explains to a concerned Billi that most people in China choose not to tell family members with terminal cancer about their diagnoses and that his family did the same thing when his grandfather was dying of cancer. As a result, Billi attempts to adjust her perception to match Chinese culture’s view of how to best socially support Nai Nai.

Keeping Nai Nai’s cancer a secret from her as a form of social support also relates to the Voice of Lifeworld. This concept is typically associated with how patients speak, emphasizing how patients are “primarily concerned with health and illness as they relate to everyday life” (du Pré, 2017, pg. 73). Since Nai Nai does not know about her illness, however, she cannot speak about its effects on her daily life, though her family can. Their main motivation for not telling Nai Nai about her cancer is because they think that knowing about her cancer will negatively impact her everyday emotional state to a severe degree. They do not want Nai Nai’s final months filled with fear that stops her from doing things she loves. As Billi’s mother humorously puts it, “If you tell her [about the cancer], you’ll ruin her good mood.” The family is much more concerned with Nai Nai’s potential feelings about the illness in her day-to-day life than they are with transmitting scientific knowledge about the illness to her. As mentioned earlier, Nai Nai’s doctor supports the family’s use of the Voice of Lifeworld, reducing the possibility of tension between the family and Nai Nai’s caregiver, which relates to Barry et al.’s (2001) findings that the most productive medical relationships are those where “both doctor and patient both stuck to the voice of medicine (Strictly Medicine) or where both used the voice of lifeworld (Mutual Lifeworld)” (p. 503). The only difference is that in this instance, the patient is replaced with the family unit. Such cohesion also positively affects Nai Nai, even if she does not realize it.

The role the Wang family takes on while navigating Nai Nai’s cancer very much shapes the overarching narrative, or story, they construct about her illness. A major component of crafting illness narratives is language use (Sharf & Vanderford, 2003). The language of the broader narrative might seem simple at first: the family does not want Nai Nai to know about her cancer, so they lie about it and say she has a respiratory infection. The reason they construct such a narrative, however, is because of the meaning they want to ascribe to Nai Nai’s illness and eventual death (Sharf & Vanderford, 2003). They assume that if Nai Nai knows she is dying, her illness will subsume her entire identity, making her death one of agitation as opposed to peace. In addition, they do not want her to focus on her death so much that she treats her life as though it no longer has any meaning. Hence this comment from one of Billi’s relatives: “It’s a good lie.”

In order to construct the meaning surrounding Nai Nai’s cancer that they want, the Wang family relies on various narrative functions to accomplish this goal. This first function is, perhaps a little too obviously asserting control (Sharf & Vanderford, 2003). Interestingly, the function has a dual effect in the film. The family constructs the narrative that Nai Nai is not actually sick in order to maintain control over what Nai Nai does and does not know about her health. In this regard, they hold enormous control over her. The reason they exercise such power, however, is because they do not want Nai Nai’s emotions to spiral out of control due to fear. Early into the film, Billi’s mom tells her, “Chinese people have a saying: ‘When people get cancer, they die. It’s not the cancer that kills them, but the fear.’ ” By controlling that Nai Nai does not know about her own cancer, the family believes that they are allowing her to retain her fullest sense of self, and thereby empowering her amidst her illness.

The second function of illness narratives is to chart transforming identities, focusing particularly on how illness affects personal relationships (Sharf & Vanderford, 2003). Choosing to keep Nai Nai’s cancer a secret from her alters how all of the family members act around her. They must actively work to not show any of their own fear or grief so they do not reveal that they are lying to Nai Nai. In this sense, illness transforms their familial identity because all their interactions become centered around Nai Nai’s cancer and making sure she does not find out about it. The narrative the family constructs also forces Billi to reevaluate her identity on an individual level. She does not agree with the decision to keep Nai Nai ignorant of her illness, which makes her an outlier to the rest of the family.

More specifically, Billi must negotiate between her Chinese heritage and her American upbringing. While having an argument with her uncle, he tells her that there are differences between how the United States and China perceive illness and death: “You think life belongs to oneself… In the East, a person’s life is part of the whole.” He challenges Billi’s view that telling Nai-Nai the truth is the only correct option because she presumably holds this view since it is the norm in U.S. culture. Stibbe (1996) writes about the illness metaphors used in publications about Traditional Chinese Medicine (TCM). TCM states, “We should see tumors as the partial manifestation of general malaise and we should not see the parts and overlook the whole,” which Stibbe connects to the recurring theme of balance in broader Chinese culture (p. 178). Billi’s uncle’s opinions reflect this deeply important cultural belief, so within the context of their conversation, he calls attention to Billi’s Western ethnocentrism, or “attitude that one’s own culture is better than others” (du Pré, 2017, p. 154). While Billi has always identified with her Chinese heritage, this experience makes her question if her U.S.-centric worldview has alienated her from her family and limited her ability to empathize with cultures outside the U.S.

Through its story of a single-family, The Farewell brings awareness to the multitude of challenges that families face when a loved one develops a life-threatening illness and how those challenges can be exacerbated across cultures. It explores the unique—and sometimes contested—roles a family can play in an attempt to show social support and the power constructing an illness narrative has in shaping the outcome of an illness. While it offers no easy answers about what is right and what is wrong (if such labels are even applicable) in handling a family member’s illness, The Farewell makes one thing evident: when the health of one is in jeopardy, the entire family is at stake.

Works Cited

Barnes, M. K., & Duck, S. (1994). Everyday communicative contexts for social support. In B.R. Burleson, T. L. Albrecht, & I.G. Sarason (Eds.), Communication of social support: Messages, interactions, relationships, and community (pp. 175-194). SAGE Publications.

du Pré, A. (2017). Communicating about health: Current issues and perspectives. (5th ed.). Oxford University Press.

Barry, C. A., Stevenson, F. A., Britten, N., Barber, N., & Bradley, C.P. (2001). Giving voice to the lifeworld: More humane, more effective medical care? A qualitative study of doctor-patient communication in general practice. Social Science and Medicine, 53(4), 487-505.

Dillard, S. J., Dutta, M., & Sun, W.S. (2014). Culture-centered engagement with delivery of health services: Co-constructing meanings of health in the Tzu Chi Foundation through Buddhist philosophy. Health Communication, 29(1), 147-156.

Sharf, B.F., & Vanderford, M.L. (2003). Illness narratives and the social construction of health. In T.L. Thompson, A.M. Dorsey, K.I. Miller, & R. Parrot (eds), Handbook of health communication (pp. 9-34). Lawrence Erlbaum.

Stibbe, A. (1996). The metaphorical construction of illness in Chinese culture. Journal of Asian Pacific Communication, 7(3), 177-188.

Wang, L. (Director). (2019). The Farewell. [Film]. A24.