Notes on the Existential and Interactional Dimensions of Authenticity: A Symbolic Interactionist Study of Breast Cancer Internet Forums

Abstract

Existential AuthenticityI still remember looking at people and hating them because they were going to get to live to be old and I wasn’t.Nobody here is stronger than you are [...] you can take charge […] if you cry all the time and live in fear […] it won’t make cancer go away.[Interaction on an Internet breast cancer forum]According to existential philosophy, death is an irrefutable aspect of life. Human existence is fundamentally being-toward-death (Sein-zum-Tode) inasmuch as it involves taking on the possibilities of self—a set of future projected personal choices and their corresponding consequences—and growing into them (Heidegger 232-233). Death is not to be seen as something that marks the end of life, but rather as something that is always already an inevitable part of it (227). One never exists without the other. Heidegger maintained that self-authenticity comprises an understanding and acceptance of the possibility that one always faces death. To live authentically, one must make choices within her or his own life, despite death’s looming. Ignoring or denying the facticity of death, or failing to maximise the possibilities of one’s life, is to live inauthentically (240-243).The first post in the epigraph above, taken from a discussion thread in an Internet forum on breast cancer, exemplifies, in the Heideggerian sense, an expression of inauthenticity. The individual had seemingly given up on the possibility of life and allowed a single possibility—death—to (at least temporarily) dictate her outlook on life. She rejected the new potentials that living with cancer presented. By giving away the possibility of choice for life, she gave up her true self. Nothingness replaced being (Sartre, Being), stripping away the authenticity of being for-itself, which is rooted in “spontaneous original choice that depends on the individual's freedom” (Onof).Such an analysis represents an historically dominant ontology of authenticity within philosophy. It has been closely followed by psychological theories of self, which posit that human beings have within them an essential, authentic self that confronts the external world. Heidegger, Sartre, and other existentialists drew on an even earlier, Romantic conception of authenticity going back at least as far as Rousseau, which contented that “individuals should follow their inner voices and resist the pressures and callings of society in order to recover intimate moral contact with themselves” (Lewin and Williams 65). Intimate moral contact with oneself is, however, lost within the auspices of contemporary societies (Gubrium and Holstein), where people are more concerned with appearing sincere (true to others) than authentic (true to themselves) (Trilling). From this perspective, people implicitly believe that an authentic self exists within them, yet it may remain largely out of reach. Inauthenticity may be the result of refusing to live authentically—for example, ignoring or rejecting choices that could lead to fulfillment—or the result of social and cultural structures that prevent individuals from expressing themselves authentically (Hochschild).Note, however, that the opening forum post is written in past tense. The person who wrote it later came to see herself as living authentically, despite, or more appropriately, because of the discourses of death that surround her condition. The second post, a response to the first, offered both encouragement and the vision of a self that was not defeated by cancer. Together, they articulate a socially constructed, interactionist ontology of the authentic cancer survivor: a person who is strong, who “can take charge,” that is, who can make spontaneous choices despite the chance of dying. This type of authentic self is not “really real” (Geertz); it is interactionally created and maintained. As we argue in this paper, authenticity is not an essential aspect of being, but is rather the product of a reflexive process of dialogue, both internally between the “I” and the “me” (Mead), and interpersonally among multiple people who come to agree upon what constitutes authenticity in a particular milieu (Vannini and Williams).In what follows, we explore the intermingling of two dimensions of authenticity: the existential dimension, which has to do with cancer patients’ being-toward-death andbeing-in-situation; and the interactional dimension, in which individuals simultaneously narrate cancer experiences and collaboratively construct the ideal meaning of an authentic cancer patient. We argue that the interactionist dimension is particularly important to understand because it facilitates the existential dimension. Whereas existentialism theorises people as naturally free and responsible agents who determine the course of their own lives, symbolic interactionism theorises the social foundation upon which people build pragmatic notions such as freedom and self-determination. For interactionists, a person’s sense of self (past, present, or future) does not naturally occur. Rather, “mind is a thoroughly social affair, a product of social experience” (Carreira da Silva 45). As human beings develop, they learn to take themselves as objects through their ongoing interactions with(in) the world, learning to interact with themselves and to define themselves in terms that often cohere with others’ definitions of them (Cooley). As we suggest in this paper, the authentic, existential self is thus not an inherent aspect of a person that is threatened by cancer to be saved or recovered. Rather, people dealing with cancer get together, online and elsewhere, and collaboratively construct what is for them an authentic image of the cancer survivor. This socially authentic image becomes the ideal upon which individuals modify their self-conceptions.Research Site and MethodsWe apply our understanding of the relation between the existential and interactional dimensions of authenticity to data we collected from an Internet forum populated by patients and survivors of breast cancer. A non-profit organisation initiated the forum around 2002 to supply general and technical information about breast cancer, with the declared goal of assisting women and their loved ones in gaining insight into the illness, its causes, and effects. As of early 2015, it was an established and reputable Internet forum that had more than 150,000 registered members who had engaged in upwards of 120,000 unique discussion topics spread across dozens of sub-forums. Forum participants could interact by reading messages, posting their own messages, and replying to others’ posts. The forum was public as it did not require registration for people to view messages, but registration was required to post messages. Members chose usernames, which could be their real or pseudonymous. The forum was segmented into 19 categories, with a total of 78 sub-forums. There were sub-forums with technical information regarding diagnosis, treatment, testing, prognosis, and specific graduations or types of breast cancer, as well as non-technical sub-forums that dealt with everyday means of recovery and/or coping with cancer, advocacies, and social networking. All the sub-forums allowed and encouraged participants to share their personal knowledge and experiences.              Our analysis follows the contours of interpretive interactionism, interactional narrative analysis, and ethnographic content analysis. Interpretive interactionism “signifies an attempt to join the traditional symbolic interactionist approach with the interpretive, phenomenological works of Heidegger […and] to make the world of lived experience directly accessible to the reader” (Denzin 14). As such, we have sought to clearly represent individuals’ reported experiences with cancer and how they relate to struggles for existential authenticity. Interactional narrative analysis highlights the co-constructed nature of the contexts, which “shape possibilities in […] women’s lives, their experiences of illness, and the specific illness narratives the women produce collaboratively” (Riessman 4; Bell). By focusing on the interactional qualities of the narratives produced by forum members, we seek to highlight how authenticity is collaboratively constructed. Lastly, ethnographic content analysis stresses the significant amount of time and effort that researchers put into the study of mediated texts. We did not discover the posts through “big data” techniques such as scraping (Kumar), nor did we cull them after conveniently scanning forum threads. Instead, we thoughtfully chose posts that represent the larger patterns of interaction that the second author identified over months of regular engagement in the forums.In this paper, we report on some characteristics of authenticity discourses. We have avoided providing pseudonyms or otherwise identifying individual posters because our analytic focus is on discourse and narrative, rather than on individuals (Bassett and O’Riordan). Nevertheless, throughout the research project (which is ongoing), we have carefully considered the ethics of Internet-based research involving experiences of a life-changing illness such as cancer. Following the ethical guidelines set forth by the Association of Internet Researchers (Markham and Buchanan), we focused on how our study, despite emphasising discourse, deals with people’s lived experiences. We support the ethical ideal that researchers studying vulnerable populations are obligated to protect those populations however possible (King; Rodham and Gavin). However, we found the forum to be full of discourse through which participants actively resisted labels such as “victim” and instead framed their online activities as important steps in maintaining or recovering an authentic sense of self, as well as being able to help others. Because the forum allows users to reveal as much or little about themselves as they choose, because the forum is open to the public for browsing, and because we do not impinge upon participants’ actions through our analysis of their interactions, we believe the benefits of the study—an improved understanding of how people collaboratively construct feelings of self-authenticity—outweigh any problems we have been able to imagine. Our ethics and methods are in line with other recent publications that use similar data (Love et al.; Sillence)Cancer and Existential CrisisThe Chinese use two brush strokes to write the word “crisis.” One brush stroke stands for danger; the other for opportunity. In a crisis, be aware of the danger—but recognize the opportunity.[John F. Kennedy]Cancer abruptly presents a person with a heightened sense of mortality. Knowledge of cancer represents a moment in which one faces the annihilation of the possibilities of being. “Cancer is a shocking thing … we don’t face death very often, so it’s overwhelming” [forum post]. It may lead to despair, aimlessness, and the loss of meaning, or to a realisation of the urgency to live life to the fullest. We borrow Denzin’s concept of an epiphany to theorise moments of existential crisis, such as when someone learns she has breast cancer. “In [epiphanies], personal character is manifested and made apparent” (Denzin 15). He postulates how a single epiphanic moment can “shatter a person's life and make it never the same again” (17). Sociologically, epiphanies occur in problematic situations that must be interpreted. They have multiple, variable meanings to the individual and others that may change with time, and they can turn lives around. Methodologically, epiphanies are both subjectively experienced but intersubjectively communicated and thus we can study them using interpretive methods.From an existentialist perspective, authenticity finds a tipping point in moments where contingencies or crises dominate. Individuals who acknowledge their being-in-situation and then confront it in the best possible way are authentic; those who do not are inauthentic.To be authentic is to realise one’s being-in-situation, no matter what this situation may happen to be: through a profound awareness, through the authentic realisation of one’s being-in-situation, one brings into existence the situation on one hand, and human existence on the other. (Sartre, War Diaries 54)Sartre’s being-in-situation relates directly to people’s experiences with cancer. A diagnosis can lead to existential crisis by suddenly increasing the salience of mortality, heightening awareness of one’s being-toward-death and thereby leading them to confront their being-in-situation. Many forms of interaction with self and other articulate this being-in-situation. We assume that most of these interactions are private, taking place behind closed doors with loved ones or with internally with oneself. However, the Internet has facilitated individuals’ ability to connect cancer as a personal trouble with cancer as a public issue (Høybye, Johansen, and Tjørnhøj-Thomsen; Klemm, Reppert, and Visich).EpiphaniesIn order to understand how forum participants understood existential authenticity for themselves, we first sought out discussions about the early moments after diagnosis. Many threads contained posts that illustrated how cancer diagnoses led to epiphanies. We found that, despite a common conception of epiphanies as sudden and immediate, they were not necessarily brief, as experiences of crisis occurred over time and had to be interpreted, both by the individual experiencing the crisis and by others. Notably, other forum members were crucial in helping provide interpretive frames for diagnosis.Shortly after I finished my tx [treatment] and was still very traumatized by it all, I met a woman […] who […] taught me something very profound, which is that when we experience something very traumatic, we have to figure out a way to use it for good, or we will continue to become a victim.” I think that’s a very powerful concept, and one of the reasons I continue to post [...] because helping newly-dx’ed [diagnosed] women helps me, too.The knowledge of cancer triggered powerful emotions in the form of spontaneous confusion and disenchantment, upheaving the continuity and planned direction of women’s lives. Many women translated the strong emotions they experienced alongside the support they received from others into an impetus to grow beyond the contingent misfortunes of cancer. In another thread, a member described that emotional spillovers and intense self-denial initially hindered her movement towards growth, but later she came to see such despair as unproductive and had to confront and overcome the being-in-situation (in other words, the crisis) of cancer.I went through a lot of the emotional changes you ladies are describing back then. The crying in the bathroom, the bargaining with god. Ultimately I think it made me focus on what was important and what absolutely was not […] I sought out new experiences, and I discarded emotional baggage that was just weighing me down […] I think the lessons learned back then have helped me face this challenge with more aplomb and a more optimistic outlook […. Cancer] can actually be a blessing in disguise.Another member agreed with this idea of cancer as a blessing:It can be a blessing if it is a catalyst to moving us to a better place emotionally, spiritually and even physically meaning we begin to take better care of ourselves and our health in every way. It isn’t easy but the changes are well worth it.From an existential perspective, rooted in a realist epistemology, narratives can be taken as reports about what “really happened.” As such, these co-constructed narratives articulate an epiphany-driven growth model of cancer-coping, where the illness stimulates a focus on one’sbeing-toward-death, necessitating a choice to live meaningfully or to reject such a choice. Similarly, among the many forum threads we observed, most contained narratives of adaptation and of wisdom gained from confronting and overcoming one’s being-in-situation. Discourses of confidence, optimism, and emotional resilience filled the forums.From a social constructionist perspective, however, we do not take these narratives to be reports of what necessarily “really” happened, but rather as moments through which reality itself is constructed. It is impossible to know whether the epiphanies described actually occurred as women described them, or whether they emerged, as Denzin has argued, over time through interaction and interpretation. Keeping this latter perspective in mind, we look again at forum data to see how members constructed a sense of self-authenticity, paying particular attention to the collaborative milieu in which individuals shared personal narratives (Bell).Collaboratively Constructing the Authenticity of Being-toward-DeathIn Time and Being, Heidegger writes, “higher than actuality stands possibility” (34), which we take here to emphasise Heidegger’s belief that authentic selves are rooted in the directions taken in response to crisis. If a cancer diagnosis is an “actuality,” then one ought to embrace the possibilities that extend from it. To allow the actuality of cancer to supersede other possibilities in life is to live (or die) inauthentically. We saw this existential phenomenon of being-toward-death in interactions throughout the forum. Many members mutually shared the notion that cancer raised awareness of mortality. Long-term members, called “veterans” in the forums, overwhelming agreed that the “right” way to handle this was to make a choice between meaningful or meaningless living.Cancer is a shocking thing […] we don’t face death very often, so it’s overwhelming […] but I’ve tried to liken it to how we all know the stats of getting in a car wreck, and yet we get in a car without our kids in a row and drive away, for we CHOOSE to live.In this and other examples, veterans used analogies and examples about how they “choose to live.” The use of analogy or example helped veterans and newer members alike connect the breadth of possibilities to mundane activities, which they defined as authentic. When a newer member complained, “my feelings are not just bubbling to the surface, they are streaming out of me. I can barely control telling others how it is and how I feel,” a veteran responded that physical exercise, being outdoors, and being in-the-present helped in coping with emotional turmoil. Such examples served as strategies through which those in crisis could “go from sick to well.” Another participant wrote that heeding veterans’ advice would help newer members “move even further along the path of a fulfilling life.”Contrary to what may seem from our examples so far to be an uplifting environment in which everyone succeeded at embracing the possibilities of life with cancer, some patients occasionally expressed their frustration with the personal troubles that emerged from their condition and associated life choices.Now, my life is turned upside-down, and I am filled with anxiety. This is all my own doing, since I decided that I needed to be true to myself. That was the one major thing that I had denied myself my entire life […] I think that I was the fool.This is an important example for two reasons. First, it represents, in existential terms, being-in-situation. For most people, life involves feelings of having been thrown into a world “not of our own making, already disposed by moods and particular commitments, with a past behind us that constrains our choices” (Varga and Guignon). The epiphanies that came with or after cancer diagnoses grossly exaggerated such feelings, as hundreds of individual forum posts demonstrated. The repetition of such personal narratives is significant, as we find epiphanies “in those interactional situations where personal troubles become public issues” (Denzin 18). The forum was one such interactional situation, comprising thousands of moments in which people openly admitted their being-in-situation and either sought or offered consolation or advice, or both. For Heidegger, admitting to being-in-situation is key to authenticity—if one hides from the facticity of her situation, there is no opportunity to choose a future (Heidegger 242-3).The second reason this is an important example is because it represents the interactional basis through which groups socially define and negotiate definitions of existential authenticity. The post stands as an interactional moment in which a participant called into question many veterans’ normative conceptions of embracing being-toward-death as necessary for an improvement in one’s quality of life. Having attested to how cancer had compelled her to make a choice between living authentically and inauthentically (a choice she had, until then, denied herself), this member then claimed that choosing authenticity had brought on additional turmoil and anxiety. Veterans and other members quickly rallied to redefine her choices as nonetheless necessary and right. Some highlighted the positive outcomes of making tough choices and downplayed the negative. In one response, a community member suggested that contracting breast cancer placed women in a position of exigency that compelled them to question life’s limitations.According to many veterans, the awareness of being-toward-death, while disruptive, offered at least as much good as it did bad. Participants collectively maintained a discourse in which individuals should worry less about things like “money” and to “absorb each moment as if it is a gift, because that is what this life is—a gift.” Other posters also highlighted how they dealt with being-toward-death and the self-authenticating decisions that came from it:Nothing like mortality in your face to make you realize that you want something different or more. I [...] have decided to make a major career change after all of this […] that makes me happy and makes a difference in the world.Life is a lot more vivid now. I notice the little things and am much grateful for them […] I am […] relaunching my career and writing a journal article with two colleagues.These and other posts discursively functioned to define the “proper” way to deal with being-toward-death by implicitly associating authenticity with the choices that individuals make and their consequences for self. In doing so, they collectively (re)construct the authenticity of a cancerous self, which “is at once a meaning from the past [acknowledged during the epiphany] and promise into a future [embracing being-toward-death] around a processual present [interacting with others as a method of working through being-in-situation]” (Weigert 37). Further, because self and social action dialectically shape one another, supporting one’s feeling of self-authenticity can motivate the individual towards “appropriate” future social actions, which will feed back into future self-authentications. Authenticity is thus not only a phenomenological and existential experience; it is a distinctly social and interactional process.ConclusionIn this paper we have attempted to articulate two ontological dimensions of authenticity—the existential and the interactional. Like other scholarly discussions of authenticity (for example, Taylor; Theodossopoulos; Vannini and Williams), we have argued that authenticity is not so much a subjective concept as it is a social, pragmatic concept that speaks to subjectivity.Beginning with Heidegger and Sartre, we investigated how members of an online cancer forum intersubjectively communicated ideas of being-toward-death and being-in-situation. Individuals experienced being-toward-death as crisis, which then required that they confront their being-in-situation and acknowledge the possibilities for life in the face of its finitude. Similar studies on cancer have considered the quest for authenticity in terms of development stage models (for example, Gullickson; Krumwiede and Krumwiede; Samson and Zerter; Westman, Bergenman and Andersson). Our findings are similar to the extent that we identified a re-orientation toward the meaning of life via epiphany, with resulting personal transformations through the re-ordering of values and social relationships, which patients themselves framed as authentic.However, we have sought to clarify an interactionist conceptualisation in which self-authenticity is facilitated by a community of people who come to share meanings about life and death. Shared meanings have to do not only with objects or events in people’s lives, but with the meaning of selves. Selves are always in the process of becoming; they are neither static nor fixed things (Mead). As such, authenticity itself is something that is situationally negotiated rather than finalized; one may move back and forth between more or less authentic self-feelings as one performs the self in various milieu (Goffman; Gubrium and Holstein, Williams).  We argue against the notion that existential authenticity is a purely psychological process and instead highlight how interpersonal communication facilitates perceptual shifts across the domains of being-toward-death and being-in-situation.Our study supports other studies of cancer forum interactions (for example, Chiu and Hsieh; Love et al.; Pinheiro et al.; Shim, Cappella, and Han), which have found that cycles of mutual interactions facilitate reciprocal understandings through shared narratives of thoughts, emotions, and behaviors, and provide structure, if not certainty, to cancer experiences. Forums serve as “communication interlocks” within which people from vastly different backgrounds become members of a meaningful subcultural community (Williams and Copes). Members rely on each other for a shared definition of the situation that legitimates their personal troubles and how they cope with them (Høybye et al.; Sillence). As patients gain knowledge from others on the forum, they in turn reproduce their newfound confidence and contribute to helping others. 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