No One Told My Grandfather He Had Cancer

Chinese culture’s way of handling health problems

Photo by National Cancer Institute on Unsplash

Someone in my family slipped up in a big way a couple of years back. They were talking about my grandfather’s cancer, and my grandfather was within hearing distance.

“Cancer? What cancer?” He asked.

It was a slip-up in a big way. In Chinese culture, when elderly people get sick, it’s traditional to tell a caretaker, but not the actual sick person themselves. I think the custom is, pardon my language, dumb as hell. If I were old and sick, I’d most certainly want to know. But I was in college and away from home — plus I try not to meddle in family affairs as a member of the younger generation.

If I were to speculate why this was the case, I would suspect it's the obligation a middle-aged adult generation feels towards caring for their elders. To care for your elders, logically, somehow means shielding them from news that can be harmful to them. And besides the constraints of heritage and culture, another reason why I would never intervene in a decision like that is the connection between parents and children will always take precedence over the connection between grandparents and grandchildren. It was my father’s father — not mine.

Marian Liu at The Washington Post also experienced her family keeping her grandmother’s cancer diagnosis from her grandmother. Citing the film The Farewell, a large reason for not telling the elderly, also, is the following:

“Chinese people have a saying: When people get cancer, they die. It’s not the cancer that kills them — it’s the fear.”

To my parents’ defense, my grandparents are both fearful for their health. At close to 80 years of age, my grandfather especially is always complaining about pain. I have never seen The Farewell, but why should I? I lived a similar circumstance. There’s a fault in keeping things hidden, but you have to be in the absurd culture to know the rationale behind why. This fear, according to Liu, is an Eastern way that emphasizes the role of community above that of the individual, a holistic way of dealing with someone’s mental and emotional health as well as their physical.

Finding out you have cancer is likely not good for your emotional health. Anyone can attest to that — but having it hidden from you and finding out later, well, that’s even worse. The characters of The Farewell call it “a good lie,” the idea that other people bear the burden of terminal or severe illness for them. Helen Hsu, the president of the Asian American Psychological Association, notes many Asian families decide not to reveal illnesses even to younger generations, like me. Many Asian students in her class reported their families kept cancer diagnoses from them for kids to focus on their studies.

To say I don’t agree with these cultural decisions is an understatement. But I will also refrain from judgment — this is likely what was done for generations. Robert Ito at the New York Times notes director Lulu Wang had the same experience with her family — her grandmother was diagnosed with Stage 4 lung cancer and her family didn’t tell her, believing nothing good could come from it. Wang thought the premise of her family situation would make a great film, but she didn’t find any Asian or American takers. American filmmakers thought the all-Asian cast and premise would be, in Ito’s words, “too Chinese” for an American market, while Chinese producers said “everybody in China does this” and insisted it wasn’t that dramatic of a premise.

The main character wrestles with whether to tell her grandmother about her prognosis. Again, I think it’s important to resist judgment of the cultural values behind hiding people’s illnesses from them. I wish it could have been another way, but I also wonder what it’s like from another perspective — the physician.

The Iran Journal of Public Health had authors talk about the differences in cultures, with European and North American societies preferring to tell the patient, while Asian countries prefer indirect truth-telling. The authors interviewed 180 physicians in the Shandong Province in China to talk about their attitudes of disclosing cancer diagnoses to patients. 98% of physicians said they would discuss cancer diagnoses with family members before discussing it with the patient. 82% said they would rather not tell the patient if the family requested they not tell.

Wang et al. refers to Confucianism as the reason why, since the belief system regards “human relations, rather than individual rights, as the basis of morality.” The family has the right to the medical decision for a family member. A family then deems it beneficial or harmful to tell the family member or not.

However, with the infusion of Western values, things are changing. Most Japanese patients have received disclosure of cancer diagnoses in the latter half of the 20th century, and 81% of physicians said they would rather know they had a cancer diagnosis than have people not tell them. The majority of cancer patients themselves in China want to know their diagnoses.

I think the old way must fade away, but in many ways, it is not going away soon. The bridge between worlds shows me what I believe to be right and what people like my parents believe to be right and what I believe to be right. When is lying about a relative’s cancer a “good lie?” In my mind, it never is, but writing this piece forced me to be more understanding to a different perspective.

Believer, Baltimore City special ed teacher, and 2:40 marathon runner. Diehard fan of “The Wire.” Email: ryanfan17@gmail.com. Support me: ko-fi.com/ryanfan

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