Angelina Jolie Is Brave — but Not a Role Model

“Free are our wives who accomplished such a feat,” says Kleist’s “Penthesilea” of the Amazons. They chose self-mutilation in order to retain control over their lives. They cut away their right breasts so that they could draw the bow more efficiently.

This radical act of mutilation makes the legendary warriors of the ancient world fascinating and disconcerting at the same time. To live an independent life they had to destroy some of their femininity. The right breast was the sacrifice for overcoming their enemies and preserving their freedom. Thus they simultaneously created admiration and horror.

With regard to Angelina Jolie, the admiration is certainly greater than the consternation, although it is quite shocking — even though she was not the first woman to have a prophylactic mastectomy. In Germany alone, these operations have been performed approximately 150 times; in the U.S., the numbers are far higher. But this kind of treatment is little known to the public.

Although there were other celebrities, like Sharon Osbourne, wife of rock star Ozzy Osbourne, who underwent this operation, no one made a big fuss about it. But now Angelina Jolie has undergone this surgery — a global star with a reputation for being the most beautiful woman in the world.

She could have had far more dangerous operations, such as the removal of a cancerous portion of the intestine, a lung or an eye — none of which would have disturbed the public as much as the news that the woman held up as the symbol of inner and outer perfection for many people had undergone a mastectomy.

Confusion also intensified the message. After the first shock had passed, compassion, respect and interest for this particular matter took hold. The shock merged several facts: mourning over the destruction of beauty, farewell to an icon of perfection. It is a tragedy that such a tiny, invisible and untrustworthy “faulty gene” can cause such disappointment to a life that combines the arts, family and social engagement so successfully. Furthermore, this radical decision — the fear of cancer without having evidence and only as a precautionary measure — proved very disconcerting.

At first it sounded outrageous: A young woman removes her healthy breast as a precautionary measure only because she does not want to live her life in fear. Is that not hysterical, or at least presumptuous? Is this not an unprecedented act of autonomy taken over nature?

Control over One’s Own Body

Self-determination is exactly the point, as Jolie wrote in her letter in The New York Times, where she made her decision public: “Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.” She has decided to take control over her body. This might be shocking, but it is not unseemly. And actually, it is not quite as shocking considering the times we live in, which offer more than the two conditions of health and sickness.

The genetic diagnosis, which shows us all different kinds of possible illnesses, has created a third state, the one of the sick-healthy person. Through the opportunity to create a genetic risk profile, a strange intermediate position has arisen: The analyzed person is not a patient yet, but also does not feel healthy after knowing what may affect him or her.

In the Waiting Room of Disease

It is a fatal condition that is not easy to handle if you — like Jolie and all the other women with the BRCA-1 or BRCA-2 gene diagnosis — have such life-threatening prospects. This is a state that provokes a decision: wait or prevent. This is a choice to be made by the patient, not the doctor. Modern medicine relies on the responsible patient, even if it every so often asks too much of him or her. Young parents know how wearing it can be during pregnancy, trying to decide about prenatal diagnosis: How many tests does one dare to do on oneself and the unborn child? How many answers can one accept and how much ignorance can one accommodate? Knowing too much can put a strain on someone, although one many deny it.

For a woman with a family history of breast cancer, the mere existence of a genetic test can be challenging. If she undergoes a test, she might learn more about her breast cancer risk than she would like to know. If she refuses the test, she might ask herself whether she acted carelessly.

And as exaggerated it may sound — the idea of one day being asked by one’s own daughters, who may inherit cancer, why one has not done everything to prevent it — this horrific accusation might turn into sleepless nights. Genetic diagnosis seems like a fast-forward button for nightmares. Whatever way one treats the options of modern medicine, they put one under pressure.

Taking Action: For Some, an Illusion

Angelina Jolie’s decision puts women under pressure who would like to escape the helpless position of “waiting for the disease.”

Do a blood test and find out what to expect, then take action. As liberating as this call for self-determination sounds, one can imagine the high hopes it triggers and how nervous women will be to rush to hospitals and gynecologists. This has its positive side: The confusion about Jolie’s claim of responsibility, as well as the admiration, shows that much more information is required. For example, Jolie’s case is an exception: Less than 10 percent of all breast cancer cases are due to inherited genetic mutations.

There Is No Guarantee

Most cancers have different and often unknown causes; no genetic test can predict them. Even a regular mammogram, which is recommended for older women, offers no guarantee on early recognition. Only 76 percent of breast cancer cases of women who undergo regular x-ray examinations are discovered by the screening. In fact, a double mastectomy can reduce the risk of cancer but does not remove it completely.

That’s how it is — where there is knowledge, there is also doubt. Life is a risk. Someone can defeat cancer today but be run over by a car tomorrow. Autonomy does not mean eliminating all risks, but dealing with the threat. Dealing with it in a self-determined way also implies that no role model exists. Everyone has to discover it for themselves.