In The Human Side of Cancer, Jimmie C. Holland, M.D.,
of Memorial Sloan-Kettering Cancer Center, explores the broad
range of emotions people with cancer and their loved ones experience
from the moment of diagnosis through the treatment and its aftermath.
THE TYRANNY OF POSITIVE THINKING
I got really depressed when people said I should
think positive. I thought, "If that's what I have to do to
survive, I'm never going to make it."
-John, a fifty-two-year-old
man with melanoma
People keep telling me to be upbeat. I say,
"Screw you. I'll be however I please in dealing with this
cancer I've never been upbeat in my life."
-Michael, a forty-five-year-old
schoolteacher with recently diagnosed sarcoma
Several years ago, Jane, a forty-nine-year-old
woman with breast cancer, came to my office at Memorial Sloan-Kettering
Cancer Center in New York City. She had recently completed her
treatment, and her doctor had given her a clean bill of health,
meaning the doctors had found no evidence of cancer in her body.
Indeed, the glow of good health had returned to her cheeks.
But as she entered my office, Jane looked agitated.
Her body was tight and tense. As she sat down, I said, "I've
heard the good news from your doctor. I hear you're doing well."
"That's what he says," she
replied despondently, "but I feel like I'm losing the battle."
Puzzled, I asked her, "What makes you feel
that way?" She responded, "Well, my sister gave me a
book on how to survive cancer, and it says it's critical to keep
a positive attitude. I've tried to stay upbeat through the treatments,
but now that they're over, I'm more afraid and worried than ever.
I'm sad, and I can't feel positive about anything."
I said, "It must have been hard to stay
positive all the time over this past year, because I remember
how crummy you felt during those first days after each of your
six chemotherapy treatments."
"Yes, it's been hard when I've felt
so washed out and tired,' she
said. "And sometimes I've been so scared and frightened,
I wondered if I could get through it. Other times, I've been down
and sad and angry that this hit me when I had wanted to do so
much for my kids. . . "
"That sounds right on to me I said. "I
can't imagine how you could have been positive all through this
last year when you had to slog through so many difficult tests
Jane started to relax a little. "You mean
it's okay, and I haven't kept my cancer from being killed off
by chemotherapy because I couldn't do what that book said?"
"No, you haven't," I said with a smile.
"You're not superwoman, you know. You're wonderfully human
and normal. Most people experience the same reactions you've had
at some time."
"Great!" she said. "Because I
was thinking that if any more people tell me to think positive,
I'm going to slug them."
Jane was echoing a refrain I often hear from
people with cancer: the notion that feeling sad, scared, upset,
or angry is unacceptable and that emotions can somehow make your
tumor grow. And the sense that if the person is not in control
on the emotional plane all the time, the battle against the disease
will be lost. Of course, patients like Jane didn't come up with
this notion on their own. It's everywhere in our culture: in popular
books and tabloids on every newsstand, on talk shows, in TV movies.
For most patients, cancer is the most difficult
and frightening experience they have ever encountered. AH this
hype claiming that if you don't have a positive attitude and that
if you get depressed you are making your tumor grow faster invalidates
people's natural and understandable reactions to a threat to their
lives. That's what I mean by the tyranny of positive thinking.
This problem has been brought to me by well-meaning families who
say, for example, "You have to help Dad. He's going to die
because he isn't positive and he's not trying." On meeting
Dad, I see that he clearly is a stoic, a man who copes well in
his own quiet way. Maintaining a positive attitude just isn't
his style. Insisting that he put on a happy face and cope in a
way that would be foreign to him would actually be an added burden;
to rob him of a coping mechanism that has worked before seems
unfair, even cruel.
Another downside of this tyranny of positive thinking is that
Dad may feel guilty for failing his family if his disease should
advance and he had been unable to change to a more Pollyanna-like
Another time, I was called by a woman whose husband had died
of lung cancer. In her grief, she blamed herself for his death
because she had not gotten him to any cancer support groups that
could have taught him mind-body techniques, which she believed
might have saved him. I tried to reassure her that she had supported
him in every way and that these techniques would not likely have
carried the day for him in the face of advanced lung cancer.