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 and treatments."

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 stance.

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.

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