THE TYRANNY OF POSITIVE THINKING (continued)

Attitudes About Getting Cancer: Blaming the Victim

The additional negative consequences of these particular beliefs and myths about cancer lead to another phenomenon: blaming the person for getting cancer. Accusing questions, such as "Why did you need to get cancer?" or "You must have wanted to have cancer" suggest that the patient must have willed it to happen.

Helen, a young woman with cancer, said to me with great sadness. "I feel as if I have been victimized twice: once because I have a brain tumor for which there is no known cause and a second time because I am blamed, that it's my fault. It just isn't fair."

The late Barbara Boggs Sigmund, who was the mayor of Princeton, New Jersey, became furious at the suggestion that she was somehow to blame for her eye cancer (ocular melanoma) and its spread. In a New York Times op-ed piece (Figure 1) she expressed her rage at self-help books that presumed that "I had caused my own cancer" out of a "lack of self-love, need to be ill, or the wish to die, and that consequently, it was up to me to cure it." Ms. Sigmund repudiated the theory that "cancer cells are internalized anger gone on a field trip all over our bodies" or that "rah-rah-sis-boom-bah, I can beat the odds if I only learn to love myself enough."

I want to set the record straight right up front and give you the most up-to-date information from research studies regarding the role of the mind in causing cancer. It's not your fault that you have cancer. For most cancers, the cause is far from clear, and your psyche did not play a role in your developing it. You surely didn't "want it"! As we learn more about cancer prevention, we are learning about habits and behaviors that do increase cancer risk. But aside from cigarette smoking and lung cancer (see Chapter 12), the results are far from definitive concerning the causes of most cancers.

How did this phenomenon of blaming the patient for the disease come about? It undoubtedly is related to the fact that cancer has been a mystery for so long, as to both cause and cure. When we know little about something, we become even more frightened by it and develop myths to try to explain it and put it in some tolerable perspective. Cancer isn't the first disease to be saddled with myths. Until a cure for tuberculosis using antibiotics was found in the 1940s, it was said that people with certain personality traits developed tuberculosis and that stress or an emotional weakness led to contracting it. Such ideas disappeared as science established that tuberculosis was caused by a bacterial infection and drugs became available to cure it.

I saw some of the first patients with AIDS in New York in the early 1980s. In those early years, fears among the public were high because we didn't know the cause and we didn't know how the disease was transmitted. Many people were terrified until the virus was identified and the blood supply for transfusions was made safe. Panic diminished when scientists identified the highest risk to be from exposure to bodily fluids containing the AIDS virus, through either contaminated needles or sexual contact.

Similarly, as we know more about the causes of cancer and as more types of cancer become curable, the myths surrounding it become less powerful. Increasingly, we depend more on valid scientific information and less on long-held beliefs.

When misfortune strikes, it is a natural human tendency to search for a reason. The ready explanation is often "he must have brought it on himself." This reaction is similar to the response when someone is mugged. People say, "What were you doing in that neighborhood, at night, anyway?" Blaming the victim lets us say, "It can't happen to me." This response is a part of a bigger psychological picture: the need to attribute a cause to any catastrophic event, whether an earthquake or an illness. By blaming the victim, we get a false sense of security that we can prevent events that are beyond our control. We seek to make sense of something that surely makes no sense at all.

The fact is we can't always prevent cancer. Susan Sontag makes the strong point in Illness as Metaphor: illness is the night side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

So it makes no sense to blame the person who is ill. Being ill makes one feel alone enough, and being blamed adds to a feeling of distance and isolation, of somehow being "different" from others in a way we've never experienced before. As Robert, a young man with Hodgkin's disease, put it, "I'm not Robert anymore. Now I'm Robert with cancer. I feel alone with it." You may have encountered the blaming response from friends and family members. If so, I advise you to tell them, "I know you have my best interests at heart. But it's not helpful to tell me that I had something to do with my getting cancer. And it's not realistic to expect me to be positive twenty-four hours a day."