THE TYRANNY OF POSITIVE THINKING (continued)

Attitudes and Surviving Cancer

The same attitudes that are at work in blaming you for having caused the cancer in the first place are often also applied in explaining why you are cured or not. Attitudes and personality, by affecting your behavior, do often lead to your getting an early diagnosis of cancer. This alone is a key factor in cure. For example, if you are the type of person who has a proper respect for staying healthy, you go to the doctor for regular checkups or when troubling symptoms develop, you cooperate with your doctor and follow advice carefully, and by so doing you are apt to discover a cancer at an early stage, should it develop. We know a lot about the ways that our personality and emotions lead us to engage in habits or behaviors that increase our risk of getting cancer. Good examples are smoking and lung cancer, and sunburn and malignant melanoma.

We also know a lot about how attitudes and emotions can affect our endocrine and immune systems as we respond to stress. However, it is less clear whether attitudes and emotions, by themselves, can change an internal process to make an impact on tumor growth or the body's response to it. We don't know whether the blips in hormone and immune levels due to stress have any connection to cancer at all or, should there be any such connection, how it works.

Indeed, research in the new field of psychoneuroimmunology--exploring connections between the brain, the hormonal (endocrine) system, and the immune system-has given us an exciting picture of the body's responses to stress. It is known that different types of stress, ranging from taking medical school exams to going through a divorce, affect both hormones and the immune system. The evidence linking stress and risk of heart disease is quite strong. Stress exerts its effect through the nervous system, which in turn affects heart rate, blood pressure, and hormones. But whether this is so for cancer is far less clear. Nevertheless, people today have many questions, based on what they've read and what their friends tell them about cancer and the mind. And people make a lot of mistakes and premature assumptions on the basis of incomplete research. They think, for instance, that if the stress of divorce affects immune function, then it follows that "my divorce must have caused my cancer." This kind of extrapolation, which is without scientific evidence, leads to many false assumptions and conclusions. In Chapter 3, we attempt to separate facts as we know them now from the hype and plain misinformation surrounding the mind-body-cancer connection.

It is common for people who have survived cancer to look back on the experience and attribute their survival to their positive thinking, discounting the fact that they also sought medical help early and had the best-known treatment for their cancer. This belief not only provides an explanation for their cure from cancer, but also buffers fears that it will come back. "If I licked it once with this attitude, then I can keep it from coming back the same way." This belief is reassuring and provides a way of coping with the normal fears people have about the cancer returning. A good attitude surely leads to the best and most logical approach to getting cancer successfully treated. But I have also known people with positive attitudes, who sought early diagnosis and treatment, and who simply weren't as fortunate. I have seen patients who had no belief in the mind-body connection and who discounted the importance of their attitude completely, yet they survived.

Ernie, a lawyer who was absolutely negative about every aspect of his diagnosis and treatment of lymphoma, was convinced from Day 1 that he would not survive. He explained that he usually saw the dark side of things and the glass as half-empty. Although he stuck faithfully to his chemotherapy treatment, no amount of encouragement or "good" results on his medical tests could persuade him he was doing well. He would say over and over again, "Dr. Holland, I'm not going to make it." It's now been eighteen years since his treatment; he's been cancer free ever since. He's still going strong and is still as much a pessimist as ever. Ernie is an example of how attitude is not the whole story in surviving cancer.

My view is that if a positive attitude comes naturally to you, fine. Some people are optimistic, confident, and outgoing in virtually every situation. Your attitude toward illness reflects your attitude toward life in general and your handling of day-to-day stresses and hassles. There is no way you will see that the glass is half-empty if you are certain that it is half-full. And the converse is true: If you see the glass as half-empty, I can't convince you that it is half-full. It is not easy to change people's ingrained attitudes and patterns of coping.

It's dangerous to generalize about attitudes and their impact on cancer without more information. The present-day tyranny of positive thinking sometimes victimizes people. If thinking positively works for you, well and good. If it doesn't, use the coping style that's natural to you and has worked in the past. (I discuss different modes of coping in Chapter 6.) Trying to get you to "put on a happy face," to pretend you are feeling confident when in fact you are feeling tremendously fearful and upset, can have a downside. By feigning confidence and ease about your illness and its treatment, you may cut off help and support from others. You may also be hiding anxious and depressed feelings that could be alleviated if you told your doctor how you really feel. Also, this tyranny of positive thinking can inhibit you from getting the help you may need out of fear of disappointing your loved ones or admitting to a personality some people think is fatal. If you are surrounded by "the positive attitude police'" ask your doctor, clergy, or therapist to call them off, letting them know that this is an important time for you to be honest about your feelings so that you can get all the help you need. (Or give your or friends this chapter to read.)

It is ironic that many negative, pessinuistic people survive cancer, while others who believe positive attitudes will cure it do not. While members of the former group are stunned by their survival, those in the latter group are made to feel guilty or ashamed that they were not "up to" beating an aggressive disease. This is unfair. I do not believe for an instant that people whose cancer progresses have a weaker spirit or character than anyone else.