Two and a half years after her diagnosis of incurable brain cancer, Jinx Kalkman, 51, is a hearty and healthy-looking woman who takes care of her house in Towson, drives her car, volunteers in the Girl Scouts organization.
The recommended surgery, her husband Donald was told, could have killed her or left her severely disabled. But she came out of it talking and alert. The wretchedness of radiation and chemotherapy is behind her. The cancer is in remission. And, despite some problems with short-term memory and an occasional inability to produce certain words, she is, she says, "a walking miracle."
In the old days, that miracle would have been ascribed exclusively to God. More recently, it would have been seen as a victory for medical science.
But now, some of the credit might also be given to attitude -- Mrs. Kalkman's own feistiness, her deep and certain faith, and the emotional support provided by her family, her friends and her "I Can Cope" support group at Greater Baltimore Medical Center.
For people who believe in the mind's ability to change the body, these are heady days. A month ago, doctors in California reported that melanomapatients who had been in a support group had developed higher levels of a tumor-fighting factor in their blood than patients with the same kind of skin cancer who had not attended a group.
An earlier study, also from California, had shown that women with advanced breast cancer who attended a support group lived longer, on average, than women at a similar stage of disease who did not go.
These results, based on formal research, add support to anecdotal reports of remissions and recoveries that seem to be related as much to attitude as to medical technology.
Norman Cousins, former editor of The Saturday Review, claimed (in "Anatomy of an Illness") that laughter was the best medicine in his recovery from devastating illness. And Dr. Bernie Siegel, a Yale-affiliated surgeon, described exceptional attitudes and recoveries (in "Love, Medicine, and Miracles") among patients determined to live life to the fullest.
There is a lot of research indicating that mental state and physical state are intertwined. Loss, stress and depression have all been tied to decreased immunological function; optimism and feelings of power and control have been associated with an immunological boost.
"We can find immune system differences in patients with a positive attitude; that's been looked at a number of times," says Dr. Gary Cohen, director of the oncology center at GBMC. "And we suspect that immune status has something to do with how you do with cancer."
However, he warns: "Some of the zealots who have taken up the cause say a positive attitude will cure cancer. That's bull. I can tell you horror story after horror story of people who have sought special diets and better attitudes" instead of medical treatment.
Belief in attitudinal healing can also exact an emotional price.
"I have worked with patients who . . . felt they were somehow responsible for making themselves healthy and surviving. Then, if they have a recurrence, it is personally devastating; they blame themselves," says Michael Stefanek, Ph.D., assistant professor in oncology and medical psychology at the Johns Hopkins Medical Institutions.
Nevertheless, he does not discount the possibility that emotional factors might have an impact on survival. "This is an interesting area of research, but it's in its infancy," he says.
"The next step is to replicate the finding [about longer survival for support group members] not only with breast cancer, but with other cancers. All types of cancers have different reasons for developing, different treatments, different survival possibilities. If the study is replicated, and we do find there is some increased survival, the next step will be to determine why it occurs, what it is about support groups that's helpful."
While experts aren't sure about how, or even if, support groups help extend quantity of life, they can describe the ways the groups help improve quality of life.
"Patients gain knowledge and come from 'What can I do?' which is hopeless and helpless, to 'Here's what I can do,' which gives them a feeling of enhanced control," says Marlene Mason, the nurse who manages support programs for cancer patients at GBMC.
"The group also provides an opportunity for open communication between patients and their loved ones, and shows them it's OK to share what they are feeling openly."
Moreover, the support group can teach people how to talk to doctors, adds Rebecca Latham, director of social services at the University of Maryland Cancer Center.