That positive attitude might not help your illness afterall

MEDICAL MATTERS

Medicine & Science

August 23, 2004|By Judy Foreman | Judy Foreman,SPECIAL TO THE SUN

Nancy Achin Audesse, 45, knows a thing or two about serious illness and optimism.

Audesse, executive director of the Massachusetts Board of Registration of Medicine, has had cancer four times: Hodgkin's disease when she was 14, the first round of breast cancer at 33, the second bout (which included a relapse of the first, plus a whole new tumor) at 34 and melanoma at 37.

"For someone who should have kicked off years ago, I'm fabulous," she said recently. "I'm here, doing good deeds, trying to make health care better." All along, she said, she has been "blessed by having a wacky sense of humor."

Despite her seemingly relentless optimism, Audesse, is quick to voice outrage at a belief that still runs rampant in our New Age-besotted culture: The idea that a positive attitude can mean the difference between life and death: "It's not fair to put that guilt and emotional burden on a person."

Indeed, there's little scientific evidence for the notion that attitude influences survival. A new, albeit flawed, study published in March in the journal Cancer showed that optimistic people with lung cancer fared no better than less optimistic patients.

Overall, for every study that suggests a survival advantage to having a positive attitude, there are at least three that find no such effect, said Dr. Pamela Goodwin, a medical oncologist who directs the Marvelle Koffler Breast Center at the University of Toronto.

What is a useful attitude, psychiatrists and cancer specialists say, is to adopt whatever philosophy helps you stick with your treatment plan and to be "authentic," that is, to acknowledge and express your honest feelings, positive or negative. And if at some point, it is no longer realistic to hope for a cure, to re-focus your hope toward a more realistic goal: maximizing day-to-day quality of life.

Dr. Jerome Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center and author of The Anatomy of Hope, welcomed the Australian study, despite its flaws. "There is this burden that patients carry -- this mantra in the popular mind that is derived from some of the New Age books of the 1970s -- that depression, anger and unprocessed emotions are what cause cancer. This is completely unsubstantiated," he says.

The insidious flip side of this belief, he adds, is that "as the disease progresses, your character flaws will lead to your own demise. This is extremely cruel, scientifically incorrect -- yet a very widely-held notion."

Likewise, Dr. Jimmie Holland, a psychiatrist at Memorial Sloan-Kettering Cancer Center in New York and author of The Human Side of Cancer, laments what she calls "the tyranny of positive thinking."

"People can be pessimistic and do well," she said. Optimism and pessimism are traits "that have nothing to do with coping with your illness."

In many ways, life-threatening illness is like rape. Many people find it easier to believe that ill fortune hits people who have somehow asked for it. The alternative is accepting that life can be a crapshoot, in which bad things happen to good people, for no fair reason.

"People would rather feel guilty than helpless -- that's why people go for this stuff," said Dr. David Spiegel, associate chair of psychiatry at Stanford University and author of Living Beyond Limits. People "want to have the fantasy of control, even if it makes them feel guilty."

Years ago, Spiegel conducted a study suggesting that women with advanced breast cancer who expressed their feelings in group therapy sessions lived 18 months longer than those who had no such therapy. But other researchers have been unable to replicate these findings.

The real message from this work, he said, is to not get caught in "the prison of positive thinking," but to "face what you have to face. If it makes you sad, cry. If it makes you angry, deal with that. If it makes you value the things you value, do that."

A hidden bonus, he added, is that some seriously ill patients discover that "cancer cures neurosis," meaning that they can shed the fruitless worries of ordinary life by facing mortality and learning to "really appreciate the things that matter."

Feeling that you have to fake it -- to help yourself or spare others your distress -- may even make things worse, at least psychologically, because feelings of "inauthenticity" can be distressing in themselves, said Ellen Langer, professor of psychology at Harvard University and author of The Power of Mindful Learning.

The bottom line? If you have cancer or any other serious disease and a positive attitude, that's great. At the very least -- and this is no small benefit -- that may improve your day-to-day quality of life.

But if you feel down, don't feel you have to keep "soldiering on as if nothing happened," Audesse advised. "Sometimes, you don't want to be courageous. You want to curl up in a corner and suck your thumb."

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