Attitude with an Attitude!

These days, most people have already heard something about the value of a positive attitude, taking charge of your treatment, and so forth. Rather than trying to cover the subject from ground zero, my aim here is to try and help you get the best out of the mind-body approach by helping you reap the benefits while avoiding some very common pitfalls and traps. If you’re interested in this area but haven’t encountered it before, then go out and get Bernie Siegel’s books. After you read this article you’ll be primed to get all of the gain with none of the blame!

My Experience

Immediately after my surgery, I was given several books on the mental aspects of surviving cancer, including Bernie Siegel's Love, Medicine & Miracles (Little did I know my experience would encompass all three!) and Carl Simonton's Getting Well Again. I am convinced that these books, particularkly Love, Medicine & Miracles, were instrumental in my survival. I just loved reading the anecdotes of people who beat the odds - they showed me that some people survive no matter what - even when it's "terminal", and equally importantly that what you do can make a difference in how things turn out. Illness isn't something that just happens to you, it's an experience in which you are an actor rather than a mere spectator. I also learned that there are many, many different paths to survival. Each person takes their own unique trajectory through cancer. Without Siegel and Simonton's books I'm not sure I would have realized there was hope or known to actively look for my path.

It turned out that using the mind to affect the body through relaxation and visualization, as these books advocated, wasn't my path. I tried relaxation and visualization tapes but I just couldn't stick with it because they bore me out of my skull! My path mainly turned out to be the path of information. "Path" may sound mystical but really all I mean is a way of coping that fit my personality, abilities, and situation.

These books also had much I couldn't accept (some of which I discuss in this article). But unlike one long term survivor I know who hurled her copy of Siegel's book against the wall in anger, I was hungry to extract every benefit I could while simply putting aside what I didn't agree with.

Three Important Things To Know

Your attitude is not the whole ball of wax. Yogi Berra once said about baseball, "90% of this game is half mental." In our case the situation isn't nearly as clear. Attitude may be one factor in some cases, but it's important that you know that you do not have to live up to some psychological or spiritual ideal to survive!

Surviving cancer is not as simple as having a "positive attitude" or being an optimist. You can be a depressed pessimist and still survive serious bad cancer (trust me, if I weren't right about that you wouldn't be reading these words). An optimist who is in deep denial might not seek out the best treatment. There is no one single right personality for surviving cancer.

You are not to blame for your cancer! Don't assume that it's even possible to know exactly why you got cancer. And even if your cancer was caused by behavior you knew was unhealthy, it doesn't matter now because the question now isn't "why?". It's always "what now?".

It’s Not Just About “Positive Thinking”

While I don’t think most proponents of mind body medicine believe it’s just a matter of positive thinking, I have known a lot of people who have simplified the view that attitude matters to think a constructive attitude is mainly a matter of optimism. I think optimism can be good, but it isn’t that simple.

The Conventional Mythology

In this view, the mind affects the body mainly through the immune system – a positive attitude improves the immune system while a negative attitude depresses it. Those with a positive attitude will do better and those with a negative attitude will do worse. In the most extreme version, how well you do depends entirely on your attitude (To be fair I don’t think the proponents of attitude actually believe this – but some people oversimplify it to that point)!

Stressing over Stress

In the days immediately following my diagnosis with metastatic disease, my mother was panicked over the notion that my depression and stress would damage my immune system. While I have no way to know whether my depression adversely affected my immune system, I had some spontaneous shrinkage of lung lesions (with progression of bone lesions) followed by a dramatic response to immunotherapy. If my stress over the diagnosis mattered at all, it must've been a minor factor.

I am sure that the mind does affect the immune system – and I would not be surprised if it really did turn out this affects the outcome for some people. But the immune system is incredibly complex – some say as complex as the brain – it’s not something that’s just on or off, healthy or unhealthy. At most your attitude is one influence on its state. And cancer is complex too. Some cancers are much, much easier for the immune system to tackle than others. Surviving cancer doesn’t necessarily require having a special immune system.

My Take: If you can think positive despite your cancer diagnosis you will be happier and less stressed. But it’s natural to be distressed with a cancer diagnosis and not everyone has a naturally optimistic personality. It’s worth looking into how things can be better! If you can find a way to improve your mood or attitude by any means – support groups, counseling, relaxation, visualization, spiritual practice or even climbing a mountain or falling in love – that’s only good. But don’t assume you’ll do badly or panic just because you are suffering stress and depression due to your situation. It’s only human. And again, optimism or pessimism is only part of your attitude – other qualities, other dimensions of attitude can also help you.

Adding Another Dimension: Steve’s Improved Mythology

Another important quality, beyond optimism, is your willingness to be an active participant in your own treatment. Being active has benefits just as being optimistic does. Being active can definitely improve your outcome through a determination both to get the best treatment and to make the treatment you do get be the best it can be. I think that this mechanism for improving odds is on far more solid ground then the optimism-immune system hypothesis. There is no question that seeking the best treatment makes the difference for some. Nothing complex or mystical is needed here!

What many people don’t realize is that whether you or not you have a fighting spirit is independent of whether or not you are an optimist. You can be an optimist but passive (Lower right quadrant of the graph). This describes people who are in denial. Denial may have real benefits because it minimizes distress but people in denial risk not getting the best treatment so denial is not the optimal attitude even though it involves optimism. Of course if the prognosis is terrific with standard treatment, there may be no reason to be particularly active. Optimistic but passive may not be denial, but rather a perfectly realistic response to the situation.

You can also be a pessimist but active (which describes me!). This is the upper left quadrant of the graph. The name of this game is grim determination. Although extreme distress and depression inherently reduce the quality of life, and really could have adverse physiological effects, believing the odds are against you can be a positive motivation to make something else happen. This attitude may not be perfect but can be a surprisingly effective way of coping as it was for me.

Even if you’re a depressed pessimist who is unable to act, curled up in a ball in the bottom left corner of the graph (the quadrant of hopelessness), remember that attitude is far from everything. You might respond very well to treatment anyway, and though it may not seem like it now, your current distress may be only temporary. If your pessimism is unjustified – if you’re chronically depressed even when the odds are good – it would pay to seek professional help.

My myth may be an improved myth but its still a myth! As you well know, there aren’t just four kinds of people in the world (though my ex-wife says there are only three kinds of people – those who can count and those who can’t!). Your attitude and personality are made up of many traits which could aid or hinder your recovery. Every person is unique. It’s complicated.

I Yam Who I Am (And So Are You)

Whatever your attitude, it comes from both who you are and from the situation. Although change is always a possibility, many people are not naturally go-getters who challenge authority, or optimists whatever the odds. How you change and adapt will depend on your natural proclivities. You might be able to become more active, even though optimism doesn’t come easily, or vice versa. Even if a different attitude would be more productive, you probably can’t totally reconfigure your personality at the drop of a hat (or a cancer diagnosis). Your way of coping is not something to be prescribed by some book (or website), but will always be a unique blend of your own personality, your wisdom, and your particular adaptations to the situation. Mind-body approaches can help you to find hope and learn to cope – just don’t feel you need to meet some heroic ideal.

Question Four: Have You Stopped Beating Your Wife Yet?
(Or don’t play the new age blame game)

Love, Medicine & Miracles asks you four questions. Question Four (said to be the most important) is:

“Why did you need the illness?”

My response was, “Say whutt? Like hell I did!”
(But I didn’t throw Siegel’s book at the wall either)

The New Age Versus Random Reality

In New Age mystical thinking, there are no coincidences. Everything happens for a reason, and you can access this reason through magical intuition. So if you get cancer, there must be a cosmic reason for it. If you survive, there is a cosmic reason for that too. If you suffer a recurrence, why it must be because you harbor some psychic defect.

What rubbish! This kind of thinking leads directly to superstition and to blaming yourself for things which are certainly not your fault. We all naturally seek a comfortable certainty, so it takes a certain amount of courage to squarely face that many things, quite possibly including your illness, simply do not have any determinable cause or reason.

New Age mystics (and many other folks) fail to see how many things are deeply and indeed almost magically unpredictable. Like it or not, your life is profoundly affected by unpredictable events on a molecular level. Tiny events can have huge and unpredictable ramifications as in the classic tale of Chaos Theory where a butterfly flapping its wings in Beijing may lead to a storm in Peoria weeks later. Consider that damage to the DNA in just one of your cells can lead to cancer years later. Molecular details of your genes and your tumor can determine if you will respond to treatment or not respond. These things are fundamentally unpredictable. The magic here, if you are open to it, is that when you can't predict what's next, the unexpected is more than possible. While many recoil from the unexpected and unpredictable, realize that the possibilities include unexpected and unaccountable blessings!

Two Examples

Case 1: At a retreat at Ghost Ranch, New Mexico, a workshop speaker describes how her father had a long standing fear of getting lung cancer because both his father and his grandfather before him had died from that cancer. He gets lung cancer and dies from it. The speaker believes her father got lung cancer because of his fear of getting it (Thus blaming her father for his illness). If it's questionable that this man's fears caused his cancer, it's patently absurd to assume that fear of a specific cancer could cause just that specific cancer. More likely explanations are that a genetic susceptibility to lung cancer runs in this family, or that since lung cancer is after all, a common disease, it was just an unfortunate coincidence.

Case 2: A psychotherapist related to me this story of a friend of hers with breast cancer: Immediately after this woman learned her breast cancer had recurred, her friends demanded to know what she had done to cause it. Her friends' assumption that she was somehow to blame for her recurrence made her so angry she just wanted to strangle them (and no wonder)! It is completely unreasonable (as well as terribly insulting) to just assume that a cancer recurrence must be caused by some personality defect or bad attitude. Like most cancers, breast cancer is well known to recur unpredictably.

It’s not just Siegel, but a general miasma pervading the whole mind-body movement which blames the patient for his cancer (to be fair I shouldn’t paint them all with the same brush – but if you delve into the popular materials you almost cannot fail to encounter this catastrophically wrong headed nonsense).

Much like the lawyers question which assumes you beat your wife, Question Four assumes that all illness arises from some need to be sick. Despite attempts to deny it, this is blaming the victim. Yes, it is certain that lifestyle and stress can contribute to illness. But this doesn’t mean that every illness has a major psychological cause – I know of no evidence that could possibly justify such an extreme position. If you believe this to be so, for starters, you should ask yourself how patients with familial forms of cancer “needed” to be born with a genetic defect! If you breathed asbestos dust 30 years ago and now have a diagnosis of mesothelioma (a cancer almost always caused by asbestos exposure) – is that because you psychologically needed to get mesothelioma, or is it because you were exposed to a powerful carcinogen? If it’s all in the mind, how come people who are exposed to this dust get that cancer?

Siegel relates Question Four to “benefits” of being sick. I am sure many people do derive some sort of benefit from their illness, such as a release from more ordinary pressures of life (If you ask me, replacing the pressures of ordinary life by those of a life and death illness isn’t much of a trade!) That still doesn’t mean they either caused or needed their illness. Just because the cloud might have a sort of silver lining, doesn’t mean the cloud was created for its silver lining!

Crisis as Opportunity

If your cancer diagnosis motivates you to re-examine your life – if it forces you to see how precious each minute of life is and pushes you to be true to your spirit, that is all good. Whether you survive longer or not, you will be able to make your remaining time more meaningful. If you do find this kind of silver lining in your illness it still doesn’t mean you “needed” it or caused it. Some people even come to regard their cancer as a “gift” but even that doesn’t mean they “needed” to get cancer (If my cancer was a “gift”, I want to know where the return counter is!).

Looking for Causes in Your Life

How I Confronted "Why?"

The day after my diagnosis I asked myself, "Why me?" and immediately realized that I would never know why I got cancer. There was no clue in either my lifestyle or my family history. Plunged into the chaos of trying to cope with the diagnosis, I decided quite deliberately that I needed to focus every bit of my energy on survival and none of it on "why?", and so for the next year I didn't spend even one second on "why?". Deciding that took me less than thirty seconds.

Many of these books ask you to look for stresses and traumatic events in the few years preceding your cancer diagnosis. But most people have some discontent and stress, and many people have suffered some kind of traumatic event in the relatively recent past. Almost anyone can find areas of discontent, stress, and trauma in their life. So when you find them in your life it’s easy to think, “Aha! My imperfections are the cause of my cancer”, especially when it’s suggested to you that some psychic discontent is probably the cause. Of course, since most people who don’t have cancer could also find stress in their life, it doesn’t prove a thing if your life isn’t perfect either.

On the other hand, sometimes life-style choices really do play a role. The classic example has to be smoking and lung cancer. In other cases it’s less clear – you might think if you’d been a health nut instead of a meat and potatoes kinda guy you wouldn’t have colon or prostate cancer, but in reality these connections are much fuzzier than with smoking and lung cancer. In many cases, there just isn’t even a hint why. Either way, if some lifestyle choice might have caused your cancer, I urge you not to spend your energy on self-blame. Instead remember that the real question isn’t “why?” It is:

“What Now?”

If your diagnosis motivates you to adopt a healthier lifestyle, that’s a positive whether or not any of your habits might have caused your cancer! I urge yourself spend your energy on what you can do today, not on your past, which you cannot change.

Knowing The Cause Doesn’t Mean You Know the Cure

Finally, remember that even if you can identify a cause in your lifestyle, it is not necessarily so that eliminating the cause will have any effect on the cancer. Cancer sits at the end of a long chain of events. Fixing a cause of one of the early steps in the chain of events which leads to cancer after the fact, (say DNA damage from a chemical carcinogen), won’t stop the cancer once it is fully established (though it might prevent a second cancer). Once the forest is ablaze, putting out the campfire doesn’t help.

You Don’t Need to Know the Cause to be Cured

I think it’s more productive to focus on what will actually help you than on causes, whether it’s treatment or lifestyle modifications. Some of these things might relate to causes and others may not. For instance, if your cancer was caused by smoking, quitting won’t cure the cancer, but it will reduce the chance of a second cancer and make you better able to withstand treatment. Very often the cure has nothing whatsoever to do with the cause. Though advanced testicular cancer is usually cured with platinum based chemotherapy, testicular cancer certainly isn’t caused by chemo deficiency!

Intuition and Common Sense

Siegel and many others urge you to do whatever feels right, or even to follow the advice of a channeled spirit guide as if your intuition is inherently wiser than your ordinary thoughts and feelings. I believe that looking to your intuition is a way to pay attention to how you really feel and that it can clarify your true desires. Paying attention to your intuition can be a way of giving yourself permission to factor your own goals and values into what your doctors and others are telling you is the right decision. But I don’t think intuition is magic which is always right or even always sensible. I urge you to cross check your intuition with common sense – in other words, do it if it feels right if it also actually makes sense! I also think your sub-conscious works best when it has all the facts – your intuition will be better if you are deeply involved in understanding your options. Intuition and information complement each other.

When facing a difficult decision where you’re not sure which way to go, it’s tempting to look to intuition to break the tie. If you have all the facts and have thought it through, I think this makes sense. But sometimes the uncertainty means you could benefit by searching harder and deeper for information that will help you to the best possible decision. What’s hard is to know when it’s time to quit searching and decide.

This CancerGuide Page By Steve Dunn. © Steve Dunn
Page Created: July 17, 2002, Last Updated: July 26, 2002