Now that I’ve knocked Pharyngula a few times, I guess I’ll do a post favoring some good ol’ enlightenment rationalism, based on this study from the BBC.
An oft-touted example of mind over matter is the efficacy of optimism in aiding cancer cures. A good outlook is supposed to equal a cure. “How brave and corageous she was,” we hear of those who pull through. “She struggled and she overcame.”
Sometimes nastier stories drift in of assumptions that people who died from cancer somehow sinned in succumbing. They gave up. They were weak. They failed to fight. They didn’t want to live. They weren’t strong enough.
My mom had such an anecdote a few years ago, to describe the way that her hairdresser’s husband had died. “[My hairdresser] says he gave up, and died a week after that. What a shame. It’s too bad he gave up.”
The appeal of such a narrative is obvious — it gives us a sense that we control our own fates. It gives us a tool — optomism — to hold against insurmountable odds. If we can be positive and uplifting enough, we have a chance against illness. It’s only those who give up that die.
Optomism as medical cure is a secular replacement for prayer as medical cure. For some religious people, it’s a way to talk about the power of prayer in language that’s acceptable to the ears of people who don’t believe in the efficacy of appealing to god for intervention. For areligious people — like my mother — it can be a replacement for prayer, a way of capturing the sense of control that we gain from something like prayer, and applying it to a (mostly) materialist view of the universe.
Unfortunately, it doesn’t actually work.
The power of the mind has been overestimated when it comes to fighting cancer, US scientists say.
They said they found that a patient’s positive or negative emotional state had no direct bearing on cancer survival or disease progression.
They do suggest that cancer patients continue with therapy and working toward a positive attitude — but they suggest it so that cancer patients can be happier, not as a life-saving measure. From the article, “Lead author Dr James Coyne said: “If cancer patients want psychotherapy or to be in a support group, they should be given the opportunity. There can be lots of emotional and social benefits. But they should not seek such experiences solely on the expectation that they are extending their lives.”
Of course, on one hand, it’s depressing to discover that we can’t cure ourselves through sheer cheerful bloodymindedness. It’s hard to acknowledge that we don’t have control over these things, that our outcomes are determined by factors we can’t affect.
I am reminded of the debates about rape, in which people will go to great lengths to blame the victim. We understand why many men do it, but I’ve always found it insightful when feminists observe that one reason many women will do it, too, is because women want to convince themselves that they have the power not to be raped. That if they are not sluts, that if they don’t drink at the wrong time, or trust the wrong person, or go out at night, or wear a short skirt, they can eliminate the possibility of being attacked.
We know it’s not true with rape, and now we know it’s not true with cancer either: you can’t force yourself to be safe, or be cured. But the silver lining in both situations is the same. If we accept that optimism and ineffective safety measures are not the protection that we want to claim, then we can stop blaming the victim. We can stop suggesting that women invite their own rapes, and we can stop suggesting that people invite their deaths because they don’t try hard enough to maintain a sunny disposition.
Julia Frater, of Cancer Research UK, said: “People with cancer can feel under pressure to cope well with their disease and treatment and to stay on top of things. They are often urged to feel positive.
“These results should reassure them that if they don’t feel like this, it’s okay. Many people do feel worried or low following a diagnosis and this isn’t likely to affect the outcome of their treatment.”
This narrative makes me crazy. The whole positive attitude=getting better thing is SO annoying if you have ever been in a position of someone who is really sick. It doesn’t just happen to cancer patients. I was in the hospital recovering from a life threatening reaction to anesthesia when I had my wisdom teeth pulled. It was an unbelievable experience for a 17 year old – 3 weeks in ICU, on a respirator, blah blah blah. By the time I was in rehab I had been in the hospital almost a month and had to learn to walk all over again because the time in bed had caused significant atrophy in my legs. My mom had purchased me a t-shirt that said, “I don’t wanna!” and it was fitting for my attitude at the time. I was so sick of doctors, residents, interns, med students (I’m an “interesting” case and a good “learning tool” after all). The head of the rehab dept (who needed to learn a thing or two about bedside manner) came up to me during one of my PT sessions and said, “You can’t wear that shirt. Next time I want to see you in a shirt that says, “I wanna!” and he said it in the most demeaning tone. I was furious. My 17 year old snappy self replied, “When you’ve been through what I’ve been through you can tell me what to wear. Till then, shut up and leave me alone.” My poor father (who worked with the guy, who was of course a head honcho, super important doc) was mortified.
Anyway, it’s the kind of thing that people tell a patient because it makes them feel better and it just sucks. Because what a sick person really needs to hear is that it’s ok to be mad, angry and sad. When you are a sick person, you sometimes spend so much time and energy making sure your loved ones know that you are “ok” that people forget you are human and need to deal with your own emotions.
And, for the people who don’t survive it’s a disgrace to their memory to suggest he or she just “gave up.” My mother in law said something to that effect to me about my mom right after my mom died and it’s something I’ll never forgive her for. It was hard enough losing my mom. I didn’t need to hear that I lost her because she “gave up.” Forget about the fact that it’s bull shit. It’s hurtful and not fair to her memory.
There’s a whole lot about that narrative that upsets me.
Unfortunately, the parallel between cancer and rape is not really legitimate.
It is inconceivable that individuals can “be responsible” for being the victim of crime, and this is most obviously clear in the case of sexual assault, and therefore the whole debate on the issue is reactionary hogwash.
However, we know so little about the immune system that it remains perfectly possible that a sanguine attitude towards a life-threatening disease is potentially positive. It is worth noting that the actual article to which you linked was more cautious; it merely indicated that it was not clear that optimism would save you. Indeed, the article made it clear that optimism would be good for you in other ways.
I suppose it can be extremely annoying, as the previous poster indicates, to have cloying do-gooders urging you to cheer up. I remember when I woke up in hospital at the age of 5, after a hypoglycaemic coma, a nurse told me to be more cheerful, and I’m rather proud that at that age I asked her “What have I got to be cheerful about?”. But then again, my state of health didn’t depend on my state of mind, in that particular case.
I’m hearing that “she gave up” over and over again right now about my mother-in-law (who died last week), and it just makes me want to scream and bash things. She “gave up” because she had three months of unrelenting misery and increasing weakness without even any decent symptomatic relief let alone a diagnosis or actual attempt at a cure. But somehow it seems to make people feel better to feel that she was responsible, rather than her body shutting down around her no matter what she did.
And now I’m going off to kick-boxing to scream and hit things.
“But then again, my state of health didn’t depend on my state of mind, in that particular case.”
I’m sorry, and what exactly is it about cancer that makes the state of health dependent on the state of mind?
Generally speaking, attempting to keep a positive attitude about things and what not is good for a person’s mental health, regardless of other states of health. Occassionally, if you slide too far into anger and depression that begins to overtake you and everything becomes harder including going to appointments, taking meds, taking care of yourself in general. I won’t deny that. However, it is necessary to allow people to express feelings of anger and sadness too because bottling it up just makes the depression hidden, and then even harder to fight.
I think attempting to stay positive and wanting to get better are important, but they are not life saving. Let’s get real here. Blaming people who have died by saying he or she “gave up” is a way to make the rest of us feel better because it allows us to retain the illusion that we have some control over our mortality, and that’s bullshit. One can do all the right things – exercise regularly, eat a healthy well balanced diet, go to a primary care physician for regular check ups and preventatie care and still get hit by a car and die. It amuses me that people think they have some sort of control over their own mortality. When these people are sick or injured they will have one hell of a time adjusting.
As for this statement, “It is inconceivable that individuals can “be responsible” for being the victim of crime, and this is most obviously clear in the case of sexual assault, and therefore the whole debate on the issue is reactionary hogwash.”
Have you never heard of a case of people saying a rape victim deserved it because she was dressed like a slut, or she was drinking and should have known better, or she shouldn’t accept a ride from an aquaintance, or she should have stayed with her friends, etc etc etc. I hear those stories ALL THE TIME. It’s not reactionary hogwash, it’s EXACTLY the same mentality. Rape victims are at fault for rape because they could have done any number of things to avoid being raped. Just like terminal cancer patients are at fault for dying because they should have had a better attitude and then they would have lived. Of COURSE it’s crap that rape victims are at fault. BUT, that doesn’t mean that reasoning and “explanation” doesn’t exist. It’s also crap that a terminal cancer patient is at fault for dying because she “gave up.” That’s the annalogy.
The opposite pole, which the quoted article seems to exemplify, is similarly dehumanizing — it’s OK for patients to seek support groups or therapy even if it won’t increase their survival, is it? Well, if length of life isn’t going to be affected, then quality of life is pretty much all you’ve got left to work on. (How important? Surveys have shown that some patients, at least, are willing to trade at least 6 months of additional life for better quality of life during the time they have.) That probably means a different set of goals for some support groups and therapists, but if anything it makes taking some control of your psyche at least as important.
Maybe there’s an analogy there to something like basic self-defense classes, which can reduce intimidation even if they don’t erase risk.
With respect Kate L, isn’t what you are describing a positive attitude? A resolute refusal to yield to bullshit, to do it your way and tell others to go to hell if necessary. There’s many a bubbly, sunny temperament hiding profound depression or discomfort with oneself, so unable to be, that you cannot allow how you really feel to show, unabashed.
I’m disappointed that your analysis of positivity is so shallow. My reading of this report is that one should still be positive but not expect it to cure, that sounds fair enough to me. As you yourself said,people can be merciless asking you to play act for them.
it’s interesting to think how this plays into disability as a whole… the whole “you can overcome” mantra is one that places the problem on the disability and not society’s refusal to be accessible. i think it also feeds into society’s need of heroes and inspirational people.
With respect Kate L, isn’t what you are describing a positive attitude?
No, it isn’t. “Unyielding to bullshit” isn’t “a positive attitude.” It is almost universally regarded as being high evidence of a tempermental rude jerk, no matter how hard I try to convince people that honesty and sincerity are more important than artificial niceness or prevarication.
When you’re sick, “a positive attitude” they’re referring to is remaining upbeat, confident in our chances, a willingness to endure all kinds of suffering with a friendly nature and lack of complaining, and absolute slavish obedience to the dictates of your medical staff. All of which may or may not increase your odds of survival, but doesn’t depress the non-sick people around you nearly as much.
Wanting to live doesn’t keep you alive any more than wanting to fly prevents you from falling. A good attitude has as much likelihood of helping you survive cancer as it does helping you survive a nazi death camp. It makes us feel a whole lot better thinking there’s some reason behind it, but it’s an illusion and in reality does nothing more than insult the dead by claiming they just didn’t want it enough. Like if everybody passed some desire-to-live threshold, there would be no victims of the holocaust and smoking cigarettes would be as safe a hobby as fly fishing.
Having had a ring-side seat recently for the insistence on positive thinking and keeping a good attitude, let me add another consequence — thinking postively feeds right into denial on the part of both the terminal patient and the patient’s friends and relatives. Denial leads to procrastination on issues like DNR orders, making sure the will is up to date, doing pre-planning for the funeral, and other end of life issues no one really wants to think about. End result? Futile (and expensive) attempts at resuscitation, people dying intestate, messy probate issues, etc.
When my cousin and good friend died a couple years ago, her siblings were in denial so deep they talked her out of seeing an attorney about a will until she was in the hospital with literally only hours to live. They kept insisting a positive attitude and prayer were going to cure her, some last minute miracle was going to happen. Her sister still won’t speak to me because I had the nerve to tell Chris it was okay to be angry, okay to feel pissed off, and okay to tell people she didn’t want visitors because she was too wiped out by her chemo or her pain meds to put on a happy face that day, and that maybe she should apply for hospice so she could get Medicaid instead of having to rely on friends holding spaghetti dinners to pay her medical bills. She knew she was dying the day the doctor told her the cancer had spread to her liver and her spine, but she was never allowed to say that out loud because it would upset people. WTF?? There’s optimism, and then there’s magical thinking — and too often what people claim is a positive attitude isn’t hope or optimism, it’s magical thinking and denial of reality.
BTW, there was a solid scholarly study done recently on the efficacy of prayer — and it turned out that the patients who knew people were praying for their recovery actually had lower survival rates than the ones who didn’t. So much for the power of positive thinking.
The Onion: “Loved Ones Recall Local Man’s Cowardly Battle With Cancer.”
I find it interesting that Kate is the one people who disagree find the most objectionable because she refused to accept that being optimistic is good for you. Why this strong need to validate optimism? Surely isn’t optimism supposed to be its own reward or is it an external validation – that we SHOULD be optimistic, or rathat that a “good attititude” is more proper, more social, more collectively good than it might be for any individual member.
If you are sick, if you are in pain, if you are going to have amputation, you are dying, you are on chemo: is not a little screaming allowed? Or should that be done through a smile too?
*puts on crackpot theorist hat*
Positive thinking. Ahh. I’ve never had a serious illness, but I’ve recently been in a position to notice that unemployment gets a lot of the same social responses: the defensive “take responsibility, think positively” that has behind it the desperation of the well-wisher’s wanting to believe it couldn’t happen to them. The idea that the situation is contagious.
And yet in the case of unemployment — and I’m sure to some extent in the case of sickness — thinking positively *is* actually pretty important. If I could take a pill that would put me in cloud-cuckoo-land and keep me totally functional, I’d take it in a heartbeat — and spend the day applying for jobs. Because, see, the more rejection you get, the harder it is to cope with rejection; the harder it is to cope, the fewer applications you send out; the fewer applications, the less likely you’ll actually get a job. In fact, the thing I think would be most beneficial would be a state of complete, optimistic naivete, an unbreakable bubble. Everyone wants to hire me! I’m so desirable!
I’ve had interviews for the most basic positions botched by the fact that I went in horribly nervous, specifically *because* the stakes were so low that I felt I would be a total failure if I didn’t get the job. I never had this problem when I was a teenager, applying for jobs when I lived with my parents, and even though I didn’t really know how to dress for an interview, my relaxation and enthusiasm managed to land me jobs.
I don’t think this naivete would be useful for dealing with health problems. I think the picture might paint something more like a curve: believe you can’t do anything, and you won’t; believe it will be OK without doing anything, and you won’t; in the middle there’s a territory where you believe you have some influence on your situation, so consciously and subconsciously you’ll do things to affect it — there are a lot of *little* things people do day to day that affect health — did you know missing even two hours of sleep causes a temporary steep increase in oxidative stress and insulin resistance? I’m sure that kind of stuff affects you whether or not you have cancer — and there are lots of things we can do to buffer ourselves against day to day wear and tear, but we don’t tend to do them unless we believe they’ll help.
…And that’s leaving aside totally the protective effects of oxytocin and deleterious effects of cortisol, among other things. But I need *my* sleep, and I’m going to go get it now.
The trouble, I think, is that the superstitious, ‘social contagion’ thing is often grafted onto the actual common-sense bit about paying attention and making the right decisions.
F’rinstance, it’s actually true that eating right and exercising will improve health. However, when thin people say that to fat people, they usually mean it as a method of social control. Even if the statement is entirely factually true, it can still be unpleasant and misguided in context of the social dynamic.