Often when confronted with a serious illness, like cancer, a patient finds themselves told to “be positive” – to ignore that feeling of sinking dread, the dire predictions that the mind creates, and instead think happy thoughts about health. Yet what are the benefits of “staying positive” and when faced with a life-threatening illness, is it the best thing to do? For a considerable amount of evidence is building up that shows the effect of the mind, and thoughts, on our body. Where positive people appear to have stronger immune systems, cope better with stress and suffer from less illness. On the other hand, the just “be positive” attitude can create a situation where its taboo to think, let alone talk about any negative alternative and any negative thoughts are suppressed. As we delve into some recent scientific studies we shall answer these questions and begin to paint a picture where we recognise that although optimism has some great benefits for our health, we should not force ourselves to feel positive when we don’t. Instead, we should see a serious illness as a challenge that we can rise to meet, be true to how we are feeling and express the emotions that arise – be they positive or negative.
The positives of being positive
To use the clichéd metaphor; some see the glass is half full, others the glass is half empty. Yet either way the glass only contains 50% water and surely it has no effect on the water or life itself? Surprisingly, this is not true. Instead it seems that science is showing that those who view life in a positive light not only enjoy their half glass of water more, but also make it go further. In a prospective study of over 5,000 people in Taiwan it was found that people who had a higher life satisfaction and enjoyed their glass half full had a 24% lower rate of death over a 10 year period[1]. On the flip side, the same study found that people who were depressed had an 8% increase in mortality for every (standard deviation) increase in the measurement of their depression. Similarly in Holland, optimistic individuals were 67% less likely to die of heart problems[2]. Even in a laboratory setting, positive individuals have been shown to have less and shorter symptoms after being exposed to a common cold (rhinovirus) than less positive individuals [3]. Together the evidence clearly shows that having a positive approach to life not only affects your outlook, but also goes on to influence your bodies physiology and health.
The problems of being positive – with cancer
In the wake of the studies previously mention and filled with the vigour of positive psychology I have seen many good-meaning people tell cancer patients to “think positive” and it will be fine. Yet this association between positive thinking and a better health does not always hold true once a person has already developed an illness. Instead it appears that it is how the patient copes with the illness and their emotional burden that effects their survival. I’ll give two fictional cases that will hopefully help clarify why, before going on to discuss the results of some scientific studies.
Case 1. You have cancer. Faced with the possibility of your own death on the inside you’re afraid, angry and confused. Yet you tell yourself to think “positive” and it will be ok. You avoid any of the “negative” emotions by swallowing them or if they do come up you distract yourself. To those around you, you may are optimistic and strong, and there are some days where you feel it; but dig deeper and it’s a different story.
Case 2. You have cancer. You are faced with the possibility of your own death and you’ve cried, raged and felt lost. In doing so you felt a release and have managed to come to accept where you are now. Yet you have so much more that you want to do with life and feel optimistic about your recovery. You have your days when you feel optimistic and strong, and you have your “bad days” when you feel anything but strong. However, dig deeper and you’ll find a sense of inner peace irrespective of how you are feeling that comes from an understanding of the meaning of cancer in your life.
In both of these cases the patient is optimistic, yet that positivity comes from a wildly different place. In the first case, the positive attitude comes from an intellectual “I should feel positive”; while in reality the individual may feel completely the opposite. There also may be a fear that in thinking of any outcome other than the positive one you will make the negative one come true. This to me is one of the greatest problems with positive psychology: the mantra of “just think positive and everything will be ok”; while everything perceived as negative is suppressed.
In the second case, the patient’s positive attitude comes from a deeper knowing and a love for life; it is not just an intellectual thought. They have also come to accept their situation and in doing so, it loses some of its fear and more energy can be directed to the future. Furthermore, they have reinterpreted their illness to give it a positive personal meaning and, as Dr. V. Frankle said,
In the second case, the patient’s positive attitude comes from a deeper knowing and a love for life; it is not just an intellectual thought. They have also come to accept their situation and in doing so, it loses some of its fear and more energy can be directed to the future. Furthermore, they have reinterpreted their illness to give it a positive personal meaning and, as Dr. V. Frankle said,
“He who knows why can endure any how”.
These subtle differences in outlook, I believe, account for some of the conflicting evidence around positive outlook in patients with cancer. For example, it has been found that higher levels of optimism are predictive of better survival [4]. Yet it has also been found that individuals with a positive mood and a tendency to avoid problems (physical and emotional) actually have a shorter survival [5].
My own experience offers a good real life example into these differences. I was diagnosed with advanced melanoma and initially fell squarely into case 1: I was very strong, very positive and it took several months before I managed to cry. I was positive while the staging went from II, to III and finally IV; yet this was a very intellectual based understanding of positivity. It was only just after I began a trial for chemotherapy that my understanding shifted deeper: I was having a counselling session with a lady who is very advanced spiritually, when I asked, “when will I get better?” To which she replied, “You already are”. Something clicked inside me, I felt and I knew that I would get better. From that point on my scans dramatically improved. 3 years later I am writing this article and recently found out that the average survival time on that trial was 8 months.
Emotions expressed, not depressed
Another big difference between the two cases previously mentioned is how they express the feelings that come with a diagnosis of cancer. Cancer on an individual level is a blatant reminder that we are mortal with a limited amount of time on this earth. In a society where we are removed from death as an everyday occurrence this can create a tremendous amount of fear, anger and confusion.
In both the cases the patients were confronted with the same emotions, yet dealt with them in different ways. In Case 1, the patient has suppressed emotions that they perceive as negative. Yet suppressing emotions does not get rid of them. Instead they smoulder away in the subconscious mind. As there the brain uses the same areas whether a feeling is thought or expressed, these emotions continue to influence our body. So while a bout of anger (not directed at anyone) would influence the body for minutes, suppressed anger can influence the body for years. Anger causes the release of stress hormones, which then influence the immune system. Therefore, it comes as no surprise that people with chronic anger have a weaker immune response to vaccination[6] and even take a longer time for wounds to heal! [7]
In Case 2 they experience the same emotions as Case 1, yet these feelings were expressed and not keep them bottled up. Contrary to what some people believe, the expression of all emotions (including sadness and anger) is a healthy thing. In a study of 1043 cancer patients Coyne found that having a lower “emotional wellbeing”, i.e. feeling sad, worried or nervous, had no effect on overall survival [10]. Indeed in studies of melanoma patients[11] and metastatic breast cancer[12] higher levels of depression and anger are predictive of a longer survival. So it appears that science supports that the healthiest way to cope with the feelings that come with cancer is to let them out.
On a cautionary side note, there is a difference between expression and wallowing in an emotion. When we express how we feel we must recognise that we have emotions, not are our emotions. So I would say, “I am feeling sad and depressed”, rather than, “I am sad and depressed”. This helps ourselves develop a slight detachment from our emotional response and allows us to recognise that emotions will eventually pass. For it has been found that patients who are continually depressed do have poorer survival outcomes [13].
Take home message
Our mind and emotions play a vital, and often underestimated, role in our health and wellbeing. A positive interpretation of life not only improved how we see traumatic and challenging events, but also improves how our body responds to these events. However this positive interpretation should not come at the cost of repressing how we are feeling. I offer the following advice from my own experience:
To good meaning friends and family of cancer patients: it is hard to know what to say sometimes, yet telling them to be positive doesn’t help. Instead ask them how they feel and be accepting of whatever their response is; people need to vent their emotions. Also, try reframing the situation in a positive light, as the small shifts in perception can often lead up to bigger overall shift. For example, try focusing on how much they’ve learnt or how cancer has given then the incentive to change parts of their life that they don’t like.
To those on a journey with cancer: be true to how you are feeling and don’t judge it. It is perfectly healthy to feel and express anger, sadness, fear etc. If you can find a personal meaning and interpretation for your journey then it will give you a huge amount of understanding and strength. It is from this deeper place that true positivity can arise.
- I wish you all peace, health and happiness throughout whatever life journey you are on.
References:
1. Collins, A.L., D.A. Glei, and N. Goldman, The role of life satisfaction and depressive symptoms in all-cause mortality. Psychol Aging, 2009. 24(3): p. 696-702.
2. Giltay, E.J., et al., Dispositional optimism and all-cause and cardiovascular mortality in a prospective cohort of elderly dutch men and women. Arch Gen Psychiatry, 2004. 61(11): p. 1126-35.
3. Doyle, W.J., D.A. Gentile, and S. Cohen, Emotional style, nasal cytokines, and illness expression after experimental rhinovirus exposure. Brain Behav Immun, 2006. 20(2): p. 175-81.
4. Allison, P.J., et al., Dispositional optimism predicts survival status 1 year after diagnosis in head and neck cancer patients. J Clin Oncol, 2003. 21(3): p. 543-8.
5. Brown, J.E., et al., Psychosocial predictors of outcome: time to relapse and survival in patients with early stage melanoma. Br J Cancer, 2000. 83(11): p. 1448-53.
6. Suinn, R.M., The terrible twos--anger and anxiety. Hazardous to your health. American Psychologist, 2001. 56(1): p. 27-36.
7. Gouin, J.P., et al., The influence of anger expression on wound healing. Brain, Behavior, & Immunity, 2008. 22(5): p. 699-708.
8. Ginzburg, K., et al., Breast cancer and psychosocial factors: early stressful life events, social support, and well-being. Psychosomatics, 2008. 49(5): p. 407-12.
9. Falagas, M.E., et al., The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast Cancer Res, 2007. 9(4): p. R44.
10. Coyne, J.C., et al., Emotional well-being does not predict survival in head and neck cancer patients. Cancer, 2007. 110(11): p. 2568-2575.
11. Fawzy, F.I., et al., Malignant melanoma. Effects of an early structured psychiatric intervention, coping, and affective state on recurrence and survival 6 years later. Archives of General Psychiatry, 1993. 50(9): p. 681-9.
12. Derogatis, L.R., M.D. Abeloff, and N. Melisaratos, Psychological coping mechanisms and survival time in metastatic breast cancer. JAMA, 1979. 242(14): p. 1504-8.
13. Pinquart, M. and P.R. Duberstein, Depression and cancer mortality: a meta-analysis. Psychol Med, 2010. 40(11): p. 1797-810.
Photos by Chad Johnson and Robyn Nola
Photos by Chad Johnson and Robyn Nola
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