A Fighting Spirit

A NYTimes op-ed piece entitled A Fighting Spirit Won't Save Your Life concludes, "Linking health to personal virtue and vice not only is bad science, it’s bad medicine."

Columbia University Medical Center's Richard Sloan, PhD writes, "[T]here’s no evidence...that an upbeat attitude can prevent any illness or help someone recover from one more readily." He cites a study that found no significant association between personality traits and the risk of developing or surviving cancer.

Many patients and their families are going to be unhappy with Sloan's article. I know this because my writing and speaking bring me in contact with hundreds of patients whose faith in the power of positive thinking is immutable, no matter what scientific studies show.

One problem with the discussion is that personality traits, attitudes, moods, thoughts and faith are terms that are often used interchangeably despite their differences.

Another is the difficulty of controlling for ALL factors that might affect healing. For example, a patient who is optimistic about a good outcome may eat healthful meals despite nausea, while a patient who is pessimistic may eat little, feeling "why bother? I'm going to die."

While Sloan's and others' trials take these variables into account and control measurable factors as much as possible, it remains difficult to control ALL factors affected by patients' personality, attitude, mood, thoughts and faith.

In my next post, I'll address whether linking health to personal virtue and vice is "good" or "bad" medicine.

Comments

[Finn]

A friend was just diagnosed with metastatic small bowel cancer and asked me for some advice. Aside from practical things about reliable information sources & second opinions, I warned him about the Attitude Police: people who would insist that he has to "stay positive" for his treatment to work and that any negative attitude would put him at risk.

Susan Sontag's 1977 book, Illness as Metaphor, is an excellent read on this topic of associating illnesses with personality. Using 19th-century notions about who gets TB and mid-20th-century notions about who gets cancer, she points out that throughout history we have tended to link poorly understood, as-yet incurable diseases with certain personality traits, and that these ideas persist until we discover a specific cause and an effective treatment.

And yet here we are, over 40 years later, still having to deal with people insisting that we get cancer or our treatment fails because we don't have the right attitude or personality.

[Wendy S. Harpham, MD]

Dear Finn,
Some people want to believe attitude controls the outcome, because then the outcome is in their control. Or, shall I say, it feels in their control.
They cling to this hope so strongly they ignore or deny evidence to the contrary, be it anecdotes or scientific studies.

As I'll share in future posts, attitude AFFECTS -- not controls -- outcome.

I'll also explore why attitude plays a huge role in Healthy Survivorship.

With hope, Wendy

[Cyn]

To start, I just want to say how happy I am I found your blog!

I am a breast cancer survivor doing my damndest to avoid a recurrence (I'm high risk). And I am trying, instead of maintaining a positive attitude, to maintain an honest attitude. Does that make sense? If I am irritable or frightened, I talk about it and try to honour the emotion. To maintain a positive attitude would require some denial, I think, and I don't think that is good for one's mental or physical well being.

Now, I think in many cases our being positive is helpful to the people around us!

I look forward to reading your blog in the future.

[Wendy S. Harpham, MD]

Dear Cyn,

Welcome! If you troll through old posts you'll see a theme: Healthy Survivors can deal with what is happening in healthy, life-enhancing ways only if they face the truth about what is happening (whether it is the truth about their current medical condition, mood, thoughts, social situation, financial means, future risks, whatever).

Honesty -- seeing and facing what is -- is one of the hallmarks of Healthy Survivorship.

"Denial" is too big a topic for a discussion in the comment section. But there is a place for denial in Healthy Survivorship, too, as long as denial does not keep you from taking care of yourself and reporting problems to your healthcare team.

I look forward to your stories, questions and insights. With hope, Wendy

[Jody Schoger]

Wendy,
I'm so glad you wrote about this. As Katie Couric said once, there are plenty of people with great attitudes in cemeteries.

The distinctions you made between expectation and hope are essential points I return to again and again. I think we can say the same thing about attitude. A "good attitude" doesn't mean that you become disingenuous or dripping with Hallmark card sentiment. People can experience the grief of cancer -- admit the fear and sadness and still have a "good attitude." It's being driven by fear that makes the difference to me. Attitude to me is about how you approach treatment, healing and the life you have to life.

Thanks so much, Wendy. Sending hope right back to you,
Jody