The Tyranny of Positive Thinking

I am truly passionate about acknowledging the emotional aspects of cancer. I was privileged twice now to speak with Dr. Jimmie Holland, a hero of mine. I read her book "The Human side of Cancer: Living With Hope,Coping with Uncertainty" shortly after I was diagnosed. Who would have believed that years later, via my involvement with the American Association for Cancer Research's Scientist Survivor Program, I would actually get the chance to hear some of her presentations, to meet her and to have conversations with her? She is an amazing woman and a wonderful advocate for cancer patients and the emotional struggles that go along with a diagnosis of cancer.

I loved the chapter of her book, The Tyranny of Positive Thinking, which is available on-line. In an excerpt from her book, she writes:

It is common for people who have survived cancer to look back on the experience and attribute their survival to their positive thinking, discounting the fact that they also sought medical help early and had the best-known treatment for their cancer. This belief not only provides an explanation for their cure from cancer, but also buffers fears that it will come back. "If I licked it once with this attitude, then I can keep it from coming back the same way." This belief is reassuring and provides a way of coping with the normal fears people have about the cancer returning. A good attitude surely leads to the best and most logical approach to getting cancer successfully treated. But I have also known people with positive attitudes, who sought early diagnosis and treatment, and who simply weren't as fortunate. I have seen patients who had no belief in the mind-body connection and who discounted the importance of their attitude completely, yet they survived.

Ernie, a lawyer who was absolutely negative about every aspect of his diagnosis and treatment of lymphoma, was convinced from Day 1 that he would not survive. He explained that he usually saw the dark side of things and the glass as half-empty. Although he stuck faithfully to his chemotherapy treatment, no amount of encouragement or "good" results on his medical tests could persuade him he was doing well. He would say over and over again, "Dr. Holland, I'm not going to make it." It's now been eighteen years since his treatment; he's been cancer free ever since. He's still going strong and is still as much a pessimist as ever. Ernie is an example of how attitude is not the whole story in surviving cancer.

My view is that if a positive attitude comes naturally to you, fine. Some people are optimistic, confident, and outgoing in virtually every situation. Your attitude toward illness reflects your attitude toward life in general and your handling of day-to-day stresses and hassles. There is no way you will see that the glass is half-empty if you are certain that it is half-full. And the converse is true: If you see the glass as half-empty, I can't convince you that it is half-full. It is not easy to change people's ingrained attitudes and patterns of coping.

It's dangerous to generalize about attitudes and their impact on cancer without more information. The present-day tyranny of positive thinking sometimes victimizes people. If thinking positively works for you, well and good. If it doesn't, use the coping style that's natural to you and has worked in the past. (I discuss different modes of coping in Chapter 6.) Trying to get you to "put on a happy face," to pretend you are feeling confident when in fact you are feeling tremendously fearful and upset, can have a downside. By feigning confidence and ease about your illness and its treatment, you may cut off help and support from others. You may also be hiding anxious and depressed feelings that could be alleviated if you told your doctor how you really feel. Also, this tyranny of positive thinking can inhibit you from getting the help you may need out of fear of disappointing your loved ones or admitting to a personality some people think is fatal. If you are surrounded by "the positive attitude police'" ask your doctor, clergy, or therapist to call them off, letting them know that this is an important time for you to be honest about your feelings so that you can get all the help you need.

As a nurse I think sometimes of other disease I see, diseases with known causes and known cures. I was hospitalized once years ago with a rather severe case of pneumococcal pneumonia. We knew the cause, a bacteria, and the treatment, antibiotics. Because the cause and cure were known, there was no expectation for me to "think positive" to aid my recovery. The attitude was that I would probably feel badly with my high temp and lung congestion until the antibiotic took effect. I wasn't to blame for my illness, a bacteria caused it, and I wasn't expected to defeat it with a positive outlook and mind body connections...there was medication to solve my problem.

Cancer is different because the causes and cures are more illusive.

Many cancer patients confide to me that they resent those around them who insist they "think positive". They are exhausted by the "positive attitude police". They are tired of trying to put on a positive front around friends and family. They want to feel free to talk about how they sometimes feel...anxious, depressed and worried, but because they are expected to always be "positive", they receive no support in dealing with some of the normal negative emotions they have. They feel very alone. I was blessed to have the support of my best friend Rose, who was always willing to hear me out when I felt angry or depressed, who never once suggested that I needed to "think positive" or have a "good attitude" to defeat my cancer.

I also know of cancer patients who buy into their "dis-ease" causing their disease, their cancer...who buy into feeling personally responsible for their diagnosis, personally responsible for curing their disease. It's a terrible burden that can lead to guilt and helplessness, both which can have a negative impact on quality of life....and in the end maybe even survival.

Cancer is tough, and sometimes negative emotions are normal. It's okay to not always feel positive and upbeat. We need to allow ourselves that. We need to be able and allowed to seek help and support when we feel troubled.