Developing and Healing Cancer -
The Power of Thought to Make Ill and to Heal (part 1)Excerpted from The Power of Thought to Heal: An Ontology of Personal Faith, Ph.D. dissertation © by Arthur Preston Smith, Claremont Graduate University: 1998
Note by Healing Cancer Naturally: Welcome! This and more pages of "Healing Cancer & Your Mind" are devoted to a detailed discussion of the amazing influence of our thoughts, beliefs, attitudes and emotions in either making us ill or in making and keeping us well, particularly as related to developing and healing cancer. In the following article, I would like to draw any cancer patient’s particular attention to the author’s insights into the wholesomeness of keeping a balance between holding positive thoughts and pictures (such as by using affirmations and guided imagery) and allowing him or herself to express and release their “negative” feelings to further their process of healing.
[Introduction:] Controlled Statistical Studies of Mental Healing
For most of the twentieth century, mainstream medical research never addressed a phenomenon that many practicing clinicians routinely observed: Attitudes, beliefs, and ideation all play a significant role in health. Since the 1970s, however, this has changed, and the research over this relatively short period has produced a gush, not a trickle, of evidence in support of psychosomatic healing. To reduce the job of reviewing these studies to a manageable size, I have chosen to focus on cancer and heart disease. Although cancer may be the more frightening of the two diseases, heart disease alone kills more Americans than all other diseases combined.(38) I will also cite an account of remission from acquired immune deficiency syndrome, or AIDS, primarily for the sake of public interest in the disease. However, we will first review some of the studies relating to the overall effect of thinking on health, as well as evidence of the effectiveness of imagery practice, the best-known mental healing technique.
I. General Effects of Thinking on Health
The great Hasidic sage Rebbe Nachman of Breslov (1722 - 1810) once made this generalization about disease and health: "All the illness that afflicts people comes only because of a lack of joy.... And joy is the great healer."(39) Dr. Bernie Siegel offers a more contemporary perspective in referring to the "contentment factor." Siegel cites a long-term study dealing with the death rate among Harvard graduates, in which:
”Those who were extremely satisfied with their lives had one-tenth the rate of serious illness and death suffered by their thoroughly dissatisfied peers even after the effects of alcohol, tobacco, obesity, and ancestral longevity were statistically eliminated.”(40)
The two best-known mental and emotional factors that adversely affect health are stress and grief, especially if the latter is accompanied by loneliness. In the first half of this century, Walter Cannon discovered that heightened emotional states could stimulate the spleen, an organ that was later found to play a major role in the immune system.(41)
One study showed that medical students have diminished immune system functioning at exam time. Activities of natural killer T-cells and levels of interferon were both found do be lower during that period. Students also reported higher incidents of coughs and colds.(42)
According to Larry Dossey, grief, especially when accompanied by loneliness, can also adversely affect the immune system. In a 1977 study of the immune systems of widowed people in Sydney, Australia, researchers found that the bereaved showed significantly less immune activity than the control group. Another study, conducted at Ohio State University, found that medical students who had the highest scores on tests for loneliness and stress also had the lowest levels of natural killer T-cells.(43)
Of course, illness itself can lead to the same loneliness that aggravates the disease. In one study, conducted over nine years in Alameda County, California, death rates in a group of 7,000 people were correlated with indicators of social interaction, such as church membership, marital status, and other indicators of social activity. Death rates were found to be highest among those who had the fewest relationships -- even when factors such as socioeconomic status, cigarette smoking, and other health-related factors were taken into consideration. Isolation was linked to higher death rates from heart disease, cancer, and all other illnesses, as well as suicide and accidental death. Of course, the study naturally raises the question of whether the diseases caused the isolation, or vice versa. According to Dossey, the cause was the loneliness. Another study, conducted in Tecumseh, Michigan, "confirmed that increased loneliness and absence of social networks were the cause and not the result of disease and illness."(44) Dossey is quick to point out that nonetheless the culprit is not the experience of being alone per se, but the meaning ascribed to the isolation. Other researchers performed a follow-up of the Alameda County study, in which:
”Women who had many social contacts but felt isolated had 2.4 times the normal risk of dying from hormone-related cancers (breast, uterine, and ovarian). And those women who had few social contacts and felt isolated were five times as likely to die from such cancers.
Interestingly, social ties did not seem to affect whether men got cancer in general, but among those who developed cancer, death was sooner in those who were socially isolated.”(45)
If, as recent breakthroughs in psychoneuroimmunology suggest, the immune, nervous, and endocrine systems are all highly interrelated, then it would follow that tampering with the immune system might have emotional side effects. One study has corroborated this theory:
”If the approach to treating cancer involves the immune system, the brain should manifest alterations as well. In support of this hypothesis, it was pointed out that scientists are now finding that the administration of interferon (an immune regulator that also inhibits viral cell growth) promotes severe depression in AIDS patients.”(46)
Given some of the studies cited earlier, one has to wonder if the side effects of the cure could actually exacerbate the disease.
Finally, we cannot ignore the effect of doctor-patient relationships, a subject that has been the focus of three of the most commonly cited authors in this essay, Cousins, Dossey, and Siegel. Cousins, arguing that "a very simple effort to improve patient-physician interactions can result in significant improvement in a patient's condition," cites a series of four studies of ulcer, hypertension, diabetes, and breast cancer patients, conducted by Drs. Sheldon Greenfield and Sherrie Kaplan of the UCLA School of Public Health. In these studies, the control group was given only general information on self-observation and care, while the experimental group was given a full, twenty-minute training session on how to be more active in their treatment. The researchers found that the increased level of patient control, as well as the greater interest shown by physicians towards their patients, both positively correlated with improved health. Cousins infers that:
”Research such as Drs. Kaplan and Greenfield's project suggests that a more active patient role helps to foster a greater sense of control over illness, better health outcome, more rapid recovery, and greater compliance with treatment. Dr. Rose Maly of the UCLA School of Public Health utilized a simple technique to improve patient interactions with their physicians. The study observed corresponding attitudinal, behavioral, and health status changes in patients, as well as attitudinal changes in physicians....
Preliminary results indicate a significant improvement in the functional status of those who experienced the enhanced interaction with their physician -- the benefits having their greatest impact on individuals over age sixty.”(47)
These studies all suggest that physicians should encourage their patients to take a more active role in their treatment, which has two important implications. The first is that patients have an opportunity to take a more active role in their own healing by monitoring and directing their thinking. The second is that the very sense of being more in control is in itself conducive to better health. Studies dealing with heart disease and cancer, to which we now turn, corroborate this theory.
II. The Effectiveness of Mental Healing Techniques
As interest in the subject of mental healing grows, a variety of different techniques may evolve. As of today, however, the technique of imagery, or visualization, stands out as the most prominent. It actually consists of nothing more than rehearsing the experience you want to have in the imagination -- with the express purpose of directing the subconscious mind to bring the experience into reality. Siegel, who used visualization extensively with cancer patients, explains how it works with respect to healing in analyzing its effectiveness in training the highly-successful athletic teams of the former Soviet bloc:
”Visualization takes advantage of what might almost be called a ‘weakness’ of the body: it cannot distinguish between a vivid mental experience and an actual physical experience....
Eastern European trainers often have their students and athletes lie down and listen to calming music Then the athlete visualizes, in full color and complete detail, a winning performance. This is repeated until the physical act becomes merely a duplication of a mental act that has already been successfully visualized. Soviet research indicates that athletes who spend as much as three-fourths of their time on mental training do better than those who place more emphasis on physical preparation.”(48)
If mental rehearsal can train the body in athletics, it can at least theoretically train it to fight disease. (If this seems farfetched now, our upcoming discussion of biofeedback may render it less so.) Dossey cites the following documented success story:
”Dr. G. Richard Smith and his colleagues at the University of Arkansas College of Medicine reported what is perhaps the first fully documented case of a human being intentionally changing the immune system. It involved a thirty-nine-year-old woman who was able to change her positive skin test for varicella zoster (the chicken pox virus) at will -- from positive toward negative, and then toward positive, a feat she repeated six months later. She used a rather specific form of imagery, imagining the redness and swelling surrounding the skin test getting smaller and smaller, while sending ‘healing energy’ to the area.”(49)
Dossey elaborates, citing the Achterberg and Lawlis studies and others as evidence of the effectiveness of visualization in altering the immune system. Achterberg collaborated with Mark S. Rider in an experiment that measured the effects of visualization in white blood cell count. The subjects were divided into two groups. Each group was asked to visualize images of the shape, location, and movement of one of two types of white blood cells, neutrophils or lymphocytes. Blood counts were taken both before and after each twenty-minute visualization sessions:
”Results showed that the neutrophils (but not the lymphocytes) decreased significantly in the neutrophil group, while the lymphocytes (but not the neutrophils) decreased significantly in the lymphocyte group. The authors concluded that the highly directed imagery was cell-specific; that is, it affected the cells toward which it was intended or directed, and not others.”(50)
Siegel cites a study in which imagery increased the count of platelets, a third kind of white blood cell.
”In 1980 psychologist Alberto Villoldo of San Francisco State College showed that regular meditation and self-healing visualization improved white-blood-cell response and improved the efficiency of hormone response to a standard test of physical stress -- immersing one arm in ice water. The subjects trained in meditation withstood the pain of the test far better than those who did not meditate, and two-thirds of them were able to stop bleeding immediately after a blood test merely by focusing their minds on the vein after the needle was removed.”(51)
Finally, Siegel cites a 1976 study, conducted by Gurucharan Singh Khalsa, founder of Boston's Kundalini Research Institute, showing that: "[R]egular yoga and meditation increased blood levels of three important immune-system hormones by 100 percent."(52)
The proven effectiveness of imagery in healing the body has two important implications. The first is that it corroborates other evidence that thinking can heal. The second is that mental healing is not a process entirely out of reach for most of us. Although people may vary in their ability to visualize, most can apply this technique to some degree. Effective mental therapy already exists and is available to just about anyone who wants to use it.
With respect to this dreaded disease, I have divided the topic into two subtopics: the role of the mental in causing cancer and the role of the mental in curing it.
The Role of the Mental in Causing Cancer
With respect to cancer, many physicians believe that the disease itself is caused by a breakdown in the immune system. Under this theory, anything that adversely affects the immune system -- including some kinds of brain activity -- can be carcinogenic. In Bernie Siegel's words:
”One of the most widely accepted explanations of cancer, the ‘surveillance’ theory, states that cancer cells are developing in our bodies all the time but are normally destroyed by white blood cells before they can develop into dangerous tumors. Cancer appears when the immune system becomes suppressed and can no longer deal with this routine threat. It follows that whatever upsets the brain's control of the immune system will foster malignancy.”(71)
This theory could explain why so many substances have been linked to cancer. Anything that interferes with the functioning of the immune system can be carcinogenic.(72) A study conducted at the Albert Einstein College of Medicine in the Bronx found that children with cancer had had twice as many recent crises as other children, who were similar except for their disease. Another study showed that 31 of 33 children with leukemia had suffered traumatic losses within two years of the onset of the disease.(73)
Mental and emotional factors have been tied to cancer in several important ways. Like heart disease, cancer correlates positively with stress. Siegel cites two studies. In the 1970s, a study of mice bred to develop breast cancer, the cancer rate varied from 92 percent, for mice that were subject to stress, to 7 percent, for those that were not. In another experiment, in which rats injected with tumor cells and then given electric shock, 73 percent of the rats that could not escape the shock developed cancer. Of those that could, only 37 percent developed the disease, doing slightly better than the rats that received no shocks at all.(74)
Although it might be argued that stress itself is not due to thinking and beliefs, but to external circumstances, Siegel argues otherwise. Referring to a 1961 study by L. E. Hinkle, he concludes that stress comes not from events but in the way in which we interpret them. Situations such as poverty, bereavement, and alcoholism in the family, which might seem to be incredibly stressful to the observer, were not associated with the illnesses by the patients who did not report them as stressful. Conversely, events one would ordinarily consider to be not very stressful can be experienced as traumatic, especially in the case of children, who have been known to commit suicide for having received a B on a report card.(75)
Cousins cites a study by David M. Kissen indicating similar results. In this study of cancer patients, Kissen's research "suggested that an individual's emotional response to a life event was more critical than an event itself in the genesis of cancer."(76) This evidence is consistent with that found in similar studies cited above, with respect to heart disease.
Dossey cites one example of a researcher who found that mental factors are heavily involved in cancer -- even though he was trying to prove otherwise.
”Professor David Spiegel, a psychiatrist and researcher at Stanford University Medical School, set out to refute the idea that mental factors were important in the course of diseases. Like many clinicians, he felt that assigning a role to the mind in cancer was not only erroneous but potentially destructive as well. (Many believe this idea generates guilt on the part of the cancer patient because it suggests that he or she was somehow responsible for causing the disease.) Spiegel followed eighty-six women with breast cancer for a period of ten years. Those who received group therapy and lessons in self-hypnosis lived an average of twice as long as those who were given only traditional medical treatment. Spiegel described himself as ‘stunned’ at this finding, which contradicted his expectations.”(77)
One of the more striking discoveries in the research of mental factors in causing cancer is that, "When combined with other psychological tests, mental imagery often is more useful than laboratory tests in assessing the patient's prospects." Siegel describes a study suggesting this:
”Work done by the Simontons, Jeanne Achterberg and G. Frank Lawlis compared the predictive value of psychological factors and blood chemistry in 126 patients with extensive cancer. Virtually every psychological test showed a statistical relationship to one or more blood components. The patients who did most poorly were those who were very dependent on others -- such as the doctor -- for motivation and esteem, who used psychological defenses to deny their condition, and who visualized their bodies as having little power to fight the disease. Compared with patients who did well, those whose disease progressed fastest were more conformist to sex-role stereotypes and developed images that were more concrete and less creative or symbolic. The researchers concluded that ‘blood chemistries offer information only about the current state of the disease, whereas the psychological variables offer future insights’ and that ‘the imagery was found to be the most important in predicting subsequent disease states.’ By analyzing drawings made by two hundred patients, Achterberg later achieved 95 percent accuracy in predicting who would die within two months and who would be in remission.”(78)
One of the best-known mental predictors of cancer is the "cancer personality type." Cousin cites the work of psychologist Lawrence LeShan, an early pioneer in this field:
”LeShan..., research psychologist of the Institute of Applied Biology in New York, conducted extensive pioneering work regarding the cancer-prone personality that led him to identify several psychological characteristics that seemed to typify cancer patients (including such factors as the inability to express aggression and disruption of a parental relationship in early childhood). He concluded that personality factors have some bearing on the observed association between traumatic life events (most notably, the loss of a significant emotional relationship) and the development of cancer, and he speculated that specific psychological attributes could be linked to particular types and locations of cancer.”(79)
One of the more important traits of the cancer personality type is an inability to express emotions. Siegel, who calls it an inability to "be your own person," says:
”As Elida Evans observed in her groundbreaking 1926 study of the cancer personality, ‘Development of individuality is a safeguard to life and health. It lifts a person out of the collective authority.’ I find in rural or rugged areas the percentage of exceptional patients is higher. They are independent, self-reliant people to begin with. Becoming your own person releases your creativity.”(80)
Cancer patients tend to be "nice" people possessing low self-esteem and an exaggerated desire to please others. Several studies have shown that cancer patients can often be identified by their psychological profile. Siegel cites several:
”By using a simple psychological test on a large group of women, some of whom had cervical cancer, Arthur Schmale was able to pick out 36 of the 51 who had malignancies (already diagnosed but unknown to him), by looking for hopelessness and a recent emotional loss. Other research groups have since gotten even better results. Marjorie and Claus Bahnson have developed a questionnaire that is 88 percent accurate in identifying those who turn out to have a biopsy-confirmed cancer. Most of these psychological tests are now more accurate than physicians' physical exams....
Some of the most valuable work has been done by Dr. Caroline Bedell Thomas of Johns Hopkins University Medical School. Beginning in 1946, she took personality profiles of 1,337 medical students, then surveyed their mental and physical health every year for decades after graduation. Her goal was to find psychological antecedents of heart disease, high blood pressure, mental illness, and suicide. She included cancer in the study for the sake of comparison, because she originally thought it would have no psychological component. However, the data showed a "striking and unexpected" result: the traits of those who developed cancer were almost identical to those of the students who later committed suicide. Almost all the cancer patients had throughout their lives been restricted in expressing emotion, especially aggressive emotions related to their own needs. She also found that, using only the drawings they made as one of the tests, she could predict what parts of their bodies would develop cancer.”(81)
Compare The “Cancer Personality”.
Dr. Fawzy Fawzy at the UCLA medical school conducted a study about the role of emotions in the levels of Leu-7 cells, one of the "natural-killer" T-cells. The study, which lasted over a year, compared levels of Leu-7 cells of an "experimental group" that had been able to "reduce anxiety about their illness and cope with life stresses more effectively" with a control group that had not. Cousins quotes Fawzy's account of the results:
”The mean change scores showed that the control group's cells had actually decreased while the experimental group showed the desired increase in these cells at six weeks. By six months the control group had managed to return to close to baseline while the experimental group had continued to increase their Leu-seven cells. This trend continues in many of the other important cell categories.”(82)
Grief also can have a profound impact on the development of cancer-fighting immune cells. Dossey cites the following study:
”Steven J. Schleifer and his colleagues at New York's Mount Sinai Hospital... studied the immune function of fifteen men whose wives had terminal breast cancer. Of interest were the T- and B-lymphocytes, the body's two main immune cells. Prior to the death of the wife, the researchers found that these cells functioned normally. But beginning shortly after the wife's death, and extending for many months in the period of grief, the cells, though normal in number, stopped working. They could not even be made to work when extracted from the blood of the men and exposed in test tubes to chemicals that ordinarily ‘turn them on.’"(83)
Divorce has even worse effects, according to Siegel, because "...it's harder to accept that the relationship is really over."
”Indeed, divorced people have higher rates of cancer, heart disease, pneumonia, high blood pressure, and accidental death than married, single, or widowed persons. Married men also have one-third the lung-cancer incidence of single men and can smoke three times as much with the same cancer incidence as single men.”(84)
Depression can also suppress immune cell activity, as well as the production of antibodies, which can both aid in the suppression of cancer. What is equally important is that some of these deleterious effects can be mitigated with relaxation and creative imagination exercises. Cousins cites a series of studies:
”Drs. Sandra M. Levy and Ronald B. Herberman of the University of Pittsburgh and the Pittsburgh Cancer Institute observed that depressive behavior (fatigue, listlessness, apathy) was associated with diminished natural-killer (NK) cell activity and accelerated tumor spread in breast cancer patients. [Cousins then cites the Schlieffer study mentioned above.] To confirm the relationship between severity of depression and suppressed immunity, the investigators conducted a series of studies comparing individuals hospitalized for depression with those not hospitalized and those hospitalized for other reasons. They concluded that the severity of depression was associated with reduction of T and B cells and their activity. This conclusion was strengthened by their observation that relief from depression is paralleled by changes in the immune system.
Drs. Janice Kiecolt-Glaser and Ronald Glaser, of Ohio State University, found that highly depressed nonpsychotic psychiatric in-patients had significantly poorer DNA (genetic) repair in immune cells exposed to irradiation than did less depressed patients; and that both depressed groups fared significantly worse with regard to DNA repair than the psychologically healthy, nonpsychotic group. All group differences were sustained through the final measurement point, five hours after irradiations time period in which DNA repair is expected to recover to pre-irradiation levels. This finding suggests... that emotional stress may contribute to the incidence of cancer by directly causing abnormal cell development or by indirectly diminishing immune surveillance or competence.
By the same mental processes, however, the immune response can be strengthened or restored. Use of relaxation exercises and creative imagination were found to be helpful in a study of cancer patients by Dr. Barry L. Gruber of the Medical Illness Counseling Center in Chevy Chase, Maryland, in collaboration with Dr. Nicholas R. Hall of George Washington University and later of the University of South Florida. For one year, the patients were asked to imagine the forces in their immune systems being fully engaged in a war against the cancer cells.
The investigators found that these exercises had the effect of stimulating lymphocytes and increasing the production of antibodies and interleukin-2 cells, enhancing NK-cell activity and augmenting the effectiveness of the cytotoxic T cells. The pattern of immune changes corresponded to the level of relaxation and imagery. Equally interesting was the fact that the patients clearly showed intense determination to overcome their disease.”(85)
With respect to the same study, Siegel adds the following comments: ”[The exercises also affected] the levels of thymosin-alpha-1, a hormone especially important to the auxiliary white cells called T helper cells. Thymosin-alpha-I also helps produce feelings of well-being, showing that the immune system can directly affect one's state of mind, as well as vice versa.”(86)
Cousins elaborates on these studies, with respect to the problem of emotional inhibitions: ”Both Dr. Temoshok's and Dr. Levy's studies linked emotional inhibitions to impairment in immune activity. This may explain the link between emotional suppression, such as passivity or stoicism, and the progression of cancer.”(87)
Evidently, the adverse effects on the immune system brought about by depression are worse when the depression is coupled with the lack of an emotional outlet. LeShan drew the distinction between the psychological condition of "depression" and that of "despair."
”LeShan conducted personality studies of 455 cancer patients and in-depth therapy of 71 ‘terminal’ cases. He found that this condition of ‘despair’ (so named to distinguish it from the more commonly recognized form of depression) was reported as predating the disease by 68 of his 71 cancer patients in therapy, but by only 3 of 88 other clients who did not have cancer.”(88)
While both depression and despair are unhappy emotional states, despair entails the sense of helplessness that we found was so important in the link between stress and heart disease. That sense of helplessness may in fact be mitigated for those who can express emotions. Siegel cites two more studies: ”[O]ver thirty years ago... internist D. M. Kissen studied a group of smokers, comparing those who had lung cancer with those having other diseases. Based on personality tests, Kissen found the cancer patients had poorer ‘outlets for emotional discharge,’ and concluded that, the more repressed a person was, the fewer cigarettes were needed to cause cancer.
Working with breast-cancer patients, Mogens Jensen of the Yale psychology department showed that ‘defensive-repressors’ die faster than patients with a more realistic outlook. These are the smiling ones who don't acknowledge their desperation, who say, ‘I'm fine,’ even though you know they have cancer, their spouses have run off, their children are drug addicts, and the house just burned down. Jensen feels this behavior ‘disregulates’ and exhausts the immune system because it is confused by the mixed messages.”(89)
In his conversations with Bill Moyers, Michael Lerner, co-founder of the Commonweal Cancer Help Program, cites a study by Lydia Temoshek, whose work was also cited by Cousins earlier, of patients with malignant melanoma: ”Temoshek looked at the difference between patients who expressed their feelings and those who didn't, and discovered that the ones who expressed their feelings had more immune activity at the site of their lesions. They also had thinner lesions than the people who did not express their feelings.”(90)
As with heart disease, denial can also have a healing influence on cancer. According to Dossey, there are definitely times when deluding one's self can in fact heal, because it can help maintain a more positive mental attitude. Tactics such as denial, making excuses, and comparing one's self to only the worst off among other victims, in order to look good by comparison, all tend to promote healing:
”Researcher Keith W. Pettingale and his colleagues at King's College School of Medicine and Dentistry in London studied the psychological response of women three months after mastectomy. At a five-year follow-up, they found that the rate of recurrence-free survival was significantly higher among patients who had reacted to their cancer either with a fighting spirit or with denial than among those who had reacted with stoic acceptance or feelings of hopelessness and helplessness.... After a follow-up period of ten years, the outcome was the same: those patients demonstrating a fighting spirit or denial did better and had higher rates of survival....
Another strategy used by most cancer patients, [psychologist Shelley E.] Taylor found, is to make selective comparisons with other persons with the same disease. Women with breast cancer tended to compare themselves with other women with cancer who were doing poorly, which enhanced their estimation of their own strengths.... Summing up, Taylor states, ‘The effective individual in the face of threat... seems to be one who permits the development of illusions, nurtures those illusions, and is ultimately restored by those illusions.’
Another device used by the secret helper is excuses.... Research by psychologists C. R. Snyder and Raymond Higgins at the University of Kansas has shown that persons who offer themselves plausible excuses have greater self-esteem, better health, and perform better on all sorts of cognitive, social, and physical tasks than people who put the blame on themselves when things go wrong.... They help preserve a sense of self-worth and personal integrity -- as when we say that we flunked a test because we didn't study hard enough, not because we weren't intelligent enough.... Excuses give them time to marshal additional psychological resources for the next challenge.... Snyder and Higgins conclude that excuses are far from the ‘simple, silly and ineffective ploys’ most people consider them to be and are, in fact, necessary illusions.”(91)
Dossey may well have exposed a conflict between moral and physical health here.
If intellectual dishonesty is sometimes helpful, emotional dishonesty is not. People who express their negative emotions tend to do better. Being ornery and cantankerous pays more often than not. Siegel, who calls this expression "fighting spirit," says: ”Psychologist Leonard Derogatis, in a study of thirty-five women with metastatic breast cancer, found that the long-term survivors had poor relationships with their physicians -- as judged by the physicians. They asked a lot of questions and expressed their emotions freely. Likewise, National Cancer Institute psychologist Sandra Levy has shown that seriously ill breast-cancer patients who expressed high levels of depression, anxiety, and hostility survived longer than those who showed little distress. Levy and other researchers have also found that aggressive ‘bad’ patients tend to have more killer T cells, white cells that seek and destroy cancer cells, than docile "good" patients. A group of London researchers under Keith Pettingale recently reported a ten-year survival rate of 75 percent among cancer patients who reacted to the diagnosis with a ‘fighting spirit,’ compared with a 22-percent survival rate among those who responded with ‘stoic acceptance’ or feelings of helplessness or hopelessness.”(92)
Siegel elaborates on fighting spirit, with respect to the Derogatis study: ”His work stands as excellent scientific support for a group of researchers nearly three decades earlier, who were ‘impressed by the polite, apologetic, almost painful acquiescence of patients with rapidly progressive disease as contrasted to the more expressive and sometimes bizarre personalities’ of those who lived longer.”(93)
Cousins cites another study that supports Siegel's contention: ”Dr. G. Nicholas Rogentine, Jr., and colleagues of the National Cancer Institute recruited patients who had been successfully treated for malignant melanoma. The patients were asked to rate the amount of ‘adjustment’ they required in order to cope with their illness. Participants who reported that they reconciled themselves to their illness were more prone to recurrence than those who resisted the idea of adapting to cancer.”(94)
Anything seems to work better than resignation. Cousins, citing the Temoshok study mentioned earlier, argues that "passive" emotional states are the most dangerous: ”[Lydia Temoshok's] structured interview with patients measured emotional, behavioral, physical, and mental reactions to events. These measurements revealed that malignant melanoma patients whose attitudes and emotions were active instead of passive exhibited better immune function and slower tumor growth.”(95)
Dossey is more specific. According to his interpretation, the following studies indicate some specific thoughts that are associated with both defeatism and suppressed immune system activity: ”When people learn... to be genuinely helpless, they tend chronically to react to their problems with the classic triad of ‘I caused it,’ ‘It'll always be this way,’ and ‘This is going to spoil everything else I do.’ This point of view seems actually to be channeled into the body. It creates physiological changes that set the stage for bad health. When Seligman and his colleagues rated 172 undergraduates for the presence or absence of this explanatory style, they accurately predicted which students would be sick the most; the predictions held both one month and one year later. In another study involving 13 patients who had malignant melanoma, absence of this style of explanation was a better predictor of survival than even the level of activity of natural killer cells, a type of white blood cell crucial in the immune response.”(96)
In sum, the studies indicate that despair, a profound feeling of sadness coupled with a sense of resignation to conditions, is the attitude that is least healthy when attempting to recover from cancer. Secondly, the social style of not expressing one's negative emotions, especially if it stems from an exaggerated fear of others' disapproval, seems to describe the personality profile of those most likely to get cancer in the first place.