Joanne, a 55 year old woman with breast cancer states, "I believe in taking responsibility for my health. But then she asks, "Does that mean I'm to blame for having cancer? And if I don't get better, will it be my fault?"
Mark, a 39 year old man with a brain tumor, has been practicing imagery and meditation regularly for several months. During this time his tumor has not changed. He wonders, "Am I doing something wrong?"
Heather, a 35 year old mother of three, has lymphoma. She is concerned because, "I believe negative emotions weaken my immune system, but I can't help feeling afraid, angry, and sad. Am I harming myself?"
Robert, a 44 year old truck driver with colon cancer asks, "Am I making myself worse? I'm trying to keep a positive mental attitude, but I must admit sometimes I feel helplessness and despair."
Questions like these are increasingly common, and reveal the confusion many feel about how to apply a mind/body perspective to cancer. There is no doubt that mind/body medicine is of tremendous benefit in improving the quality of life by reducing pain, nausea, and emotional distress. And many former patients are certain such practices as meditation, imagery, and deep relaxation have contributed to their recovery.
However, with the sometimes overwhelming enthusiasm of self-help advocates, sensational media reports, and an avalanche of popular books, the true place of the mind/body perspective within a context of comprehensive care can be lost.
As a result of this confusion, some people have come away with feelings of self-blame or guilt--that they may have "given themselves cancer." Or they may have feelings of failure or inadequacy from unfulfilled expectations about mind/body techniques--for "not doing it right." People who are already inclined toward self-blame are especially vulnerable.
This problem could be called the "psychosocial morbidity" of mind/body medicine. It is preventable, and arises out of certain misguided beliefs being promoted in the self-help movement.
This is a delicate subject because for many, mind/body medicine represents hope, particularly when there is no medical cure available. And indeed, hope is medically beneficial. I emphasize that the problem results not from mind/body medicine itself, but from misunderstanding its application.
How can you enjoy the benefits and avoid the risks? By examining your beliefs and expectations closely. Below are four areas of beliefs which deserve close scrutiny.
Taking Responsibility For Your HealthFew would argue with Joanne's belief that we should take responsibility for our health. But what does this really mean? Many of us learned growing up to associate "taking responsibility" with blame, guilt, or shame for past mistakes--as in, "Who's responsible for this mess?" Many assume taking responsibility entails a sullen inventory of where we went wrong.
Reflecting upon whether we may have contributed to our vulnerability to cancer is worthwhile, especially if it leads to changing risky or unhealthful habits. The problem comes when we enter into judgment or condemnation of ourselves. A blameful attitude toward yourself for the past will only erode self-esteem and confidence now. Living with cancer is stressful enough as it is. What is needed now is self-acceptance, not self-judgement.
A more constructive view of "taking responsibility" is to shift our focus from the past to the present. Research tells us that an active stance of self-support is associated with better medical outcome. We can take responsibility to do the best we can to help ourselves from this moment forward, and to be a full participant in our health. We can make the shift, if necessary, from self-blame to self-support.
The Role of Mind/body TechniquesMark's concern over his meditation and imagery reveals a belief that "If you do your self-help practices long enough and well enough, you will get better. And, if you are not getting better, you must not be doing it right." This implies that self-help is curative, and recovery depends on performance.
Recent years have indeed brought exciting discoveries about mind/body interventions. Studies have found that we can influence our immune system with such techniques as imagery and relaxation. However, we do not know enough to say what medical outcomes can be expected.
When studies report significant effects, this usually means that a "statistically" significant change was found (for example, increased natural killer cell activity). But this is different from saying the effects were "clinically" significant. That is, such effects may or may not be of a magnitude that would affect the course of a person's illness.
These studies are, however, cause for hope. They illustrate that there are pathways of influence and potentials to be explored. Perhaps future research will find ways to predictably influence medical outcomes. For now, we simply do not know to what degree such methods can be a factor.
So what can we expect? There is no doubt that we can reduce symptoms of illness and side effects of treatment, and improve emotional well-being. We can hope to also help the body heal. A realistic perspective is that self-help works in partnership with medical treatment, but is not treatment in itself.
Emotions and ImmunityHeather's concern about emotions reveals two common beliefs: that emotions are negative or positive, and that emotions can harm immunity.
Our culture tells us that certain feelings are desirable and others are not. As a result we have created categories of "negative" and "positive." Then we think we should somehow engineer our lives to have only the preferred feelings.
Since we are human beings, however, this is not possible. It means going against nature, cutting off or denying important aspects of our emotional experience. This leaves us in a real bind. We learn to suppress or repress our anger, fear, or sadness.
The reality is that emotions are neither negative nor positive. They are simply life energy flowing through us in its variety of colors. Research in psychoneuroimmunology (PNI) has shown that what matters most to our immune system is what we do with our feelings. Do we suppress, repress, or express? In the words of Dr. Lydia Temoshok, a prominent PNI researcher, "If there's a hero in all this, it's probably emotional expression."
This applies to our love and joy as well as our anger, sadness, or fear. The free expression of all our feelings allows a flowing of life energy through the body, and the immune system seems to appreciate this.
The Meaning of "Positive Mental Attitude"Robert's confusion over positive mental attitude is based on a popular concept which goes something like this: "Strive to have only positive thoughts and feelings. Negative thoughts or feelings will harm you. A positive attitude is curative, and a negative attitude is harmful."
There is no doubt that having a positive expectancy and hope are important, not only to quality of life but possibly to healing as well. Research has shown that belief in recovery is associated with better medical outcome. What's more, with a positive expectancy we are more likely to follow through with medical recommendations and healthful lifestyle changes.
However, many people have construed this as implying they should deny or suppress certain thoughts or feelings.
A more healthy "positive attitude" involves having a full acceptance of ourselves as we are. This includes full expression of all our feelings--our sadness, fear, and anger as well as our love, joy and optimism. It means acknowledging rather than denying those darker moments when we may feel helplessness, hopelessness, or despair.
It means not having energy bound up in suppressing so-called "unacceptable" thoughts or feelings when they are present within us. In a climate of self-acceptance and expression, the darkness and doubt will lift more easily, allowing hope to shine through once again.
ConclusionMind/body medicine makes a valuable contribution to the lives of patients and their families. Sometimes, however, especially if we are anxiously grasping for black and white answers or simple solutions, we can end up feeling overwhelmed by the flood of new information and advice.
We need to keep a perspective that truly serves us rather than becomes a burden for us. Mind/body medicine helps us empower ourselves to participate fully in comprehensive care. It is an integral part of a whole-person approach to cancer.