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Ignore pressure to be optimistic

For the seriously ill, such expectations can create guilt and add stress, and there's no proof that a sunny outlook pays off.

August 23, 2004|Judy Foreman | Special to The Times

Nancy Achin Audesse, 45, knows a thing or two about serious illness and optimism. She's had cancer four times: Hodgkin's disease when she was 14, two bouts of breast cancer in her early 30s and melanoma at 37.

"For someone who should have kicked off years ago, I'm fabulous," said Audesse, executive director of the Massachusetts Board of Registration in Medicine. "I'm here, doing good deeds, trying to make healthcare better."

Despite her optimism, Audesse is quick to voice outrage at a belief that still runs rampant -- the idea that a positive attitude can mean the difference between life and death. "It's not fair to put that guilt and emotional burden on a person."

There's little scientific evidence to support the idea that attitude influences survival. For every study that finds a positive attitude enhances one's odds of survival, there are at least three that find no such effect, said Dr. Pamela Goodwin, a medical oncologist who directs the Marvelle Koffler Breast Centre at Mount Sinai Hospital at the University of Toronto.

What is useful, psychiatrists and cancer specialists say, is to adopt whatever philosophy helps you stick with your treatment plan and to be "authentic," that is, to acknowledge and express your honest feelings, positive or negative. And if, at some point, it is no longer realistic to hope for a cure, to refocus your hope toward a more realistic goal: maximizing day-to-day quality of life.

Dr. Jerome Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston and author of "The Anatomy of Hope," noted that a study published this year in the journal Cancer found that lung cancer patients with optimistic outlooks fared no better than those with bleaker expectations.

"There is this burden that patients carry ... that is derived from some of the New Age books of the 1970s, that depression, anger and unprocessed emotions are what cause cancer," he said. "This is completely unsubstantiated."

Such a notion may lead some cancer patients to conclude that "as the disease progresses, your character flaws will lead to your own demise," Groopman said. "This is extremely cruel, scientifically incorrect -- yet a very widely held notion."

Dr. Jimmie Holland, an attending psychiatrist at Memorial Sloan-Kettering Cancer Center in New York and author of "The Human Side of Cancer," agreed. "People can be pessimistic and do well," she said.

In many ways, life-threatening illness is like some violent crimes. Many people find it easier to believe that ill fortune hits people who have somehow asked for it than to accept that life can be a gamble, in which bad things happen to good people.

"People would rather feel guilty than helpless; that's why people go for this stuff," said Dr. David Spiegel, associate chair of psychiatry and behavioral science at Stanford University. Years ago, Spiegel ran a study that suggested women with advanced breast cancer who participated in group therapy lived 18 months longer than those who had no such therapy. But other researchers have been unable to replicate those findings.

The real message, he said, is not to get caught in "the prison of positive thinking" but to "face what you have to face. If it makes you sad, cry. If it makes you angry, deal with that. If it makes you value the things you value, do that."

Dr. Donna Greenberg, a psychiatrist at Massachusetts General Hospital in Boston who consults at the hospital's cancer center, put it bluntly.

"Patients shouldn't be afraid that having a bad thought is going to make their tumor grow." The idea "that if we will it, it will work out" is a "very American concept," Greenberg said. "But life is more complicated than that."

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