In 2004, New York's Shelley Contin-Hubbs was diagnosed with the most advanced stage of breast cancer; two different doctors told her she could have as little as six months to live.
Contin-Hubbs found a third physician, one who was as optimistic and hopeful as she was. Today, the 52-year-old credits the power of positive thinking — along with an integrative treatment plan — with helping her beat back the cancer that had spread to her lungs and bones.
But so far, the findings are stronger for cardiovascular disease and HIV infection than cancer. Though it's widely believed that a positive attitude can enhance cancer treatment, some experts say the notion places an unfair burden on patients because it doesn't allow them to express fear and anger. Moreover, critics say it suggests that people could cure themselves if only they were sufficiently optimistic.
Perhaps most important, there's no evidence to show that positive feelings can stop cancer from growing or prevent death. One study concluded that "to insist patients believe in its power to cure may be courting emotional disaster."
Optimism, however, has become a common theme in the current culture of cancer care. When writer Barbara Ehrenreich was diagnosed with breast cancer, she struggled to find bloggers and writers who shared her sense of outrage over the disease and its treatments. As an experiment, she posted a negative message in a chat room on Komen.org, the Web site for Susan G. Komen for the Cure, the world's largest grass-roots network of breast cancer survivors and activists. Several responders chastised her for not being more upbeat.
"The effect of all this positive thinking is to transform breast cancer into a rite of passage — not an injustice or tragedy to rail against, but a normal marker in the life cycle, like menopause or grandmotherhood," Ehrenreich wrote in "Bright-Sided: How Positive Thinking Is Undermining America" (Picador, $15).
She added: "The sugarcoating of cancer can exact a dreadful cost. First it requires the denial of understandable feelings of anger and fear, all of which must be buried under a cosmetic layer of cheer."
Still, a positive outlook can address helplessness and return some control to a patient. That can help alleviate conditions such as anxiety, depression and despair that often accompany cancer and other major illnesses.
Aspinwall's work has shown that optimism is associated with better preventive self-care: It leads people to exercise more, eat a healthier diet and refrain from smoking. In addition, optimism is associated with greater perceived social support and more frequent, higher-quality social interactions. Fatalism, on the other hand, is associated with several serious health-compromising behaviors.
She argues that researchers in the positive-psychology field aren't advocating "mandated cheerfulness," or even encouraging positive thinking among people managing life-threatening illnesses. Instead, "people should not be discouraged from holding positive beliefs and expectations," she said.
But some doctors actively urge their patients to resist negative thoughts. Dr. Keith Block, who treated Contin-Hubbs, tells his patients to prepare for the worst and live for the best. "(Fatal thoughts) can be prophetic and have physiologic impact," said Block, medical director of the Block Center for Integrative Cancer Treatment.
"A terminal mindset can have terminal consequences; if a patient is hearing terrifying words from a medical authority that he or she has come to respect, it can lead to a self-fulfilling prophecy," he said.
"If told, 'You have only six months to live,' a patient may inadvertently develop the psychophysiology needed to fulfill the prediction. This can hasten a dying process and increase the odds of a terminal outcome."
Contin-Hubbs said Block's attitude was exactly what she needed. "He looked me in the eye and said, 'I have no doubt we can get you six months, the real goal is can we get you past five years?'" recalled Contin-Hubbs, whose e-mail address is, in part, "stage4nomore." She maintains there is no such thing as false hope. "It's a double negative, which means it's a positive," she said.
Optimism can help, hinder patients
Though fatalistic thoughts have a proven track record, experts say the push to think positive may stifle emotions and imply that happiness cures.
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