I love this piece in the New York Times about the myth that a fighting spirit and good attitude make all the difference in how (and if) you recover from a life-threatening condition. I wrote a piece in 2009 about this and am reposting here since the topic has received attention this week.
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“Having a good attitude makes all the difference.”
People say that to me all the time. I am sure every person who’s had cancer hears that. I think what people are saying is that there is something you can control in all of this mess. There is so much you can’t control, that you have no choice in. People say how you deal with it, how you choose to behave once these things are thrown your way, is up to you.
Here’s what I think:
I think what matters is good health insurance. I think what matters are friends and social support to get you through. I think what matters are children, or pets, or others who nurture your soul and remind you why you are going through all of this: there are others who care about and depend on you.
I think good medicines matter. I think caring and capable oncologists matter. I think talented surgeons matter. I think getting good advice matters.
Why am I resistant to the idea that attitude matters? Not because I don’t believe it. I reject this idea because it places the burden of healing on the individual patient. It places the weight of getting better in his/her hands. I think cancer patients have enough to deal with. We have enough to feel guilty about and responsible for. I think tossing our collective attitude into the mix is a lot of pressure. All eyes are on us anyway.
Now we have to watch how we treat the thing which is killing us.
Having a good attitude says:
the power is in you to survive.
The power is in you to heal.
The power is in you to do well.
But looking at the converse is troubling. The implication is that if you suffer, if you relapse, if you die– it is your fault.
If you had only had the right attitude,
you could have been better at keeping it away.
You could have been stronger.
You could have beaten it.
That may be flawed logic in the philosophical sense but I think it’s worth exploring. Even if that logic can’t be reversed so easily, I think the implication is there: you should have the right attitude because it makes a difference. Difference in what? Difference in your outcome. If it didn’t, then they would not say it.
Or would they?
There is an impetus to control, as I’ve talked about frequently in my writing. You just feel like you need to do something. I think that’s what people are grasping on to with their advice. They know you can’t do much, so they tell you to control the one thing you can: your mindset about what is happening to you.
Sometimes I just don’t want to have a good attitude.
I don’t necessarily think it makes a difference.
I don’t want to think positive thoughts all day
and see the good in what is happening to me.
I think that can be healthy too.
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Interesting NYT piece, because my oncologist told me the exact opposite thing. When I was first diagnosed, and she took my medical history and my family history, she was puzzled as to why I had cancer at all. (I did think this was funny.) She then asked me if I had undergone a particularly stressful series of events in my life recently. I said yes and proceeded to tell her about being laid off three times in four years, being unemployed for two years straight, being homeless for six months, having a good friend suddenly turn on me and attack me professionally…you could say all these things were sudden and stressful. And I asked her why she asked. So she told me that although she had no scientific evidence to back up her theory, she frequently found that new breast cancer patients who don’t fit any normal criteria for being at risk for the disease often developed it after coming out of a series of stressful life events. Later, my breast surgeon told me the same thing. “Oh, no doubt – prolonged stress is a factor.”
Ironically, when I was diagnosed, I was finally coming out of that period of prolonged stress, I was interviewing for new job I really wanted and was feeling pretty damned god about life. I had, however, zero money and no insurance. But I discovered that being told I had cancer, was – all in all – less upsetting than when I learned I was going to be homeless. It just didn’t bother me nearly as much as I thought it would. There are things I left like I had no control over – being laid off, losing my home, etc. And there are things that I felt I had a modicum of control over, like being treated for cancer. Really, once I talked over the treatment options with my doctors, I was like “Okay, let;s get this over with. I have other shit to do.” I didn’t cry. I didn’t get depressed (and I am someone with a severe history of clinical depression). I didn’t ask why. None of these things occurred to me. I just sort of shrugged and said “Oh, well!” The folks at the hospital set me up with a social worker who got me set up with emergency Medicaid in two days and we were off and running.
The day of my first surgery, while I was was actually IN recovery, I was offered the job I had been interviewing for. I made the nurse let me use my cell phone so I could accept the offer over the phone. Two days after that, the HR department at my new employer called me to tell me that their insurance would cover me regardless of any preexisting conditions. So even though I had cancer, it sure seemed like the tide was turning in my favor. Hard to feel bad about any of that.
It wasn’t that I was determined to “have a good attitude”; it was that I know there are worse things than cancer and I’ve already experienced a lot of them. So cancer has been a walk in the park, all things considered. Yes, I really believe that.
Frankly, it has been hard not to laugh at some points. Even the day I was first diagnosed, I had a terrible attack of the giggles, because after talking to my breast surgeon and several other people on the medical team, my friend and I were tossed to someone who ran a breast cancer support group, who immediately started talking about guided meditation and visualization and then threw a pink bag of cancer swag at me. At which point my friend and I burst into a fit of uncontrollable laughter. It was just so ridiculous.
Since my diagnosis in July, I realize that I’ve found much more to laugh about in dealing with the cancer than to cry about. In fact, I haven’t cried at all. I get annoyed sometimes, but it doesn’t last very long. This is just me, just who I am, just my personality. It’s not me “trying” to be anything. But I do think my naturally upbeat attitude and tendency to see the humor in everything has helped me enormously, and it has helped me survive a lot more than just cancer.
My two cents.
Oh, but I do blame cancer for my inability to spot my own typos. Chemo brain is so much fun!
I think the idea that “attitude makes a difference” is intended less to blame or put responsibility on the patient for their recovery/lack of; it’s saying that you can have a great oncologist, supporting family, and health insurance, but what’s the point if you don’t believe in them? Or if you don’t have the other benefits, at least your life doesn’t have to be one long string of misery. Now, it’s not forbidding you from feeling horrible about the situation, but it tries to encourage that attitude of fighting spirit. I talk to many people who have issues with depression, self abuse, and suicidal tendencies, and I think this is very applicable to that as well. It’s all in the way you look at the situation.
This post illustrates one of the many reasons I admire you. You say what so many need to hear and what many others are afraid to say out loud.
Personally, I don’t like putting the word “should” together with any feeling. I also don’t like putting the word “right” together with any attitude. You feel what you feel. Your attitude is what it is. Why spend a lot of time and energy trying to pretend you feel something you don’t? We all have better things to do with our time and energy. Those who are dealing with cancer – even more so.
I also agree that the concept that we can control the outcome of things by having “the right” attitude is an illusion people like to cloak themselves in – primarily to reassure themselves that it can’t happen to them (because they have “the right” attitude).
I prefer dealing with reality. Sometimes life sucks. Sometimes bad things happen for absolutely no reason. There are a lot of things we cannot control. I find it liberating.
Thank you for putting this out there for folks who are tired of being told what they “should” feel and what the “right” attitude is.
Oh…the tyranny of positive thinking. A wonderful psychiatrist at MSKCC addresses the psychological burden of reminding patients to keep a positive mental attitude. http://www.humansideofcancer.com/chapter2/chapter.2.htm
One practically needs a support group to deal with this taxing and overused expression of well meaning friends and family.
Jackie –
I certainly have never felt pressured or “tyrannized” by anyone insisting I keep up a good attitude, nor has anyone ever said to me “You should have a positive mental attitude.” I have, however, felt pressured by other women who have had cancer to “take the cancer more seriously” and have been questioned by people who really should know better as to just why I’m not sitting around weeping in my coffee about it.
The fact is that I have a pretty naturally upbeat attitude toward most things in life. As someone who has struggled with severe clinical depression most of my life, learning to always see the humor in everyday things – even things like breast cancer – has probably saved my life more than once. Does it mean that I think I am controlling the situation itself? Of course not. But I’m certainly controlling how many of my mental & physical resources I choose to expend on it, and in which way I choose to direct those resources.