I finished a new novel recently, one I enjoyed enough to share with all of you. It’s called The Good Father by Noah Hawley, and it’s an exploration of what might happen to a parent when his child is accused of doing something terrible. In this case, Dr. Paul Allen’s son is accused of shooting and killing a candidate for President (I’m not giving anything away by revealing that plotline). Paul eventually starts traveling around, talking to people who knew his son during the months leading up to the shooting. One man he talks to is named Carlos.
Carlos tells Paul a story about his brother who stepped on a land mine. His legs were saved but his intestines were crippled. He needed a colostomy, and doctors repeatedly told him it was temporary. They keep telling him that he will use the toilet in the normal fashion again. But their promises don’t come true. He continues to need the colostomy. After two years of false hope his brother couldn’t take it anymore, and he kills himself. Carlos says:
Acceptance is the key to happiness. If those doctors had told my brother he’d be crapping in a bag for the rest of his life, he would have accepted it. He could have found a way to be happy. But instead they gave him hope. They promised him a better life. And so he spent every day hating the life he had.
Though fictional dialogue, this scene really struck home. It immediately reminded me of Admiral Jim Stockdale and The Stockdale Paradox. Jim Stockdale was the highest-ranking naval officer held as a Prisoner of War during Vietnam. Captive for more than seven years, tortured more than 20 times, Stockdale is an expert in how to deal with hope. Stockdale talked about his experience to James C. Collins, eventually published in the book Good to Great:
I never doubted not only that I would get out, but also that I would prevail in the end and turn the experience into the defining event of my life, which, in retrospect, I would not trade.
Stockdale’s next observation floored me the first time I heard it. He was asked to talk about those who did not make it home, who died in Vietnam after being taken into custody:
They were the ones who said, ‘We’re going to be out by Christmas.’ And Christmas would come, and Christmas would go. Then they’d say, ‘We’re going to be out by Easter.’ And Easter would come, and Easter would go. And then Thanksgiving, and then it would be Christmas again. And they died of a broken heart.
This is a very important lesson. You must never confuse faith that you will prevail in the end—which you can never afford to lose—with the discipline to confront the most brutal facts of your current reality, whatever they might be.
Stockdale is telling us to forget the eternally positive attitude, the belief that hope is enough. He says, rather, that you must always believe you will succeed, but not place an expiration date on it. In fact, doing so (“I’ll be better by Christmas”) can, in his opinion, be a recipe for disaster and self-destruction. Stockdale had a failed political career, but that doesn’t matter to me. He made it through his confinement, and what he thinks about the reasons for it interest me.
I’ve never been a believer in the “a positive attitude is everything.” That doesn’t mean I don’t think you generally should have one. Like Stockdale, I believe you must fight as if you will win. But, and this is key to me, you must accept that you do not know the outcome. This is where I differ with Stockdale’s prescription. I believe you cannot confuse having hope with the reality that your hope may not be, and often will not be, enough.
A few weeks ago as my three children had their dental checkups, I picked up People magazine. I skimmed the letters to the editor. One letter, from a woman named Barbara, referred to a prior People story about Ryan O’Neal having cancer. “I know that he will overcome this because he has immense strength and courage,” she wrote. Barbara is not unique. I have heard this exact statement countless times.
First, I’m fascinated by Barbara’s knowledge over O’Neal’s outcome. To claim she knows what’s going to happen to him is pretty remarkable. She has no knowledge about anything except a few quotes in a pop culture magazine and yet she “knows” he will overcome it. Second, and this is the big one: strength and courage are not enough, I’m sorry to say. Don’t those who die from cancer have strength and courage? Is it their fault that they aren’t surviving? Strength and courage are needed, for sure. But just having them won’t do it. You can’t think the cancer away.
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Interesting to think about what buoys us and what may crush us. It seems to me some people do best facing tough situations with realism and determination. Maybe some people can make it on a hope and a wish–but I don’t think I’m one of those people.
I watched my mother go through cancer and treatment three times (there had been one before I was born). The first time, she was determined that it would have as little effect as possible on us, and she was relentless–popped right up and went back to work, carried on with life as a mother of two relatively young kids. The second time, she was still positive, having beaten the disease twice before, but the recovery was much more difficult. The third time, her energy to fight had eroded into a difficulty accepting the reality that there was nothing more that could be done and she was going to die. I agree with you that assuming the outcome is dangerous, but I think that my mother’s example taught me the importance of not assuming a negative outcome. False positivity can make it seem like some fail because of their spirits, when in fact they are subject to the frailty of our human vessels. Still, I can see the appeal of hope, have tried to hope, and been disappointed. That seems like human nature.
Prayer and hope are not strategies. Selecting the right doctors may be and far more so than the aforementioned.
Oh Lisa… This hit me like a truck.
When my father was diagnosed with lung cancer, he had to have a lung removed. The doctor explained that his lung worked as a balloon and held the cancer from escaping to the rest of his body. Can you imagine? We were elated as he lay in the recovery room. That’s not what happened and he passed away within 2 years.
When my mother was diagnosed with Multiple Myloma, the oncologist told me he expected her to have a very healthy 5 to 7 years before she became too ill. That’s not what happened either, she passed away within a year of that conversation.
I felt like I had failed, I still do actually but working on that.
I think you could even take it a step further — during all of that time I was in a marriage that sapped me of all my strength and dignity. I said so many times, “everything will be okay after (this or that)”. That’s not what happened.
I think you’re totally right about having a positive attitude and that absolutely should not have an expiration date on it.
Strength and courage are great, but there’s a lot of people who have amazing strength and super courage but still experience some horrific things.
Thank you for this my sweet friend.
I’ve been waiting to read your thoughts. I saw that People Magazine tweet to Ryan O, too. And I remember thinking the same thing. A positive attitude helps with the quality of your ATTITUDE but it does nothing to help a disease. It doesn’t stop its progression. It doesn’t fix what’s already caused a problem. It’s just a frame of mind. This is not to say a good frame of mind isn’t helpful but I’m with you. We can’t “think” our way to wellness.
Thank you for being brave.
Love,
AnneMarie
The last paragraph is so comforting to me after losing my Mom on Mother’s Day to poorly differentiated widespread abdominal carcinoma.
She went to the hospital March 18th thinking she had food poisoning to discover the 32 pounds she had gained was NOT FAT it was tumors and tumor fluid. Her positive attitude was evident from the first moment she was told. In the emergency room, with out missing a a beat,
Doc-“Mrs Tichy you have widespread cancerous tumors all throughout your abdomen.”
Mom-Turns to me with a huge smile on her face and said, “Well, there is good news. I am not just fat Kara.”
She had a lightening fast battle of 8 weeks from cancer diagnosis to death, her strength and courage and POSITIVE enlightened attitude about briefly trying to fight it then accepting her death and organizing her own passing and she partied all the way out. I will carry those weeks in my heart for ever. I was flying high every minute spent with her.
Every moment with her was like waking up on Christmas morning. You know that feeling? It was here. She was STILL there. She loved me. She loved life, what little she had left.
She was on a higher plane. It had nothing to do with losing hope, not having strength, not wanting to fight. Mom was a genius. She accepted was WAS. She lived those last weeks as fully as possible although she never got out of bed. She put on lipstick everyday, ordered up her favorite cocktails (which she drank through a kid’s zippy cup with such style and élan & entertained hundreds of friends that came through her bedroom those last 2 weeks.
Thank you Lisa, you hit the nail on the head. True Strength comes from accepting what IS, and fighting whatever obstacle we face from that point of view. Not creating some false hope and being disappointed when bad things continue to occur, or some false deadline passes.
sorry for the typos, didn’t notice them through the tears.
That was beautiful and heartbreaking. Thank you for sharing – may we all try to have the same joy and elan your mother did!
Wow. This post really gives me something on which to chew. I was just thinking about acceptance and what part it plays in living, as in, “If I accept that life throws X and Y at me, will I be better equipped to deal with it? Will being realistic, and setting fact-based expectations, hinder my chances of healing or set me back?”
I wonder if there are studies which document unrealistic PMA and its effect on the body’s ability to heal?
Wonderful post, as always.
You know, I always relate your thoughts on cancer to my own past struggles with infertility. In infertility circles, too, there is this language of positivity that I always found toxic–that if you couldn’t manage to be cheerful and optimistic in the midst of early morning blood draws and invasive procedures and outrageously expensive medical bills that somehow you didn’t deserve to be pregnant.
I was never good at being hopeful in general, but I was good at compartmentalizing hope: I was hopeful that tests would yield actionable results or that procedures would work, but I could never dare to hope about the ultimate goal, the possibility of having a baby in the end.
I’ve long held that hope is not a prerequisite for courage, duty or purpose.
These can be found in the absence of hope.
And hope can indeed be a dangerous thing, with a vicious backlash each time it turns to dust. (It was the last item in Pandora’s container of *woes and ills*. Hmm.)
I can’t even go completely with Admiral Stockdale: I’m not sure I can have “faith that you will prevail in the end”.
Heroes, and just ordinary people doing what they can and ought, can lose. Many do.
That doesn’t make them any less heroes, it doesn’t make them wrong.
There is a real place for hope, but misuse it in any of several ways and it can be a monster.
Me, I’m facing a debilitating chronic illness that I may not beat and makes every day a battle. There is, realistically, some hope. But I’m not counting on it.
I’m counting on doing what I ought to, the best that I can.
Win or lose, and I’m not currently winning.
A key line from the epic poem “The Battle of Maldon”:
“Will shall be the sterner, heart the bolder,
spirit the greater as our strength lessens.” (Tolkien’s translation).
Chris, with Chronic Fatigue Syndrome.
Great post. I vary day to day in my thinking. On a good day, I feel as though breast cancer will never bother me again. On a bad day, I feel scared that I am going to die before I finish raising my third child. In between, I just keep moving. I want to live cancer free for many years and grow old, with grandchildren on my lap. Since I have no idea what my outcome will be, I’m grateful for each day I have. I think what this means to me, is that I have accepted the fact that I may die from breast cancer. Honestly, if I think about it too much, I wouldn’t be able to get out of bed.
Thank you, thank you, thank you for this post. I think it is really hard for healthy/nondisabled people to understand the double-edged sword of hope. I resonated so strongly with this post.
Among my chronically ill friends, we have two phrases that healthy people often find odd, confusing, or funny: Aggressive resting, and radical acceptance.
Radical acceptance has been a huge part of my coping well with becoming disabled by chronic illness at the age of 25. But hope has become much more dangerous for me in the last few years. When I first got sick, it was with two illnesses that are known to be chronic. I knew people who had them, and I knew you could improve and manage it, but never fully recover. I accepted and adapted to my new life with disabilities.
Then, in 2007, I got Lyme disease. All the information I read told me that after a short course of antibiotics, I would be cured. The way I approached this new illness was with aggressive treatment and the belief that if I did enough rigorous treatments fast enough, I would get better.
I still am severely disabled by chronic Lyme, and I struggle now with depression and hopelessness that I never had before. I think part of the reason is that I cannot let go of the belief that I will be cured of it, eventually. And of the damage done to my life by an approach to treatment that brutalized me physically and psychologically.
Hope is like fire, or medicine, or anger. Usually, some amount of it is necessary. But too much of it, or an uncontrolled measure — an out-of-control fire, an overdose, a perpetual burning rage — is destructive.
Lisa, another thoughtful and thought-provoking post. Fascinating to hear Stockdale’s point of view; completely nuanced, and so important. Thank you for writing.
A dear friend of mine who has cancer, sent me this post- Excellent reading, thank you! We lost our 18 year old son to a brain tumor 8/27/11. He made it 15 months, in spite of having odds that “should” have seen a longer survival and better response to treatment: he was young, healthy, he had the right gene expression that meant the tumor should have responded well to treatment, yet he didn’t make it. He always held out hope that he would have more time, but he knew the odds weren’t in his favor, he never fooled himself, but he was upbeat about it, never questioning why him etc. I never really saw him lose hope that he’ d have more time until he started losing the ability to do things he loved bit by bit, and then the last blow was the day right before he was to go into surgery for a last ditch attempt to give him more time, the surgeon coming 5 minutes before surgery and saying that between the time we had scheduled the surgery and the mapping MRI they did that morning (1 week, to be exact), the tumor had grown too much, there was nothing further more to do-we should go home and enjoy our time together–maybe we had a week or 2. This was the only time that he ever said “Kill me now,” His strong resolve pretty much ended that morning. A little while later he expressed an interest in my seeking out other alternatives, and ultimately another surgeon did attempt to do a surgery in hopes we’d be able to prolong his life and possibly get some effective treatment. In spite of that, however, it gave him 5 months of life that were in no way a good quality of life.
I’m still an active participant in the BT community, and this topic comes up periodically – especially when someone is so sure that the reason they’re still around and beating the odds is because they have faith, or truly believe that they are going to beat this thing. Or that their God has such love for them that he is responsible for their survival. Arrrgh! For some people, they find this kind of talk inspiring–especially if they’re amongst the lucky ones who are blessed with markedly longer survival times. For many of us, however, especially the ones who have lost someone they love, these kinds of remarks can be very upsetting, degrading, and very hurtful! I mean, honestly, did our loved ones try to fight and survive less than others? Did they not have hope, did they not do what it took to try to beat the odds? I’ve always maintained that If pure will, inner strength, and desire to live were enough, no one would be succumbing to this beast- My son would still be here if that were the case. Certain cancers have better outcomes, of course, but for many, it seems that it was a losing proposition from the start. No amount of this positive thinking is going to make that much of a difference. I think the realistic expectation is much more valuable and allows one to live the life they now have more fully.
Not sure if I’m even saying anything here or just blabbering, but i did want to let you know that I liked your post, and the way you are looking at all this. Thank you for sharing!
Ellen, my condolences to you. The death of a child is heartbreaking and the story you tell is gut-wrenching. I appreciate your willingness to add your story here and grateful that your friend shared the post with you.
People so want to control, well, everything. Need a reason. Need to be able to be good enough in order to get what they want. I love that you remind us it’s never been that way. It will never be that way. You do so firmly, but kindly.
I think this can be applied to so many things in life Lisa. Amazing article once again. xo
To the young woman that says I’ll be married at 24
To the entrepreneur that says I’ll makes million by 40
To the struggling mom that says next year I’ll feel better
To the abused spouse who says it won’t happen again
We all live by & set impossible standards for will or success. Imagine the outcome of we just tried our best everyday but perhaps there needs to be a line drawn between dreams, aspirations & hope.
Great post, Lisa.
My sisters and I were raised to cope rather than hope. Maintaining an even keel during a crisis while dealing with the day-to-day business of existence is enough for us.
It scares me that so many people commit themselves to positive outcomes when the true outcome is unknowable. It’s magical thinking, and I want to tell them to stop. Dealing with reality, putting one foot in front of another and carrying on, is what’s called for.
Cope rather than hope. My parents were dreamers, and coupled with growing up a Boomer with Cinderella syndrome, that is the wisest advice I’ve ever heard. Thank you!
I’ve watched people approach the challenge of disease with a stoic fortitude ever single day, confident in their willingness to do whatever they have to do. Some have lived and some have died. And I’ve watched people crumble to despair, continue treatments, and some have live and some have died.
That in itself feels arbitrary and makes you wonder, where is the kind of logic and order that can let us trust life?
The truth is that we can’t. Existence isn’t trustworthy. It’s beyond our control and beyond our understanding, working in minute twists and turns at a speed beyond anything we could hope to understand, and with more vitality and consequence than we could every emotionally bear to witness.
It’s wondrous in its vast beauty.
Everyone one of us is faced with the question of how we want to live. When we are faced with an aberration, a consequence of the universe that leaves us facing dire uncertainty or profound loss, we’re brought to a moment that requires us to commit to a way of life.
The greatest courage, I think, is expressed in the willingness to embrace every moment, to be as present as physically possible, even when faced with the complete uncertainty of our own mortality. Cancer is that insidious enemy, the agent of uncertainty, a vessel of pain and disorder. When we are present in the moment, we can have the certainty of other moments following. That’s what I believe Stockdale captures in his principal of survival. The “I” will survive forever because it is alive in the very moment.
I love that you write about your experience with such clear-sighted compassion, and that you work to move people past platitudes to the kind of realities that let them accept what is and to keep the sense of their own self as intact as possible.
We don’t control life, and hope means relinquishing our self to that absence of control. We do control our presence in the moment, and it is the hardest and most rewarding task for anyone facing uncertainty to complete. You inspire people to have the confidence to do it.
Hope is as important as the air we breathe. It’s the intangible that allows us to put one foot in front of the other and continue on in the face of darkness. I am, however, fascinated by those who say, “I’m going to beat this thing.” It’s almost akin to the woman who said she just knows Ryan O’Neil will overcome his cancer. Perhaps you and I know too much about cancer. We know that while a positive attitude is a key ingredient to making it through treatment, we also know how insidious cancer can be and that sometimes, our positive attitude is not enough.
This post has given me a huge takeaway, Lisa. I’m working on an incredibly difficult project with a self-imposed deadline. As my deadline draws near, I find I’m becoming discouraged because I haven’t achieved my goal yet. While I hope I will succeed, and will do everything in my power to make that happen, I’ve lifted my expiration date. I feel better already. Thank you.
Brenda
Lisa, that is a great post. That is a tough topic to flesh out and you did it well. I love the way you presented the take from the novel, and the real-life hero perspectives. Two very good perspectives to help us figure it out. The comments are all helpful.
In some of these doctor/patient scenarios, the physicians are LYING to families. In many situations there would be no false hope, if the cold, hard, whole truth-was told. Then the patient and families would have a decision to make: accept it and adapt; or decide to live in delusion. We do need to hear truth. After that, it’s up to that individual what their attitude will be- no matter the news.
Thanks again, for this post.
i hate the term survivor or fighter for this reason. we are all fighting and it’s confusing when we lose the battle. were we not good enough?
hope, cynicism, faith. these things are good in small doses. but what’s more important is being aware of the reality of the situation, and trying your hardest to embrace that while living through it.
Thank you – very thought provoking, what a great perspective!
[…] this Stockdale paradox. I first read about it here. Basically, a naval officer named Stockdale was a prisoner of war in Vietnam. During this time, […]