No wonder our rates of suicide, drug
addiction, and middle-age death are way above average. Just give one of us
an airplane and pilot’ s license, and then ask an actuary what the insurance
risk is. “For get that thunderstorm,” the doctor thinks. “I have a meeting to
get to. Other people crash, not me.”
In a recent article Glen Gabbard, MD, of the Menninger Clinic
discussed the role of compulsiveness in the physician creating doubt, guilt,
and an exaggerated sense of responsibility . This is reflected in dif ficulty
relaxing, vacationing, and finding family time. In feeling responsible for
things beyond one’ s control, feeling that one is not doing enough, and
confusing selfishness and healthy self-interest. To paraphrase a story of Larry LeShan’ s: Doctors are busy playing God
when so few of us have the qualifications. And besides the job is taken. Playing God leads to self-destruction.Many colleges are now trying to teach compassion through courses in
humanistic medicine, but perhaps the admission of more women to the
profession will gradually do more to end this pathetic bravado. The best
physicians are those who can find both the “masculine” and “feminine”
virtues that exist within their personalities—the ability to make tough
decisions and yet remain compassionate and caring. Neither extreme makes
a good physician. You can become too involved to make good decisions,
and you can also make decisions based on diseases and think nothing of the
patient. Combining both is the best way . This has been borne out by studies
showing that those who combine both aspects become more ef fective
doctors and also remain happier amid the stresses of their profession. It’s important for most patients to know that their doctors themselves
take the advice they give. Yet, feeling immortal, many physicians smoke,
drink too much, eat badly and too much, and exercise not at all. This is sad enough for the physician, but for the patient it’ s far worse. A
sense of invulnerability makes a doctor discount the fears of the patient,
who lives in no such charmed fantasy . When someone asks, “What should I
eat?” the invincible deity says, “Eat whatever you want. I’m going home
and having hot dogs.” Asked about the carcinogenic nitrites in them, the
physician, behind that invisible shield, laughs. With such an outlook, we M.D.s sometimes fail to think of the most
obvious things, as our son Keith taught me when he was four years old and
had to go into the hospital for a hernia repair . I explained all the mechanical
details, but when he woke up he said, “Y ou for got to tell me it was going to
hurt.” Recently , as a teenager , when he came home with problems, his
father had solutions like love-accept-for give, but he said, “I don’ t need
answers. I need someone to listen.” When we play the role of a saint with
one-word answers, we don’ t help people. We help when we listen and share
our pain. We must live the sermon, not just deliver it. A severe staph infection, which once kept me in a hospital for a week,
was a crucial part of my education. I found out the dif ficulties of being in
isolation, hooked up to an intravenous line, required to call for help for
everything I needed, when I was used to being responsible and in control. I
found how hard it is to maintain your dignity in the skimpy gowns that the
hospital provides. This illness came at a time of many changes in my life—a new home,
more children, starting practice—all positive events, and yet I became ill. Itmade me aware that patients in my of fice must be experiencing similar
things. I began to joke with them about changes in their  lives. I would ask,
“Did you get a new job? Did you move to a new house?” They were
astonished. How did I know? I learned more about what doctors were like, too. Since I was a
physician, I had eminent professors caring for me, but I couldn’ t get them
all together at one time to give me a straight answer . They even wanted to
move me to a more depressing, windowless ward because it was closer to
one professor ’s office. I said no and told them I was leaving the hospital. Suddenly everyone showed up. I think a few days as a patient on a busy ward should be an integral part
of every physician’ s training—including, as one patient recently added, “an
IV in his arm and a tube up his nose.” Most tribal cultures recognize a
similar necessity . Usually one cannot become a healer without first passing
through sickness to health. In our culture, one cannot become a
psychoanalyst without being analyzed, but one can become a medical
mechanic without ever experiencing the need for repair . The denial of empathy benefits no one. As mechanics, we doctors
always fail in the long run, but as counselors, teachers, healers, and care
givers we can always contribute, and even help at the moment of death. Then there’ s no need to hide in the cafeteria with the beeper and force the
nurse to face the patient’ s death alone. A cooperative arrangement, in which
the doctor and patient both realize that they are essentially the same except
for a few years’  training, of fers more to both than the accustomed roles of
master and supplicant. In the words of Dr . Francis Peabody , a pioneering
medical researcher at Harvard in the 1920s, “The treatment of a disease
may be entirely impersonal; the care of a patient must be completely
personal…the secret of the care of the patient is in caring for the patient.”
For most doctors, like myself, the change is long and dif ficult, but there
is no ef fective alternative. The mental components of all disease make it
imperative that the physician be as enlightened, and as much at peace with
the self, as a good psychotherapist. In Modern Man in Sear ch of a Soul ,
Carl Jung stated the requirement thus:
 
And in dealing with himself the doctor must display as much
relentlessness, consistency and perseverance as in dealing with his patients. To work upon himself with an equal concentration is truly no smallachievement; for he brings to bear all the attentiveness and critical
judgment he can summon in showing his patients their mistaken paths, their
false conclusions and infantile subterfuges. No one pays the doctor for his
introspective ef forts; and moreover , we are generally not interested enough
in ourselves. Again, we so commonly undervalue the deeper aspects of the
human psyche that we hold self-examination or preoccupation with
ourselves to be almost morbid. We evidently suspect ourselves of
harbouring rather unwholesome things all too reminiscent of a sick-room. The physician must overcome these resistances in himself, for who can
educate others while himself uneducated? Who can enlighten his fellows
while still in the dark about himself, and who can purify if he is himself
unclean?…The physician may no longer slip out of his own dif ficulties by
treating the dif ficulties of others. He will remember that a man who suf fers
from a running abscess is not fit to perform a sur gical operation. Jung also addressed the need to go beyond a narrow , specialized
approach. In his autobiography , Memories, Dr eams, Reflections , he wrote
that, just as physicians learned to use x-rays with no thought of lecturing on
subatomic physics, he was “not concerned with proving anything to other
disciplines; I am merely attempting to put their knowledge to good use in
my own field.” Jung broadened psychology by incorporating the
perspectives of mythology and philosophy , and, in like manner , today’ s
physicians must apply the insights of psychology and religion to medicine. Later in the same book Jung describes the advantage a doctor derives from
this willingness to learn from other fields:
 
The dif ference between most people and myself is that for me the
“dividing walls” are transparent. That is my peculiarity . Others find these
walls so opaque that they see nothing behind them and therefore think
nothing is there. To some extent I perceive the processes going on in the
background, and that gives me an inner certainty . This expanded outlook helps a doctor to inspire hope, give with the
heart as well as the head and hands, keep ego in the background, and share
major decisions with the patient. Such an approach rewards the physician aswell as the patient. The love returns in words and looks of gratitude, in
cards and letters, and in little gifts for the of fice, all of which restore you. A
doctor who acts out of love doesn’ t burn out. He or she may get tired
physically , but not emotionally . The wonders produced by close doctor -patient collaboration never cease
to amaze me. One experience illustrates how acceptance can lead a patient
to utilize the doctor ’s recommendations, and also how it can reduce pain. Thelma, a patient with recurrent breast cancer , came to me and said that she
wanted God to heal her while I observed and monitored the process. I
explained how dif ficult I thought that would be. On her next visit, the
cancer was smaller , and I asked her what had happened. She said, “I left the
house with the phone ringing.” It was the first time she’d ever said no to
anything. Next time, her cancer was even smaller . Again I asked what
happened. All smiles, she said, “When my alcoholic husband acted up I
called the police. He said, ‘Y ou’re embarrassing me in front of the
neighbors.’  I told him, ‘I have cancer now , and I don’ t accept your behavior
anymore.’” By the third visit, however , she realized how much I cared for
her and we became a team. She said, “It’ s hard work becoming a saint and
healing yourself. Why don’ t you operate and remove the tumor? I’ll work
on staying well.”
Thelma told me that the night after sur gery the nurse came in, pulled the
curtain, and said, “T ell me about Dr . Siegel.”
My patient responded, “What do you mean? You act like you think he
hypnotized me.”
The nurse said, “W ell, you’ve had a radical mastectomy , and yet you’re
walking around the ward cheering up the rest of us, and you have no pain. What did he do to you?”
“He shared with me. This was our decision, so there’ s no reason for me
to be depressed or in pain. I know the right thing was done to me by the
right person. This is my way of getting well.”
Another woman with breast cancer , a young law student named Julie,
had terrible fears and dreams about dying under anesthesia. She asked me if
I could do the operation under local. I told her , “I had a dream in which I
did it under local and permanently injured your arm.” It was her dream
against mine! Our laughter broke the tension. She was able to see my
concerns, and, after talking it over some more, she had her mastectomy
under general anesthesia with no complications.Let me explain that this was a fear dream, not a precognitive one. Otherwise I would never have defused it with a joke. If a patient had a
dream that I felt predicted that person’ s death, I would not operate that day . For example, one patient dreamed of her headstone with “Thursday”
engraved on it, so we made sure her sur gery was not done on a Thursday . The day after Julie’ s operation I was at a seminar in a nearby town. A
familiar voice asked a question from the audience. It was Julie. I rushed
over to ask what in the world she was doing there. She said, “Don’ t worry . All the tubes are under my dress. When I had no pain and wanted to leave,
the nurses said, ‘Oh, she’ s just another one of Dr . Siegel’ s patients,’  and
your partner signed the dischar ge order .”
It isn’ t me, though. It’ s the relationship that makes such results possible. It’s sharing and caring, doing things for people, not to them. We physicians
must become instruments. When that happens, motivated patients will use
us to work miracles. Just how fundamentally we can change the patient’ s
reaction to our treatments has been exquisitely captured by Page Coulter ,
one of my patients, in her poem “Repairs.” Even the title points up the
difference between a cooperative approach and the typical medical talk of
“assaulting,” “mutilating,” or “insulting” the body in order to heal it. After
showing how her fears were calmed by a gentle anesthesiologist, she
continues:
We could justify the need for love, or crack open the eye of a tulip. Who cares? We try to stretch our bodies to catch the rain
Or fallout or darkness, anything that falls from outer space. But instead I hear the sur geon singing “Desert Song,”
And I feel his gentle tugs and pulls as though it were my father
Caning chairs or my mother sewing pockets in my wedding dress. OceanofPDF .com3
The gr eat majority of us ar e requir ed to live a life of constant, systematic
duplicity . Your health is bound to be affected if, day after day , you say the
opposite of what you feel, if you gr ovel befor e what you dislike and r ejoice
at what brings you nothing but misfortune. Our nervous system isn’ t just a
fiction, it’ s a part of our physical body , and our soul exists in space and is
inside us, like the teeth in our mouth. It can’ t be for ever violated with
impunity . —B ORIS PASTERNAK , Doctor Zhivago
OceanofPDF .comDisease and the Mind
Neglect of the mind-body link by technological medicine is actually a brief
aberration when viewed against the whole history of the healing art. In
traditional tribal medicine and in Western practice from its beginning in the
work of Hippocrates, the need to operate through the patient’ s mind has
always been recognized. Until the nineteenth century , medical writers rarely
failed to note the influence of grief, despair , or discouragement on the onset
and outcome of illness, nor did they ignore the healing ef fects of faith,
confidence, and peace of mind. Contentment used to be considered a
prerequisite for health. The modern medicine man has gained so much power over certain
diseases through drugs, however , that he has for gotten about the potential
strength within the patient. One elderly physician friend recently told me of
reading the diary of his uncle, also a doctor . In the early years, the diarist
always recorded what happened to the individual or the community prior to
an illness or epidemic, but as medicine became more technological, this part
of the history grew less and less important to him and finally was omitted
altogether . Awareness of the mind’ s powers was lost as medicine cast out all
“soft” data, the information that’ s not easily quantified or scientific. THE MIND—BENIGN OR MALIGN
Part of the mind’ s effect on health is direct and conscious. The extent to
which we love ourselves determines whether we eat right, get enough sleep,
smoke, wear seat belts, exercise, and so on. Each of these choices is a
statement of how much we care about living. These decisions control about
90 percent of the factors that determine our state of health. The trouble is
that most people’ s motivation to attend to these basics is deflected by
attitudes hidden from everyday awareness. As a result, many of us have
mixed intentions. Consider , for example, Sara, a woman who came to me with breast
cancer a few years ago; she was smoking when I walked into her hospital
room. Her action clearly stated: “I want you to get rid of my cancer , but I’m
ambivalent about living, so I think I’ll risk a second cancer .” She looked up
sheepishly and said, “I suppose you’re going to tell me to stop smoking.”
“No,” I said, “I’m going to tell you to love yourself. Then you’ll stop.”She thought for a moment and replied, “W ell, I do love myself. I just
don’t adore myself.” (Sara ultimately did come to adore herself—and
stopped smoking.) It was a good quip, but it exemplified an important problem many
people have with themselves. Self-love has come to mean only vanity and
narcissism. The pride of being and the determination to care for our own
needs have gone out of the meaning. Nevertheless, an unreserved, positive
self-adoration remains the essence of health, the most important asset a
patient must gain to become exceptional. Self-esteem and self-love are not
sinful. They make living a joy instead of a chore. The mind does not act only through our conscious choices, however . Many of its ef fects are achieved directly on the body’ s tissues, without any
awareness on our part. Consider some of our common expressions: “He’ s a
pain in the neck/ass. Get of f my back. This problem is eating me up alive. You’re breaking my heart.” The body responds to the mind’ s messages,
whether conscious or unconscious. In general, these may be either “live” or
“die” messages. I am convinced we not only have survival mechanisms,
such as the fight-or -flight response, but also a “die” mechanism that
actively stops our defenses, slowing the body’ s functions and bringing us
toward death when we feel our life is not worth living. Every tissue and or gan in the body is controlled by a complex
interaction among chemicals circulating in the bloodstream, the hormones
secreted by our endocrine glands. This mixture is controlled by the “master
gland,” the pituitary gland, located in the middle of the head just below the
brain. The output of pituitary hormones in turn is controlled by both
chemical secretions and nerve impulses from the neighboring part of the
brain, called the hypothalamus. This tiny region regulates most of the
body’ s unconscious maintenance processes, such as heartbeat, breathing,
blood pressure, temperature, and so forth. Nerve fibers enter the hypothalamus from nearly all other regions of the
brain, so that intellectual and emotional processes occurring elsewhere in
the brain af fect the body . For example, about five years ago, child-
development researchers discovered “psychosocial dwarfism,” a
disturbingly common syndrome in which an unhealthy emotional
atmosphere at home stunts a child’ s physical growth. When a child is
caught in a crossfire of hostility and feels rejected by his or her parents,
thereby growing up with little self-esteem, the brain’ s emotional center , orlimbic system, acts upon the nearby hypothalamus to shut of f the pituitary
gland’ s production of growth hormone. The immune system consists of more than a dozen dif ferent types of
white blood cells concentrated in the spleen, thymus gland, and lymph
nodes, and patrolling the entire body through the blood and lymphatic
systems. They are divided into two main types. One group, called B cells,
produce chemicals that neutralize poisons made by disease or ganisms while
helping the body mobilize its own defenses. The other group, called T cells,
consists of killer cells and their helpers, which destroy invading bacteria
and viruses. Recent research has shown heretofore unknown nerves connecting the
thymus and spleen directly to the hypothalamus. Other work has proven
that white blood cells re spond directly to some of the same chemicals that
carry messages from one nerve cell to another . This anatomical evidence for direct control of the immune system by
the brain has been confirmed in studies of animals. Two groups of scientists
have independently used Pavlovian conditioning techniques to change the
immune response. At the University of Rochester Medical Center ,
psychiatrist Robert Ader and immunologist Nicholas Cohen repeatedly gave
rats saccharin-sweetened water along with an immune-suppressant drug. Later they were able to “trick” the animals into suppressing their own
immune responses by giving them the sweetened water alone. Working for
the National Institutes of Health, Dr . Novera Herbert Spector similarly
conditioned mice to increase their immune responses when exposed to the
smell of camphor . The immune system, then, is controlled by the brain, either indirectly
through hormones in the bloodstream, or directly through the nerves and
neurochemicals. One of the most widely accepted explanations of cancer ,
the “surveillance” theory , states that cancer cells are developing in our
bodies all the time but are normally destroyed by white blood cells before
they can develop into dangerous tumors. Cancer appears when the immune
system becomes suppressed and can no longer deal with this routine threat. It follows that whatever upsets the brain’ s control of the immune system
will foster malignancy . This disruption occurs primarily by means of the chronic stress
syndrome first described by Hans Selye in 1936. The mixture of hormones
released by the adrenal glands as part of the fight-or -flight responsesuppresses the immune system. This was all right in dealing with the
occasional threats our ancestors faced from wild beasts. However , when the
tension and anxiety of modern life keep the stress response “on”
continually , the hormones lower our resistance to disease, even withering
away the lymph nodes. Moreover , there is now experimental evidence that
“passive emotions,” such as grief, feelings of failure, and suppression of
anger , produce over -secretion of these same hormones, which suppress the
immune system. We don’ t yet understand all the ways in which brain chemicals are
related to emotions and thoughts, but the salient point is that our state of
mind has an immediate and direct ef fect on our state of body . We can
change the body by dealing with how we feel. If we ignore our despair , the
body receives a “die” message. If we deal with our pain and seek help, then
the message is “Living is dif ficult but desirable,” and the immune system
works to keep us alive. I therefore use two major tools to change the body—emotions and
imagery . These are the two ways we can get our minds and bodies to
communicate with each other . Our emotions and words let the body know
what we expect of it, and by visualizing certain changes we can help the
body bring them about. Both emotions and imagery are obviously
transmitted through the central nervous system and may relate to work that
Robert Becker , an orthopedic sur geon and researcher , has done. Becker has studied the body’ s electrical systems. His work led directly
to the use of electricity to heal broken bones that have failed to knit. Becker
found that hypnotized patients can produce voltage changes in specific
areas of the body on command. If these voltages control the chemical and
cellular processes of healing, as Becker believes, then we soon may have a
scientific explanation for hypnosis cures and the placebo ef fect. It is well
known, for example, that hypnotized patients can cure their own warts. As
Lewis Thomas wrote in The Medusa and the Snail:
 
You can’ t sit there under hypnosis, taking suggestions in and having
them acted on with such accuracy and precision, without assuming the
existence of something very like a controller . It wouldn’ t do to fob of f the
whole intricate business on lower centers without sending along a quite
detailed set of specifications, way over my head.Some intelligence or other knows how to get rid of warts, and this is a
disquieting thought. It is also a wonderful problem, in need of solving. Just think what we
would know , if we had anything like a clear understanding of what goes on
when a wart is hypnotized away . …we would be finding out about a kind of
superintelligence that exists in each of us, infinitely smarter and possessed
of technical know-how far beyond our present understanding. It would be
worth a War on Warts, a Conquest of Warts, a National Institute of Warts
and all. Bioelectricity may someday enable us to reach this “controller” directly ,
to understand exactly how and why tumors sometimes regress when
patients are convinced that an unorthodox treatment—hypnosis, diet,
prayer , meditation—is going to work. As Becker once wrote to me, “The
placebo ef fect is not only real but of great importance, and your methods
may be far more ef fective than you think they are.”
Whether or not we can ever control all healing with electrical stimuli,
exceptional patients—that is, potentially all patients—need not wait
helplessly for artificial aids. They can learn to heal themselves and stay
well. If I can teach you how to feel good about your life, love yourself and
others, and achieve peace of mind, the necessary changes can occur . My
loving and hugging may look silly on the ward, but they’re scientific. The
problem is that we don’ t yet know the psychological techniques necessary
to turn on the healing process quickly and ef ficiently in everyone. So many
of the changes happen at an unconscious level that they are hard to measure
clinically without careful psychological testing. One day I hope we can
prescribe something like “one hug every three hours” instead of a drug or
electrical impulse, but for the moment we must return to our consideration
of the mind’ s potential for harm, as a prelude to finding its antidote. COPING WITH STRESS
It’s often said that stress is one of the most destructive elements in
people’ s daily lives, but that’ s only a half truth. The way we react to stress
appears to be more important than the stress itself. This was borne out in the
experience of Hans Selye, the scientist who developed the entire concept of
stress and its ef fects on the body .At age sixty-five, Selye developed reticulum cell sarcoma, a type of
cancer whose cure rate is extremely low . This is perhaps the ultimate stress,
but in an interview Selye discussed how he reacted to it in an exceptional
way:
 
“I was sure I was going to die, so I said to myself, ‘All right now , this is
about the very worst thing that could happen to you, but there are two ways
you can handle this; either you can go around feeling like a miserable
candidate on death row and whimper away a year , or else you can try to
squeeze as much from life now as you can.’  I chose the latter because I’m a
fighter , and cancer provided me with the biggest fight of my life. I took it as
a natural experiment that pushed me to the ultimate test whether I was right
or wrong. Then a strange thing happened. A year went by , then two, then
three, and look what happened. It turned out that I was that fortunate
exception….”
“Afterward I made a particular ef fort to cut down my stress level. I have
to be very careful what I say here because I am a scientist, and no statistics
now exist to say whether stress is related to cancer . Apart from the genetic
and environmental causes of cancer , I can only say that the relationship
between stress and cancer is rather complicated. In just the same way that
electricity can both cause and prevent heat, depending on how things are
balanced, stress can both initiate and prevent illness.”
[The interviewer asked,] “Some people have described cancer as a
disease that is somewhat like the body’ s way of rejecting itself. Now to
carry that premise one step further , could it be that when people drastically
reject their basic needs they are possibly more apt to develop cancer? In
other words, if a person rejects his own needs, can his body rebel and reject
itself?”
[Selye said,] “I don’ t say yes and I don’ t say no. I’m a scientist, not a
philosopher . All I can say as a scientist is that the great majority of physical
illnesses have in part some psychosomatic origin.”
 
The evidence gathered since Dr . Selye wrote these words suggests he
was overly cautious. In particular , the onset and course of disease are
strongly linked to a person’ s ability and willingness to cope with stress. Stresses that we choose  evoke a response totally dif ferent from those we’dlike to avoid but cannot. Helplessness is worse than the stress itself. This is
probably why the rate of cancer is higher for blacks in America than for
whites, and why cancer is associated with grief and depression. Those most
likely to die of heart attacks are not the hard-driving Type A executives but
rather those who are driven, the underlings and factory workers who have
no autonomy and whose shortened lives give new meaning to the phrase
“deadly boredom.”
The interpretation of stress is always tricky for an outsider , for the same
circumstances can be detrimental to one and neutral or even beneficial to
another . Johns Hopkins University psychiatrist Jerome Frank, citing a 1961
study by L. E. Hinkle, notes that “stress comes mainly from the patient’ s
interpretation of events.” In Hinkle’ s long-term study of the subject, life
experiences that seemed benign to an objective observer were often felt as
stressful by the patients and associated with illness. Conversely , stresses
that appeared horrendous to the observer—such as poverty , bereavement,
alcoholism in the family—usually were not associated with illnesses if the
patients did not report them as stressful. This is especially true in the case of children. Adults often assume that
children are happy when they are actually being traumatized by events,
even though they often don’ t show it. Children have been known to commit
suicide over receiving a B instead of an A on a report card, because they
internalized their parents’  expectations, or reacted to a comment that made
them feel unloved. But the scientific mind is seldom convinced by psychological studies on
humans. There are just too many variables for a researcher to control them
all. Tests on animals have yielded conclusive evidence, however . In the
mid-1970s the late Vernon Riley , at Seattle’ s Pacific Northwest Research
Foundation, completed a thorough series of experiments with a strain of
mice bred to be susceptible to breast cancer . By raising some in sheltered,
stress-free environments and others in stressful surroundings, he was able to
vary the rate of cancer from 7 to 92 percent. A 1981 experiment by a team of three psychologists proved the point
with an even better simulation of the human experience. Madelon
Visintainer and two co-workers injected three groups of rats with live tumor
cells. One day later they subjected two of the groups to electric shock. The
stress was administered so that one group could not evade it, while the other
rats were warned by a signal so they could escape by jumping over abarrier . Of the helpless rats, 73 percent came down with the cancer , while
only 37 percent of the other group developed it. They did slightly better
than the control group, which received no shocks at all! The level of stress is determined partly by society . Cultures that place
the highest value on a combination of individualism and competition are the
most stressful. Those that seem to produce the least stress and have the
lowest rates of cancer are close-knit communities in which supportive,
loving relationships are the norm, and the elderly retain an active role. Religious faith and a fairly open, accepting attitude toward sexuality are
two other common characteristics of low-cancer societies. These are some of the same circumstances that favor longevity . Soviet
Geor gia, the Hunza valley , Mormon communities in America, and the
villages of the Abujmarhia tribe of central India are excellent examples. The
Abujmarhia enjoy a pollution-free environment, a wholesome natural diet,
abundantly loving sexual relationships beginning premaritally in early
adolescence, relaxed but occasionally strenuous work in the fields by day ,
dancing and storytelling by evening, and plenty of rest. Cancer is absolutely
unknown among them. It must be noted that these societies don’ t invest time and ef fort to help
malformed infants survive, so physical factors determined by natural
selection also influence disease rates. Still, externals are not the whole
story . Environmental purity and death from genetic defects still prevail in
other undeveloped areas, but cancer is more common among tribes who
regularly engage in warfare than among those who live at peace. The security of routine also seems to help limit serious disease. Closed
structured societies in which all members know what is expected of them,
even when deviation from the norm is not tolerated—Mormons, Seventh
Day Adventists, and Mennonites in the United States, for example—have
lower rates of disease than the surrounding, more open society . When
individuals leave the cluster for a life with more unknowns, their incidence
of disease reaches that in the culture they enter . In a society like ours, the response to stress is left to the individual, who
must learn to disconnect psychologically from external pressures. Dr . Herbert Benson of Harvard Medical School has shown that the ability to
maintain a healthy cholesterol level is directly related to the ability to
handle stress through relaxation. With meditation and exercise, we can
teach hard-driving, success-oriented (T ype A) persons to avoid heart attackswhile keeping their Type A behavior . Studies of people who meditate
regularly have shown that their physiological age is much lower than their
chronological age. These techniques do people no good without the
motivation to use them. The first requirement is to get people to love
themselves enough to care for their bodies and minds. Stress can be measured. One of the yardsticks for it, developed by Drs. Thomas Holmes and Richard Rahe, uses a list of forty-three stressful
changes to assess a person’ s likelihood of becoming ill. The evaluation
begins with a history of the persons’ s recent emotional life, then assigns a
certain number of “points” to each life crisis, such as changing or losing a
job, children leaving for college, marriage or divorce, moving to a new
house, and so on. The highest value, 100 points, is attached to the most grievous loss, the
death of one’ s spouse. This most traumatic of events is often followed by
cancer or other catastrophic illness in one or two years. Recent studies have
confirmed that grieving spouses have depressed immune systems for over a
year. Additional work has shown that within one day  any uncontrollable
stress lowers the ef ficiency of the body’ s disease-fighting killer cells. New evidence suggests that divorce may be even more devastating to
many people, since it’ s harder to accept that the relationship is really over . Indeed, divorced people have higher rates of cancer , heart disease,
pneumonia, high blood pressure, and accidental death than married, single,
or widowed persons. Married men also have one-third the lung-can cer
incidence of single men and can smoke three times as much with the same
cancer incidence as single men. Career reversals also commonly lead to malignancy . The defeats of
Napoleon Bonaparte, Ulysses S. Grant, William Howard Taft, and Hubert
Humphrey have often been implicated in their fatal cancers. One of the ar guments of those who discount mental factors in cancer
has been the notion that the latency period is too long for the mind to play a
role in childhood cancer , but there is now evidence to the contrary . A study
at the Albert Einstein College of Medicine in the Bronx found that children
with cancer had had twice as many recent crises as other children matched
to be similar except for their disease. Another study showed that 31 of 33
children with leukemia had experienced a traumatic loss or move within the
two years before their diagnosis. Psychologists are now learning that infants
are far more perceptive than heretofore imagined, and I wouldn’ t besurprised if cancer in early childhood was linked to messages of parental
conflict or disapproval perceived even in the womb. I don’ t say this to
create guilt but to give us more insight into our participation in the healing
process. In dealing with the problems presented by cancer , therefore, we must
not for get the ef fects this crisis may have on family and friends, particularly
if the patient dies. The doctor must help the others deal with their fears and
grief openly , in an ef fort to prevent further disease. When stress is
confronted and love is shared, everyone—the family as well as the patient
—benefits. QUIET  DESPERA TION
Not everyone who suf fers a tragic loss or stressful change in lifestyle
develops an illness. The deciding factor seems to be how one copes with the
problem. Those who can give vent to their feelings yet continue with their
lives generally stay well. The husband of a patient once called me up and asked, “What did you
tell my wife?” He said she came home and yelled at him for hours about
their twenty years of marriage —and he thought they had been pretty good. I told him, “I didn’ t say anything to your wife, but she has learned that she
has cancer , and she’ s sharing the resentment that she has built up over the
years.” Anger is a normal emotion if it is expressed when it is felt. If it isn’ t
it develops into resentment or even hatred, which can be very destructive. A
woman who says, “I’ll make this marriage work if it kills me” may find it
will. If a person deals with anger or despair when they first appear , illness
need not occur . When we don’ t deal with our emotional needs, we set
ourselves up for physical illness. Yet what are most of us more comfortable
with—telling the neighbors we have to see a psychiatrist or that we need an
operation? We’re uncomfortable saying we’re being driven crazy but not
that we’re being driven to illness. The simple truth is, happy people generally don’ t get sick. One’ s
attitude toward oneself is the single most important factor in healing or
staying well. Those who are at peace with themselves and their immediate
surroundings have far fewer serious illnesses than those who are not.In one of the most thorough studies of this “contentment factor ,”
psychiatrist Geor ge Vaillant followed two hundred Harvard graduates for
thirty years, correlating health surveys with psychological tests each year . Comparing the happiest versus the unhappiest group, he reported: “Of 59
men with the best mental health assessed from the age of 21 to 46 years,
only two became chronically ill or died by the age of 53. Of the 48 men
with the worst mental health from the age of 21 to 46, 18 became
chronically ill or died.” Those who were extremely satisfied with their lives
had one-tenth  the rate of serious illness and death suf fered by their
thoroughly dissatisfied peers. The findings remained valid when the ef fects
of alcohol, tobacco, obesity , and ancestral longevity were statistically
eliminated—even though unhappiness obviously can contribute to all but
the last variable. Mental health, Vaillant found, retards mid-life
deterioration in physical health. The common denominator in all depression is a lack of love or a loss of
meaning in life, at least as perceived from the depressed person’ s point of
view . Illness then often functions as an escape from a routine that has
become meaningless. In this sense it might even be called a Western form
of meditation. One of the most common precursors of cancer is a traumatic loss or a
feeling of emptiness in one’ s life. When a salamander loses a limb, it grows
a new one. In an analogous way , when a human being suf fers an emotional
loss that is not properly dealt with, the body often responds by developing a
new growth. It appears that if we can react to loss with personal growth, we
can prevent growth gone wrong within us. In like manner , researchers have
found, if a salamander is given cancer on a limb or tail and the appendage is
then amputated near the tumor , a new limb or tail appears and the cancer
cells become normal again. We know that the human body tries to heal
some cancers, such as neuroblastoma, by changing the malignant cells back
to normal in the same way , as well as by attacking them. Thus it is my main
job as a doctor to help you develop into a new person so you can resist the
unwanted, uncontrolled development of illness. If I transplant a kidney into you and give you drugs that inhibit your
immune system, the graft will take. Later we may find that the transplanted
kidney contained a cancer . The kidney and cancer will both thrive. If I take
away the drugs that keep your body from rejecting the kidney , the new
organ will be destroyed, and so will the cancer . A vigorous immune systemcan overcome cancer if it is not interfered with, and emotional growth
toward greater self-acceptance and fulfillment helps keep the immune
system strong. Depression’ s effects on the immune system often appear very quickly if
some remnant of a previous disease remains. Arnold, a patient who had had
malignant melanoma and had been in remission for seven years, came to me
with a recurrence in a lymph node in his armpit. I asked what had happened
in his life during the last six months. He told me he had brought up all his
children himself, because his wife had been mentally ill. The last child, a
son to whom he was especially close, had just gotten married and left home. He’d been so depressed by his son’ s departure that he’d cried for weeks. Despair had depressed Arnold’ s immune response, allowing residual
cancer cells that had been under control to multi ply again. As part of his
therapy we brought together his children and the rest of the family , to help
plan new interests and social activities for him, as well as to find ways in
which the others could remain close to him. He was able to understand the
physical danger of sinking into despair and self-pity . He began to
participate in staying well by learning to deal with the unavoidable
emotional problems of his life. He eventually died of his disease, but his
remaining time was filled with happiness from the love of his family , new
friends, and a girlfriend. Depression as defined by psychologists generally involves quitting or
giving up. Feeling that present conditions and future possibilities are
intolerable, the depressed person “goes on strike” from life, doing less and
less, and losing interest in people, work, hobbies, and so on. Such
depression is strongly linked with cancer . Dr. Bernard Fox of Boston, for
example, found that depressed men are twice as likely to get cancer as
nondepressives. A study of identical twins, one of whom in each pair had
leukemia, showed that the one with the disease had become severely
depressed or suf fered an emotional loss beforehand, while the healthy twin
had not. However , there is a specific form of depression even more closely
related to malignancy . Typical depressed patients, by abdicating normal activity , are at least
offering some response to what they perceive as an unbearable situation. The reaction is negative, but at least it’ s an attempt to back away . Many
people, however , continue with their routines and an outward show of
happiness, when on the inside their lives have come to lack all meaning.These persons are seldom diagnosed as clinically depressed, because they
manage to keep functioning. Their state is the “quiet desperation” of James
Thurber ’s Walter Mitty , meek and obliging on the outside, but filled with
unacknowledged rage and frustration. A cancer patient named Sandy , for example, wrote me a long letter
explaining how she’d become conditioned to be a “doormat” most of her
life. In her teens she’d trained as a singer and actress, even studying in a
noted experimental theater group. She told me that, each time she came of f
the stage flushed with excitement, her mother would say , “It was good. Keep practicing and maybe next time  you’ll do better .” Her mother likewise
greeted every report card with “ Next time  see if you can bring me all A’s.”
Sandy had a lovely , voluptuous figure, but her mother always told her ,
“Don’ t eat this, don’ t eat that, you’re too fat.” By her late teens, Sandy’ s
self-confidence was so low that she only sang at the back of the church
choir , and pretty soon not even there. Then, just out of high school, Sandy got married:
 
We never knew each other until it was too late. Being Catholic, I had to
try to make it work out. We had three kids, three years apart…. [My
husband] worked two jobs—I did odd jobs cleaning houses whenever I
could. My Mother was there every day “to see the kids,” and she would
constantly remind me that no one would hire me because I was too fat and
that, besides, what could I ever do to earn any money? When I reminded her
that I used to be a legal secretary…she would brush that of f with, “W ell,
you can’ t go to work until the kids are in school. I can’ t take care of them,
they are too much work, and I forbid you to have strangers raising my
grandchildren.”
 
Sandy was always getting sick, and her mother was always there
reminding her how tired she must be and how ungrateful she was for all her
mother did for her . Her husband started staying out all night, then coming
home drunk and beating her up. When she asked him for a divorce, he put
the whole family in the car , took them to the edge of a clif f and threatened
to drive of f unless she promised never again to talk of leaving him. She
made the promise and kept it.Although she tried to keep up appearances, Sandy decided, on an
unconscious level, to be sick. She developed phlebitis and stayed in bed all
the time, having no relationship with her husband. After he was killed in an
auto accident, her phlebitis cleared up within days. Later , during a second
marriage in which she again took a subordinate role, Sandy developed
breast cancer . At that time she redirected her life and is well today . During more than two decades of research into the men tal aspects of
cancer , experimental psychologist Lawrence LeShan conducted personality
studies of 455 cancer patients and in-depth therapy of 71 “terminal” cases. He found that this condition of “despair” (so named to distinguish it from
the more commonly recognized form of depression) was reported as
predating the disease by 68 of his 71 cancer patients in therapy , but by only
3 of 88 other clients who did not have cancer . In The W ill to Live  Arnold
Hutschnecker wrote, “Depression is a partial surrender to death, and it
seems that cancer is despair experienced at the cellular level.”
The relationship between cancer and withheld emotion was put on a
scientific basis over thirty years ago when internist D. M. Kissen studied a
group of smokers, comparing those who had lung cancer with those having
other diseases. Based on personality tests, Kissen found the cancer patients
had poorer “outlets for emotional dischar ge,” and concluded that, the more
repressed a person was, the fewer cigarettes were needed to cause cancer . Working with breast-cancer patients, Mogens Jensen of the Yale
psychology department showed that “defensive-repressors” die faster than
patients with a more realistic outlook. These are the smiling ones who don’ t
acknowledge their desperation, who say , “I’m fine,” even though you know
they have cancer , their spouses have run of f, their children are drug addicts,
and the house just burned down. Jensen feels this behavior “disregulates”
and exhausts the immune system because it is confused by the mixed
messages. Thus, when a patient tells me he or she is fine, I have to know whether
it’s a performance or the truth. One must be careful when evaluating a
patient who says cancer is not stressful. It may not be if it’ s a solution to
life’s problems. Then again, if one can face the disease with peace of mind
instead of fear , it becomes a challenging stress rather than a purely
destructive one. The outcomes will be dif ferent, and they will not be
interpreted properly unless the attitudes are carefully measured by
psychological testing.Jensen also noted that those with imagery or daydreams that were
always positive, in the sense of denying illness or the possibility of death,
had a poor chance of survival. Imaging techniques don’ t work with people
who deny , because they can’ t accept their illness and therefore don’ t really
participate in fighting it. In drawings, defensive-repressors depict
themselves with enormous smiles, portraying the illness outside their bodies
on another page, or representing their own bodies with pictures of healthy
bodies cut out of magazines. One such woman told me, “I’m not a good
artist, so I had my ten-year -old son draw a picture.” (Later , after I asked
how she expected to get over cancer if she didn’ t even have the courage to
do a picture, she did draw her own.) Psychiatrist Geor ge Engel surveyed the evidence and concluded that the
most important factor in bringing on despair is usually a change in the
environment about which the patient feels powerless—in other words, he or
she has a sense of hopelessness and helplessness. Sudden death often
follows these changes. Such deaths sometimes occur with amazing speed,
as when a spouse of fifty years dies and the survivor collapses and dies ten
minutes later . Both men and women are subject to hopelessness, but because of their
often diver gent roles, the situations that trigger it are often dif ferent. Men
typically get sick soon after losing a job or retiring, because they have
traditionally identified more strongly with their work than women have. My
own father developed lung cancer shortly after retiring. At first it was hard
for him to admit the significance of his retirement. Fortunately , after
surgery, he was able to find fulfillment in his life, and the disease has not
recurred in over twelve years. Men are generally better able to express anger , while women tend to
hold it in and become depressed. For them the change generally happens in
the home. It may be a divorce or the growing up and departure of children. As a woman who developed cancer after her children left home expressed it
in a letter to me, “I had an empty place in me, and cancer grew to fill it.”
The cause may simply be a gradual dissatisfaction with the role of
housewife, if that role is unfulfilling for the woman. It is not the role itself,
but rather the feeling of being trapped. Housewives get 54 percent more
cancer than the general population, and 157 percent more than women who
work outside the home. When these results were first published, by Dr . William Morton of the University of Oregon, many researchers assumedthere must be a carcinogen in the kitchen, and much fruitless research was
spent looking for it. Now , there may well be some carcinogens in many
American kitchens, but a further statistical analysis revealed that salaried
domestics have less cancer than housewives, despite working in two
kitchens. However , most research funds still are allocated to look for
chemical causes. Little thought has been given to the possibility that the
housewife’ s high risk of cancer may be due to her feeling trapped and the
fact that often she is not living the life she wants but a performance. In a ballad called “Miss Gee,” W. H. Auden poignantly expressed the
relationship between disease and a loveless, frustrated life:
She bicycled down to the doctor ,
And rang the sur gery bell;
“O, doctor , I’ve a pain inside me,
And I don’ t feel very well.”
Doctor Thomas looked her over ,
And then he looked some more;
Walked over to his wash-basin,
Said, “Why didn’ t you come before?”
Doctor Thomas sat over his dinner . Though his wife was waiting to ring;*
Rolling his bread into pellets;
Said, “Cancer ’s a funny thing. “Nobody knows what the cause is,
Though some pretend they do;
It’s like some hidden assassin
Waiting to strike at you. “Childless women get it,
And men when they retire;
It’s as if there had to be some outlet
For their foiled creative fire.”A psychiatrist once told me, “Not everything that rhymes is true,” but I
rather subscribe to Lawrence LeShan’ s outlook. Before he begins new
research, he reads to see whether poets and artists have already expressed
the same ideas. If they have, he proceeds, knowing he’ s on the right track. Lack of emotional outlet is a common theme in the histories of cancer
patients. It is probably the reason cancer is more common in convents than
in prisons: in jail you can at least act out your frustrations. One of LeShan’ s
patients was a former gang leader who developed Hodgkin’ s disease when
his exciting life—surrounded by supporters and danger—ended. The gang
grew up and disbanded. The young man felt bored with his life and showed
no response to therapy . As the issues became clear , LeShan encouraged him
to join the fire department, which brought male camaraderie and danger
back into his life. Soon his body began to respond, and the disease receded. A new problem appeared when he was of fered a promotion. His wife
wanted him to accept, but he was afraid taking a desk job would imperil his
recovery . Time will tell whether he has grown enough to choose the right
course. To some extent, then, cancer is not a primary disease. It is partly a
reaction to a set of circumstances that weaken the body’ s defenses. That is
why, when a doctor cures cancer or some other disease without ensuring
that the treatment addresses the patient’ s entire life, a new illness may
appear . Since everyone is subject to external changes, truly ef fective
treatment must get a patient to become the kind of person who can live
comfortably and happily in spite of such stresses. This process is never
complete, but it is the process itself that benefits our bodies. One does not
have to be a saint to be healed. It’ s the ef fort of working towar d sainthood
that brings the rewards. As Richard Bach, author of Jonathan Livingston
Seagull, wrote, “Here’ s a test to find whether your mission on earth is
finished: If you’re alive, it isn’ t.”
PERSONALITY  PROGRAMMING
As a young woman, my mother had severe hyperthyroidism and
weighed about ninety pounds. She also desperately wanted a child. She
went to many obstetricians, but they all said her body couldn’ t stand the
strain and she would probably die if she became pregnant. After several
years during which her condition didn’ t improve, she and my father decideda baby was worth the risk. At that point she became an exceptional patient:
she began to share her hopes and fears with her doctors, dealing with them
on the emotional as well as the intellectual level, and my mother and father
took ultimate responsibility for the decision to have a child. Finally my parents found one obstetrician who was willing to help my
mother take the chance. He told her he would support her in her attempt to
carry through a normal pregnancy if she could gain thirty pounds. My
mother had a wonderful asset at home—a Jewish mother . She took her
daughter home, had her lie down on the couch, and fed her constantly for
three months. My mother gained the required weight and conceived, and I
was born. Her hyperthyroidism disappeared after my birth, and my parents
had the gift of a healthy infant. The delivery was traumatic. At first my features were grossly distorted
from the forceps. When my mother took me for walks in the carriage, she
covered it to hide me. Neighbors would stop, lift the cover , and start to coo,
“Oh, what a cute…” until they caught a glimpse, saw that the usual phrases
weren’ t appropriate, and were left gaping. My mother decided to keep me
home and save the neighbors embarrassment. There are no baby pictures
from these early months, which proves it. My grandmother stepped in,
anointing and stroking my face until the damage healed, relieving my
mother of her distress and continuing the unconditional love. So I received the message that I was loved unconditionally , even more
strongly than babies who enter life under easier circumstances. I know that I
have my parents’  support and love no matter what I choose to do. I am
absolutely convinced that the feeling of support I grew up with gave me the
belief that I could be what I wanted to be and guided me toward my desire
to give and to heal. These first experiences conditioned me to be a survivor . Life became a
series of obstacles that I always felt I could overcome. If I was not valued
by others, I knew I could count on my family and the self-esteem they
helped me develop. In a sense, this was a handicap for me as a physician,
because I didn’ t realize what went on in other people’ s lives. The hardest lesson for me to learn was that most of my patients are not
the products of such love. In fact, I would estimate that 80 percent of my
patients were unwanted or treated indif ferently as children. Even laboratory
rats, when prematurely separated from their mothers, become more
susceptible to cancer . Rats that are frequently petted in infancy become lesssusceptible. How dissimilar my experience from those who hear “W e
always wanted a boy instead of a girl,” or “Y our father was drunk—we
didn’ t want more children,” or even “I wish I’d had an abortion instead of
you.” Such messages lead to a lifelong feeling of unworthiness. Then an
illness is something the patient deserves, and treatment becomes
undeserved. For such people the disease can be their way of finally
satisfying their parents’  wishes—or God’ s, since many people carry a
burden of guilt from their religion, experiencing illness as punishment for
sin. At bottom, they feel that the only way they can be really good or
receive love is by dying. One of my patients was a New Yorker named Jan, who’d been an
actress since her early teens. Her mother had constantly warned her to
protect her breasts, since they were all-important for her appearance. She
told her she shouldn’ t sleep on her stomach, and when she danced she
should be careful no one bumped them. Naturally , Jan got breast cancer and
couldn’ t consider sur gery. Instead she tried every alternative therapy on the
market. I told her that if she could concentrate her incredible ener gy on one
or two choices and learn to love herself, she would have a great chance for
a cure. But, like many performers, she lived mainly for the approval of
others. She said, “If I don’ t hear any applause, how do I know I’m
lovable?” She died of her disease, burning away her ener gy looking for an
outside miracle. The miracles come from within. You ar e not that unloved child
anymor e. You can be reborn, rejecting the old messages and their
consequent diseases. When you choose to love you will have those days
when you’re not all you’d like to be, but you can learn to for give yourself. You can’ t change your shortcomings until you accept yourself despite them. I emphasize this because many people, especially those at high risk of
cancer , are prone to for give others and crucify themselves. I see all of us as
being perfectly imperfect, and ask that we accept ourselves that way . As
Elisabeth Kübler -Ross says, “I’m not okay , you’re not okay , but that’ s
okay .”
The remaining chapters will show how personality reprogramming is
done, but let me give you a little example here from my own experience. The problem—seasickness—is undoubtedly trivial compared with cancer ,
but the principles are the same, and the episode taught me how powerful
and potentially dangerous the mind is.One summer I was reading a book whose authors recommended as a
technique for losing weight that you visualize yourself feeling sick as you
approached the dinner table. I was enthusiastic about trying all these
exercises, and I had also gotten dreadfully seasick since childhood every
time I’d gone out on choppy water . In fact, I’d recently gone fishing on
vacation and had gotten seasick again. So I thought I’d go the book one
better and imagine myself becoming seasick every time I sat down to eat. By the next day I was dizzy and vomiting owing to labyrinthitis. My
imaging had af fected the or gan of balance. I had to stay in bed for three or
four days. My illness certainly mimicked the worst seasickness I’ve ever
had. I strongly suggest that you never deliberately think negative thoughts
about your body , even for a positive goal such as losing weight. The picture
in your mind is likely to come much too true. As I learned more about the mind-body link, I began to realize that I
had become programmed to be seasick since I was five years old. That year
I’d gone fishing with my father , had immediately gotten seasick, and
presumed that I always would. My family and I still loved boating and
fishing enough to keep trying year after year , but my discomfort cut into the
fun. Just as many of my patients on chemotherapy get sick on the way to
their oncologist’ s office, I would start to get seasick on the way to the boat. I decided I would have none of that, and through meditation I
reprogrammed myself not to get sick. Next summer I was able to take my
wife and children fishing several times without a trace of the problem. In
fact, one of the trips was rather stormy , and I was so thrilled with my
success that I kept us all out there until they started feeling a bit queasy . To become exceptional in caring for the body , one must take stock of
the beliefs one has about it, especially those so ingrained that they’re
normally unconscious. If a person can turn from predicting illness to
anticipating recovery , the foundation for cure is laid. I have a patient, a frail woman named Edith, who weighs all of eighty-
five pounds. She told me, “I don’ t need you and your group. My mother
always told me when I was a youngster , ‘You’re scrawny , but whatever
happens, you’ll always get over it. You’ll live to be ninety-three, and then
they’ll have to run you over with a steamroller .’” Edith has survived a heart
attack, a bleeding duodenal ulcer , the death of her husband, and breast
cancer invading the chest wall. She is now alive more than half a dozenyears after her sur gery. Every time something happens, she hears her
mother ’s words. If we all programmed our children this way , we’d be creating survivors. As parents, we are, in a sense, our children’ s first hypnotists and can give
them positive post-hypnotic suggestions. Instead, negative conditioning is all too common. Over the years I’ve
found that my patients tend to get the same diseases as their parents and to
die at the same age. I think conditioning is at least as much a factor as
genetic predisposition (I call it “psychological genetics”), because I’ve seen
people change the scenario once they become aware of it. When a patient
says resignedly , “I first learned about my cancer in March, I had a
recurrence in March, and here it is March again,” then has a second
recurrence and dies within a month, you begin to see that there’ s more
involved than genetics. Fatalism can be fatal. Too many people think
they’re doomed to reenact their parents’  scripts. As a nurse told me after one
of my lectures, “I think you may have saved my life. I’ve been waiting to
die of cancer , since my mother has it and my father had it. It never occurred
to me that I didn’ t have to have it.”
I recently treated a patient named Henry , whose father used to tear the
obituary page out of the newspaper , as well as any other page that had any
mention of illness on it. Now Henry was confronted with cancer . His panic
was incredible, but with a great deal of work we were able to bring him
through sur gery, and he has done beautifully . Yet the fear that was created
because his parents never taught him to deal with illness was an enormous
contrast with Arthur , who came to my of fice on the same day I initially
examined Henry . Arthur was a Christian Scientist who came because his
family wanted him to. Even though he had a much more serious condition
than the other man, his fear was much less. Psychological “genes” can be as helpful or as damaging as physical
genes. I often see this when I have drawings from a parent and child who
have each developed cancer . How incredible to see the similarity . One is
often a duplicate of the other , although they were made years apart, neither
patient having seen the other ’s drawing. A hopeless, helpless parent
produces a hopeless, helpless child. TARGET  ORGANSPsychological shaping in the formative years plays a lar ge part in
determining who will develop a serious illness. Its ef fects are even more
specific, however . It often determines what disease will occur , and when
and where it will appear . Consider the experience of Lee, a psychologist who has helped conduct
some of the ECaP  workshops. His troubles began with a persistent
hoarseness that was eventually diagnosed as carcinoma of the larynx. His
physician told him that the “treatment of choice” was laryngectomy , adding,
“The only things you won’ t be able to do are sing and scuba dive.” This was
intended as reassurance that the life changes would be inconsequential, but
the doctor never asked what Lee’ s life was all about, and Lee never told
him. Singing and scuba diving happened to be his favorite pastimes. Lee was a nonsmoker , so the location of his tumor was unusual. As a
result of his work with ECaP  and his training as a psychologist, he realized
there must be psychological factors at work. I suggested that his throat must
have some special significance for him. Obviously , the ability to speak well
was crucial to his profession. We found that it went beyond the obvious. Lee’ s family was lar ge and
noisy , and often when the boy was talking loudly , his father put his hand
around Lee’ s throat and squeezed, telling him, “Shut up, Lee. Shut up,
Lee,” in a husky , whispery voice just like Lee’ s esophageal speech now . With much pain and work, Lee has overcome the ef fects of his
childhood messages. After the operation, his physicians kept coming up
with good reports, but intuitively he knew problems still existed, and finally
the tests confirmed this. He developed a second cancer on his back, and
then a third, lymphoma. Through all these trials he meekly went along with
the “treatment of choice,” until the last time, when he was told the most he
could expect was another five years with chemotherapy .
_OceanofPDF.com_Love_Medicine_n_Miracles_-_Bernie_Siegel.txt
Summarize the following text section accurately and concisely. Maintain specific details and numerical information, and use anti-repetition mechanisms:

        No wonder our rates of suicide, drug
addiction, and middle-age death are way above average. Just give one of us
an airplane and pilot’ s license, and then ask an actuary what the insurance
risk is. “For get that thunderstorm,” the doctor thinks. “I have a meeting to
get to. Other people crash, not me. ”
In a recent article Glen Gabbard, MD, of the Menninger Clinic
discussed the role of compulsiveness in the physician creating doubt, guilt,
and an exaggerated sense of responsibility. This is reflected in dif ficulty
relaxing, vacationing, and finding family time. In feeling responsible for
things beyond one’ s control, feeling that one is not doing enough, and
confusing selfishness and healthy self-interest. To paraphrase a story of Larry LeShan’ s: Doctors are busy playing God
when so few of us have the qualifications. And besides the job is taken. Playing God leads to self-destruction. Many colleges are now trying to teach compassion through courses in
humanistic medicine, but perhaps the admission of more women to the
profession will gradually do more to end this pathetic bravado. The best
physicians are those who can find both the “masculine” and “feminine”
virtues that exist within their personalities—the ability to make tough
decisions and yet remain compassionate and caring. Neither extreme makes
a good physician. You can become too involved to make good decisions,
and you can also make decisions based on diseases and think nothing of the
patient. Combining both is the best way. This has been borne out by studies
showing that those who combine both aspects become more ef fective
doctors and also remain happier amid the stresses of their profession. It’s important for most patients to know that their doctors themselves
take the advice they give. Yet, feeling immortal, many physicians smoke,
drink too much, eat badly and too much, and exercise not at all. This is sad enough for the physician, but for the patient it’ s far worse. A
sense of invulnerability makes a doctor discount the fears of the patient,
who lives in no such charmed fantasy. When someone asks, “What should I
eat. ” the invincible deity says, “Eat whatever you want. I’m going home
and having hot dogs. ” Asked about the carcinogenic nitrites in them, the
physician, behind that invisible shield, laughs. With such an outlook, we M. D. s sometimes fail to think of the most
obvious things, as our son Keith taught me when he was four years old and
had to go into the hospital for a hernia repair. I explained all the mechanical
details, but when he woke up he said, “Y ou for got to tell me it was going to
hurt. ” Recently, as a teenager, when he came home with problems, his
father had solutions like love-accept-for give, but he said, “I don’ t need
answers. I need someone to listen. ” When we play the role of a saint with
one-word answers, we don’ t help people. We help when we listen and share
our pain. We must live the sermon, not just deliver it. A severe staph infection, which once kept me in a hospital for a week,
was a crucial part of my education. I found out the dif ficulties of being in
isolation, hooked up to an intravenous line, required to call for help for
everything I needed, when I was used to being responsible and in control. I
found how hard it is to maintain your dignity in the skimpy gowns that the
hospital provides. This illness came at a time of many changes in my life—a new home,
more children, starting practice—all positive events, and yet I became ill. Itmade me aware that patients in my of fice must be experiencing similar
things. I began to joke with them about changes in their  lives. I would ask,
“Did you get a new job. Did you move to a new house. ” They were
astonished. How did I know. I learned more about what doctors were like, too. Since I was a
physician, I had eminent professors caring for me, but I couldn’ t get them
all together at one time to give me a straight answer. They even wanted to
move me to a more depressing, windowless ward because it was closer to
one professor ’s office. I said no and told them I was leaving the hospital. Suddenly everyone showed up. I think a few days as a patient on a busy ward should be an integral part
of every physician’ s training—including, as one patient recently added, “an
IV in his arm and a tube up his nose. ” Most tribal cultures recognize a
similar necessity. Usually one cannot become a healer without first passing
through sickness to health. In our culture, one cannot become a
psychoanalyst without being analyzed, but one can become a medical
mechanic without ever experiencing the need for repair. The denial of empathy benefits no one. As mechanics, we doctors
always fail in the long run, but as counselors, teachers, healers, and care
givers we can always contribute, and even help at the moment of death. Then there’ s no need to hide in the cafeteria with the beeper and force the
nurse to face the patient’ s death alone. A cooperative arrangement, in which
the doctor and patient both realize that they are essentially the same except
for a few years’  training, of fers more to both than the accustomed roles of
master and supplicant. In the words of Dr. Francis Peabody, a pioneering
medical researcher at Harvard in the 1920s, “The treatment of a disease
may be entirely impersonal; the care of a patient must be completely
personal…the secret of the care of the patient is in caring for the patient. ”
For most doctors, like myself, the change is long and dif ficult, but there
is no ef fective alternative. The mental components of all disease make it
imperative that the physician be as enlightened, and as much at peace with
the self, as a good psychotherapist. In Modern Man in Sear ch of a Soul,
Carl Jung stated the requirement thus:
 
And in dealing with himself the doctor must display as much
relentlessness, consistency and perseverance as in dealing with his patients. To work upon himself with an equal concentration is truly no smallachievement; for he brings to bear all the attentiveness and critical
judgment he can summon in showing his patients their mistaken paths, their
false conclusions and infantile subterfuges. No one pays the doctor for his
introspective ef forts; and moreover, we are generally not interested enough
in ourselves. Again, we so commonly undervalue the deeper aspects of the
human psyche that we hold self-examination or preoccupation with
ourselves to be almost morbid. We evidently suspect ourselves of
harbouring rather unwholesome things all too reminiscent of a sick-room. The physician must overcome these resistances in himself, for who can
educate others while himself uneducated. Who can enlighten his fellows
while still in the dark about himself, and who can purify if he is himself
unclean. …The physician may no longer slip out of his own dif ficulties by
treating the dif ficulties of others. He will remember that a man who suf fers
from a running abscess is not fit to perform a sur gical operation. Jung also addressed the need to go beyond a narrow, specialized
approach. In his autobiography, Memories, Dr eams, Reflections, he wrote
that, just as physicians learned to use x-rays with no thought of lecturing on
subatomic physics, he was “not concerned with proving anything to other
disciplines; I am merely attempting to put their knowledge to good use in
my own field. ” Jung broadened psychology by incorporating the
perspectives of mythology and philosophy, and, in like manner, today’ s
physicians must apply the insights of psychology and religion to medicine. Later in the same book Jung describes the advantage a doctor derives from
this willingness to learn from other fields:
 
The dif ference between most people and myself is that for me the
“dividing walls” are transparent. That is my peculiarity. Others find these
walls so opaque that they see nothing behind them and therefore think
nothing is there. To some extent I perceive the processes going on in the
background, and that gives me an inner certainty. This expanded outlook helps a doctor to inspire hope, give with the
heart as well as the head and hands, keep ego in the background, and share
major decisions with the patient. Such an approach rewards the physician aswell as the patient. The love returns in words and looks of gratitude, in
cards and letters, and in little gifts for the of fice, all of which restore you. A
doctor who acts out of love doesn’ t burn out. He or she may get tired
physically, but not emotionally. The wonders produced by close doctor -patient collaboration never cease
to amaze me. One experience illustrates how acceptance can lead a patient
to utilize the doctor ’s recommendations, and also how it can reduce pain. Thelma, a patient with recurrent breast cancer, came to me and said that she
wanted God to heal her while I observed and monitored the process. I
explained how dif ficult I thought that would be. On her next visit, the
cancer was smaller, and I asked her what had happened. She said, “I left the
house with the phone ringing. ” It was the first time she’d ever said no to
anything. Next time, her cancer was even smaller. Again I asked what
happened. All smiles, she said, “When my alcoholic husband acted up I
called the police. He said, ‘Y ou’re embarrassing me in front of the
neighbors. ’  I told him, ‘I have cancer now, and I don’ t accept your behavior
anymore. ’” By the third visit, however, she realized how much I cared for
her and we became a team. She said, “It’ s hard work becoming a saint and
healing yourself. Why don’ t you operate and remove the tumor. I’ll work
on staying well. ”
Thelma told me that the night after sur gery the nurse came in, pulled the
curtain, and said, “T ell me about Dr. Siegel. ”
My patient responded, “What do you mean. You act like you think he
hypnotized me. ”
The nurse said, “W ell, you’ve had a radical mastectomy, and yet you’re
walking around the ward cheering up the rest of us, and you have no pain. What did he do to you. ”
“He shared with me. This was our decision, so there’ s no reason for me
to be depressed or in pain. I know the right thing was done to me by the
right person. This is my way of getting well. ”
Another woman with breast cancer, a young law student named Julie,
had terrible fears and dreams about dying under anesthesia. She asked me if
I could do the operation under local. I told her, “I had a dream in which I
did it under local and permanently injured your arm. ” It was her dream
against mine. Our laughter broke the tension. She was able to see my
concerns, and, after talking it over some more, she had her mastectomy
under general anesthesia with no complications. Let me explain that this was a fear dream, not a precognitive one. Otherwise I would never have defused it with a joke. If a patient had a
dream that I felt predicted that person’ s death, I would not operate that day. For example, one patient dreamed of her headstone with “Thursday”
engraved on it, so we made sure her sur gery was not done on a Thursday. The day after Julie’ s operation I was at a seminar in a nearby town. A
familiar voice asked a question from the audience. It was Julie. I rushed
over to ask what in the world she was doing there. She said, “Don’ t worry. All the tubes are under my dress. When I had no pain and wanted to leave,
the nurses said, ‘Oh, she’ s just another one of Dr. Siegel’ s patients,’  and
your partner signed the dischar ge order. ”
It isn’ t me, though. It’ s the relationship that makes such results possible. It’s sharing and caring, doing things for people, not to them. We physicians
must become instruments. When that happens, motivated patients will use
us to work miracles. Just how fundamentally we can change the patient’ s
reaction to our treatments has been exquisitely captured by Page Coulter,
one of my patients, in her poem “Repairs. ” Even the title points up the
difference between a cooperative approach and the typical medical talk of
“assaulting,” “mutilating,” or “insulting” the body in order to heal it. After
showing how her fears were calmed by a gentle anesthesiologist, she
continues:
We could justify the need for love, or crack open the eye of a tulip. Who cares. We try to stretch our bodies to catch the rain
Or fallout or darkness, anything that falls from outer space. But instead I hear the sur geon singing “Desert Song,”
And I feel his gentle tugs and pulls as though it were my father
Caning chairs or my mother sewing pockets in my wedding dress. OceanofPDF. com3
The gr eat majority of us ar e requir ed to live a life of constant, systematic
duplicity. Your health is bound to be affected if, day after day, you say the
opposite of what you feel, if you gr ovel befor e what you dislike and r ejoice
at what brings you nothing but misfortune. Our nervous system isn’ t just a
fiction, it’ s a part of our physical body, and our soul exists in space and is
inside us, like the teeth in our mouth. It can’ t be for ever violated with
impunity. —B ORIS PASTERNAK, Doctor Zhivago
OceanofPDF. comDisease and the Mind
Neglect of the mind-body link by technological medicine is actually a brief
aberration when viewed against the whole history of the healing art. In
traditional tribal medicine and in Western practice from its beginning in the
work of Hippocrates, the need to operate through the patient’ s mind has
always been recognized. Until the nineteenth century, medical writers rarely
failed to note the influence of grief, despair, or discouragement on the onset
and outcome of illness, nor did they ignore the healing ef fects of faith,
confidence, and peace of mind. Contentment used to be considered a
prerequisite for health. The modern medicine man has gained so much power over certain
diseases through drugs, however, that he has for gotten about the potential
strength within the patient. One elderly physician friend recently told me of
reading the diary of his uncle, also a doctor. In the early years, the diarist
always recorded what happened to the individual or the community prior to
an illness or epidemic, but as medicine became more technological, this part
of the history grew less and less important to him and finally was omitted
altogether. Awareness of the mind’ s powers was lost as medicine cast out all
“soft” data, the information that’ s not easily quantified or scientific. THE MIND—BENIGN OR MALIGN
Part of the mind’ s effect on health is direct and conscious. The extent to
which we love ourselves determines whether we eat right, get enough sleep,
smoke, wear seat belts, exercise, and so on. Each of these choices is a
statement of how much we care about living. These decisions control about
90 percent of the factors that determine our state of health. The trouble is
that most people’ s motivation to attend to these basics is deflected by
attitudes hidden from everyday awareness. As a result, many of us have
mixed intentions. Consider, for example, Sara, a woman who came to me with breast
cancer a few years ago; she was smoking when I walked into her hospital
room. Her action clearly stated: “I want you to get rid of my cancer, but I’m
ambivalent about living, so I think I’ll risk a second cancer. ” She looked up
sheepishly and said, “I suppose you’re going to tell me to stop smoking. ”
“No,” I said, “I’m going to tell you to love yourself. Then you’ll stop. ”She thought for a moment and replied, “W ell, I do love myself. I just
don’t adore myself. ” (Sara ultimately did come to adore herself—and
stopped smoking. ) It was a good quip, but it exemplified an important problem many
people have with themselves. Self-love has come to mean only vanity and
narcissism. The pride of being and the determination to care for our own
needs have gone out of the meaning. Nevertheless, an unreserved, positive
self-adoration remains the essence of health, the most important asset a
patient must gain to become exceptional. Self-esteem and self-love are not
sinful. They make living a joy instead of a chore. The mind does not act only through our conscious choices, however. Many of its ef fects are achieved directly on the body’ s tissues, without any
awareness on our part. Consider some of our common expressions: “He’ s a
pain in the neck/ass. Get of f my back. This problem is eating me up alive. You’re breaking my heart. ” The body responds to the mind’ s messages,
whether conscious or unconscious. In general, these may be either “live” or
“die” messages. I am convinced we not only have survival mechanisms,
such as the fight-or -flight response, but also a “die” mechanism that
actively stops our defenses, slowing the body’ s functions and bringing us
toward death when we feel our life is not worth living. Every tissue and or gan in the body is controlled by a complex
interaction among chemicals circulating in the bloodstream, the hormones
secreted by our endocrine glands. This mixture is controlled by the “master
gland,” the pituitary gland, located in the middle of the head just below the
brain. The output of pituitary hormones in turn is controlled by both
chemical secretions and nerve impulses from the neighboring part of the
brain, called the hypothalamus. This tiny region regulates most of the
body’ s unconscious maintenance processes, such as heartbeat, breathing,
blood pressure, temperature, and so forth. Nerve fibers enter the hypothalamus from nearly all other regions of the
brain, so that intellectual and emotional processes occurring elsewhere in
the brain af fect the body. For example, about five years ago, child-
development researchers discovered “psychosocial dwarfism,” a
disturbingly common syndrome in which an unhealthy emotional
atmosphere at home stunts a child’ s physical growth. When a child is
caught in a crossfire of hostility and feels rejected by his or her parents,
thereby growing up with little self-esteem, the brain’ s emotional center, orlimbic system, acts upon the nearby hypothalamus to shut of f the pituitary
gland’ s production of growth hormone. The immune system consists of more than a dozen dif ferent types of
white blood cells concentrated in the spleen, thymus gland, and lymph
nodes, and patrolling the entire body through the blood and lymphatic
systems. They are divided into two main types. One group, called B cells,
produce chemicals that neutralize poisons made by disease or ganisms while
helping the body mobilize its own defenses. The other group, called T cells,
consists of killer cells and their helpers, which destroy invading bacteria
and viruses. Recent research has shown heretofore unknown nerves connecting the
thymus and spleen directly to the hypothalamus. Other work has proven
that white blood cells re spond directly to some of the same chemicals that
carry messages from one nerve cell to another. This anatomical evidence for direct control of the immune system by
the brain has been confirmed in studies of animals. Two groups of scientists
have independently used Pavlovian conditioning techniques to change the
immune response. At the University of Rochester Medical Center,
psychiatrist Robert Ader and immunologist Nicholas Cohen repeatedly gave
rats saccharin-sweetened water along with an immune-suppressant drug. Later they were able to “trick” the animals into suppressing their own
immune responses by giving them the sweetened water alone. Working for
the National Institutes of Health, Dr. Novera Herbert Spector similarly
conditioned mice to increase their immune responses when exposed to the
smell of camphor. The immune system, then, is controlled by the brain, either indirectly
through hormones in the bloodstream, or directly through the nerves and
neurochemicals. One of the most widely accepted explanations of cancer,
the “surveillance” theory, states that cancer cells are developing in our
bodies all the time but are normally destroyed by white blood cells before
they can develop into dangerous tumors. Cancer appears when the immune
system becomes suppressed and can no longer deal with this routine threat. It follows that whatever upsets the brain’ s control of the immune system
will foster malignancy. This disruption occurs primarily by means of the chronic stress
syndrome first described by Hans Selye in 1936. The mixture of hormones
released by the adrenal glands as part of the fight-or -flight responsesuppresses the immune system. This was all right in dealing with the
occasional threats our ancestors faced from wild beasts. However, when the
tension and anxiety of modern life keep the stress response “on”
continually, the hormones lower our resistance to disease, even withering
away the lymph nodes. Moreover, there is now experimental evidence that
“passive emotions,” such as grief, feelings of failure, and suppression of
anger, produce over -secretion of these same hormones, which suppress the
immune system. We don’ t yet understand all the ways in which brain chemicals are
related to emotions and thoughts, but the salient point is that our state of
mind has an immediate and direct ef fect on our state of body. We can
change the body by dealing with how we feel. If we ignore our despair, the
body receives a “die” message. If we deal with our pain and seek help, then
the message is “Living is dif ficult but desirable,” and the immune system
works to keep us alive. I therefore use two major tools to change the body—emotions and
imagery. These are the two ways we can get our minds and bodies to
communicate with each other. Our emotions and words let the body know
what we expect of it, and by visualizing certain changes we can help the
body bring them about. Both emotions and imagery are obviously
transmitted through the central nervous system and may relate to work that
Robert Becker, an orthopedic sur geon and researcher, has done. Becker has studied the body’ s electrical systems. His work led directly
to the use of electricity to heal broken bones that have failed to knit. Becker
found that hypnotized patients can produce voltage changes in specific
areas of the body on command. If these voltages control the chemical and
cellular processes of healing, as Becker believes, then we soon may have a
scientific explanation for hypnosis cures and the placebo ef fect. It is well
known, for example, that hypnotized patients can cure their own warts. As
Lewis Thomas wrote in The Medusa and the Snail:
 
You can’ t sit there under hypnosis, taking suggestions in and having
them acted on with such accuracy and precision, without assuming the
existence of something very like a controller. It wouldn’ t do to fob of f the
whole intricate business on lower centers without sending along a quite
detailed set of specifications, way over my head. Some intelligence or other knows how to get rid of warts, and this is a
disquieting thought. It is also a wonderful problem, in need of solving. Just think what we
would know, if we had anything like a clear understanding of what goes on
when a wart is hypnotized away. …we would be finding out about a kind of
superintelligence that exists in each of us, infinitely smarter and possessed
of technical know-how far beyond our present understanding. It would be
worth a War on Warts, a Conquest of Warts, a National Institute of Warts
and all. Bioelectricity may someday enable us to reach this “controller” directly,
to understand exactly how and why tumors sometimes regress when
patients are convinced that an unorthodox treatment—hypnosis, diet,
prayer, meditation—is going to work. As Becker once wrote to me, “The
placebo ef fect is not only real but of great importance, and your methods
may be far more ef fective than you think they are. ”
Whether or not we can ever control all healing with electrical stimuli,
exceptional patients—that is, potentially all patients—need not wait
helplessly for artificial aids. They can learn to heal themselves and stay
well. If I can teach you how to feel good about your life, love yourself and
others, and achieve peace of mind, the necessary changes can occur. My
loving and hugging may look silly on the ward, but they’re scientific. The
problem is that we don’ t yet know the psychological techniques necessary
to turn on the healing process quickly and ef ficiently in everyone. So many
of the changes happen at an unconscious level that they are hard to measure
clinically without careful psychological testing. One day I hope we can
prescribe something like “one hug every three hours” instead of a drug or
electrical impulse, but for the moment we must return to our consideration
of the mind’ s potential for harm, as a prelude to finding its antidote. COPING WITH STRESS
It’s often said that stress is one of the most destructive elements in
people’ s daily lives, but that’ s only a half truth. The way we react to stress
appears to be more important than the stress itself. This was borne out in the
experience of Hans Selye, the scientist who developed the entire concept of
stress and its ef fects on the body. At age sixty-five, Selye developed reticulum cell sarcoma, a type of
cancer whose cure rate is extremely low. This is perhaps the ultimate stress,
but in an interview Selye discussed how he reacted to it in an exceptional
way:
 
“I was sure I was going to die, so I said to myself, ‘All right now, this is
about the very worst thing that could happen to you, but there are two ways
you can handle this; either you can go around feeling like a miserable
candidate on death row and whimper away a year, or else you can try to
squeeze as much from life now as you can. ’  I chose the latter because I’m a
fighter, and cancer provided me with the biggest fight of my life. I took it as
a natural experiment that pushed me to the ultimate test whether I was right
or wrong. Then a strange thing happened. A year went by, then two, then
three, and look what happened. It turned out that I was that fortunate
exception…. ”
“Afterward I made a particular ef fort to cut down my stress level. I have
to be very careful what I say here because I am a scientist, and no statistics
now exist to say whether stress is related to cancer. Apart from the genetic
and environmental causes of cancer, I can only say that the relationship
between stress and cancer is rather complicated. In just the same way that
electricity can both cause and prevent heat, depending on how things are
balanced, stress can both initiate and prevent illness. ”
[The interviewer asked,] “Some people have described cancer as a
disease that is somewhat like the body’ s way of rejecting itself. Now to
carry that premise one step further, could it be that when people drastically
reject their basic needs they are possibly more apt to develop cancer. In
other words, if a person rejects his own needs, can his body rebel and reject
itself. ”
[Selye said,] “I don’ t say yes and I don’ t say no. I’m a scientist, not a
philosopher. All I can say as a scientist is that the great majority of physical
illnesses have in part some psychosomatic origin. ”
 
The evidence gathered since Dr. Selye wrote these words suggests he
was overly cautious. In particular, the onset and course of disease are
strongly linked to a person’ s ability and willingness to cope with stress. Stresses that we choose  evoke a response totally dif ferent from those we’dlike to avoid but cannot. Helplessness is worse than the stress itself. This is
probably why the rate of cancer is higher for blacks in America than for
whites, and why cancer is associated with grief and depression. Those most
likely to die of heart attacks are not the hard-driving Type A executives but
rather those who are driven, the underlings and factory workers who have
no autonomy and whose shortened lives give new meaning to the phrase
“deadly boredom. ”
The interpretation of stress is always tricky for an outsider, for the same
circumstances can be detrimental to one and neutral or even beneficial to
another. Johns Hopkins University psychiatrist Jerome Frank, citing a 1961
study by L. E. Hinkle, notes that “stress comes mainly from the patient’ s
interpretation of events. ” In Hinkle’ s long-term study of the subject, life
experiences that seemed benign to an objective observer were often felt as
stressful by the patients and associated with illness. Conversely, stresses
that appeared horrendous to the observer—such as poverty, bereavement,
alcoholism in the family—usually were not associated with illnesses if the
patients did not report them as stressful. This is especially true in the case of children. Adults often assume that
children are happy when they are actually being traumatized by events,
even though they often don’ t show it. Children have been known to commit
suicide over receiving a B instead of an A on a report card, because they
internalized their parents’  expectations, or reacted to a comment that made
them feel unloved. But the scientific mind is seldom convinced by psychological studies on
humans. There are just too many variables for a researcher to control them
all. Tests on animals have yielded conclusive evidence, however. In the
mid-1970s the late Vernon Riley, at Seattle’ s Pacific Northwest Research
Foundation, completed a thorough series of experiments with a strain of
mice bred to be susceptible to breast cancer. By raising some in sheltered,
stress-free environments and others in stressful surroundings, he was able to
vary the rate of cancer from 7 to 92 percent. A 1981 experiment by a team of three psychologists proved the point
with an even better simulation of the human experience. Madelon
Visintainer and two co-workers injected three groups of rats with live tumor
cells. One day later they subjected two of the groups to electric shock. The
stress was administered so that one group could not evade it, while the other
rats were warned by a signal so they could escape by jumping over abarrier. Of the helpless rats, 73 percent came down with the cancer, while
only 37 percent of the other group developed it. They did slightly better
than the control group, which received no shocks at all. The level of stress is determined partly by society. Cultures that place
the highest value on a combination of individualism and competition are the
most stressful. Those that seem to produce the least stress and have the
lowest rates of cancer are close-knit communities in which supportive,
loving relationships are the norm, and the elderly retain an active role. Religious faith and a fairly open, accepting attitude toward sexuality are
two other common characteristics of low-cancer societies. These are some of the same circumstances that favor longevity. Soviet
Geor gia, the Hunza valley, Mormon communities in America, and the
villages of the Abujmarhia tribe of central India are excellent examples. The
Abujmarhia enjoy a pollution-free environment, a wholesome natural diet,
abundantly loving sexual relationships beginning premaritally in early
adolescence, relaxed but occasionally strenuous work in the fields by day,
dancing and storytelling by evening, and plenty of rest. Cancer is absolutely
unknown among them. It must be noted that these societies don’ t invest time and ef fort to help
malformed infants survive, so physical factors determined by natural
selection also influence disease rates. Still, externals are not the whole
story. Environmental purity and death from genetic defects still prevail in
other undeveloped areas, but cancer is more common among tribes who
regularly engage in warfare than among those who live at peace. The security of routine also seems to help limit serious disease. Closed
structured societies in which all members know what is expected of them,
even when deviation from the norm is not tolerated—Mormons, Seventh
Day Adventists, and Mennonites in the United States, for example—have
lower rates of disease than the surrounding, more open society. When
individuals leave the cluster for a life with more unknowns, their incidence
of disease reaches that in the culture they enter. In a society like ours, the response to stress is left to the individual, who
must learn to disconnect psychologically from external pressures. Dr. Herbert Benson of Harvard Medical School has shown that the ability to
maintain a healthy cholesterol level is directly related to the ability to
handle stress through relaxation. With meditation and exercise, we can
teach hard-driving, success-oriented (T ype A) persons to avoid heart attackswhile keeping their Type A behavior. Studies of people who meditate
regularly have shown that their physiological age is much lower than their
chronological age. These techniques do people no good without the
motivation to use them. The first requirement is to get people to love
themselves enough to care for their bodies and minds. Stress can be measured. One of the yardsticks for it, developed by Drs. Thomas Holmes and Richard Rahe, uses a list of forty-three stressful
changes to assess a person’ s likelihood of becoming ill. The evaluation
begins with a history of the persons’ s recent emotional life, then assigns a
certain number of “points” to each life crisis, such as changing or losing a
job, children leaving for college, marriage or divorce, moving to a new
house, and so on. The highest value, 100 points, is attached to the most grievous loss, the
death of one’ s spouse. This most traumatic of events is often followed by
cancer or other catastrophic illness in one or two years. Recent studies have
confirmed that grieving spouses have depressed immune systems for over a
year. Additional work has shown that within one day  any uncontrollable
stress lowers the ef ficiency of the body’ s disease-fighting killer cells. New evidence suggests that divorce may be even more devastating to
many people, since it’ s harder to accept that the relationship is really over. Indeed, divorced people have higher rates of cancer, heart disease,
pneumonia, high blood pressure, and accidental death than married, single,
or widowed persons. Married men also have one-third the lung-can cer
incidence of single men and can smoke three times as much with the same
cancer incidence as single men. Career reversals also commonly lead to malignancy. The defeats of
Napoleon Bonaparte, Ulysses S. Grant, William Howard Taft, and Hubert
Humphrey have often been implicated in their fatal cancers. One of the ar guments of those who discount mental factors in cancer
has been the notion that the latency period is too long for the mind to play a
role in childhood cancer, but there is now evidence to the contrary. A study
at the Albert Einstein College of Medicine in the Bronx found that children
with cancer had had twice as many recent crises as other children matched
to be similar except for their disease. Another study showed that 31 of 33
children with leukemia had experienced a traumatic loss or move within the
two years before their diagnosis. Psychologists are now learning that infants
are far more perceptive than heretofore imagined, and I wouldn’ t besurprised if cancer in early childhood was linked to messages of parental
conflict or disapproval perceived even in the womb. I don’ t say this to
create guilt but to give us more insight into our participation in the healing
process. In dealing with the problems presented by cancer, therefore, we must
not for get the ef fects this crisis may have on family and friends, particularly
if the patient dies. The doctor must help the others deal with their fears and
grief openly, in an ef fort to prevent further disease. When stress is
confronted and love is shared, everyone—the family as well as the patient
—benefits. QUIET  DESPERA TION
Not everyone who suf fers a tragic loss or stressful change in lifestyle
develops an illness. The deciding factor seems to be how one copes with the
problem. Those who can give vent to their feelings yet continue with their
lives generally stay well. The husband of a patient once called me up and asked, “What did you
tell my wife. ” He said she came home and yelled at him for hours about
their twenty years of marriage —and he thought they had been pretty good. I told him, “I didn’ t say anything to your wife, but she has learned that she
has cancer, and she’ s sharing the resentment that she has built up over the
years. ” Anger is a normal emotion if it is expressed when it is felt. If it isn’ t
it develops into resentment or even hatred, which can be very destructive. A
woman who says, “I’ll make this marriage work if it kills me” may find it
will. If a person deals with anger or despair when they first appear, illness
need not occur. When we don’ t deal with our emotional needs, we set
ourselves up for physical illness. Yet what are most of us more comfortable
with—telling the neighbors we have to see a psychiatrist or that we need an
operation. We’re uncomfortable saying we’re being driven crazy but not
that we’re being driven to illness. The simple truth is, happy people generally don’ t get sick. One’ s
attitude toward oneself is the single most important factor in healing or
staying well. Those who are at peace with themselves and their immediate
surroundings have far fewer serious illnesses than those who are not. In one of the most thorough studies of this “contentment factor,”
psychiatrist Geor ge Vaillant followed two hundred Harvard graduates for
thirty years, correlating health surveys with psychological tests each year. Comparing the happiest versus the unhappiest group, he reported: “Of 59
men with the best mental health assessed from the age of 21 to 46 years,
only two became chronically ill or died by the age of 53. Of the 48 men
with the worst mental health from the age of 21 to 46, 18 became
chronically ill or died. ” Those who were extremely satisfied with their lives
had one-tenth  the rate of serious illness and death suf fered by their
thoroughly dissatisfied peers. The findings remained valid when the ef fects
of alcohol, tobacco, obesity, and ancestral longevity were statistically
eliminated—even though unhappiness obviously can contribute to all but
the last variable. Mental health, Vaillant found, retards mid-life
deterioration in physical health. The common denominator in all depression is a lack of love or a loss of
meaning in life, at least as perceived from the depressed person’ s point of
view. Illness then often functions as an escape from a routine that has
become meaningless. In this sense it might even be called a Western form
of meditation. One of the most common precursors of cancer is a traumatic loss or a
feeling of emptiness in one’ s life. When a salamander loses a limb, it grows
a new one. In an analogous way, when a human being suf fers an emotional
loss that is not properly dealt with, the body often responds by developing a
new growth. It appears that if we can react to loss with personal growth, we
can prevent growth gone wrong within us. In like manner, researchers have
found, if a salamander is given cancer on a limb or tail and the appendage is
then amputated near the tumor, a new limb or tail appears and the cancer
cells become normal again. We know that the human body tries to heal
some cancers, such as neuroblastoma, by changing the malignant cells back
to normal in the same way, as well as by attacking them. Thus it is my main
job as a doctor to help you develop into a new person so you can resist the
unwanted, uncontrolled development of illness. If I transplant a kidney into you and give you drugs that inhibit your
immune system, the graft will take. Later we may find that the transplanted
kidney contained a cancer. The kidney and cancer will both thrive. If I take
away the drugs that keep your body from rejecting the kidney, the new
organ will be destroyed, and so will the cancer. A vigorous immune systemcan overcome cancer if it is not interfered with, and emotional growth
toward greater self-acceptance and fulfillment helps keep the immune
system strong. Depression’ s effects on the immune system often appear very quickly if
some remnant of a previous disease remains. Arnold, a patient who had had
malignant melanoma and had been in remission for seven years, came to me
with a recurrence in a lymph node in his armpit. I asked what had happened
in his life during the last six months. He told me he had brought up all his
children himself, because his wife had been mentally ill. The last child, a
son to whom he was especially close, had just gotten married and left home. He’d been so depressed by his son’ s departure that he’d cried for weeks. Despair had depressed Arnold’ s immune response, allowing residual
cancer cells that had been under control to multi ply again. As part of his
therapy we brought together his children and the rest of the family, to help
plan new interests and social activities for him, as well as to find ways in
which the others could remain close to him. He was able to understand the
physical danger of sinking into despair and self-pity. He began to
participate in staying well by learning to deal with the unavoidable
emotional problems of his life. He eventually died of his disease, but his
remaining time was filled with happiness from the love of his family, new
friends, and a girlfriend. Depression as defined by psychologists generally involves quitting or
giving up. Feeling that present conditions and future possibilities are
intolerable, the depressed person “goes on strike” from life, doing less and
less, and losing interest in people, work, hobbies, and so on. Such
depression is strongly linked with cancer.
The author is concerned about the negative impact of the medical profession on the well-being of both the doctor and the patient, and the importance of changing this by becoming more empathetic and compassionate.
What is the author's concern about the medical profession?
The key is to help patients develop a positive self-image and a sense of self-worth, which can be achieved through self-love, self-acceptance, and self-forgiveness.
What is the key to helping patients recover from illness?
The author emphasizes the importance of empathy, compassion, and understanding in patient care, and believes that a doctor must be willing to listen and share their own experiences to build a trusting relationship with the patient.
What is the author's approach to patient care?
The author suggests that stress and a lack of emotional fulfillment can contribute to the development of cancer, and that it is essential to address these underlying issues to prevent or treat the disease.
What is the author's view on the relationship between cancer and stress?
The author is trying to convey that he and his son are both going through a similar experience, and that his son should not be afraid to express his feelings and seek help when needed.
What is the author's message to his son Keith?