Finally Lee spoke up for himself. He told his doctors he wanted more
than a miserable few years on drugs. He wanted to beat the whole thing. He
charted his own course of psychological readjustment and nutritional
therapy . His oncologist told him he was “just chasing rainbows.” Since the
rainbow is a universal symbol of hope and life, that was just what he needed
to hear . He is now alive and well, outdoing his specialist’ s prediction with
no recurrence, despite abandoning standard medical treatment. Nevertheless, I don’ t necessarily recommend his approach to others. Not
everyone is as strong as Lee, or can accomplish such profound change. Forsome his rigid nutritional program might become a burden, negating its
benefits. Lee’s case is not unusual. Target or gans—parts of the body with special
significance to the conflicts or losses in a person’ s life—are the most likely
areas for disease to take root. Franz Alexander , the father of psychosomatic
medicine, recognized this over forty years ago when he wrote: “There is
much evidence that, just as certain pathological microor ganisms have a
specific af finity for certain or gans, so also certain emotional conflicts
possess specificities and accordingly tend to af flict certain internal or gans.”
The discovery of oncogenes has been a great step forward in understanding
cancer . Yet, if oncogenes are the sole cause, persons susceptible to cancer
should develop many primary tumors at one time, in various parts of the
body . Instead, they invariably develop cancer in only one area that is
psychologically significant to them—the tar get or gan. Occasionally I get a chance to talk with psychiatrists, either as patients
or at conferences. Many of them tell stories about patients’  need for disease
or the significance of tar get or gans. One told me of a psychotic patient who
became mentally well when he became physically ill and, as soon as the
illness was over , became psychotic again. Another described a man who
insisted he was pregnant and grew an enormous tumor of the urethra and
prostate (the closest male equivalents of the womb), so that he looked
pregnant. I remember one woman in the hospital who gave me a positive
statement when I asked her how she visualized her x-ray therapy . She said,
“I see it as a golden beam of sunshine entering my body .”
I told her , “Someone must have been here before me and explained all
this to you.”
She said, “Just the woman in the next bed.” A woman with both hands
in bandages was lying there. I talked to her and learned that six or seven
years before she’d had a mesothelioma, was told she’d be dead in six
months, made enormous spiritual changes in her life, and the disease had
disappeared. I asked, “Why did you need this illness?” And she said, “I
don’t know .”
We talked for a while, and she told me she had a lovely husband and
two beautiful children, but at home there was no one to talk to about the
incredible changes she had made in healing herself. And it was wonderful to
be in the hospital. She had all the interns, nurses, and staf f to talk to. I said,“Aha. Then that’ s why you’re here with your hands wrapped up with these
infections.” And I said to her , “I’ll find people for you to talk to. You go
ahead and get well.”
Women whose children die young or who have unhappy love
relationships are especially vulnerable to breast or cervical diseases. One
ECaP  patient, who had lost two husbands to cancer , had uterine cancer and
herpes zoster (shingles) in one of her breasts. I don’ t think it was a
coincidence that, after two such losses, she developed diseases of two sex
organs that would ef fectively keep other men away . One of my breast-cancer patients was a perfect example, not only of this
connection but also of the hope that comes from realizing  the connection. Diana’ s son had lost his life in a hit-and-run accident, and she was making
an enormous ef fort to track down the killer , since the police had botched the
job and ruined the evidence. Her friends kept telling her that she was
literally “killing herself.” She became overweight and developed high blood
pressure. Finally came the breast cancer that compounded her despair . As
we talked, however , Diana came to realize that her own emotions and
actions had contributed to her disease, and that by changing them she could
contribute to her ability to get well. After she left the of fice, my nurse
asked, “Didn’ t you tell her she has cancer?”
“Of course,” I replied. “Why?”
“Because she was smiling on the way out.”
Many patients already know something of this link and only require an
open-minded doctor to be able to use the knowledge. As one said, “I was
always considered spineless, and here I’ve developed multiple myeloma of
my backbone.” Or a woman involved in a stressful love af fair with a
married man says, “I was afraid I’d get cancer , and I knew if I did, it would
be in the cervix.” After seeing a man with cancer of the rectum, I asked him
what had happened in the last year or two of his life. He said, “Nothing
much.” So I asked his daughter . She said she had married out of the family
religion and her brother had run away from home. Later , while helping the
man explore his attitudes in ECaP , one of the other members said, “That
boy must have been some pain in the ass!” A multi ple sclerosis patient
whose household help left her with five young children to care for , lost the
use of her right hand. She had just lost her right-hand man. To an outsider a connection may sometimes seem far -fetched, but only
the patient can finally judge whether it’ s real or not. Having seen it happentime and time again, I’ve concluded that we sensitize the tar get or gans of
our bodies in a form of negative biofeedback. PSYCHOLOGICAL  PROFILE OF  CANCER
In the second century A.D., Galen noted that melancholy people were
more likely to get cancer than those with more sanguine dispositions. In the
eighteenth and nineteenth centuries, many physicians realized that cancer
tends to follow tragedy or crisis in a person’ s life, especially in those whom
today we term depressed. Before the advent of modern psychology ,
however , there was little they could do to help their depressed patients
change their outlook. Despite the twentieth century’ s far-reaching discoveries about the mind,
medicine has been strangely reluctant to apply them to a better
understanding of cancer . Elida Evans, a student of Carl Jung, paved the way
in 1926 with her Psychological Study of Cancer , but it went almost
completely ignored. The copy I came across in the Yale Medical Library in
the mid-1970s had been borrowed only six times in fifty years. The book
clearly spells out the cancer risk incurred by the personality type for whom
life’s meaning comes entirely from people or things outside the self. When
that connection is disrupted, illness follows. Evans concluded, “Cancer is a
symbol, as most illness is, of something going wrong in the patient’ s life, a
warning to him to take another road.”
Today , thanks to further work by LeShan, Dr . Caroline Bedell Thomas,
and others, we are able to sketch a fairly complete psychological profile of
those people who are most likely to develop cancer . The typical cancer patient, let’ s say a man, experienced a lack of
closeness to his parents during childhood, a lack of the kind of
unconditional love that could have assured him of his intrinsic value and
ability to overcome challenges. As he grew up, he became strongly
extraverted, but not so much from an innate attraction to others as from a
dependency on them for validation of his own worth. Adolescence was an
even harder time for this future cancer patient than for other teenagers. Difficulty in forming more than superficial friendships led to an
excruciating loneliness and reinforcement of earlier feelings of inadequacy . Such a person tends to view himself as stupid, clumsy , weak, and inept
at social games or sports, despite real achievements that are often the envyof classmates. At the same time he may cherish a vision of the “real me,”
who is supremely gifted, destined to benefit the human race with vague but
transcendent accomplishments. But this authentic self is carefully hidden in
the belief that it would jeopardize the (subjectively) minimal acceptance
and love that the person has received. He thinks, “If I act the way I really
feel—childlike, brilliant, loving, and ‘crazy’—I’ll be rejected.”
I gave one of my patients, a young woman named Adrienne, a copy of
Gerald Jampolsky’ s book Love Is Letting Go of Fear . After she’d read it,
she told me, “I was like this book. I was a ‘flower child,’  in love with the
world, and my parents said, ‘Grow up.’  So I grew up and got cancer , and
you walk in and say , ‘Become a child.’” Adrienne went back to her
authentic loving self and is well today . Loving doesn’ t mean one hasn’ t
grown up. Being childlike is not childish. At some time, however , usually in the late teens or early twenties, the
patient-to-be falls in love, finds one or two close friends, gets a job that
provides real satisfaction, or otherwise reaches some level of happiness
based outside the self. He is unable to take any credit for this turn of events. It seems like pure luck, more than he deserves, but for the time being all is
well. As an adult, he is still characterized by a poor self-image and passivity
regarding his own needs, but he shows extreme devotion to the one other
person, cause, or group that has become his life. Sooner or later—it may be a few years, it may be decades—the external
meaning vanishes. The friends move away , the job disappears or becomes
less satisfying, the loved spouse leaves or dies. These changes happen to us
all, and they are always painful, but to someone who has put all his eggs in
one basket, the loss is disabling. Yet it usually doesn’ t appear to be. Others
think he is “taking it remarkably well,” but inside there is a hollowness. All
the old feelings of unworthiness come flooding back, and all feeling of
meaning in his life is lost. The routine usually goes on. Having been a compulsive giver since
childhood, the future cancer patient continues going through the motions
with whoever remains in his life, until depleted and exhausted. Over and
over again I hear friends and relatives say , “He was a saint. Why him?” The
truth is that compulsively proper and generous people predominate among
cancer patients because they put the needs of others ahead of their own. Cancer might be called the disease of nice people. They are “nice” by other
people’ s standards, however . They are conditional lovers. They are givingonly in order to receive love. If their giving is not rewarded, they are more
vulnerable to illness than ever . It generally shows up within two years of the
time when their psychological mainstay has disappeared. The broadest, most complete picture has come from therapists working
one-on-one with cancer patients and thus able to get an in-depth knowledge
of the person’ s life as related to the disease. However , now there is also a
rapidly increasing body of experimental evidence, focusing on specific
aspects of the profile. By using a simple psychological test on a lar ge group of women, some
of whom had cervical cancer , Arthur Schmale was able to pick out 36 of the
51 who had malignancies (already diagnosed but unknown to him), by
looking for hopelessness and a recent emotional loss. Other research groups
have since gotten even better results. Marjorie and Claus Bahnson have
developed a questionnaire that is 88 percent accurate in identifying those
who turn out to have a biopsy-confirmed cancer . Most of these
psychological tests are now more accurate than physicians’  physical exams. By the same token, the receptionist in my of fice is a pretty good
diagnostician, basing her suppositions merely upon her contact with the
new patient. Some of the most valuable work has been done by Dr . Caroline Bedell
Thomas of Johns Hopkins University Medical School. Beginning in 1946,
she took personality profiles of 1,337 medical students, then surveyed their
mental and physical health every year for decades after graduation. Her
goal was to find psychological antecedents of heart disease, high blood
pressure, mental illness, and suicide. She included cancer in the study for
the sake of comparison, because she originally thought it would have no
psychological component. However , the data showed a “striking and
unexpected” result: the traits of those who developed cancer were almost
identical to those of the students who later committed suicide. Almost all
the cancer patients had throughout their lives been restricted in expressing
emotion, especially aggressive emotions related to their own needs. She
also found that, using only the drawings they made as one of the tests, she
could predict what parts of their bodies would develop cancer . Certain other diseases also stem from a lifelong pattern of self-denial. In
chronic rheumatoid arthritis, for example, there is often a conscious
restriction of one’ s own achievements. When I mentioned this to my
mother , who has arthritis, she agreed: “Y es, that’ s me. I’ve belonged tomany or ganizations, and I would work my way up to be vice-president, but
when I was of fered the presidency , I would say , ‘No, I’m too involved with
my family . I have to refuse.’”
It’s important for a patient to understand the lifelong pattern, but for the
immediate purpose—getting well—the problem must be put in terms that
can be dealt with now . In most cases, this involves a recognition of conflict. For cancer patients it usually means finding out how the needs of others,
seen as the only ones that count, are used to cover up one’ s own. Often a real power struggle develops. I saw this most clearly and
tragically in the case of Norma, an ECaP  member with an abusive husband. Her disease started to disappear as she became more “self-caring.” Then her
husband developed heart disease and was hospitalized. Norma was faced
with a choice. Rather than force her husband to choose between growing
with her or fostering his illness, she chose to return to her old self. He
resumed his abuse and got well, while she went home to die, telling the rest
of the group there was to be no “funny business”—i.e., no attempts to
change her mind—if we came to visit her . Each of us has more or less the same choices. Norma’ s husband could
have learned to love, or she could have asserted herself and gone on to live. But old patterns, though painful, are easier . Change is dif ficult,
uncomfortable, and frightening. That’ s how we know we’re changing. It is often extraordinarily hard for the compulsive giver to stop, to say
no without feeling guilty . Many of my female patients have come to group
meetings saying, “I’ll do anything to get well.” Then I outline our program,
including time for exercise and meditation, and they say , “Oh, but then
dinner will be late.” A patient named Sharon told us her husband’ s secretary
had left, so she “had” to go in and work for him until he could find a
replacement. The trouble was she hated the job. I told her , “You can’ t
survive cancer if you get up every morning thinking how you hate what
you’ll be doing all day .” Still it took her two or three months to, as she put
it, “give her husband notice.”
When individuals think about saying no, the thing that most often helps
them do it is the sense of a time limit in their lives. If you knew you had a
day to live, would you spend three hours lying in the x-ray department
waiting for a test to be done? Hell, no. You’d say , “Take me back to my
room. This is the last twenty-four hours of my life, and I’m not going tospend one-eighth of it in the x-ray department.” Then they’ll probably get
the test done in five minutes. I tell all my patients to make their choices based on what would feel
right if they knew they were going to die in a day , a week, or a year . That’ s
one way of giving people an immediate awareness of how they feel, even if
they have never paid any attention to feelings. We don’ t have the luxury of
five years of psychoanalysis when someone may not live that long. We have
to begin change immediately , and the best way is by asking what you’d
want to do with this short period of time. INDIVIDUAL  REACTIONS
Any psychological picture of cancer can only be a general one, of
course, and examples from other people can only serve as guideposts. Though the broad features are the same, the specifics are dif ferent for each
individual. However , many of our cancer patients are astonished when other
cancer patients outline their personalities and life stories without ever
having met them before. That can be a key motivating factor . The patient
may think, “W ow! If you know all that, I guess I’d better change my life.”
The work of uncovering conflicts is the most important job facing the
patient, for when the outer choices match the inner desires, ener gy formerly
tied up in contradictions becomes available for healing. My job as a physician is not only to find the right treatment but to help
the patient find an inner reason for living, resolve conflicts, and free healing
energy. Although the mind is incredibly powerful, it often takes something
equally powerful to turn it on. That’ s why I ask patients to mobilize their
faith in everything they can possibly believe in. Patients who want to get
well through the doctor alone or God alone are minimizing their chances. More often than not, such people are really thinking, “I’m not so sure I
want to survive, so I’ll limit myself to the comfortable choices.” The
frequency of passive suicide remains unknown, but it’ s definitely a factor . The one crucial question is what approach will work for each person. Never underestimate the value of the truth, even if it’ s a shock. I remember
a patient who was in congestive heart failure, not taking her medicine,
smoking like a chimney , and then coming to me for a gallbladder operation. I asked her , “Did you come here to have me kill you?”The question surprised her . She said, “Nobody has talked to me like that
since I gave up psychotherapy .” I just explained that, before I could deal
with her gallbladder , I had to deal with her depression and try to give her a
reason for living. I recently saw a patient with a brain tumor that had already progressed
to the point of causing seizures. She was trying to decide whether to have it
surgically removed or treat it only with a nutritional program. A friend had
asked her to talk to me, since her regular doctors were all angry at her for
shying away from aggressive treatment of this critical illness. I sat and
talked with her until we got to the root of the problem—the fact that she
was very depressed, with no great desire to go on living. Therefore, it was
easier for her just to change her diet a little. This would cause her no great
discomfort, and if she died it would be no great loss as far as she was
concerned. My ef fort, then, was to show her how to make her life
interesting enough to continue living. Then she would be in a position to
choose modern techniques for dealing with the emer gency , as well as to
change her outlook thoroughly for the future. I recommend that patients do not reject standard medical techniques, at
least as one option. Most people are simply not strong enough to “leave
their troubles to God,” that is, heal themselves through finding peace of
mind and developing a clear conscience. Drugs and sur gery buy time, and
may cure, while patients work to change their lives. Soon after we’d set up ECaP , I was interviewed by the Midnight Globe
tabloid. The resulting article was very fair and the quotations accurate, but I
was upset by the headline: “Sur geon Says Mind Can Cure Cancer .” I
thought it was simplistic and misleading. The more I worked with patients,
however , the more I came to see that the statement was correct. Now I
consider those omnipresent supermarket newspapers to be important
medical journals. (I say this tongue mostly in cheek.) The mind can cure
cancer , but that doesn’ t mean it’ s easy . The paradox is wonderfully expressed by an old Sufi story . A stranger
comes upon a man on his hands and knees under a street lamp in front of
his house. He’ s looking for his keys, and the stranger gets down on all fours
to help him. After a time, the stranger asks, “Where exactly did you drop
them?”
“In my house,” comes the reply . Exasperated, the stranger asks, “Then why are you looking out here?”“Because it’ s dark in the house.”
The light is better in our conscious minds, but we must look for healing
in the dark unconscious. The doctor works in the light. He is verbal and
logical. The patient’ s world may be dark, but there are sources of
illumination. Within each of us is a spark. Call it a divine spark if you will,
but it is there and can light the way to health. There are no incurable
diseases, only incurable people. OceanofPDF .com4
In the long run…no conscious will can ever r eplace the life instinct . —C ARL JUNG, Late Thoughts
OceanofPDF .comThe Will to Live
One of my patients, as soon as she was diagnosed as having cancer , went
home and donated all her clothes to Goodwill Industries. More clearly than
anything she ever said, this act showed her belief that the disease would
inevitably kill her , so she might as well give up without a fight. For many people, “Y ou have cancer” are the three most dreaded words
in our language. Those who hear them experience many emotions, which
often change as people accept the news and deal with it. Some of these
feelings may remain buried in the unconscious, and it’ s essential to bring
them into the patient’ s conscious awareness. Initially , the diagnosis is always handled with some degree of denial. This allows a person to accept it over a period of time. Sometimes patients
are more depressed six months later than when they first hear the bad news,
because it may take that long to truly hear what they have been told. Some
persons seem to disbelieve the diagnosis, going on with their lives as
though nothing is wrong. Usually they are simply denying their emotions:
internally they are coming apart, but they refuse to reveal their feelings,
perhaps because of early parental messages, such as “Don’ t tell the
neighbors your troubles.” That is a sure way to self-destruct. Performing for
the sake of others destroys you. A small number may act almost psychotic, really believing that nothing
has happened to them. If a person can maintain that kind of abnormal
denial, then cancer is not an emotional stress. But the majority cannot. Others seem to accept the truth, yet refuse to admit it on a deeper level. These are often the ones who submit to treatment but never commit
themselves wholeheartedly to trying to get well. One of my patients
declined to join ECaP  with the explanation “I haven’ t told my children I
have cancer , so how can I appear in a group? I might meet someone I
know .” To many people, it’ s less painful in the short run to keep up a false
front than to confront the terror of a life-threatening illness. Knowing the
truth yet refusing to admit it prevents an ef fective response. Sharing one’ s
fears and problems leads to relief and healing within the body . Knowing
what you are fighting and how to fight are the keys. Denial may be better
than stoicism or despair but it is not the best approach. I try to carefully
convert deniers into fighters.As we’ve seen in the previous chapter , those who develop cancer have
often felt a sense of despair about their lives for months or years. After the
diagnosis, they may feel this even more painfully , sometimes withdrawing
from all human contact. They may also see their impending death as a sort
of sacrifice or martyrdom. These are the ones who refuse to spend money
on treatment because they feel they must save it for other people’ s needs,
such as their children’ s college education. Some simply have never done
anything for themselves and don’ t “know how .” Others are trading their
illness for conditional love and may even, in a sense, die to gain love. Many cancer patients experience a flood of self-pity , an attitude of
“Why me?” This is usually linked to strong feelings of anger , only some of
which are conscious. The patient wonders why he, instead of someone else,
has been af flicted with a predisposition to cancer . Hence many people get
furious with God, as well as with the physician—the messenger who
brought the bad news. Oddly enough, only a few express rage against the
cigarette industry , the pesticide industry , the food-additive industry , the
nuclear -power industry , and other external sources of malignancy . In the
case of smoking, patients tend to realize that they took the risk themselves
because they were unhappy , and thus get angry with family members and
others who, they feel, made them unhappy . While the typical patient may
ask, “Why me, Lord?” the exceptional patient says, as one ECaP  member
did, “T ry me, Lord.”
I want to emphasize that all emotions are justified at this stage and must
be expressed. Much of the anger is well founded. Cancer ’s complex causes
aren’ t all in the mind. Genes and carcinogens are important factors, and it’ s
worthwhile to work toward genetic cures and environmental sanity . But
some whose parents had cancer or who have been heavily exposed to
carcinogens still don’ t come down with the disease. Cigarette smokers who
are emotionally well adjusted or who eat a healthy diet high in vitamin A
have less lung cancer than those who are depressed or eat poorly . To
balance our research into cancer ’s molecular seeds, we need to learn about
the state of mind and body that prevents the seeds from growing. Moreover , patients often concentrate on the obvious external tar gets
while more personal angers that are harder to acknowledge remain hidden
and increase their susceptibility to illness. For those who already have
cancer , the psychological aspects of the disease are the crucial ones. We
can’t change the past—our parents and our exposure to carcinogens—butwe can change ourselves and thus our future. As one of my patients said,
“Cancer isn’ t a sentence, it’ s just a word.”
When I began ECaP , I experienced tremendous amounts of this anger . The first group of patients had never had a chance to express it, and they all
came angry to the first meetings. Initially this made it hard for me to talk to
other doctors about my work. I heard so much anger at physicians that
when I left the meetings I was mad at doctors, too. For a while I told every
colleague I met, “Y ou’re a typical doctor .” They knew this was a derogatory
statement. Fortunately , my partners asked me what was happening, and I
realized I was taking home my patients’  anger , because I was the only one
there to absorb it. Now the more experienced ECaP  members also help the
newcomers work through their rage. I’m not saying that anger at the externals should be suppressed—just
the opposite. Patients must be encouraged to express all their angers,
resentments, hatreds, and fears. These emotions are signs that we care to the
utmost when our lives are threatened. Time after time, research has shown
that peo ple who give vent to their negative emotions survive adversity
better than those who are emotionally constricted. Among patients with
spinal-cord injuries, those who express strong grief and anger make more
progress in rehabilitation than those with a more stoical attitude. Mothers
who show great distress after giving birth to a deformed infant give the
child better care than those who seem to take the misfortune calmly . In a
study of people living near Three Mile Island, Dr . Andrew Baum found that
those who showed their rage and fear suf fered far less from stress and
psychological problems than those who took a “rational” approach. Unexpressed feelings depress your immune response. Some cancer patients also experience strong feelings of guilt. They
blame themselves, just as many children who get sick think their illness is a
punishment for being bad. Although not ideal, this attitude is not entirely
destructive, for it often leads to a more realistic sense of participation in the
onset of disease. In fact, a lar ge amount of research on people who’ve
suffered catastrophe has proven that those who feel they contributed to it
(even if they did not) tend to get over the trauma more easily than those
who feel totally helpless. This holds true for such tragedies as rape,
earthquakes, and floods, as well as sickness. For example, if a woman who
has been raped can think, no matter what the circumstances, “It wouldn’ t
have happened if I’d been more careful, if I had learned to protect myself,”she can reduce her sense of powerlessness and plan to make herself less
vulnerable in the future. Researchers have found that such an attitude
enables people to accept human evil and natural disaster without believing
that life is devoid of beauty or meaning. Using a battery of psychological tests, Leonard Derogatis discovered in
1979 that breast-cancer patients who felt and freely expressed much anger ,
fear, depression, and guilt lived far longer than patients who showed little of
these emotions. Those who died within a year had relied heavily on
repression, denial, and other psychological defenses. The hostility that the
survivors vented on their physicians led to the conclusion, mentioned in
Chapter 1, that they formed “poor” doctor -patient relationships. Derogatis
used rigorous statistical con trols to exclude physical dif ferences between
the short-term and long-term survivors. His work stands as excellent
scientific support for a group of researchers nearly three decades earlier ,
who were “impressed by the polite, apologetic, almost painful acquiescence
of patients with rapidly progressive disease as contrasted to the more
expressive and sometimes bizarre personalities” of those who lived longer . THE FOUR QUESTIONS
Before I can help patients choose treatment, I must learn about their
attitudes toward themselves and their disease. It is especially important to
gauge the strength of their will to live, and then to strengthen it by getting
them to express their anger , fear , and other emotions. As Norman Cousins
wrote in his Anatomy of an Illness ,
 
The will to live is not a theoretical abstraction, but a physiologic reality
with therapeutic characteristics. Not every illness can be overcome. But many people allow illness to
disfigure their lives more than it should. They cave in needlessly . They
ignore and weaken whatever powers they may have for standing erect. There is always a mar gin within which life can be lived with meaning and
even with a certain measure of joy , despite illness. At first a patient’ s emotions and attitudes may not be fully accessible to
consciousness. To retrieve them I’ve found that we need to explore the
answers to four basic questions. 1. Do you want to live to be a hundred? Most people won’ t answer without some hypothetical guarantee of
health. They don’ t instinctively take the responsibility for making all their
years worthwhile. A few years ago gerontologist Ken Dychtwald asked
hundreds of people, “How old do you want to be before you die?” A
majority didn’ t want to live past sixty or sixty-five, because they assumed
their lives then would be devoid of play , sex, independence, or meaning,
and filled with problems. The elderly , however , tended to want more years,
and women generally wanted more years than men. This question always leads to others, such as “Do you love yourself
enough to take care of your body and mind?” The answer is contained in
your lifestyle. Do you eat moderately , avoiding too much sugar , caffeine,
and fat? Are there plenty of fresh fruits and vegetables in your diet? Do you
avoid most processed, additive-laden foods? Do you smoke? Do you eat a
good breakfast and get adequate rest? Do you exercise? Are you self-
motivated? (Most centenarians have been self-employed for much of their
lives.) Do you seek activities that give you joy and satisfaction? The answers all depend on whether or not you feel in control of your
life and thus whether you look forward to the future with hope or with fear . One ECaP  member , a wonderful woman named Shirley , joined the group at
the age of ninety-two. Once, when everyone was talking about how afraid
they were of cancer , pain, dying, and so on, I asked her , “Shirley , what are
you afraid of?”
She said, “Driving on the parkway at night.” That put the other
members’  fears to rest, because she has lived through everything they’re
still afraid of, except death. Remember if you decide to live to be 100 loved
ones may die before you. It takes courage to survive and be “the last apple
on the tree,” as one of my patients said. 2. What happened to you in the year or two before your illness? This question, along with tools such as the Holmes-Rahe stress scale,
explores the short-term psychological predisposing factors discussed inChapter 3. Inevitably , it also leads back to the long-term conditioning
factors that determine how a person reacts to the recent events. It’ s essential
to consider internal stresses, too, such as an identity crisis or the giving up
of one of youth’ s cherished dreams. We must also consider how the patient
reacted to the crisis. Did he or she openly grieve, rejoice, and face the
challenge, or try to be calm and stoical? 3. What does the illness mean to you? If cancer , for example, automatically means death, then the patient has a
problem that must be solved before dealing with the disease itself. Such a
meaning is programmed and reinforced by silence. When the adults in a
family say , “We don’ t talk about that,” or a parent says, “Y ou get whatever
your sister gets, and whatever happens to your sister happens to you,” when
the sister dies of cancer the siblings believe there is no hope for them. Without frank acceptance, death, like sex, becomes an embarrassment. The
husband who only tells his wife over and over , “Don’ t die,” or “Y ou’re
going to get well,” no matter how extensive the disease, prevents her from
sharing her fears and hinders her ef forts to face death openly . In such an
atmosphere, the patient is cast into the outer darkness without love or any
way to share emotions. On the other hand, if the disease means a challenge,
formidable but not invincible—then the patient has a basis for dealing with
it. This question is useful, but actions and expectations are often even
more revealing. Jennifer had been entered in a hospice program by her
doctor , who expected her to die within six months. But she kept on living. When the hospice staf f asked if she looked forward to spring, she said, “Oh,
yes, I love to watch the flowers come up.” They asked if she liked summer . “Very much.” Fall? “Oh, I just love the leaves changing color .” Even
winter? “Y es, the snow .” Eventually the hospice personnel told her they had
to stop coming. They would return when she was ready to die. She became
a “hospice dropout” and joined one of our ECaP  groups. When winter approached, however , Jennifer told me, “I don’ t think I’m
going to be buying any winter clothes.” This indicated that perhaps she was
getting ready to die. Then she came to one of our meetings wearing a lovely winter suit. I
said, “Aha! I see you decided to buy some winter clothes.”“No,” she said, “I just brought some down from the attic.” To me that
said she’d made a compromise. She was saying, “Let’ s see how the winter
goes. I’m not going to invest in it, but I’ll give it a try .”
Another cancer patient I know , named Matt, went to his physician one
day looking awful and came home looking fine. His family asked, “Gee,
what did the doctor do?”
Matt said, “Oh, he gave me my aller gy shot.” This let him know that the
doctor expected him to live through the spring, and his body responded. 4. Why did you need the illness? Like the previous two questions, this one helps the patient understand
the psychological needs that the disease may meet. Sickness gives people
“permission” to do things they would otherwise be inhibited from doing. It
can make it easier to say no to unwelcome burdens, duties, jobs, or the
demands of other people. It can serve as permission to do what one has
always wanted but has always been “too busy” to start. It can allow a
person to take time of f to reflect, meditate, and chart a new course. It can
serve as an excuse for failure. It can make it easier to request and accept
love, speak your feelings, or otherwise be more honest. Even a cold has a
meaning. Often its message is “Y ou’ve been working too hard. Go home
and nurture yourself.” Remember we are brought up on “sick days,” not
“health days.” Take days to meet your needs and you won’ t need an illness. Since physical illness usually brings sympathy from friends and
relatives, it can be a way of gaining love, or nurturing. It can become a
patient’ s only way of relating to the world, the only control one has over
life. Gladys, a patient of mine who’d had a chronic intestinal inflammation
for some fifty years, learned to manipulate her whole family this way . I met
her after she developed cancer . The family looked sicker than she did,
because she had some family member awake to wait on her twenty-four
hours a day . Even when they hired a nurse to care for her , Gladys would
awaken the family and let the nurse sleep. Over and over she developed
severe pains at home, which mysteriously disappeared each time she was
admitted to the hospital. Nearly every weekend she would have those who
were not home during the week in the emer gency room with her to help
evaluate her recurrent chest pains. Thus those who worked during the week
got their share. She was constantly asking someone to hand her a glass of
water or a tissue, even when what she wanted was only inches away .After I got to know Gladys, I gave her Arnold Hutschnecker ’s The W ill
to Live . The next morning when I returned on my rounds, she said I’d
forgotten something—the book. The message was clear: “Please don’ t try to
teach me to give up my illness, because it’ s the only way I can relate to
people.” Learning to love was frightening. I kept trying to reach Gladys, and she said I was the only doctor who
ever gave her hope. Truthfully I think I was the only one who continued to
care for her without being worn out by constant manipulation, which
included side ef fects to every medication I recommended. I learned to let
her do much of the talking, then recommend things that fit her belief
system. Then I would always get the credit and be called a wonderful
doctor . Finally , during one of her phone calls, I told her I had a new drug that
would cure her cancer . I asked her to come to the of fice, since it had to be
given by injection. I did this after explaining my plan to the family and
asking them to watch Gladys’ s reaction. I was trying to save them  from
being the victims of her illness. She made an appointment for Friday , but on
that day she called to postpone it for a week because the weather was bad. Next Friday she couldn’ t get a ride, and the week after that she had to go
shopping. In short, Gladys never returned to my of fice, although she tried to
maintain our relationship by phone or at the hospital, where I didn’ t have
the drug. I took this approach only for the family’ s sake, since I knew she
would refuse the of fer. Her family then had the option of going along in the
old pattern or refusing to be victimized any longer . It’s important to realize that we can’ t force others to change, we can
only help them to change themselves. I have had two male patients much
like Gladys, both with extensive cancers. I said to each of them, “I’ll
guarantee you a cure of your cancer if you leave your family business,”
which both found very stressful but meaningful, and which would give the
family many benefits in the event of the man’ s death. Each man said exactly
the same thing: “I’ll have to go home and think about it.”
A cancer patient was advised by his sur geon to sell his business,
because the sur geon felt he was terminal. He did, and got well. One day I
encountered him in the hospital hallway . He was yelling at his sur geon—
because now he was well but had no business. I explained that he’d been
given the right advice for the wrong reason. He’d been encouraged to quitbecause statistics said he would soon die, whereas the reduced stress and
more enjoyable life had in fact led to his recovery . My purpose is not to judge these patients’  motives, but to bring them
out into the open. Then the family knows when a person doesn’ t really want
to change, and can work on the conflict with love, and meet its needs too. Throughout our lives we’re trained to associate sickness with rewards. We get to stay in bed and relax. People send us cards and flowers. Friends
visit and tell us they love us. Parents and spouses bring us chicken soup and
read to us. I remember a patient named Myrna telling me that the happiest
times in her childhood were when she was sick, because then her father
would sit on her bed and hold her hand. Her experience is far from unique. As children we get to stay home from school, and as adults we get a paid
respite from work. If we stay healthy , we have to either show up every day
or pretend  to be sick. We should be able to call up and say , “I want to stay
well, so today I’m taking a health day .”
Even our insurance system rewards illness by penalizing those who take
care of themselves. If payments reflected our commitment to health instead
of statistical assumptions based on age, family history , and a cursory
physical, we could give people more of an incentive to take char ge of their
health. We should establish certain basic requirements—controlling weight,
not smoking, and so on. When those are met for a minimum fee, all medical
expenses would be covered. Those who meet none of the requirements
would have to pay much lar ger premiums. Cigarette and liquor taxes could
also be set aside for a national health-insurance fund to keep those who
work at their health from having to pay the bills of those who don’ t.
Those who try to get patients to understand how their own actions have
contributed to illness are often criticized for “blaming the victim.” This
attitude misses the point. All people eventually die even when they’ve done
some beautiful things. And even when a person’ s lifestyle obviously
contributed to disease, guilt is not a productive way of relating to the ef fects
of the past. No doctor should ever encourage a patient to take on this
additional burden. Illness and the prospect of death are not seen as failures
but as motivators. However , most illnesses do have a psychological component, and a
realization of one’ s participation  and responsibility in the disease process is
entirely dif ferent from blame or guilt. Of course few ever really want a life-
threatening sickness, but it usually functions as a message to change orgives patients something they are not getting from their lives. As Carl
Simonton has said, “I believe we develop our diseases for honorable
reasons. It’ s our body’ s way of telling us that our needs—not just our
body’ s needs but our emotional needs, too—are not being met, and the
needs that are fulfilled through our illnesses are important ones.”
It cannot be overemphasized that this last and most important question
—Why did you need this illness?—must be asked constructively , not as a
way of saying, “Look what a mess you’ve made of your life.” It is intended
to help patients realize that the emotional needs met by illness are all valid. Then, when the needs are accepted, a person can move on to satisfy them in
constructive ways, without the disease. William James wrote, “The greatest discovery of my generation is that
human beings, by changing the inner attitudes of their minds, can change
the outer aspects of their lives.” Years of experience have taught me that
cancer and indeed nearly all diseases are psychosomatic. This may sound
strange to people accustomed to thinking that psychosomatic ailments are
not truly “real,” but, believe me, they are. The new con cept is not a cop-out,
but rather a source of tremendous hope. David Bohm, the physicist,
suggests the word “soma-significance” as a better way of thinking of the
relationship. The body knows only what the mind tells it. To accept some of
the responsibility for disease, to realize that one has participated, is actually
a very positive step. If one has taken part in getting sick, one can also take
part in getting well. However , as I’ll discuss in more detail later , getting well isn’ t the main
objective. That can set you up for failure. If you set a physical goal, then
you may fail, but if you make peace of mind your goal, you can achieve it. My message is peace of mind, not curing cancer , blindness, or paraplegia. In achieving peace of mind, cancer may be healed, sight may be restored,
and paralysis may disappear . All of these things may occur through peace of
mind, which creates a healing environment in the body . Anyone who is
willing to work at it can achieve it, and the first step is understanding—
realistically , without guilt or self-pity—how the mind has contributed to the
body’ s ills. This understanding can show you how you must change to be at
peace with yourself. MESSAGES FROM THE UNCONSCIOUSThe mind and body communicate constantly with each other , but most
of this communication is on an unconscious level. Therefore, the doctor
must ask the patient about his attitudes but must not take all the answers at
face value. What seems like a strong will to live may actually be a surface
resolve, a performance, rather than a true inner connection to the life force. It’s necessary to get beyond the verbal, conscious level to make sure that
what the patient says is what he really feels. The surest way to do this is by
examining images from his unconscious mind. These images surface spontaneously in dreams, which sometimes can
be used to diagnose physical illness, as Carl Jung was able to do. However ,
the process of inferring somatic facts from mental images is so complex and
often involves such seemingly far -fetched connections that even Jung
declined to discuss it, for fear of having his work rejected. Fostering and
interpreting diagnostic and curative dreams was essential to the methods of
ancient Greek and Egyptian healing temples and was practiced by
Hippocrates and Galen, but today it is a lost art just beginning to be
restudied by a few psychologists. It is not yet a tool that most doctors can
use. However , some spontaneous dreams are relatively easy to interpret. Often a patient and I can understand a dream by discussing it together . Sandy had such a dream when she developed breast cancer during her
second marriage. She saw three roads ahead of her: one gray and black with
everyone carrying a heavy bundle, a second road filled with many colors
and active, cheerful people, and a third, which she couldn’ t see clearly . After drawing a picture of the dream and talking it over in the group, she
realized that the first road represented her cancer as a burden and bringing
despair , the second represented it as a challenge to live and develop, and the
third represented the choice she would have to make. She chose the path of
life, and as she grew , her cancer shrank. She responded well to therapy and
was “reborn” as a new person. She shared her experience by writing articles
and eventually went back to school and now has a new career and her
health. The easiest dreams to understand are those with self-explanatory images
or those which the dreamer spontaneously knows the meaning of. One
patient with breast cancer dreamed her head was shaved and the word
cancer was written on her scalp. She woke knowing she had brain
metastases. There were no physical signs or symptoms until three weekslater, when the dream diagnosis was confirmed. I once had a dream during a
time when I was having certain symptoms that might have been due to
cancer . In my dream I was a member of a group whose other members all
had cancer , but I was pointed out as not having it. Tests later verified what
the dream had communicated. One day in the operating room I was discussing dreams and a nurse
recounted one of the “direct insight” dreams. She had been very sick for
several weeks, and no one could figure out what was wrong. Then one night
she had a dream in which a shellfish opened, a worm stood up inside it, and
an old woman pointed at the worm and said, “That’ s what’ s wrong with
you.” The nurse woke up knowing she had hepatitis, which was confirmed
by subsequent tests. Such direct dreams often give information that medical tests can’ t. One
leukemia patient, who had recently had a bone-marrow aspiration whose
results were normal, nevertheless dreamed of termites eating away at the
foundation of her house. We encouraged her to imagine exterminators being
brought in during her meditations, but she then dreamed of maggots eating
potatoes at her feet. She died in three weeks. Her mind knew what the tests
didn’ t.
Often, however , dream interpretation is dif ficult, even for an
experienced psychotherapist. The meaning of the symbols often depends on
emotions or events in the patient’ s life that may be hidden from
consciousness. Dreams can be explored on two levels. The first is the level
of personal meanings, which can almost always be worked out with the
patient. The other is the deeper , unconscious level of symbols and myths,
which is more problematic. Anyone who takes the time can explore his or
her own dreams on the first level. For this there are several excellent books
that can serve as guides, including Gail Delaney’ s Living Y our Dr eams , Ann
Faraday’ s The Dr eam Game , and Patricia Garfield’ s Creative Dr eaming . Jung’ s techniques are discussed in “The Meaning in Dreams and Dreaming”
by Maria F . Mahoney . Fortunately , there is a simpler , more reliable way to reveal unconscious
beliefs. The doctor merely asks the patient to draw a picture. I give all new
patients the following instructions:
1. On a white sheet of paper , held vertically , draw a picture of yourself,
your treatment, your disease, and your white blood cells eliminatingthe disease. Please have all colors of the rainbow , brown, black, and
white available to you, and use crayons. 2. On a separate sheet of white paper , held horizontally , draw another
picture or scene in color using crayons. 3. You may also choose to draw an additional picture of your home and
family , as well as additional images (such as a tree, boat, or bird, etc.) that may call forth further significant material from the unconscious. Pictures relating to conflicts or choices, such as a job or impending
surgery, may also be important. Such drawings bypass verbal deceptions and get to the universal
symbolic language of the unconscious. What we say is often a cover -up,
because we’re all trained in language and use it, consciously or not, to
conceal things that disturb us. But when we communicate in visual images,
we tell the truth, because we can’ t manipulate the language as well. This is
a language of the collective unconscious. The patient’ s and doctor ’s
appearance, religion, race, culture, and language are all unimportant, for the
archetypal pictures inside us are all the same and have the same meanings. Of course, it is important to know some specifics about a patient’ s
background, because conscious statements involving them may be made in
the drawing. For example, if a patient draws himself wearing a black suit
and says he chose that color simply because he was wearing a black suit
that day , then you can’ t infer anything about his emotional state from the
symbolism of the color . When these aspects of the drawing have been dealt with, however , it
remains a vital window on the unconscious. Susan R. Bach, the Jungian
therapist who developed a systematic approach to the interpretation of
spontaneous pictures, has written:
 
The study of such spontaneous material could give us a glimpse into the
psyche-soma relation comprehended as the oldest and best married couple
on this earth, serving conjointly the life and health of the individual, each in
its own right, with its own mode of expression and its own laws. Further study and deeper understanding made me aware that the somatic
side is equally reflected in the pictorial images of dreams, in the work of
artists, in basic motifs of fairy tales, in heroic figures of mythology , down toprehistoric paintings of early man. They can be comprehended as an
expression of man as a whole. I’ve found that analysis of these drawings is one of a doctor ’s most
accurate aids to prognosis. When there’ s time, I even use the approach in
the emer gency room. When a child with abdominal pain, for example, just
draws her head with her eyes looking around with an expression that says,
“I don’ t like this place,” it’ s a good bet there’ s nothing seriously wrong with
her abdomen. I remember a young man who colored his abdomen green,
even though every note on his chart said, “Operate.” Green is a natural,
healthy color , and the drawing indicated that the trouble spots were the
man’ s head, genitals, and one foot. The drawing represented an emotional
problem, a sexual problem, and a foot that he had injured. We waited, and
he recovered without sur gery. We learned later that the abdominal pain was
due to a drug reaction, not disease. This and similar experiences have led
me to think of myself as a Jungian sur geon. A child in my of fice shared for the first time with her parents a dream
that told her she would have cancer in a year in her right leg. She told her
sister not to tell the parents as they would only worry for a year . She began
to draw one-legged teddy bears and a year later had an amputation for a
sarcoma of her right leg. The story came out because I created a safe
environment for this discussion as we shared the families’  drawings. When combined with other psychological tests, mental imagery often is
more useful than laboratory tests in assessing the patient’ s prospects. Work
done by the Simontons, Jeanne Achterber g and G. Frank Lawlis compared
the predictive value of psychological factors and blood chemistry in 126
patients with extensive cancer . Virtually every psychological test showed a
statistical relationship to one or more blood components. The patients who
did most poorly were those who were very dependent on others—such as
the doctor—for motivation and esteem, who used psychological defenses to
deny their condition, and who visualized their bodies as having little power
to fight the disease. Compared with patients who did well, those whose
disease progressed fastest were more conformist to sex-role stereotypes and
developed images that were more concrete and less creative or symbolic. The re searchers concluded that “blood chemistries of fer information only
about the current state of the disease, whereas the psychological variables
offer future insights” and that “the imagery was found to be the most
important in predicting subsequent disease states.” By analyzing drawingsmade by two hundred patients, Achterber g later achieved 95-percent
accuracy in predicting who would die within two months and who would be
in remission. The drawing of a young patient named Toby dramatically illustrated the
predictive value of images. The young man had had regional enteritis for
many years and had become addicted to painkillers. He was so depressed
and angry about his condition that he prayed to God every night that he
wouldn’ t wake up the next morning. After two months he decided God
probably needed more specific instructions, so he prayed for a brain tumor . In two months he woke up unable to speak, with a brain tumor . Eventually
it made him quadriplegic. The experience changed his outlook. Dying in his
sleep was okay , but being unable to move or communicate wasn’ t. Now
Toby recalled a visit to me years before. He returned, joined ECaP , and
began to see the world with love and express that love to others. When Toby first came to the group, his tumor was in remission. He
drew a tree whose outline looked almost exactly like the brain seen in
profile. He pictured black throughout the branches. This let me know that
he had a recurring disease, even though his brain scans showed none. I did
not depress or frighten him by telling him so. By talking in the group about
how he would deal with a recurrence, I was able to help him prepare for
what I knew was coming. In this instance, the tree obviously symbolized the brain. A tree can also
stand for many other things, including a person’ s entire life and
development. After a long battle with his cancer and despite quadriplegia, Toby
decided to leave the hospital. At this point when asked how he was Toby
responded, “Fine.” His answer meant he was at peace and had no fear . To
his doctor it meant I was lying to him about his disease. His doctor
predicted he would live two weeks and told his mother , “This is no TV
program. It’s going to be horrible.” His family was able to create a warm,
supportive environment, and with love his only therapy he improved to the
point where he could move his arms again. His neurologist was courageous
enough to visit him at home, and afterward said, “I see what Bernie is
talking about.”
Toby lived eight more months at home, a time that brought the family
closer than ever and helped them share enough love to survive his death. On
Memorial Day his breathing became labored, and his mother told him,“Toby, if you want to go it’ s all right. I’ll be okay . We all love you and will
miss you, but we’ll be all right.” He took three breaths and died. The
holiday has become a day when he can be with his loved ones, always. Philosopher Benedetto Croce wrote, “T rue happiness is to be won by
learning to love with such elevation of spirit as to attain the power to stand
up to grief…. Surpass the old love with an even greater new love.” Through
his life in those eight months, Toby gave his family the capacity to achieve
this kind of love, which helped them all survive and overcome their grief. The interpretation of drawings is a technique that I’ll discuss in a later
chapter . Here I merely want to introduce two important symbols—the
rainbow and the butterfly . In dreams, mythology , and art, the rainbow is a
symbol of hope and a manifestation of our entire emotional spectrum and
life. The butterfly is a universal symbol of metamorphosis, a change from
ugliness to beauty , from hate to love, and from this life to the next. Children
in a Nazi concentration camp scratched butterflies on the walls of their
cells. In the excerpt from Cancer W ard quoted at the beginning of this book,
Aleksandr Solzhenitsyn, himself a survivor of cancer and a concentration
camp, brilliantly captured the meaning of these images, out of his
unconscious creative awareness. EXCEPTIONAL  DETERMINA TION
No matter what their content, the mere fact that a patient is willing to
make the drawings shows a basic desire to survive. It takes courage to do
something that will reveal aspects of yourself that you might be more
comfortable concealing. Some patients are unwilling to do even this much
work, a clear message that they don’ t want to participate. They say things
like “I lost the crayons” or “I can’ t find the instructions.” Others call from
out of state to say they’ll come to a group meeting tomorrow . I tell them,
“Wait. There’ s some homework first, some reading and some drawings.”
“Fine,” they say . “I’ll have it done by tomorrow .” It’s this type of aggressive
patient who has the best chance. The resolve to do whatever is necessary , including opening up the
unconscious, is one of the first requirements for being an exceptional
patient. In the next chapter I’ll discuss in more detail how to gain the “clear
conscience” mentioned by Solzhenitsyn. But no prescription for change will
do any good without the courage to accept the challenge—to take control ofyour life, find your true path, sing your song, and regardless of your age
decide what you want to be when you grow up. Several years ago I received a letter from a remarkable woman named
Lois Becker . After hearing of my work, she wrote to share her experience,
thanking me for verbalizing what she intuitively knew . After a terrible year in which her father died of cancer , her husband
underwent sur gery, her brother was divorced, and her mother and aunt were
badly injured in an auto accident, Lois Becker decided to make something
good happen by becoming pregnant with her second child. During an
examination, her midwife discovered a lump in her right breast and sent her
for an immediate biopsy . Her letter continues:
 
A three-day wait for the results, which I already know in my gut. Three
days lying flat on the couch, staring as the television changes programs
hour after hour . The phone rings—they’ll cut of f my breast on Monday . I
am thirteen weeks pregnant. I am 33 years old. They do it. They really meant it. My right side has a 12-inch incision;
no lymph glands, no breast. There are 12 more tumors in my glands. I have three choices: immediate abortion, a caesarean section or induced
labor at about 30 weeks, or a full-term delivery . My cancer is hormone-
positive, and my body is lousy with hormones. I can’ t have any of the usual
cancer therapy if I keep the baby . Even with an abortion and therapy , my
chances are a shattering one in six for five more years of life. I choose to go for 30 weeks. I don’ t choose it to save the baby . I choose
it to get out of the hospital, so they won’ t do anything more to me now . They pull two long, sucking tubes out of my side, and I go home. It is
January in Minnesota, as frozen as you can get, unless, of course, you are
pregnant and have cancer . When you are a human time-bomb, it is a lot longer than five months
from January to May . Each day my baby grows, more of the hormones, so
enormously dangerous to me, flood my body . There is little reason to hope
that I will complete the pregnancy with no further cancer spread. I am so
numb, so angry , so very , very sad that my face freezes into an
expressionless mask. I lose the ability to read (previously one of my
greatest joys), because my concentration is completely destroyed. I don’ t
expect to see my girl become eight years old on June 30, 1978. I buy all her
gifts and wrap them in February . I plan my burial.But I really was two people, each fighting hard for the upper hand. One
heard what the doctors said and reacted as I have just described. But the
other shouted obscenities at the hospital whenever her car passed by . This
second person decided to fight, even though the first person was after her
every day , sometimes every hour , to give up and give in. Physically , my mastectomy didn’ t hurt very much. My chest, upper arm,
and back were numb, but I healed fast, without complications. But my arm
hurt from the beginning, sometimes so badly that I couldn’ t straighten it for
days. Unfortunately it was my right arm, the one I used to strum my guitar . But it really didn’ t matter , because I wasn’ t happy enough to sing anymore. As soon as I left the hospital, I tried to listen to my insides. I wanted my
body and mind to tell me how to help them survive. I got some answers,
and I tried to follow them even when I was too depressed to move or care. My body said, “Drink orange juice,” a curious craving I’d never
experienced before. I drank and drank, and it felt right. I put serious thought
into what I put into my body . I told my food to make me strong. I told each
vitamin, as it slid down my throat, to go to the right places and do the right
things, because they were the only cancer pills I had. My body said, “Move, Lois, and do it fast!” Thirty minutes after I came
home from the hospital I went for a walk. It was hard. I was afraid of falling
on my side. I was humped like an old lady . But my legs were strong. I
bought a pedometer and walked of f miles and miles. When spring came, I
walked, ran, walked, and ran, until there was too much baby . I told my body through exercise that I loved it and wanted it to be
healthy . I started yoga again the week I came home. At first I could only
move my arm about five inches from my side in any direction, but I
stretched and stretched it. I got my three-pound weights out and made my
arm muscles and tendons work even though they protested painfully . I got
my arm back quickly and have full mobility and strength today . Reach to
Recovery says, “W alk your fingers slowly up the door .” I say , “Hang on the
door, and then do chin-ups if you can.”
My mind and body said, “Make love,” and they were right. Making love
(and other forms of exercise) gave me the only times I was free, the only
times I was me again, the only times I didn’ t have cancer . My mind said, “I need peace. I need some rest every day from the
overpowering pressure. Rest me!” I had never meditated, but I went to the
library and discovered the forms that worked for me. I practiced.
_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:

        Finally Lee spoke up for himself. He told his doctors he wanted more
than a miserable few years on drugs. He wanted to beat the whole thing. He
charted his own course of psychological readjustment and nutritional
therapy. His oncologist told him he was “just chasing rainbows. ” Since the
rainbow is a universal symbol of hope and life, that was just what he needed
to hear. He is now alive and well, outdoing his specialist’ s prediction with
no recurrence, despite abandoning standard medical treatment. Nevertheless, I don’ t necessarily recommend his approach to others. Not
everyone is as strong as Lee, or can accomplish such profound change. Forsome his rigid nutritional program might become a burden, negating its
benefits. Lee’s case is not unusual. Target or gans—parts of the body with special
significance to the conflicts or losses in a person’ s life—are the most likely
areas for disease to take root. Franz Alexander, the father of psychosomatic
medicine, recognized this over forty years ago when he wrote: “There is
much evidence that, just as certain pathological microor ganisms have a
specific af finity for certain or gans, so also certain emotional conflicts
possess specificities and accordingly tend to af flict certain internal or gans. ”
The discovery of oncogenes has been a great step forward in understanding
cancer. Yet, if oncogenes are the sole cause, persons susceptible to cancer
should develop many primary tumors at one time, in various parts of the
body. Instead, they invariably develop cancer in only one area that is
psychologically significant to them—the tar get or gan. Occasionally I get a chance to talk with psychiatrists, either as patients
or at conferences. Many of them tell stories about patients’  need for disease
or the significance of tar get or gans. One told me of a psychotic patient who
became mentally well when he became physically ill and, as soon as the
illness was over, became psychotic again. Another described a man who
insisted he was pregnant and grew an enormous tumor of the urethra and
prostate (the closest male equivalents of the womb), so that he looked
pregnant. I remember one woman in the hospital who gave me a positive
statement when I asked her how she visualized her x-ray therapy. She said,
“I see it as a golden beam of sunshine entering my body. ”
I told her, “Someone must have been here before me and explained all
this to you. ”
She said, “Just the woman in the next bed. ” A woman with both hands
in bandages was lying there. I talked to her and learned that six or seven
years before she’d had a mesothelioma, was told she’d be dead in six
months, made enormous spiritual changes in her life, and the disease had
disappeared. I asked, “Why did you need this illness. ” And she said, “I
don’t know. ”
We talked for a while, and she told me she had a lovely husband and
two beautiful children, but at home there was no one to talk to about the
incredible changes she had made in healing herself. And it was wonderful to
be in the hospital. She had all the interns, nurses, and staf f to talk to. I said,“Aha. Then that’ s why you’re here with your hands wrapped up with these
infections. ” And I said to her, “I’ll find people for you to talk to. You go
ahead and get well. ”
Women whose children die young or who have unhappy love
relationships are especially vulnerable to breast or cervical diseases. One
ECaP  patient, who had lost two husbands to cancer, had uterine cancer and
herpes zoster (shingles) in one of her breasts. I don’ t think it was a
coincidence that, after two such losses, she developed diseases of two sex
organs that would ef fectively keep other men away. One of my breast-cancer patients was a perfect example, not only of this
connection but also of the hope that comes from realizing  the connection. Diana’ s son had lost his life in a hit-and-run accident, and she was making
an enormous ef fort to track down the killer, since the police had botched the
job and ruined the evidence. Her friends kept telling her that she was
literally “killing herself. ” She became overweight and developed high blood
pressure. Finally came the breast cancer that compounded her despair. As
we talked, however, Diana came to realize that her own emotions and
actions had contributed to her disease, and that by changing them she could
contribute to her ability to get well. After she left the of fice, my nurse
asked, “Didn’ t you tell her she has cancer. ”
“Of course,” I replied. “Why. ”
“Because she was smiling on the way out. ”
Many patients already know something of this link and only require an
open-minded doctor to be able to use the knowledge. As one said, “I was
always considered spineless, and here I’ve developed multiple myeloma of
my backbone. ” Or a woman involved in a stressful love af fair with a
married man says, “I was afraid I’d get cancer, and I knew if I did, it would
be in the cervix. ” After seeing a man with cancer of the rectum, I asked him
what had happened in the last year or two of his life. He said, “Nothing
much. ” So I asked his daughter. She said she had married out of the family
religion and her brother had run away from home. Later, while helping the
man explore his attitudes in ECaP, one of the other members said, “That
boy must have been some pain in the ass. ” A multi ple sclerosis patient
whose household help left her with five young children to care for, lost the
use of her right hand. She had just lost her right-hand man. To an outsider a connection may sometimes seem far -fetched, but only
the patient can finally judge whether it’ s real or not. Having seen it happentime and time again, I’ve concluded that we sensitize the tar get or gans of
our bodies in a form of negative biofeedback. PSYCHOLOGICAL  PROFILE OF  CANCER
In the second century A. D. , Galen noted that melancholy people were
more likely to get cancer than those with more sanguine dispositions. In the
eighteenth and nineteenth centuries, many physicians realized that cancer
tends to follow tragedy or crisis in a person’ s life, especially in those whom
today we term depressed. Before the advent of modern psychology,
however, there was little they could do to help their depressed patients
change their outlook. Despite the twentieth century’ s far-reaching discoveries about the mind,
medicine has been strangely reluctant to apply them to a better
understanding of cancer. Elida Evans, a student of Carl Jung, paved the way
in 1926 with her Psychological Study of Cancer, but it went almost
completely ignored. The copy I came across in the Yale Medical Library in
the mid-1970s had been borrowed only six times in fifty years. The book
clearly spells out the cancer risk incurred by the personality type for whom
life’s meaning comes entirely from people or things outside the self. When
that connection is disrupted, illness follows. Evans concluded, “Cancer is a
symbol, as most illness is, of something going wrong in the patient’ s life, a
warning to him to take another road. ”
Today, thanks to further work by LeShan, Dr. Caroline Bedell Thomas,
and others, we are able to sketch a fairly complete psychological profile of
those people who are most likely to develop cancer. The typical cancer patient, let’ s say a man, experienced a lack of
closeness to his parents during childhood, a lack of the kind of
unconditional love that could have assured him of his intrinsic value and
ability to overcome challenges. As he grew up, he became strongly
extraverted, but not so much from an innate attraction to others as from a
dependency on them for validation of his own worth. Adolescence was an
even harder time for this future cancer patient than for other teenagers. Difficulty in forming more than superficial friendships led to an
excruciating loneliness and reinforcement of earlier feelings of inadequacy. Such a person tends to view himself as stupid, clumsy, weak, and inept
at social games or sports, despite real achievements that are often the envyof classmates. At the same time he may cherish a vision of the “real me,”
who is supremely gifted, destined to benefit the human race with vague but
transcendent accomplishments. But this authentic self is carefully hidden in
the belief that it would jeopardize the (subjectively) minimal acceptance
and love that the person has received. He thinks, “If I act the way I really
feel—childlike, brilliant, loving, and ‘crazy’—I’ll be rejected. ”
I gave one of my patients, a young woman named Adrienne, a copy of
Gerald Jampolsky’ s book Love Is Letting Go of Fear. After she’d read it,
she told me, “I was like this book. I was a ‘flower child,’  in love with the
world, and my parents said, ‘Grow up. ’  So I grew up and got cancer, and
you walk in and say, ‘Become a child. ’” Adrienne went back to her
authentic loving self and is well today. Loving doesn’ t mean one hasn’ t
grown up. Being childlike is not childish. At some time, however, usually in the late teens or early twenties, the
patient-to-be falls in love, finds one or two close friends, gets a job that
provides real satisfaction, or otherwise reaches some level of happiness
based outside the self. He is unable to take any credit for this turn of events. It seems like pure luck, more than he deserves, but for the time being all is
well. As an adult, he is still characterized by a poor self-image and passivity
regarding his own needs, but he shows extreme devotion to the one other
person, cause, or group that has become his life. Sooner or later—it may be a few years, it may be decades—the external
meaning vanishes. The friends move away, the job disappears or becomes
less satisfying, the loved spouse leaves or dies. These changes happen to us
all, and they are always painful, but to someone who has put all his eggs in
one basket, the loss is disabling. Yet it usually doesn’ t appear to be. Others
think he is “taking it remarkably well,” but inside there is a hollowness. All
the old feelings of unworthiness come flooding back, and all feeling of
meaning in his life is lost. The routine usually goes on. Having been a compulsive giver since
childhood, the future cancer patient continues going through the motions
with whoever remains in his life, until depleted and exhausted. Over and
over again I hear friends and relatives say, “He was a saint. Why him. ” The
truth is that compulsively proper and generous people predominate among
cancer patients because they put the needs of others ahead of their own. Cancer might be called the disease of nice people. They are “nice” by other
people’ s standards, however. They are conditional lovers. They are givingonly in order to receive love. If their giving is not rewarded, they are more
vulnerable to illness than ever. It generally shows up within two years of the
time when their psychological mainstay has disappeared. The broadest, most complete picture has come from therapists working
one-on-one with cancer patients and thus able to get an in-depth knowledge
of the person’ s life as related to the disease. However, now there is also a
rapidly increasing body of experimental evidence, focusing on specific
aspects of the profile. By using a simple psychological test on a lar ge group of women, some
of whom had cervical cancer, Arthur Schmale was able to pick out 36 of the
51 who had malignancies (already diagnosed but unknown to him), by
looking for hopelessness and a recent emotional loss. Other research groups
have since gotten even better results. Marjorie and Claus Bahnson have
developed a questionnaire that is 88 percent accurate in identifying those
who turn out to have a biopsy-confirmed cancer. Most of these
psychological tests are now more accurate than physicians’  physical exams. By the same token, the receptionist in my of fice is a pretty good
diagnostician, basing her suppositions merely upon her contact with the
new patient. Some of the most valuable work has been done by Dr. Caroline Bedell
Thomas of Johns Hopkins University Medical School. Beginning in 1946,
she took personality profiles of 1,337 medical students, then surveyed their
mental and physical health every year for decades after graduation. Her
goal was to find psychological antecedents of heart disease, high blood
pressure, mental illness, and suicide. She included cancer in the study for
the sake of comparison, because she originally thought it would have no
psychological component. However, the data showed a “striking and
unexpected” result: the traits of those who developed cancer were almost
identical to those of the students who later committed suicide. Almost all
the cancer patients had throughout their lives been restricted in expressing
emotion, especially aggressive emotions related to their own needs. She
also found that, using only the drawings they made as one of the tests, she
could predict what parts of their bodies would develop cancer. Certain other diseases also stem from a lifelong pattern of self-denial. In
chronic rheumatoid arthritis, for example, there is often a conscious
restriction of one’ s own achievements. When I mentioned this to my
mother, who has arthritis, she agreed: “Y es, that’ s me. I’ve belonged tomany or ganizations, and I would work my way up to be vice-president, but
when I was of fered the presidency, I would say, ‘No, I’m too involved with
my family. I have to refuse. ’”
It’s important for a patient to understand the lifelong pattern, but for the
immediate purpose—getting well—the problem must be put in terms that
can be dealt with now. In most cases, this involves a recognition of conflict. For cancer patients it usually means finding out how the needs of others,
seen as the only ones that count, are used to cover up one’ s own. Often a real power struggle develops. I saw this most clearly and
tragically in the case of Norma, an ECaP  member with an abusive husband. Her disease started to disappear as she became more “self-caring. ” Then her
husband developed heart disease and was hospitalized. Norma was faced
with a choice. Rather than force her husband to choose between growing
with her or fostering his illness, she chose to return to her old self. He
resumed his abuse and got well, while she went home to die, telling the rest
of the group there was to be no “funny business”—i. e. , no attempts to
change her mind—if we came to visit her. Each of us has more or less the same choices. Norma’ s husband could
have learned to love, or she could have asserted herself and gone on to live. But old patterns, though painful, are easier. Change is dif ficult,
uncomfortable, and frightening. That’ s how we know we’re changing. It is often extraordinarily hard for the compulsive giver to stop, to say
no without feeling guilty. Many of my female patients have come to group
meetings saying, “I’ll do anything to get well. ” Then I outline our program,
including time for exercise and meditation, and they say, “Oh, but then
dinner will be late. ” A patient named Sharon told us her husband’ s secretary
had left, so she “had” to go in and work for him until he could find a
replacement. The trouble was she hated the job. I told her, “You can’ t
survive cancer if you get up every morning thinking how you hate what
you’ll be doing all day. ” Still it took her two or three months to, as she put
it, “give her husband notice. ”
When individuals think about saying no, the thing that most often helps
them do it is the sense of a time limit in their lives. If you knew you had a
day to live, would you spend three hours lying in the x-ray department
waiting for a test to be done. Hell, no. You’d say, “Take me back to my
room. This is the last twenty-four hours of my life, and I’m not going tospend one-eighth of it in the x-ray department. ” Then they’ll probably get
the test done in five minutes. I tell all my patients to make their choices based on what would feel
right if they knew they were going to die in a day, a week, or a year. That’ s
one way of giving people an immediate awareness of how they feel, even if
they have never paid any attention to feelings. We don’ t have the luxury of
five years of psychoanalysis when someone may not live that long. We have
to begin change immediately, and the best way is by asking what you’d
want to do with this short period of time. INDIVIDUAL  REACTIONS
Any psychological picture of cancer can only be a general one, of
course, and examples from other people can only serve as guideposts. Though the broad features are the same, the specifics are dif ferent for each
individual. However, many of our cancer patients are astonished when other
cancer patients outline their personalities and life stories without ever
having met them before. That can be a key motivating factor. The patient
may think, “W ow. If you know all that, I guess I’d better change my life. ”
The work of uncovering conflicts is the most important job facing the
patient, for when the outer choices match the inner desires, ener gy formerly
tied up in contradictions becomes available for healing. My job as a physician is not only to find the right treatment but to help
the patient find an inner reason for living, resolve conflicts, and free healing
energy. Although the mind is incredibly powerful, it often takes something
equally powerful to turn it on. That’ s why I ask patients to mobilize their
faith in everything they can possibly believe in. Patients who want to get
well through the doctor alone or God alone are minimizing their chances. More often than not, such people are really thinking, “I’m not so sure I
want to survive, so I’ll limit myself to the comfortable choices. ” The
frequency of passive suicide remains unknown, but it’ s definitely a factor. The one crucial question is what approach will work for each person. Never underestimate the value of the truth, even if it’ s a shock. I remember
a patient who was in congestive heart failure, not taking her medicine,
smoking like a chimney, and then coming to me for a gallbladder operation. I asked her, “Did you come here to have me kill you. ”The question surprised her. She said, “Nobody has talked to me like that
since I gave up psychotherapy. ” I just explained that, before I could deal
with her gallbladder, I had to deal with her depression and try to give her a
reason for living. I recently saw a patient with a brain tumor that had already progressed
to the point of causing seizures. She was trying to decide whether to have it
surgically removed or treat it only with a nutritional program. A friend had
asked her to talk to me, since her regular doctors were all angry at her for
shying away from aggressive treatment of this critical illness. I sat and
talked with her until we got to the root of the problem—the fact that she
was very depressed, with no great desire to go on living. Therefore, it was
easier for her just to change her diet a little. This would cause her no great
discomfort, and if she died it would be no great loss as far as she was
concerned. My ef fort, then, was to show her how to make her life
interesting enough to continue living. Then she would be in a position to
choose modern techniques for dealing with the emer gency, as well as to
change her outlook thoroughly for the future. I recommend that patients do not reject standard medical techniques, at
least as one option. Most people are simply not strong enough to “leave
their troubles to God,” that is, heal themselves through finding peace of
mind and developing a clear conscience. Drugs and sur gery buy time, and
may cure, while patients work to change their lives. Soon after we’d set up ECaP, I was interviewed by the Midnight Globe
tabloid. The resulting article was very fair and the quotations accurate, but I
was upset by the headline: “Sur geon Says Mind Can Cure Cancer. ” I
thought it was simplistic and misleading. The more I worked with patients,
however, the more I came to see that the statement was correct. Now I
consider those omnipresent supermarket newspapers to be important
medical journals. (I say this tongue mostly in cheek. ) The mind can cure
cancer, but that doesn’ t mean it’ s easy. The paradox is wonderfully expressed by an old Sufi story. A stranger
comes upon a man on his hands and knees under a street lamp in front of
his house. He’ s looking for his keys, and the stranger gets down on all fours
to help him. After a time, the stranger asks, “Where exactly did you drop
them. ”
“In my house,” comes the reply. Exasperated, the stranger asks, “Then why are you looking out here. ”“Because it’ s dark in the house. ”
The light is better in our conscious minds, but we must look for healing
in the dark unconscious. The doctor works in the light. He is verbal and
logical. The patient’ s world may be dark, but there are sources of
illumination. Within each of us is a spark. Call it a divine spark if you will,
but it is there and can light the way to health. There are no incurable
diseases, only incurable people. OceanofPDF. com4
In the long run…no conscious will can ever r eplace the life instinct. —C ARL JUNG, Late Thoughts
OceanofPDF. comThe Will to Live
One of my patients, as soon as she was diagnosed as having cancer, went
home and donated all her clothes to Goodwill Industries. More clearly than
anything she ever said, this act showed her belief that the disease would
inevitably kill her, so she might as well give up without a fight. For many people, “Y ou have cancer” are the three most dreaded words
in our language. Those who hear them experience many emotions, which
often change as people accept the news and deal with it. Some of these
feelings may remain buried in the unconscious, and it’ s essential to bring
them into the patient’ s conscious awareness. Initially, the diagnosis is always handled with some degree of denial. This allows a person to accept it over a period of time. Sometimes patients
are more depressed six months later than when they first hear the bad news,
because it may take that long to truly hear what they have been told. Some
persons seem to disbelieve the diagnosis, going on with their lives as
though nothing is wrong. Usually they are simply denying their emotions:
internally they are coming apart, but they refuse to reveal their feelings,
perhaps because of early parental messages, such as “Don’ t tell the
neighbors your troubles. ” That is a sure way to self-destruct. Performing for
the sake of others destroys you. A small number may act almost psychotic, really believing that nothing
has happened to them. If a person can maintain that kind of abnormal
denial, then cancer is not an emotional stress. But the majority cannot. Others seem to accept the truth, yet refuse to admit it on a deeper level. These are often the ones who submit to treatment but never commit
themselves wholeheartedly to trying to get well. One of my patients
declined to join ECaP  with the explanation “I haven’ t told my children I
have cancer, so how can I appear in a group. I might meet someone I
know. ” To many people, it’ s less painful in the short run to keep up a false
front than to confront the terror of a life-threatening illness. Knowing the
truth yet refusing to admit it prevents an ef fective response. Sharing one’ s
fears and problems leads to relief and healing within the body. Knowing
what you are fighting and how to fight are the keys. Denial may be better
than stoicism or despair but it is not the best approach. I try to carefully
convert deniers into fighters. As we’ve seen in the previous chapter, those who develop cancer have
often felt a sense of despair about their lives for months or years. After the
diagnosis, they may feel this even more painfully, sometimes withdrawing
from all human contact. They may also see their impending death as a sort
of sacrifice or martyrdom. These are the ones who refuse to spend money
on treatment because they feel they must save it for other people’ s needs,
such as their children’ s college education. Some simply have never done
anything for themselves and don’ t “know how. ” Others are trading their
illness for conditional love and may even, in a sense, die to gain love. Many cancer patients experience a flood of self-pity, an attitude of
“Why me. ” This is usually linked to strong feelings of anger, only some of
which are conscious. The patient wonders why he, instead of someone else,
has been af flicted with a predisposition to cancer. Hence many people get
furious with God, as well as with the physician—the messenger who
brought the bad news. Oddly enough, only a few express rage against the
cigarette industry, the pesticide industry, the food-additive industry, the
nuclear -power industry, and other external sources of malignancy. In the
case of smoking, patients tend to realize that they took the risk themselves
because they were unhappy, and thus get angry with family members and
others who, they feel, made them unhappy. While the typical patient may
ask, “Why me, Lord. ” the exceptional patient says, as one ECaP  member
did, “T ry me, Lord. ”
I want to emphasize that all emotions are justified at this stage and must
be expressed. Much of the anger is well founded. Cancer ’s complex causes
aren’ t all in the mind. Genes and carcinogens are important factors, and it’ s
worthwhile to work toward genetic cures and environmental sanity. But
some whose parents had cancer or who have been heavily exposed to
carcinogens still don’ t come down with the disease. Cigarette smokers who
are emotionally well adjusted or who eat a healthy diet high in vitamin A
have less lung cancer than those who are depressed or eat poorly. To
balance our research into cancer ’s molecular seeds, we need to learn about
the state of mind and body that prevents the seeds from growing. Moreover, patients often concentrate on the obvious external tar gets
while more personal angers that are harder to acknowledge remain hidden
and increase their susceptibility to illness. For those who already have
cancer, the psychological aspects of the disease are the crucial ones. We
can’t change the past—our parents and our exposure to carcinogens—butwe can change ourselves and thus our future. As one of my patients said,
“Cancer isn’ t a sentence, it’ s just a word. ”
When I began ECaP, I experienced tremendous amounts of this anger. The first group of patients had never had a chance to express it, and they all
came angry to the first meetings. Initially this made it hard for me to talk to
other doctors about my work. I heard so much anger at physicians that
when I left the meetings I was mad at doctors, too. For a while I told every
colleague I met, “Y ou’re a typical doctor. ” They knew this was a derogatory
statement. Fortunately, my partners asked me what was happening, and I
realized I was taking home my patients’  anger, because I was the only one
there to absorb it. Now the more experienced ECaP  members also help the
newcomers work through their rage. I’m not saying that anger at the externals should be suppressed—just
the opposite. Patients must be encouraged to express all their angers,
resentments, hatreds, and fears. These emotions are signs that we care to the
utmost when our lives are threatened. Time after time, research has shown
that peo ple who give vent to their negative emotions survive adversity
better than those who are emotionally constricted. Among patients with
spinal-cord injuries, those who express strong grief and anger make more
progress in rehabilitation than those with a more stoical attitude. Mothers
who show great distress after giving birth to a deformed infant give the
child better care than those who seem to take the misfortune calmly. In a
study of people living near Three Mile Island, Dr. Andrew Baum found that
those who showed their rage and fear suf fered far less from stress and
psychological problems than those who took a “rational” approach. Unexpressed feelings depress your immune response. Some cancer patients also experience strong feelings of guilt. They
blame themselves, just as many children who get sick think their illness is a
punishment for being bad. Although not ideal, this attitude is not entirely
destructive, for it often leads to a more realistic sense of participation in the
onset of disease. In fact, a lar ge amount of research on people who’ve
suffered catastrophe has proven that those who feel they contributed to it
(even if they did not) tend to get over the trauma more easily than those
who feel totally helpless. This holds true for such tragedies as rape,
earthquakes, and floods, as well as sickness. For example, if a woman who
has been raped can think, no matter what the circumstances, “It wouldn’ t
have happened if I’d been more careful, if I had learned to protect myself,”she can reduce her sense of powerlessness and plan to make herself less
vulnerable in the future. Researchers have found that such an attitude
enables people to accept human evil and natural disaster without believing
that life is devoid of beauty or meaning. Using a battery of psychological tests, Leonard Derogatis discovered in
1979 that breast-cancer patients who felt and freely expressed much anger,
fear, depression, and guilt lived far longer than patients who showed little of
these emotions. Those who died within a year had relied heavily on
repression, denial, and other psychological defenses. The hostility that the
survivors vented on their physicians led to the conclusion, mentioned in
Chapter 1, that they formed “poor” doctor -patient relationships. Derogatis
used rigorous statistical con trols to exclude physical dif ferences between
the short-term and long-term survivors. His work stands as excellent
scientific support for a group of researchers nearly three decades earlier,
who were “impressed by the polite, apologetic, almost painful acquiescence
of patients with rapidly progressive disease as contrasted to the more
expressive and sometimes bizarre personalities” of those who lived longer. THE FOUR QUESTIONS
Before I can help patients choose treatment, I must learn about their
attitudes toward themselves and their disease. It is especially important to
gauge the strength of their will to live, and then to strengthen it by getting
them to express their anger, fear, and other emotions. As Norman Cousins
wrote in his Anatomy of an Illness,
 
The will to live is not a theoretical abstraction, but a physiologic reality
with therapeutic characteristics. Not every illness can be overcome. But many people allow illness to
disfigure their lives more than it should. They cave in needlessly. They
ignore and weaken whatever powers they may have for standing erect. There is always a mar gin within which life can be lived with meaning and
even with a certain measure of joy, despite illness. At first a patient’ s emotions and attitudes may not be fully accessible to
consciousness. To retrieve them I’ve found that we need to explore the
answers to four basic questions. 1. Do you want to live to be a hundred. Most people won’ t answer without some hypothetical guarantee of
health. They don’ t instinctively take the responsibility for making all their
years worthwhile. A few years ago gerontologist Ken Dychtwald asked
hundreds of people, “How old do you want to be before you die. ” A
majority didn’ t want to live past sixty or sixty-five, because they assumed
their lives then would be devoid of play, sex, independence, or meaning,
and filled with problems. The elderly, however, tended to want more years,
and women generally wanted more years than men. This question always leads to others, such as “Do you love yourself
enough to take care of your body and mind. ” The answer is contained in
your lifestyle. Do you eat moderately, avoiding too much sugar, caffeine,
and fat. Are there plenty of fresh fruits and vegetables in your diet. Do you
avoid most processed, additive-laden foods. Do you smoke. Do you eat a
good breakfast and get adequate rest. Do you exercise. Are you self-
motivated. (Most centenarians have been self-employed for much of their
lives. ) Do you seek activities that give you joy and satisfaction. The answers all depend on whether or not you feel in control of your
life and thus whether you look forward to the future with hope or with fear. One ECaP  member, a wonderful woman named Shirley, joined the group at
the age of ninety-two. Once, when everyone was talking about how afraid
they were of cancer, pain, dying, and so on, I asked her, “Shirley, what are
you afraid of. ”
She said, “Driving on the parkway at night. ” That put the other
members’  fears to rest, because she has lived through everything they’re
still afraid of, except death. Remember if you decide to live to be 100 loved
ones may die before you. It takes courage to survive and be “the last apple
on the tree,” as one of my patients said. 2. What happened to you in the year or two before your illness. This question, along with tools such as the Holmes-Rahe stress scale,
explores the short-term psychological predisposing factors discussed inChapter 3. Inevitably, it also leads back to the long-term conditioning
factors that determine how a person reacts to the recent events. It’ s essential
to consider internal stresses, too, such as an identity crisis or the giving up
of one of youth’ s cherished dreams. We must also consider how the patient
reacted to the crisis. Did he or she openly grieve, rejoice, and face the
challenge, or try to be calm and stoical. 3. What does the illness mean to you. If cancer, for example, automatically means death, then the patient has a
problem that must be solved before dealing with the disease itself. Such a
meaning is programmed and reinforced by silence. When the adults in a
family say, “We don’ t talk about that,” or a parent says, “Y ou get whatever
your sister gets, and whatever happens to your sister happens to you,” when
the sister dies of cancer the siblings believe there is no hope for them. Without frank acceptance, death, like sex, becomes an embarrassment. The
husband who only tells his wife over and over, “Don’ t die,” or “Y ou’re
going to get well,” no matter how extensive the disease, prevents her from
sharing her fears and hinders her ef forts to face death openly. In such an
atmosphere, the patient is cast into the outer darkness without love or any
way to share emotions. On the other hand, if the disease means a challenge,
formidable but not invincible—then the patient has a basis for dealing with
it. This question is useful, but actions and expectations are often even
more revealing. Jennifer had been entered in a hospice program by her
doctor, who expected her to die within six months. But she kept on living. When the hospice staf f asked if she looked forward to spring, she said, “Oh,
yes, I love to watch the flowers come up. ” They asked if she liked summer. “Very much. ” Fall. “Oh, I just love the leaves changing color. ” Even
winter. “Y es, the snow. ” Eventually the hospice personnel told her they had
to stop coming. They would return when she was ready to die. She became
a “hospice dropout” and joined one of our ECaP  groups. When winter approached, however, Jennifer told me, “I don’ t think I’m
going to be buying any winter clothes. ” This indicated that perhaps she was
getting ready to die. Then she came to one of our meetings wearing a lovely winter suit. I
said, “Aha. I see you decided to buy some winter clothes. ”“No,” she said, “I just brought some down from the attic. ” To me that
said she’d made a compromise. She was saying, “Let’ s see how the winter
goes. I’m not going to invest in it, but I’ll give it a try. ”
Another cancer patient I know, named Matt, went to his physician one
day looking awful and came home looking fine. His family asked, “Gee,
what did the doctor do. ”
Matt said, “Oh, he gave me my aller gy shot. ” This let him know that the
doctor expected him to live through the spring, and his body responded. 4. Why did you need the illness. Like the previous two questions, this one helps the patient understand
the psychological needs that the disease may meet. Sickness gives people
“permission” to do things they would otherwise be inhibited from doing. It
can make it easier to say no to unwelcome burdens, duties, jobs, or the
demands of other people. It can serve as permission to do what one has
always wanted but has always been “too busy” to start. It can allow a
person to take time of f to reflect, meditate, and chart a new course. It can
serve as an excuse for failure. It can make it easier to request and accept
love, speak your feelings, or otherwise be more honest. Even a cold has a
meaning. Often its message is “Y ou’ve been working too hard. Go home
and nurture yourself. ” Remember we are brought up on “sick days,” not
“health days. ” Take days to meet your needs and you won’ t need an illness. Since physical illness usually brings sympathy from friends and
relatives, it can be a way of gaining love, or nurturing. It can become a
patient’ s only way of relating to the world, the only control one has over
life. Gladys, a patient of mine who’d had a chronic intestinal inflammation
for some fifty years, learned to manipulate her whole family this way. I met
her after she developed cancer. The family looked sicker than she did,
because she had some family member awake to wait on her twenty-four
hours a day. Even when they hired a nurse to care for her, Gladys would
awaken the family and let the nurse sleep. Over and over she developed
severe pains at home, which mysteriously disappeared each time she was
admitted to the hospital. Nearly every weekend she would have those who
were not home during the week in the emer gency room with her to help
evaluate her recurrent chest pains. Thus those who worked during the week
got their share. She was constantly asking someone to hand her a glass of
water or a tissue, even when what she wanted was only inches away. After I got to know Gladys, I gave her Arnold Hutschnecker ’s The W ill
to Live. The next morning when I returned on my rounds, she said I’d
forgotten something—the book. The message was clear: “Please don’ t try to
teach me to give up my illness, because it’ s the only way I can relate to
people. ” Learning to love was frightening. I kept trying to reach Gladys, and she said I was the only doctor who
ever gave her hope. Truthfully I think I was the only one who continued to
care for her without being worn out by constant manipulation, which
included side ef fects to every medication I recommended. I learned to let
her do much of the talking, then recommend things that fit her belief
system. Then I would always get the credit and be called a wonderful
doctor. Finally, during one of her phone calls, I told her I had a new drug that
would cure her cancer. I asked her to come to the of fice, since it had to be
given by injection. I did this after explaining my plan to the family and
asking them to watch Gladys’ s reaction. I was trying to save them  from
being the victims of her illness. She made an appointment for Friday, but on
that day she called to postpone it for a week because the weather was bad. Next Friday she couldn’ t get a ride, and the week after that she had to go
shopping. In short, Gladys never returned to my of fice, although she tried to
maintain our relationship by phone or at the hospital, where I didn’ t have
the drug. I took this approach only for the family’ s sake, since I knew she
would refuse the of fer. Her family then had the option of going along in the
old pattern or refusing to be victimized any longer. It’s important to realize that we can’ t force others to change, we can
only help them to change themselves. I have had two male patients much
like Gladys, both with extensive cancers. I said to each of them, “I’ll
guarantee you a cure of your cancer if you leave your family business,”
which both found very stressful but meaningful, and which would give the
family many benefits in the event of the man’ s death. Each man said exactly
the same thing: “I’ll have to go home and think about it. ”
A cancer patient was advised by his sur geon to sell his business,
because the sur geon felt he was terminal. He did, and got well. One day I
encountered him in the hospital hallway. He was yelling at his sur geon—
because now he was well but had no business. I explained that he’d been
given the right advice for the wrong reason. He’d been encouraged to quitbecause statistics said he would soon die, whereas the reduced stress and
more enjoyable life had in fact led to his recovery. My purpose is not to judge these patients’  motives, but to bring them
out into the open. Then the family knows when a person doesn’ t really want
to change, and can work on the conflict with love, and meet its needs too. Throughout our lives we’re trained to associate sickness with rewards. We get to stay in bed and relax. People send us cards and flowers. Friends
visit and tell us they love us. Parents and spouses bring us chicken soup and
read to us. I remember a patient named Myrna telling me that the happiest
times in her childhood were when she was sick, because then her father
would sit on her bed and hold her hand. Her experience is far from unique. As children we get to stay home from school, and as adults we get a paid
respite from work. If we stay healthy, we have to either show up every day
or pretend  to be sick. We should be able to call up and say, “I want to stay
well, so today I’m taking a health day. ”
Even our insurance system rewards illness by penalizing those who take
care of themselves. If payments reflected our commitment to health instead
of statistical assumptions based on age, family history, and a cursory
physical, we could give people more of an incentive to take char ge of their
health. We should establish certain basic requirements—controlling weight,
not smoking, and so on. When those are met for a minimum fee, all medical
expenses would be covered. Those who meet none of the requirements
would have to pay much lar ger premiums. Cigarette and liquor taxes could
also be set aside for a national health-insurance fund to keep those who
work at their health from having to pay the bills of those who don’ t. Those who try to get patients to understand how their own actions have
contributed to illness are often criticized for “blaming the victim. ” This
attitude misses the point. All people eventually die even when they’ve done
some beautiful things. And even when a person’ s lifestyle obviously
contributed to disease, guilt is not a productive way of relating to the ef fects
of the past. No doctor should ever encourage a patient to take on this
additional burden. Illness and the prospect of death are not seen as failures
but as motivators. However, most illnesses do have a psychological component, and a
realization of one’ s participation  and responsibility in the disease process is
entirely dif ferent from blame or guilt. Of course few ever really want a life-
threatening sickness, but it usually functions as a message to change orgives patients something they are not getting from their lives. As Carl
Simonton has said, “I believe we develop our diseases for honorable
reasons. It’ s our body’ s way of telling us that our needs—not just our
body’ s needs but our emotional needs, too—are not being met, and the
needs that are fulfilled through our illnesses are important ones. ”
It cannot be overemphasized that this last and most important question
—Why did you need this illness. —must be asked constructively, not as a
way of saying, “Look what a mess you’ve made of your life. ” It is intended
to help patients realize that the emotional needs met by illness are all valid. Then, when the needs are accepted, a person can move on to satisfy them in
constructive ways, without the disease. William James wrote, “The greatest discovery of my generation is that
human beings, by changing the inner attitudes of their minds, can change
the outer aspects of their lives. ” Years of experience have taught me that
cancer and indeed nearly all diseases are psychosomatic. This may sound
strange to people accustomed to thinking that psychosomatic ailments are
not truly “real,” but, believe me, they are. The new con cept is not a cop-out,
but rather a source of tremendous hope. David Bohm, the physicist,
suggests the word “soma-significance” as a better way of thinking of the
relationship. The body knows only what the mind tells it. To accept some of
the responsibility for disease, to realize that one has participated, is actually
a very positive step. If one has taken part in getting sick, one can also take
part in getting well. However, as I’ll discuss in more detail later, getting well isn’ t the main
objective. That can set you up for failure. If you set a physical goal, then
you may fail, but if you make peace of mind your goal, you can achieve it. My message is peace of mind, not curing cancer, blindness, or paraplegia. In achieving peace of mind, cancer may be healed, sight may be restored,
and paralysis may disappear. All of these things may occur through peace of
mind, which creates a healing environment in the body. Anyone who is
willing to work at it can achieve it, and the first step is understanding—
realistically, without guilt or self-pity—how the mind has contributed to the
body’ s ills. This understanding can show you how you must change to be at
peace with yourself. MESSAGES FROM THE UNCONSCIOUSThe mind and body communicate constantly with each other, but most
of this communication is on an unconscious level. Therefore, the doctor
must ask the patient about his attitudes but must not take all the answers at
face value. What seems like a strong will to live may actually be a surface
resolve, a performance, rather than a true inner connection to the life force. It’s necessary to get beyond the verbal, conscious level to make sure that
what the patient says is what he really feels. The surest way to do this is by
examining images from his unconscious mind. These images surface spontaneously in dreams, which sometimes can
be used to diagnose physical illness, as Carl Jung was able to do. However,
the process of inferring somatic facts from mental images is so complex and
often involves such seemingly far -fetched connections that even Jung
declined to discuss it, for fear of having his work rejected. Fostering and
interpreting diagnostic and curative dreams was essential to the methods of
ancient Greek and Egyptian healing temples and was practiced by
Hippocrates and Galen, but today it is a lost art just beginning to be
restudied by a few psychologists. It is not yet a tool that most doctors can
use. However, some spontaneous dreams are relatively easy to interpret. Often a patient and I can understand a dream by discussing it together. Sandy had such a dream when she developed breast cancer during her
second marriage. She saw three roads ahead of her: one gray and black with
everyone carrying a heavy bundle, a second road filled with many colors
and active, cheerful people, and a third, which she couldn’ t see clearly. After drawing a picture of the dream and talking it over in the group, she
realized that the first road represented her cancer as a burden and bringing
despair, the second represented it as a challenge to live and develop, and the
third represented the choice she would have to make. She chose the path of
life, and as she grew, her cancer shrank. She responded well to therapy and
was “reborn” as a new person. She shared her experience by writing articles
and eventually went back to school and now has a new career and her
health. The easiest dreams to understand are those with self-explanatory images
or those which the dreamer spontaneously knows the meaning of. One
patient with breast cancer dreamed her head was shaved and the word
cancer was written on her scalp. She woke knowing she had brain
metastases. There were no physical signs or symptoms until three weekslater, when the dream diagnosis was confirmed. I once had a dream during a
time when I was having certain symptoms that might have been due to
cancer. In my dream I was a member of a group whose other members all
had cancer, but I was pointed out as not having it. Tests later verified what
the dream had communicated. One day in the operating room I was discussing dreams and a nurse
recounted one of the “direct insight” dreams. She had been very sick for
several weeks, and no one could figure out what was wrong. Then one night
she had a dream in which a shellfish opened, a worm stood up inside it, and
an old woman pointed at the worm and said, “That’ s what’ s wrong with
you. ” The nurse woke up knowing she had hepatitis, which was confirmed
by subsequent tests. Such direct dreams often give information that medical tests can’ t. One
leukemia patient, who had recently had a bone-marrow aspiration whose
results were normal, nevertheless dreamed of termites eating away at the
foundation of her house. We encouraged her to imagine exterminators being
brought in during her meditations, but she then dreamed of maggots eating
potatoes at her feet. She died in three weeks. Her mind knew what the tests
didn’ t. Often, however, dream interpretation is dif ficult, even for an
experienced psychotherapist. The meaning of the symbols often depends on
emotions or events in the patient’ s life that may be hidden from
consciousness. Dreams can be explored on two levels. The first is the level
of personal meanings, which can almost always be worked out with the
patient. The other is the deeper, unconscious level of symbols and myths,
which is more problematic. Anyone who takes the time can explore his or
her own dreams on the first level. For this there are several excellent books
that can serve as guides, including Gail Delaney’ s Living Y our Dr eams, Ann
Faraday’ s The Dr eam Game, and Patricia Garfield’ s Creative Dr eaming. Jung’ s techniques are discussed in “The Meaning in Dreams and Dreaming”
by Maria F. Mahoney. Fortunately, there is a simpler, more reliable way to reveal unconscious
beliefs. The doctor merely asks the patient to draw a picture. I give all new
patients the following instructions:
1. On a white sheet of paper, held vertically, draw a picture of yourself,
your treatment, your disease, and your white blood cells eliminatingthe disease. Please have all colors of the rainbow, brown, black, and
white available to you, and use crayons.
That he was "just chasing rainbows."
What did Lee's oncologist tell him?
Franz Alexander
Who is the father of psychosomatic medicine?
The target organs are the most likely areas where disease takes root, as they are connected to the person's conflicts or losses.
What is the significance of the target organs in the body, according to the text?
The author's approach is to help patients understand their emotions and attitudes, and to encourage them to change their lives and take control of their health.
What is the author's approach to helping patients?
The author believes that the mind and body are interconnected, and that the body responds to the mind's messages, but also acknowledges that the body's physical state can be a powerful motivator for change.
What is the author's stance on the relationship between the mind and body?