I was sick the other day. A bout of gastroenteritis that had me vomiting with diarrhea for 24 hours and feeling weak for another 48. I felt rough for a while, but got over it pretty quickly.  My family gave me just the right amount of care, and avoided me appropriately because I get grumpy when I am sick.

Had they dared approach me with the suggestion that my state of mind would get me better sooner, or even prevent me having fallen sick in the first place, I probably would have exploded.

And yet, that is how many doctors and family members approach people with serious illness like cancer.  I did it myself, writing, A doctor’s letter to a patient with newly diagnosed cancer here on KevinMD.com.

I wrote to my sick friend, “Take one day at a time while you fight this disease, be grateful for each completed day, look forward to the next one.  Remain positive.  Your state of mind alone can make the difference in being in the percentage of people who survive.”

I believed that what I wrote was true.  In hindsight, this was opinion stated as fact, and on the blog I was gently corrected by people by their comments, and not so gently on a cancer forum I found where I was accused of forwarding the “tyranny of positive thinking.” These comments came from cancer patients.  They should know. But my original opinion is found all over the internet, on YouTube pronouncements, in magazines and in bookstores. It is ubiquitous, and the result is telling on people with cancer who cannot bring themselves to think that way.

The tyranny of positive thinking describes the enforced, unwelcomed negative message from well people that sick people get better or worse depending on how they feel, that they are to some extent responsible for the outcomes of their treatment, good or bad.

In The Human Side of Cancer, Jimmie C. Holland, M.D., of Memorial Sloan-Kettering Cancer Center devotes a whole chapter to this topic, and it is well worth a read.

The chapter starts like this:

“I got really depressed when people said I should think positive. I thought, “If that’s what I have to do to survive, I’m never going to make it.”
-John, a fifty-two-year-old man with melanoma

“People keep telling me to be upbeat. I say, ‘Screw you. I’ll be however I please in dealing with this cancer. I’ve never been upbeat in my life.'”
-Michael, a forty-five-year-old schoolteacher with recently diagnosed sarcoma

Dr. Holland does a far better job than I could do in giving examples and why this particular tyranny is not a good thing for many sick people.

To summarize her, many pessimists survive, and many optimists die early from their diseases.  Being one or the other is no guarantee any way.

But popular culture does not think so. There are, to the best of my knowledge, no books that suggest being positive is no use whatsoever, and that being negative causes no harm.  There are hundreds that suggest otherwise, and that is no surprise, seeing that any book with the earlier premise is unlikely to find readers or be featured on whoever replaces Oprah Winfrey for the TV public.  It is a book that is simply not worth writing.  The latter however are bound to find willing buyers, even if just as a gift from a relative to nudge poor old Uncle Bob into a positive state of mind so his cancer stops spreading.

What scientific evidence is there to support positive thinking for cancer patients?  In essence, none!. A PubMed search reveals very little scientific literature on the subject.  An article titled “Positive psychology in cancer care: bad science, exaggerated claims and unproven medicine” in the Annals of Behavioural Medicine spells it out in detail.  Their abstract conclusion is telling: “We urge positive psychologists to rededicate themselves to a positive psychology based on scientific evidence rather than wishful thinking.”  That says it all.

This article did stimulate a rebuttal in the same journal, arguing that outcomes for cancer may not have been improved but that for other diseases it “was premature to abandon efforts …” and “more research was needed.” Researchers’ slugging it out in the journals is never a good sign that there is compelling evidence either way.

I corrected my blog later down the comments, suggesting this would have been a better thing to tell my friend, “Take one day at a time while you fight this disease, and celebrate each completed day, for that is an accomplishment in itself. No one can tell you how you should feel. Anger, fear, disappointment, depression, insecurity are all part of the package, and we, as your friends and family, must expect you to be your authentic self. Lean on us when you need us. We’re not going anywhere!”

At the same time however I do wish being positive and keeping a sunny disposition was of universal benefit.  It certainly impacts positively on the families, friends and medical carers of people fighting serious illnesses, and I believe there are positives to be had from this in marking this critical time in interpersonal relationships.  For death after all is inescapable.  It comes to us all.

But is it fair to expect this of those facing the fight of their lives, when the healthy are the ones most likely to benefit?

I no longer think it is.

Martin Young is an otolaryngologist and founder and CEO of ConsentCare.

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