Optimism isn't the cure

Nancy Achin Audesse, 45, knows a thing or two about serious illness and optimism.

Audesse, executive director of the Massachusetts Board of Registration in Medicine, has had cancer four times: Hodgkin's disease when she was 14, breast cancer at 33, a second bout (which included a relapse of the first, plus a whole new tumor) at 34, and melanoma at 37.

"For someone who should have kicked off years ago, I'm fabulous," she said recently. "I'm here, doing good deeds, trying to make health care better." All along, she said, she has been "blessed by having a wacky sense of humor."

But despite her seemingly relentless optimism, Audesse, who lives in Wenham, is quick to voice outrage at a belief that runs rampant in our New Age-besotted culture: The idea that a positive attitude can mean the difference between life and death: "It's not fair to put that guilt and emotional burden on a person."

Indeed, there's little scientific evidence for the idea that attitude influences survival.

Overall, for every study that suggests a survival advantage to having a positive attitude, there are at least three that find no such effect, said Dr. Pamela Goodwin, a medical oncologist who directs the Marvelle Koffler Breast Centre at Mount Sinai Hospital at the University of Toronto. A March study in the journal Cancer, for showed that optimistic people with lung cancer fared no better than those with bleaker expectations.

What is a useful attitude, psychiatrists and cancer specialists say, is to adopt whatever philosophy helps you stick with your treatment plan and to be "authentic," that is, to acknowledge and express your honest feelings, positive or negative. And if, at some point, it is no longer realistic to hope for a cure, the specialists say it is best to refocus your hope toward maximizing day-to-day quality of life.

Dr. Jerome Groopman, chief of experimental medicine at Beth Israel Deaconess Medical Center and author, most recently, of "The Anatomy of Hope," said he welcomes the March study, though it has flaws. "There is this burden that patients carry, this mantra in the popular mind that is derived from some of the New Age books of the 1970s -- that depression, anger, and unprocessed emotions are what cause cancer," he said. "This is completely unsubstantiated."

Dr. Donna Greenberg, a psychiatrist at Massachusetts General Hospital who consults at the hospital's cancer center, put it bluntly: "Patients shouldn't be afraid that having a bad thought is going to make their tumor grow." The idea "that if we will it, it will work out" is a "very American concept," she said. "But life is more complicated than that."

In many ways, life-threatening illness is like rape. Many people find it easier to believe that ill fortune hits people who have somehow asked for it -- as in rapes blamed on women for wearing provocative clothing or being in the wrong part of town -- than to accept that life can be a crapshoot in which very bad things happen to people, for no fair reason.

"People would rather feel guilty than helpless, that's why people go for this stuff," said Dr. David Spiegel, associate chair of psychiatry and behavioral science at Stanford University and author of "Living Beyond Limits." People "want to have the fantasy of control, even if it makes them feel guilty." Years ago, Spiegel ran a study suggesting that women with advanced breast cancer who participated in group therapy that encouraged them to express their feelings lived 18 months longer than those who had no such therapy. But other researchers have been unable to replicate these findings.

The real message from his work, he said, is to not get caught in "the prison of positive thinking," but to "face what you have to face. If it makes you sad, cry. If it makes you angry, deal with that. If it makes you value the things you value, do that."

A hidden bonus, he added, is that some people with serious illness discover that "cancer cures neurosis," meaning that some people learn to shed the fruitless worries of ordinary life by facing mortality and learning to "really appreciate the things that matter."

The bottom line? If you have cancer or any other serious disease and a positive attitude, that's great. At the very least -- and this is no small benefit -- that may improve your day-to-day quality of life. But if you feel down, don't feel you have to keep "soldiering on as if nothing happened," Audesse said.

"Sometimes, you don't want to be courageous. You want to curl up in a corner and suck your thumb."

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.