"The Tyranny of Positive Thinking," by Jimmie Holland, M.D., is adapted from the recent book, The Human Side of Cancer, Living with Hope, Coping with Uncertainty, by Holland and Sheldon Lewis. Dr. Holland is a physician/psychiatrist who has counseled people with cancer over the past 24 years at Memorial Sloan-Kettering Cancer Center, in New York City.

As a physician/psychiatrist who has counseled people with cancer over the past 24 years, I have learned a lot about the difficult things people have to cope with when they have any kind of cancer--the negative and frightening meaning of the word cancer (particularly leukemia or lymphoma), and the feeling that people look at them differently. A patient said to me,"I'm not Joe anymore, I'm Joe with cancer." And they must cope with the distress of symptoms of the illness and its treatments, which is enough in itself, but that gets coupled with dealing with the nagging fears about the future.

It began to be clear to me about ten years ago that society was placing another undue and inappropriate burden on patients that seemed to come out of the popular beliefs about the mind-body connection. I would find patients coming in with stories of being told by well meaning friends, "I've read all about this-- if you got cancer, you must have wanted it." Others said, "I've been told that my personality must have caused my cancer and I guess I just didn't handle stress right in my life." Even more distressing was the person who said, "I know I have to be positive all the time and that is the only way to cope with cancer-but it's so hard to do. I know that if I get sad, or scared or upset, I am making my tumor grow faster and I will have shortened my life." These people didn't come up these ideas on their own--they got them from many places in our current culture: books, tabloids, talk shows, and TV. These ideas have come out of interest in the mind-body connection, based on research showing that stress can affect the immune system. The connection is carried further: if stress affects the immune system, and the immune system has something to do with cancer, then stress must cause cancer. This oversimplified pop psychology is typified by an article in the National Enquirer about Jackie Kennedy. The headline was "Stresses in Jackie's Life Led to Her Death From Lymphoma." It is important that people know that research simply does not back up these ideas. The only way that personality becomes a factor in causing cancer is when your personality leads to a life style that puts you at greater risk of cancer, such as smoking and sun exposure, raising the risk of lung cancer and melanoma. Obviously, also important is the fact that your personality leads you to have a rational approach to health, like diet and exercise, and that you followup in a timely way any significant suspicions of cancer with a consultation and treatment.

I felt some one needed to advocate for patients who were having to deal with these negative attitudes and I set out to set the record straight in my recent book about the human side of cancer, outlining what is myth and what is reality, based on what we know from research on the mind-body connection and cancer. Barbara Boggs Sigmund, mayor of Princeton in the 1980s, wrote an Op-Ed piece in The New York Times that I very much admired for her courage to fight back when accosted with these attitudes. She suffered from a melanoma that developed in the back of her eye. In an article titled, "I didn't give myself cancer," she spoke of her rage at self-help books that suggested "I had caused my own cancer out of lack of self-love, a need to be ill, or the wish to die and that consequently, it was up to me to cure it." She spoke against the theory that "cancer cells are internalized anger gone on a field trip all over our bodies" or that "rah-rah-sis-boom-bah, I can beat the odds if I only learn to love myself enough."

The attitude that "you caused your cancer" is very much related to a common psychological method we use in dealing with a catastrophic event or illness, namely we "blame the victim." We look for a rational cause as to why it happened--often concluding that the person must have "brought it on himself." That allows us to say, "Well, it couldn't happen to me--it was his own fault." It produces a false sense of security that we can prevent events that are actually beyond our control.

So rule number one in coping is: "Don't believe you brought cancer on yourself." The research does not show that either personality or how you handle stress in your life raises risk of developing cancer. This is one of the myths that makes coping more difficult these days..

Rule number two is: "Don't believe that you have to have a positive attitude all the time and that sadness or worry will shorten your survival." This tyranny of positive thinking is also related to the "mind over matter" ideas of our society. It is unrealistic that as you cope with nausea, fatigue, and worry and sadness, that you can be positive all the time. Yet, zealous believers in positive thinking may make you feel guilty when you find yourself crying sometimes. There is no evidence that if you do become "down" at times, it affects your tumor. If you are surrounded by the "positive attitude police," tell them to get off your case and be realistic--and offer them The Human Side of Cancer to read to get the facts straight, separating facts from beliefs.

It is also important to remember that our ways of coping with adversity (and illness is just one more example) are as different as our DNA and our fingerprints-each of us copes in a unique way because of our genetic makeup, our temperament, and the events in our lives that shape how we cope and see the world around us. Some people are innately optimistic--the positive thinking idea fits them well-they see the glass as two-thirds full! But just as many others are pessimistic by nature--the glass is only one third full! I recall Ernie who never believed for a moment that his treatment for lymphoma would help--he went through each treatment, telling me that he wouldn't make it. If the positive attitude told the story, Ernie shouldn't have made it. But 10 years later, he is healthy--and just as pessimistic about life as he had always been!

The problem that comes from this paradigm is that if the positive thinker's illness begins to worsen, the immediate response is guilt that "I wasn't strong enough the fight the disease." This is an unfair burden for a person who has coped and with courage and grace. There are many other factors that determine outcome, many that we don't know. I have seen positive copers who didn't make it and negative pessimists who did--which simply says that personality and coping isn't everything.

Surely we need much more research in this area of mind-body, which is developing in the new, small field of psychoneuroimmunology. While stress does affect the immune system, there is no evidence that the blips produced are in the range of those that would affect tumor growth. We will know more in the future, but for now, the studies do not support the myths about psychological causes of cancer and the role of emotions in tumor growth. The mind-body connection is fascinating because people hold such strong beliefs about it. I have come to feel that it is very much like religion. There are people who are "believers" and all the data in the world couldn't shake their faith. "Nonbelievers" simply are those who would not likely believe in the mind-body connection, even if the data were produced.

I strongly advocate that people use whatever beliefs or activities they find helpful - like relaxation, meditation, religious and spiritual approaches. Prayer is likely the most widely used of all interventions to help in coping.

What matters in the long run is that you find a view of illness and way of coping that is comfortable. Whether it involves believing or not believing in the mind-body connection is far less important. We have found that how you cope will likely be similar to how you have coped with major problems in your life. Don't allow family and others to tell you that you are "doing it all wrong," and that you must be more positive and cope in a new way that is foreign to your natural style. The old adage, "Don't change horses in the middle of the stream," is quite apt here. If your way of coping starts not to work, however, it is wise to seek counseling with someone who is familiar with the problems of people with cancer, like the social worker, psychologist, or psychiatrist (when medicine is needed for anxiety or depressed mood or poor sleep.) They can help to reinforce your familiar and proven ways of coping and offer you some ideas about how to approach the problems of illness to make it less upsetting and a little easier for you to deal with them.

Bottom line--identify your own beliefs about the mind-body connection and use them as they are comfortable for you, based on your temperament and your natural ways of coping. Remind your family and your doctor that they are most helpful when they respect your well-honed way of coping and respect your need to express how you feel, even if it isn't positive!

This article is based on the chapter, "The Tyranny of Positive Thinking," in The Human Side of Cancer: Living with Hope, Coping with Uncertainty, by Jimmie C. Holland, M.D., and Sheldon Lewis, published by HarperCollins and available in local bookstores, Barnes & Noble and Amazon.com.