[acb-hsp] A Fighting Spirit Won't Save Your Life

[peter altschul]

January 24, 2011

A Fighting Spirit Won't Save Your Life

By RICHARD P.  SLOAN

GABRIELLE GIFFORDS's remarkable recovery from a bullet to her 
head has provided a heartening respite from a national calamity.  
Representative Giffords's husband describes her as a "fighter," 
and no doubt she is one.  Whether her recovery has anything to do 
with a fighting spirit, however, is another matter entirely.

The idea that an individual has power over his health has a long 
history in American popular culture.  The "mind cure" movements 
of the 1800's were based on the premise that we can control our 
well-being.  In the middle of that century, Phineas Quimby, a 
philosopher and healer, popularized the view that illness was the 
product of mistaken beliefs, that it was possible to cure 
yourself by correcting your thoughts.  Fifty years later, the New 
Thought movement, which the psychologist and philosopher William 
James called "the religion of the healthy minded," expressed a 
very similar view: by focusing on positive thoughts and avoiding 
negative ones, people could banish illness.

The idea that people can control their own health has persisted 
through Norman Vincent Peale's "Power of Positive Thinking," in 
1952, to a popular book today, "The Secret," by Rhonda Byrne, 
which teaches that to achieve good health all we have to do is to 
direct our requests to the universe.

It's true that in some respects we do have control over our 
health.  By exercising, eating nutritious foods and not smoking, 
we reduce our risk of heart disease and cancer.  But the belief 
that a fighting spirit helps us to recover from injury or illness 
goes beyond healthful behavior.  It reflects the persistent view 
that personality or a way of thinking can raise or reduce the 
likelihood of illness.

The psychosomatic hypothesis, which was popular in the mid-20th 
century, held that repressed emotional conflict was at the core 
of many physical diseases: Hypertension was the product of the 
inability to deal with hostile impulses.  Ulcers were caused by 
unresolved fear and resentment.  And women with breast cancer 
were characterized as being sexually inhibited, masochistic and 
unable to deal with anger.

Although modern doctors have rejected those beliefs, in the past 
20 years, the medical literature has increasingly included 
studies examining the possibility that positive characteristics 
like optimism, spirituality and being a compassionate person are 
associated with good health.  And books on the health benefits of 
happiness and positive outlook continue to be best sellers.

But there's no evidence to back up the idea that an upbeat 
attitude can prevent any illness or help someone recover from one 
more readily.  On the contrary, a recently completed study of 
nearly 60,000 people in Finland and Sweden who were followed for 
almost 30 years found no significant association between 
personality traits and the likelihood of developing or surviving 
cancer.  Cancer doesn't care if we're good or bad, virtuous or 
vicious, compassionate or inconsiderate.  Neither does heart 
disease or AIDS or any other illness or injury.

And while we may be able to point anecdotally to a Gabrielle 
Giffords as an example of how a fighting spirit improves medical 
outcome, other people with a spirit just as strong die -- think 
of Elizabeth Edwards, for example.  And many patients who employ 
negative thinking nevertheless recover from illness every day.  
We want good things to happen to good people and this desire 
blinds us to evidence to the contrary.

But such beliefs have implications for how we regard people who 
are ill.  If people are insufficiently upbeat after a cancer 
diagnosis or inadequately "spiritual" after a diagnosis of AIDS, 
are we to assume they have willfully placed their health at risk? 
And if they fail to recover, is it really their fault? The 
incessant pressure to be positive imposes an enormous burden on 
patients whose course of treatment doesn't go as planned.

Very early in my career, I participated in a study of young women 
who were hospitalized and awaiting the results of biopsies to 
determine if they had cervical cancer.  While I was interviewing 
one of my patients, the biopsy results of the woman in the next 
bed came back to her -- negative.  The fortunate woman's father, 
who was there with her, said in relief: "We're good people.  We 
deserve this." It was a perfectly understandable response, but 
what should my patient have said to herself when her biopsy came 
back positive? That she got cancer because she wasn't a good 
person?

It is difficult enough to be injured or gravely ill.  To add to 
this the burden of guilt over a supposed failure to have the 
right attitude toward one's illness is unconscionable.  Linking 
health to personal virtue and vice not only is bad science, it's 
bad medicine.

Richard P.  Sloan, a professor of behavioral medicine at Columbia 
University Medical Center, is the author of "Blind Faith."