By: Greg Anderson
You possess incredible healing potential. For many people, the body’s ability to heal remains a greatly underutilized resource. In large part, it is because many people have forgotten how to listen to the healing messages our bodies give us. We live in a busy world: work, family, friends, and finances all take their important place and have their unique demands. Sometimes they become more important than our self-care. If we take the time to reconnect with our inner healing wisdom, we can tap into the resources of emotion, memory, and imagery. Then an awakened sense of wholeness is found, and we can activate this mind/body connection to support our immune system and promote healing.
What we think and feel directly impacts our health. Research has demonstrated that mind power can translate to muscle power. In a fascinating study, medical researchers in the Department of Psychology at University College in London, England, explained the health benefits of the physical activity involved with the work to the hospital cleaning staff. Once understood, the employees lost body fat, decreased their blood pressure, and increased their lean muscle mass. Their activity levels did not change. The only difference was what they were told about the health benefits of their work. Researchers concluded that increased mental awareness accounted for the health gains.
Sadly, many healthcare professionals summarily dismiss this as the placebo effect, the well-documented fact that sustained positive outcomes can be observed in response to treatment with a sugar pill or inert treatment versus actual medication. The nocebo effect is related. This refers to an undesirable effect being observed after receiving a placebo. Neither the placebo nor nocebo responses are biochemically generated. They are attributed solely to the recipient’s optimistic or pessimistic beliefs and expectations.
Both the placebo and nocebo effects are very real. For cancer patients, if and when patients believe in a treatment, that belief itself nurtures health. Of course, the opposite is also true.
Your mind can be effectively employed in your quest for healing. By visualizing thoughts, images, and pictures of healing through use of the imagination, your body’s defense mechanisms respond. Cortisol levels that inhibit maximum immune function drop. Endorphin levels rise, indicating increased immune activity.
In my own case, I came to believe my mind/body disciplines as more important than medicine. I employed the phrase, “I am cancer-free, a picture of health.” Concurrently I would imagine myself vital and alive, arms outstretched overhead, reaching to the clear blue skies, and a big smile on my face.
I ask you to employ something similar. Or you may wish to seek the help of being guided by someone, either in person or by listening to a recording. The point is the mind/body connection can be triggered through visualization, guided imagery, and affirmation.
Although these techniques and modalities enhance the mind/body effect, simply listening to and honoring what your body is telling you to do is a good start. For example, fatigue is the single most common symptom of people with cancer. From the perspective of integrated cancer care, fatigue is your body’s way of telling you to rest and to take time for self-care. Listen to what your body is telling you. Feel your energy level, and adjust your activity levels accordingly.
As you quiet your mind and deepen the intimate connection with your body, you will hear what your body is telling us. I am asking you to mobilize your mind, to listen to and nurture your body’s healing wisdom. It is a powerful source of health.
The Mind/Body Connection Matures
My wife and I began our work in 1985, just months after I was told by my surgeon, “I’d give you about thirty days to live.” At that time a book called Love, Medicine and Miracles by Bernie Siegel, M.D., was just making its debut. The book’s release was widely embraced by the media. Soon I found a copy and began to devour it.
Dr. Siegel’s experience as a surgeon led him to become aware that those patients, especially cancer patients, who held expectations of a positive outcome often did better than those patients who simply gave up. This led him and his wife, Bobbi, to form a group he called ECaP (Exceptional Cancer Patients). They held support group meetings, and central to the experience was the practice of mind/body techniques. Many different meditative disciplines were taught at ECaP, as well as the concept that mind and body worked together to positively impact health. “Bernie,” as he preferred to be called, through his books and public appearances, did much to popularize the mind/body movement as it applied to cancer and healing.
Others came before Bernie, including Herbert Benson, M.D., and Lawrence LeShan, Ph.D. Both made significant and lasting contributions to our understanding of the mind/body connection. But the foremost pioneer in modern-day psychosocial oncology was O. Carl Simonton, M.D. (1942–2009). Trained as a physician at the University of Oregon Medical School, Simonton completed a three-year residency in radiation oncology. It was during this time that he developed a model of emotional support for the treatment of cancer patients. As Chief of Radiation Oncology at Travis Air Force Base, Simonton first implemented the model. Dr. Simonton’s work was the first systematic emotional intervention used in the treatment of cancer. His program was actually approved by the Surgeon General’s Office in 1973. Simonton was the pioneer who introduced and applied the concept that one’s state of mind could influence one’s ability to survive cancer.
This idea was revolutionary. Enthusiastically received by cancer patients, Simonton’s work was widely condemned by the medical community. Oncologists derided the idea that the mind and emotions had a role in either the onset of cancer or in the recovery from it. The American Cancer Society put Simonton’s model on their so-called blacklist of dangerous unproven methods, an unfortunate derogatory characterization that would remain with Simonton through the 1990s.
The groundbreaking Simonton Cancer Program was founded on ten major tenets. Dr. Simonton postulated:
- Our emotions significantly influence health and recovery from disease (including cancer). Emotions are a strong driving force in the immune system and other healing systems.
- Our beliefs and attitudes influence our emotions, thereby affecting our health and healing systems.
- We can significantly influence our beliefs and attitudes. As a result, we shape our emotions, and therefore, significantly influence our health.
- Ways of influencing beliefs, attitudes and emotions can be readily taught and learned by using a variety of accessible methods that are presented in this (Simonton) program.
- All of us function as physical, mental, social and spiritual/philosophical beings. These aspects need to be addressed in the broad context of healing, with a focus on the particular needs of a person who is ill, and that person’s family, community, and culture.
- Harmony is central to health—balance among the physical, mental, and spiritual/philosophical aspects of being. This extends to relationships with self, family, friends, community, planet, and universe.
- We have inherent (genetic, instinctual) tendencies and abilities that aid us in moving in the direction of health and harmony (physical, mental, spiritual/philosophical and social).
- These abilities can be developed and implemented in meaningful ways through existing techniques and methods that are presented in this program.
- As these abilities are developed, proficiency evolves, as when learning other skills. The result is greater harmony and improved quality of life, which significantly impacts one’s state of health.
- These skills and insights also change our relationship with death by lessening our fear and pain, and freeing more energy for getting well and living life more fully today.
A New Era in Mind/Body Approaches
Many pioneering medical efforts prove to be less than complete, even dangerous. Not so with Simonton’s. His work has stood the test and is now being confirmed in the new and burgeoning field of health psychology called “illness representations.” These new insights and understandings are creating a revolution in mind/body medicine.
Illness representations are a patient’s beliefs and expectations about a symptom or illness and how those beliefs and expectations actually impact the experience and outcome of the symptom or illness. An example may best explain this construct.
Assume a healthy person starts to feel slightly achy and begins to experience a runny nose. The individual identifies and then “labels” the symptoms as most likely the beginning of the common cold. Since this person believes a cold to be a temporary phenomenon lasting perhaps a week to ten days, a “timeline” is now added to the initial label. And the initial label of a common cold instills a belief that the symptoms, and any resulting illness, present a minor threat. Thus the “consequences” of a cold are not believed to be serious.
This individual may also think, I know where I got this. Harry at work was sneezing and coughing for a couple of days. That’s it. Thus a “cause” is assigned. This leads to the individual’s beliefs about colds and how they are best managed. Okay, he thinks. I need to drink lots of fluids, get extra rest, and have chicken soup a couple of times a day. This reflects the individual’s beliefs about a “cure” for the common cold.
There are parallel emotional reactions to each of these cognitive processes. And even though in the case of the common cold the emotions will tend to be subtle or muted, the emotions are nonetheless present. For many people the emotional reaction to a cold will be annoyance, Oh no, I’ll probably have to miss work and this will put an extra burden on my coworkers to meet the project deadline. Or the emotional impact could be concern about the cold being a precursor to a more serious health problem. The emotional response to the individual’s beliefs is called “illness coherence.”
Cancer typically triggers a completely different set of beliefs and emotional responses. As an illustration, let’s assume a woman detects an unusual lump in her breast. For millions of women, the first thought (label) that comes to mind is breast cancer. This suspicious-lump-equals-breast-cancer belief runs deep and often sets in motion a complex combination of personal and cultural beliefs. The cluster of thoughts that tend to be fused together with very intense emotions include breast cancer runs in my family (cause), this is going to mean surgery and the dreaded chemotherapy (cure), breast cancer is serious, even life-threatening (consequences), this will mean a year or two of treatment and uncertainty (timeline), and I may die (illness coherence). It’s easy to see why cancer is called a “hot cognition.”
Several researchers are now dedicated to understanding illness representations more fully. But the pioneer is clearly Howard Leventhal, Ph.D., Director of the Rutgers Center for the Study of Health Beliefs and Behaviors, Institute of Health, Department of Psychology at Rutgers University in New Jersey. Leventhal and his colleagues have broken new ground in the understanding of the mind’s role in health and healing. And consistent with Simonton, the central point of understanding is that our emotions greatly impact our health and prospects for recovery from illness.
One of the Leventhal team’s most basic discoveries is that patients are only partially aware of how they create and maintain personal views of disease and treatment. And in the case of cancer, the typical beliefs are detrimental to recovery, healing, and maintenance of health.
In our work we have found the belief that cancer equates with death to be very widely held. Countless times I have listened as patients maintain their views and defend their beliefs, even if those beliefs are harmful. For tens of thousands of cancer patients, the mind-set is, “Yes, I will fight. I’ll do anything to survive. But in the end, my cancer is probably going to kill me.”
About three years ago, a gentleman going through prostate cancer was in my office. His surgery followed by hormone therapy was successful in controlling the cancer. And even though he suffered from incontinence and impotence following treatment, his follow-up tests showed no signs of cancer. In an effort to instill a more upward look, I proclaimed, “Celebrate with me, Omar. You are a survivor!” His answer foreshadowed a different outcome. He said, “You know, Greg, I’m doing well now, but this kind of cancer always gets you.” We examined his belief, but to limited avail. I spoke at his funeral service about four years following his initial diagnosis.
As stated in the “50 Essential Things to Do”, cancer absolutely does not equate with death. This is a very harmful toxic illness representation. For patients who want to get well and stay well, illness representations that equate cancer and death must be changed.
Simonton was one of the first to ask patients to illustrate their cancer and their treatment. He gave them a small box of crayons and one sheet of paper and said, “Draw your cancer and your treatment.” The objective was to help the patient gain a greater understanding of the beliefs they brought to the recovery process. For example, a person who illustrated their illness as a mountainous rock formation and their treatment as a mere hand shovel were led to explore the beliefs behind those images. In the end, one hoped the power of the images of treatment would match the power of the images of the illness. We continue to implement variations of this exercise in our work today.
Traditional mind/body techniques have their place. Transcendental Meditation, and it less-religious offspring the relaxation response, can clearly help counter stress. They also assist in lowering blood pressure and changing other vital bodily functions that are normally unconscious. Biofeedback and mindfulness meditation yield similar results. But none demonstrate the physiological outcomes like illness representations—the new frontier in mind/body understanding.
The Power of Awareness
There is a great deal to be gained when cancer patients better understand the way in which they are processing their experience. We are now aware that illness representations have a predictive validity that can significantly assist patients in examining their beliefs and attitudes toward a cancer diagnosis.
New tools to assess illness representation are being developed around the globe. I would like to add to these efforts. I wish to acknowledge the work of Dr. Elizabeth Broadbent at the University of Auckland’s School of Medicine for allowing me to borrow from her work in developing this tool specifically for cancer patients.
Is the Glass Half Full or Half Empty?
The subject of illness representation quickly leads to the question of positive thinking—a state of mind that is deeply imbedded in the beliefs we hold. Over the past quarter-century, my work has been the leading voice of the positive thinking school in the cancer field. Through our work we have encouraged literally millions of cancer patients to change their negative beliefs into positive expectations. Unapologetically, I want people to embrace hope and the possibility for healing.
This message is not universally appealing. Many patients have made it clear that in their eyes I am naïve, uninformed, and even cruel. “Positive thinking? Is that all it takes to cure my lung cancer?” wrote a patient. “You’ve got to be kidding. Are you sure you had lung cancer?” Another e-mailed, “You can talk about hope all day long. But there are days I just need to cry.”
Jerome Groopman, M.D., is an oncologist and author of the book The Anatomy of Hope. The book chronicles patients who he considers were helped by positive hopeful thinking and some whose demise he attributes, in large part, to lack of hope. Groopman’s studies show that positive beliefs and expectations—the essential contents of hope—impact the body on a physiological level. Pain management, respiration, circulation, and even motor function are demonstrated to be enhanced with a positive outlook.
I have never represented the view that all it takes to cure cancer is positive thinking. But I have long advocated that a person with cancer is best served by beliefs and attitudes that project an upward look. Evidence has existed for decades that immunoglobulin levels, a precursor and one measurement of immune function, increase with a more hopeful stance. Yet as soon as I put forward this evidence and make the positive outlook assertion, there is a small but vocal group of patients who respond, “Stop laying a guilt trip on me. You’re saying, at some level, I caused my cancer.” Not so.
The hopeful outlook bolsters health—emotionally and physically. It produces a sense of guilt only if that is how it is received. Today we can note the further evidence from the field of illness representation leads to a profound conclusion: belief and hope are very real and very powerful forces in health and healing. And there is a biology connected to positive thinking.
Of course this is interpreted as “false hope” by many people. But once again, I firmly believe there is no such thing as false hope. I believe there is only real hope—for a cure, for a peaceful death, for a better tomorrow no matter how long we may have to live.
Unfortunately, there is a very real and toxic force called “false no-hope.” This is typically when the doctor finds it necessary to give patients the “get your affairs in order” speech. It is a devastating experience. I can still clearly recall how despondent I became after my surgeon gave me thirty days to live. Every week we counsel frightened and depressed patients who have been given a terminal diagnosis.
Our guidance to these patients has changed over the decades. I used to encourage everyone who received the “terminal” news to actively and forcefully challenge the doctor. My advice was helpful to only a few and probably created what some called a positive thinking prison for some patients.
Today we encourage cancer patients to experience all their feelings and help them understand that fear and despair are normal natural responses to a life-threatening illness. Face it, some days following chemotherapy are lousy. The bone-deep fatigue that often comes with radiation therapy generates understandable thoughts of hopelessness. One patient remarked, “If I started to feel bad, I began to think there was something wrong with me.”
Now we teach, “Feel the feelings—the positive as well as the negative. But do not get into the habit of replaying the negatives ones.” Repeatedly rehearsing our ills is a trap even more deadly than denial. We remind patients that all our emotions are rooted in our beliefs—and beliefs are things we have the absolute power to change.
Positive thinking? Yes. Optimism? Of course. As long as they lead to feelings of hope. Positive thinking and optimism are cognitive behaviors—decisions. Hope is an emotion, a feeling that differentiates this force from merely choosing an upward look.
Our emotions make the difference. And it is the hopeful emotional response that serves us best in our illness representations.
Welcome to the new era of mind/body medicine.