Express yourself!

Dr. Linda Friedland Women's Health & Lifestyle

 “Breast cancer did not make me stronger, more feminine or spiritual. It was a very personal, agonising encounter with a force that encourages us to deny reality, submit cheerfully to misfortune and blame only ourselves for our fate,” writes Barbara Ehrenreich in her book Smile or Die: How Positive Thinking Fooled America and the World (Granta 2009).

She goes on to say that the first thing she discovered when faced with breast cancer was that, “the appropriate attitude must be upbeat.” This new book is written by a justifiably angry breast cancer patient. Although the author makes some sweeping nonscientific statements, she also makes valid and accurate comments – the most important being that, “the effect of all this positive thinking is to transform breast cancer into a rite of passage – not an injustice or a tragedy to rail against, but a normal marker in the life cycle, like motherhood and menopause.”

There are many proponents of this simplistic school of ‘positive thinking’, who suggest that all you need to do is think positively and everything will be okay; or if you’re not winning the ‘battle’, you are simply not trying hard enough. While I do believe that there is a strong mind-body connection, and agree with the wide body of scientific evidence that demonstrates a strong relationship between emotions and health, ‘positive thinking’ is just one piece in the vastly multifaceted puzzle of cancer therapies. It is not the cornerstone of healing, but simply an adjunct to mainstream surgery, chemotherapy, radiotherapy and other responsible medical practices.

Positive thinking can’t hurt, but, as Ehrenreich puts it: “The sugar coating of cancer can exact a dreadful cost.” She believes it requires the denial of understandable feelings of anger and fear – “all of which must be buried under a cosmetic layer of cheer.” And this is where I believe she misses the point: the entire field of scientific study into attitude and emotions emphasises, in the strongest terms, the need to express anger and fear. The value of emotional expression is far more significant than a ‘positive attitude’. There is no doubt that if a patient feels generally pessimistic,it is important to acknowledge these feelings as acceptable and valid. Some individuals in the cancer care industry have begun to speak out against

“the tyranny of positive thinking”. This is because when positive thinking fails and the cancer spreads or eludes treatment, the patient may blame herself for not being positive enough. “At this point, to think positively, is an additional burden to an already devastated patient,” says oncology nurse Cynthia Rittenberg from the Los Angeles Oncology Nursing Association in the US.

My advice: beware of sugar-coated promises and don’t believe the many misguided zealots who sell you simplistic self-help affirmations to ‘think your cancer away’. At the same time, let’s not throw the baby out with the bath water. Science has come too far to go back to the mechanistic model that cuts off the patient’s head and heart from her cancer and her healing.


In a study conducted at the University of Colorado in the US, researchers found that repressing anger may increase the risk of cancer. Extreme suppression of anger was the most commonly identified characteristic of breast cancer patients. In another study conducted by the university, researchers found that people who buried their emotions had lowered immune systems compared to those who shared their feelings.

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