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Attitude - The Will to Live
Ernest H. Rosenbaum, MD, and Isadora R. Rosenbaum, MA
Attitude! When Winning is Everything: The Will to Live
Reprinted with Permission from Coping with Cancer-Published March/April 1999
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How often do you use the expression the will to live? Does it have any meaning? Can it prolong your life? Can it bolster your immune system? In our oncology practice, we can unequivocally affirm that the expression does have meaning and that it can vastly improve the quality of life and may even prolong the life of a cancer survivor. However, it will be many years before we know the answer to the third question.
As medical professionals, we have always been fascinated by the power of the will to live. Like all creatures in the animal world, human beings have a fierce instinct for survival. The will to live is a force within all of us to fight for survival when our lives are threatened by a disease such as cancer. Yet this force is stronger in some people than in others.
Sometimes the biology of a cancer will dictate the course of events regardless of the patient's attitude and fighting spirit. These events are often beyond our control. But patients with positive attitudes are better able to cope with disease-related problems and may respond better to therapy. Many physicians have seen how two patients of similar ages and with the same diagnosis, degree of illness and treatment program experience vastly different results. One of the few apparent differences was that one patient was pessimistic and the other optimistic.
We have known for over 2,000 years--from the writings of Plato and Galen--that there is a direct correlation between the mind, the body and one's health. The cure of many diseases is unknown to physicians, Plato concluded, "because they are ignorant of the whole. For the part can never be well unless the whole is well."
Recently, there has been a shift in health care toward recognizing this wisdom, namely that the psychological and the physical elements of a body are not separate, isolated and unrelated, but are vitally linked elements of a total system. Health is increasingly being recognized as a balance of many inputs, including physical and environmental factors, emotional and psychological states, nutritional habits and exercise patterns.
Researchers are now experimenting with methods of actively enlisting the mind in the body's combat with cancer, using techniques such as meditation, biofeedback and visualization (creating in the mind positive images about what is occurring in the body). Some doctors and psychologists now believe that the proper attitude may even have a direct effect on cell function and consequently may be used to arrest, if not cure, cancer. This new field of scientific study, called psychoneuroimmunology, focuses on the effect that mental and emotional activity has on physical well-being, indicating that patients can play a much larger role in their recovery.
It will be many years before we know whether it is possible for the mind to control the immune defense system. Experiments with biofeedback and visualization are helpful in that they encourage positive thinking and provide relaxation, thereby increasing the will to live. But they can also be damaging if a patient puts all of his or her faith in them and ignores conventional therapy.
The mind's role in causing and curing disease has been endlessly debated. No studies have proven in a scientifically valid way that a person can control the course of his or her cancer with the mind, although many individuals attest to the power of positive attitudes and emotions. One patient with high-risk cancer had a mastectomy at age 29. At 31, she had advanced stage IV cancer with widespread massive liver and bone involvement and, subsequently, extensive lung metastases. She also had an amazingly strong will to live.
"I get out of bed every morning as if nothing was wrong,'' she once said. "I may have known I was going to have to face things and could feel sick during the day, but I never got out of bed that way. There was a lot I was fighting for. I had a three-year-old child, a wonderful life and a magical love affair with my husband." Twenty-six years later, she was still alive, still on chemotherapy and still living an active life.
We often ask our patients to explain how they are able to transcend their problems. We have found that however diverse they are in ethnic or cultural background, age, educational level or type of illness, they have all gone through a similar process of psychological recovery. They all consciously made a decision to live. After an initial period of feeling devastated, they simply decided to assess their new reality and make the most of each day.
Their will to live means that they really want to live, whether or not they're afraid to die. They want to enjoy life, they want to get more out of life, they believe that their life is not over and they're willing to do whatever they can to squeeze more out of it.
The threat of death often renews our appreciation of the importance of life, love, friendship and all there is to enjoy. We open up to new possibilities and begin taking risks we didn't have the courage to take before. Many patients say that facing the uncertainties of living with an illness makes life more meaningful. The smallest pleasures are intensified and much of the hypocrisy in life is eliminated. When bitterness and anger begin to dissipate, there is still a capacity for joy.
One patient wrote, "I love living, I love nature. Being outdoors, feeling the sun on my skin or the wind blowing against my body, hearing birds sing, breathing in the spray of the ocean. I never lose hope that I may somehow stumble upon or be graced with a victory against this disease."
Unfortunately, and quite understandably, many patients react to the diagnosis of cancer in the same way that people in primitive cultures react to the imposition of a curse or spell: as a sentence to a ghastly death.
This phenomenon, known as bone pointing, results in a paralytic fear that causes the victim to simply withdraw from the world and await the inevitable end. In modern medical practice a similar phenomenon may occur when, out of ignorance or superstition, a patient believes the diagnosis of cancer to be a death sentence. However, the phenomenon of self-willed death is only effective if the person believes in the power of the curse.
In the treatment of cancer, we've seen patients fail on their first course of chemotherapy, fail again on the second and third treatments, then--with more advanced disease--a fourth treatment is highly successful.
In all things, you have to take a risk if you want to win, to get a remission or recover with the best quality of life. Just the willingness to take a risk seems to generate hope and a positive atmosphere in which the components of the will to live are enhanced. There are many other ways of strengthening the will to live.
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