From the ubiquitous smiley face that gave rise to an instantly sharable universe of emojis to constant pressure to just keep your chin up in the face of pain or adversity, ours is a culture that reveres positive thinking. But for patients undergoing treatment for cancer, this pressure to always look on the bright side can be an isolating aspect of their experience.
“We do hear a lot from patients that they feel pressure to feel positive,” says Devita Streva, a psychotherapist and counselor with the Cancer Center Psychosocial Oncology program at The Ohio State University James Cancer Hospital and Solove Research Institute in Columbus. “Well-meaning family and friends tell patients to ‘look on the bright side’ or ‘just be positive’ and it can be a real source of stress for [patients] when they’re not feeling that way,” she says.
[See: What Causes Cancer? 5 Unlikely Claims Explained.]
Our perpetual need as a society to find the silver lining in a challenging diagnosis and treatment protocol can be hard to hear for people dealing with cancer who may just want their pain and grief acknowledged. Some of this need stems from general and widely assumed misconceptions about the findings of some studies that have examined the complex interaction of mental states and health outcomes as well as the field of positive psychology.
“Positive psychology is an attempt to try to highlight what human strengths might be that help people withstand adversity,” says Lisa G. Aspinwall, a psychology professor and researcher at the University of Utah. She says the field aims to “take seriously” and examine what aspects of optimism or positive mental state might help improve health outcomes, resiliency and quality of life and comparing that analysis to what happens in people who have a more negative mindset or those who “ignore adversity and pretend it doesn’t happen and don’t talk about it.” Looking at these differences in how people respond to life’s stressors and how they cope with difficulty or trauma may reveal information about how best to help others facing similar challenges. “I see it as a call to be serious about what positive beliefs can do, without prejudging.”
Various studies over the years have indicated that there could be some benefits to positive thinking in improving health, such as boosting the body’s immune system. But Aspinwall notes that some of the positive improvements may have nothing to do with survival or the eventual outcome of the disease. Rather, some of the improvements that have been noted with positive thinking and resiliency revolve around improving quality of life and helping patients deal with aspects of treatment in the moment. “I think when people look only at the health outcome — length of life — that they’re missing the relationship of positive thinking to other things related to quality of life that have to do with coping, pain management, anxiety, social integration and other things that are useful.”
In studies she and other researchers have conducted into this interaction between attitude and health outcomes, Aspinwall says “time and again, whether it’s cancer or HIV, people report both positive and negative changes. The big surprise is that they reported some positive result,” from what was a difficult and potentially deadly diagnosis. It seems that for many patients, even in the worst moments of dealing with cancer or a life-threatening illness, they could still experience positive emotions and happiness.
But somehow, those findings have taken on a somewhat different connotation in popular culture that amounts to a lot of wishful thinking. “Now things have morphed on sort of a runaway train of positive thinking,” that has become a cultural trend towards acknowledging only the positive thoughts and aspects and stuffing down or hiding the negative, Aspinwall says.
That has spawned a pervasive misconception that a positive outlook itself might help cure you of cancer and the only way to battle a life-threatening or chronic condition like cancer is by staying positive all the time. “But that’s not what those studies show,” she says. Instead, the studies generally show that people going through difficult diagnoses experience a wide range of emotions, all of which are important.
“Going through cancer evokes so many powerful emotions from shock and disbelief initially and anger, fear, sadness,” Streva says. “All of those are normal and to tell someone to ‘just think positive’ really discounts the normal range of emotions that they’re experiencing and it’s not helpful to move them through it.” So-called “bright-siding” of patients can actually make things worse, despite it typically coming from someone who’s well-intentioned and trying to help. “Then [patients] not only feel sadness and anger but also guilt about being sad and angry. That keeps them stuck, and it certainly doesn’t help them move through coping and maximizing outcomes by doing what they need to do for treatment,” she says.
[See: What Not to Say to a Breast Cancer Patient.]
One of the most potentially damaging aspects of the stay-positive mantra is that if a person dies of cancer or their cancer comes back, they themselves are somehow at fault for not “fighting” hard enough or maintaining a positive enough outlook or having done something wrong. “It’s over-simplistic at best and akin to victim blaming at worst,” Streva says.
Aspinwall says this pressure to stay positive can lead to patients “editing what they tell others,” which is “sort of the opposite of what positive thoughts do in terms of binding you to your social network.” If you only share the rosy side of your battle with those close to you, you’re not getting as much support as you might if you shared your fears and needs, too.
“I think [staying positive] has been taken to an extreme that has become damaging to really feeling the full range of feelings, and knowing that that’s OK and that doesn’t inherently undermine treatment or outcomes to feel the feelings that are part of the experience,” Streva says. “A cancer diagnosis is life threatening. When you’re facing life and death, that’s a whole mixed bag of emotions.”
Aspinwall says positive psychology doesn’t tell us to “suppress any negative feelings and avoid telling people about them,” but rather to understand what’s happening and why your feelings exist. Streva says “our emotions are information. They are adaptive. Evolutionarily we have them and they have helped us survive. So, all of them have a purpose.” The initial feelings of shock and disbelief you may experience at diagnosis “help you process what’s too overwhelming in the moment. And subsequent fear and anger can prompt you to take action to change unhealthy behaviors and follow doctor’s orders, seek second opinions — all of those positive things that improve your outcome.”
Streva notes that all of these feelings and any other emotions you may experience during your cancer journey are OK and not a sign of weakness. “Knowing that those struggles, especially at initial diagnosis, are normal, is important. Try not to pathologize those feelings,” she says, and she encourages patients to “reach out to talk to people honestly about what they’re going through and find support in family and friends. Try not to stuff [your feelings] or deny them out of fear or shame or embarrassment” that they aren’t appropriate or that you’re not “being strong.”
And if you’re struggling and feeling like you’re not able to move through the myriad emotions you’re feeling, it’s important to ask for help. ” Reaching out to professionals for support is a sign of strength and wisdom and self-awareness,” Streva says. “There are evidence-based practices to help manage anxiety and deal with sadness and I just encourage people to know that they have resources and don’t have to go through it alone.”
[See: How Social Workers Help Your Health.]
Because as much as being too positive can be stifling, so can being too negative. There is substantial evidence in the medical literature that depression and anxiety can be detrimental to cancer outcomes, and dealing with these feelings can help you become more resilient in coping with cancer treatment. Aspinwall says “recognize that small experiences of good, whether it’s aesthetic appreciation of a painting or a flower or a movie or taking time to enjoy lunch with friends — something that may be trivial may actually improve your ability to cope with the demands of treatment. It doesn’t mean that it’ll cure you, but it may mean that you’ve got better connections to your social network,” which is very important for everyone, especially those dealing with a serious illness. She says that having that support can help you be “more open to info that’s given to you,” by your care team “even if it’s negative information.”
Being able to notice and embrace whatever small positives you are experiencing, “that helps you handle the bad things by being more open to information about them,” Aspinwall says. “If you feel more able to handle something, you’re more willing to learn about it.” And from there, you may be able to help yourself by taking appropriate action or controlling what you can control, rather than feeling lost and helpless. And feelings of control are important to our overall sense of well-being. Cancer is a disease that can rob people of feeling like they have any control over their lives, so finding small things you can do that give you a sense of accomplishment or mastery over a task or situation may help.
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Will Staying Positive Help Me Survive Cancer? originally appeared on usnews.com
