There’s no scientific research to suggest that being sad, worried or anxious causes cancer or causes cancer to worsen. And there’s no evidence to show that thinking positively leads to a better cure rate.
But there’s lots of talk about “staying positive” when it comes to cancer diagnosis and treatment. Here, Dr. Elie Isenberg-Grzeda, psycho-oncologist at Sunnybrook’s Odette Cancer Centre, tackles a few of the common questions he receives about positive thinking and cancer.
When it comes to my cancer diagnosis, treatment and mood, I’ve heard “fake it ’til you make it” and “put on a brave face” from family and friends. Do those things help?
I often tell my patients that these things can help for some people, but I make sure to be clear about what they can help with. There is no scientific evidence that these things help with cancer outcomes, but that doesn’t mean they can’t still help with something. For example, when someone is feeling down or depressed — whether due to cancer or anything else — they may withdraw and isolate themselves from social activities. This can lead people to become further depressed because by isolating themselves, they miss out on opportunities for social encounters that might otherwise help cheer them up. There is a therapy called behavioural activation, whereby people work with a therapist to try re-engage them in activities that might allow for more positive reinforcement. This might include something as simple as showering or getting dressed in the morning, or it could include something as demanding as planning an outing. Almost invariably, these are positively reinforcing and rewarding experiences, but at least initially, I can understand how some of these techniques might lead people to feel like they are “faking it until they make it”.
Are there any other benefits to trying to stay positive?
This really depends on each individual. For some people, cancer can cause them to feel completely powerless, and staying positive might be an important way for them to feel like they have some power or some control over their illness. That same person might feel like they are betraying themselves, their family, or their community by not staying positive. So I can see how staying positive might be extremely beneficial for that individual, given their personal belief system, their background, and their need to feel like they are truly ‘doing something’ to help their illness.
I’m feeling down. Now I feel guilty that I feel down because what if that affects my cancer? What do you say to that?
The whole idea of staying positive is really a double-edged sword because it can clearly help some people (as mentioned above), but at the same it, it’s hard to imagine that anyone can stay positive all the time, particularly when negative feelings (e.g. sad, angry, worried) are so natural following a diagnosis of cancer. It’s not uncommon for patients to come see me, not because they are feeling badly about their cancer— as we would expect — but because they are feeling badly about not staying positive all the time. We call this the ‘tyranny of positive thinking’. (Definition of tyranny: cruel and oppressive rule). In those cases, the goal will be to help relieve someone of the burden of being all positive all the time. The good news is that the scientific evidence does not support the notion that staying positive is important for cancer outcomes.
In other instances, people worry that if they don’t stay positive, then their family might think they are not coping well. The truth is that it is completely normal to feel sad about something that is sad. By not expressing sadness when sadness is due (e.g., by putting on a brave face all the time), we may be modelling to those around us, perhaps inadvertently, that it’s not ok to talk about things that are sad. For parents of young children, for example, staying positive is almost always a parent’s way of wanting to protect their children, but the unintended message to those children is that it’s not ok to talk about sad things, such as a parent’s cancer. For spouses or other family or friends, staying positive might create distance in relationships if the partner perceives a similar message in their partner’s positivity: that it’s not ok to talk about things that are sad. These are just some examples of many unintended consequences of staying positive.
So when someone feels bad for feeling sad, I try to validate what they are feeling and normalize it for them with the hopes of unburdening them from the tyranny of positive thinking. Usually, people are glad to hear to that the scientific evidence does not show any causal relationships between thinking positively and cancer outcomes.