The Downside of Positive


As the name of this blog would strongly suggest, I’m a big fan of the benefits of positive thinking. A lot of people misunderstand this. They tell me it’s not at all natural to be happy all the time. I completely agree. That’s not what ‘positive thinking’ means.

Rather than ‘being happy all the time’ positive thinking is about having optimism as a kind of default setting. I’ll give you an example.

Two people get out of bed. They both trip over the cat. They both bruise their right hip. They both drop their coffee cup and make a mess of their kitchen while discovering that they forgot to pay their phone bill. The first person says, “Well this is just going to be a terrible day. Why does this kind of thing always happen to me?” The second person says, “Well that was an unusually unhappy sequence of events. I’m sure the rest of my day will be better.”

Two people. Exactly the same circumstances but they frame them in different ways.

Staying positive includes being grateful for what I already have rather than longing after what I don’t. It includes finding activities that play to my strengths and match my values. It includes association with people that really appreciate me for who I am.

I wasn’t always this way. I had to learn it.

Recently though, with the need for a second surgery and the wait for my next lot of pathology results I’ve realised that there is a downside to being so sunny side up. Sometimes I set myself up for a fall.

Before my first lot of surgery I managed to convince myself that the chemotherapy I had prior to surgery had killed off all four of my tumours. Three of them were clearly gone. The remaining tumour looked unstable. My surgeon told me she was confident of a full pathological response. My oncologist told me she was almost certain that’s what we were looking at. I suspect my optimism was contagious. Both doctors are brilliant professionals with a long track record of great outcomes for their patients. It’s likely that they’re usually more taciturn when it comes to predicting surgical outcomes.

When my pathology came back there were pockets of active cancer throughout the tumour. I did not have a full pathological response. Even more shocking was the discovery of ductal carcinoma in situ underneath the tumour. This was the first time it had been discovered.

I was shocked. I was sad. How could this have happened. I’d been doing everything my medical team had told me to do and then some. Surely my daily yoga, my new healthy diet and my refusal of alcohol could only have helped? What had gone wrong?

Well…nothing. This is cancer. Dangerous. Unpredictable. Not inclined to meet anyone’s expectations just because they had their positive thinking sorted.

I spent the next three weeks feeling sad and disappointed and, well, just a bit ripped off. That’s the downside of positive thinking. It can easily tip over into magical thinking where you come to believe that you can make things happen with your imagination. It’s a fine line. On the one hand, there’s no doubt that you can mentally control all kinds of bodily functions with time and practice. The easiest one is your salivary glands. Think of lemons. Think really hard.

With patience and practice you can also learn to lower your heart rate and your blood pressure. Many people use meditation to relieve chronic pain and Buddhist monks actually overcome their ‘startle response’, long thought to be uncontrollable.

My point is that our mind and our body are not separate and we can exert some influence over it. But we can’t kill tumours.

The research will tell you that having a positive attitude (or ‘being optimistic’) will give you a longer life and a stronger immune system, so there’s certainly an advantage to this kind of philosophy when you’re facing a serious illness, or when you’re not, but there are no cases that I’ve been able to find of anyone ‘thinking cancer to death’.

I was a model patient. I coped well with chemotherapy and got an early and impressive result when three tumours died. I really did start to believe that my attitude had something to do with my outcome. Perhaps it did. Or perhaps I would have had exactly the same result being a bag of misery. How would we test for that?

I have pathology results due tomorrow. I had another slice of tissue removed last week and there are a scattering of suspect cells through it. By now it’s probably been sectioned and dyed and examined under a microscope to determine exactly what those cells are. Tomorrow afternoon I get the results. I’ve had a good week of resting and healing and taking it very easy. What I haven’t done is to imagine that these cells are nothing to worry about.

My new mantra when waiting on pathology: It is what it is.

It might be fat necrosis which would be great. It might be remnant dead cells which would also be great. It might be active DCIS which would be less great, but it would also be out of my body with no reason to believe I have cancer any where else.

You see the real pity of getting my hopes up last time was that I missed the good news. The tumour was out and with clear margins. There was no intrusion into my lymph nodes which is VERY rare for triple negative breast cancer and has a BIG impact on my survival odds. My surgeon said, “I know it’s not what you wanted but it’s still good news.” All I could hear was “pockets of active cancer throughout the tumour”. It’s not that this didn’t matter. It also affects my chances of survival, as does the high mitotic rate of the remaining cancer. It’s still a good outcome.

Here’s the most important thing to remember about having a positive attitude. It won’t cure you.

The reason this is important is that the other downside of being positive is the risk that a bad mood or a bad day makes people with cancer fearful that they’re damaging their own health. You would not be human if you went through this treatment without experiencing shock, horror, grief, pain, sadness, humiliation and a fear so raw it’s like ice through your heart. Cancer can kill you. It doesn’t get much more terrifying than that. Twist the ‘positive thinking’ the wrong way and you wind up with people receiving the diagnosis that their cancer is terminal and blaming themselves. Worse, you open yourself up to being blamed for your own illness. “She’s gone terminal. Clearly not positive enough.”

People seem the think that “stay positive” is a good thing to say. I don’t find it helpful. I particularly dislike, “I’m sure everything is going to be fine. I can just feel it!” Really? You have some kind of psychic ability for predicting health outcomes? I also dislike anything that starts with the phrase “at least”. “At least you don’t have it anywhere else in your body.” “At least they’ve taken it out, whatever it is.” The irony here is that this is exactly the kind of thing I say to myself when I feel the panic rise. In recent times I’ve discovered that it’s a lot more useful to just acknowledge the rising panic, decide if it’s useful and then let it drift away. I know about all of my “at leasts” and I’m grateful for them but now is not the time to remind me. Please.

I am blessed to have wonderful friends. Here’s some of the things they’ve said this week that I’ve found really helpful:

1. I’ve made you some lasagne and some sticky date pudding so you don’t have to cook. When can I drop it over?
2. I have no idea what you’re going through but I’m here for you.
3. I understand why doing nothing is so frustrating for someone like you. Does it help to remember it’s temporary?
4. Would you like a hug?
5. You look amazing and really healthy.
6. Breathe. Be mindful. Be present. Don’t waste a minute of your life on worry.
7. I love you.
8. I’m here to do some weeding.

Positive thinking won’t cure your cancer.

It will make your life more pleasant. It will make you feel better on a day-to-day basis. You’ll probably keep more of your friends because you’re more fun to be around. You’ll probably get less colds and recover faster from the ones you get. You’ll also sleep better. You probably won’t cure your cancer with your brain (but if you figure out how to do this then please let me know).

My pathology results tomorrow will either be cause for celebration, or cause for an even bigger celebration. If the verdict is DCIS then it’s likely I will have an entirely appropriate cry about that.

It is what it is.