En excerpt from the book :
IN CANCER THERAPY"
by Ross, R.Ph. Pelton, Lee Overholser
Support Groups and Psychotherapy
THE USE OF psychotherapy and emotional support in treating cancer may soon lose its status as an alternative therapy and become part of the standard, conventional treatment. The cancer establishment has long been suspicious of the idea that emotions and belief could influence cancer. Recently, however, a study published in the British medical journal Lancet has created shock waves that may change the course of medicine forever.
In a ten-year study of women with advanced breast cancer who were treated medically for their condition, Dr. David Spiegcl unexpectedly found that women who took part in a support group lived more than twice as long as the women who did not participate in a support group. (8)
Support and Survival
Often researchers find only what they are looking for. Most of the psychotherapy offered to cancer patients by mainstream medicine is designed to reduce the side effects of the therapy and help patients cope with the feelings of depression that come from a diagnosis of cancer. The early studies of support groups and psychotherapy examined only the emotions of cancer patients. (2)
The very influential study by David Spiegel and his colleagues started out as another investigation of how support groups could
help patients with metastatic breast cancer to cope. (8) Eighty-six women took part in the study, and were randomly divided into therapy and control groups. The support groups met weekly for an hour and a half for one year—the period of data-gathering for the study. The patients felt that the groups were so helpful that they continued to meet for two more years.
The support groups encouraged sharing of mutual fears and concerns in a supportive, nonconfrontive setting. The group members communicated with one another frequently outside the group setting. In the group they dealt with difficult family relationships, shared with the others what they had learned from their disease, and mourned those members who had died. They also worked on improving communication with surgeons and oncologists.
As expected, the results showed lowered scores for tension anxiety, fatigue, and confusion. There was an increase in tests measuring vigor. Because of the emphasis on finding meaning in the rest of their lives, some members set up tasks to carry out before they died, such as writing a book of poetry, helping their children or grandchildren, and letting family members know how much they meant to the patient. (8)
The surprise came when the researchers undertook a ten-year follow-up study designed to show that although the quality of life had been improved, the time of survival was not affected. Dr. Spiegel was absolutely convinced that there was no benefit beyond the psychological aspects. (7) What he discovered was that the patients who entered the therapy group lived nearly twice as long. The survival time from entry into the study was 18.9 months for those who did not participate in the support groups and 36.6 months for those in the support groups. (9)
Spiegel and his fellow researchers were astounded. They checked for possible errors in assigning members to the control or therapy groups, but found that the assignments were absolutely random. (7)
Spiegel's discovery that a simple support group can dramatically prolong survival supports the many attempts by psychotherapists to treat cancer through counseling, visualization, meditation, and hypnosis. Currently Dr. Spiegel has been funded by the National Institute of Mental Health (NIMH) to replicate his study, and at least four other studies are currently under way to test the same question.
To me, Dr. Spiegel's study represents the beginning of an important paradigm shift. We are beginning to get solid evidence that mental processes can influence the development and course of cancer. As we begin to harness the power of the mind to influence health and healing, we will truly enter into an exciting new era of health care.
We are starting to recognize the importance and necessity of treating the whole person. The current crisis in health care in the United States is bitter proof that treating only physical symptoms is not enough. There is a psychological and emotional component to every physical illness. The new era of health and healing, called holistic health, recognizes the necessity of treating the "bodymind."
Psychotherapy and Cancer
Recent studies have shown us that emotions have a powerful influence on the development and outcome of cancer. Repressed anger, depression, and chronic stress can promote the development of cancer. Research shows that having a good social support system, a fighting spirit, and a positive outlook can lead to a good prognosis for survival. Also, having a sense of joy in life and future-oriented goals may help patients overcome cancer. On the other hand, depression and feeling helpless/hopeless are correlated with a poor prognosis.
For these discoveries to be of more than academic interest, there has to be some way of making positive changes in the emotions and expectations for cancer patients. Pioneering psychotherapists like Lawrence LeShan, Carl Simonton, and Stephanie Matthews-Simonton wanted to do more than just make their patients feel better. They wanted their patients to live longer and to help in their struggle against the disease.
Ultimately it is the personal experiences of the therapists and patients involved in psychological treatments for cancer that give meaning to their efforts. It is in these person-to-person exchanges that real change takes place.
Lawrence LeShan was one of the first to use psychotherapy as a treatment for cancer. He began working with cancer patients in 1952 with a grant to study the relationship between personality characteristics and cancer. Through in-depth interviews and psychological tests he found that the large majority of patients suffered a loss of hope in ever achieving a satisfactory, meaningful life before the first signs of their cancer appeared. (3) He also noted that in men the incidence of cancer peaked shortly after retirement, no matter whether that occurred at age sixty, seventy, or earlier.
In You Can Fight for Your Life LeShan identifies a pattern of childhood deprivation followed by hope and then crushing removal of that hope. Catherine, who was one of his patients, felt rejected and unloved during her childhood. Her mother resented interference with her life-style, and her father, who was very puritanical, could not stand any physical contact with his daughter. Her only outlet was an interest in music. Like many such patients, she had few childhood friends and was a loner.
After leaving college due to an injury, Catherine moved to another city to study piano and lived with two other young women who were studying art and music. She felt wonderful, had long exciting talks with her friends, and began dating men. But after a year her father refused to let her continue living in the "immoral" city. She entered an unsatisfying marriage, lost her zest for music, and within eight years developed Hodgkin's disease.
LeShan contends that if the promising new relationships are ended, the person is so devastated as to "fall back totally into the old loneliness, a loneliness compounded by the fear of further loss." (4) The sense of despair these patients feel is the precipitating event for the collapse of their immune systems and the onset of cancer.
LeShan's background was Freudian, and he began by offering his cancer patients traditional psychoanalysis. He soon found that they were feeling better emotionally, but they were not improving physically. He identified three problems with the traditional analytic model:
- The sessions did not deal with the patient's present concerns, their physical pain, and deep anxieties about the present and the future.
- There was no place in the traditional theory for basic positive motives.
- The patients were not living longer. (4)
The fact that he even expected a change in survival time was a break from the usual psychotherapeutic approach. LeShan adopted two guiding questions for his new approach to therapy:
- What is right with this person, and what is this person's unique song in life?
- What has blocked this person's ability to express his or her uniqueness in the past, and how can we work together so that this person can live a full and zestful life?
LeShan guides his patients toward an encounter with their authentic selves so they can discover what is special about themselves and "sing their own song." He contends that twenty years after adopting his new approach, approximately half of his "terminal" patients are in remission and alive.
One dramatic case history concerns Pedro, a patient he met in 1960 who had Hodgkin's disease and who found a way to "sing his own song." (5) At that time there was no effective treatment, and the disease was almost invariably fatal.
Pedro was about twenty, of Puerto Rican ancestry, and had grown up in the south Bronx. Gradually LeShan overcame the barriers between them through a long series of brief conversations. He learned that Pedro had joined a gang at age nine and become leader at age sixteen. Soon after the gang broke up. Some members were killed, some arrested; others married and left. Pedro felt lost. About a year after the gang broke up he developed Hodgkin's disease.
As Pedro described gang life, he had close friends who spent a great deal of time together without much to do. They might have squabbles, but they could count on each other in times of trouble. Both LeShan and Pedro realized they were discussing the life of a fire fighter. Pedro suddenly began to regain his interest in life. He finished high school through correspondence courses and began to respond to his chemotherapy.
He got some favorable job recommendations, and had improved to the point that he took the physical test for his job and passed. Six months later he became a fire fighter. After twenty years he was still in remission, had a wife and children, and loved both his life and his job.
This case illustrates many of the characteristics LeShan sees in both the etiology and psychological treatment of cancer. First there was deprivation in childhood and a sense of loneliness. Then there was an escape, followed by further loss and despair. Pedro developed cancer but found a way of fulfilling his life, of "singing his own song," which led to the remission of his cancer. The challenge in this case was finding a socially acceptable way of expressing a life spirit that had previously manifested itself in gang activity.
Despair and Cancer
To LeShan despair is the result of being unable to accept the self for what it is. As he says, "If the self is seen as something that will be rejected by others, then the person is doomed to be eternally and deeply alone. If it is seen as something that one rejects oneself, the loneliness is made even greater." (4) This hopelessness compromises the immune system in his view and leads to the cancer. Learning to accept and express the self restores integrity to the system.
Certainly LeShan's approach to therapy, emphasizing developing a zest for life and learning to express individual uniqueness, is a valuable and health-promoting goal for anyone. It seems unfortunate that a person would have to develop cancer to be given such an opportunity. In a way, cancer places important time constraints on the process. We are all going to die, but it is easy to put off thinking about that eventuality. Patients with aggressive or advanced disease are given a time limit, and some realize that if they are to enjoy life and find meaning in it, they must do so now. They do not have the luxury of years of psychotherapy to search for emotional fulfillment. They must begin to live in the present if they are to realize the value and rewards of life.
Analysis and Cancer
One psychotherapist who has not abandoned analysis is Dr. Frederick Levenson. In his book The Causes and Prevention of Cancer (6) he identifies the cause of cancer as a learned process for dealing with irritation during early infancy. He believes that if the mother meets the baby's needs and establishes a bond, the infant moves on to develop healthy relationships. If the mother cannot meet the baby's needs, the infant is conditioned to hold irritation in and produce increased levels of internal biochemical agents that soothe some areas of the body while irritating others. Irritation later in life proceeds along the same lines, producing changes in genetic material that cause cancer. Levenson proposes that cancer can be viewed as one way the organism processes irritation.
In his opinion, the way to prevent cancer is to train the child to deal with irritation in a healthy way while providing emotional support. The parent who says "Keep crying, and I'll give you something to cry about" is training the child to internalize irritation. The parent who gives the child a reasonable choice, such as an appropriate punishment and a chance to play later, shows a child how to do something about irritation.
It is perhaps unfortunate that Levenson refers to repressive interactions between parent and child as "carcinogenic." This label might cause guilt in parents of a cancer patient and certainly does not help the patient improve.
The treatment he outlines is sometimes confrontive, forcing the patient to take responsibility for dealing with life and guiding the patient to learn healthy ways of dealing with irritation. In his view, anger is a healthier response than continued inner irritation.
Choice and Cancer
Some authors consider health to be a matter of choice. They believe that in some sense we choose a life path that leads to illness or health. It is unfortunate that this view is taken by some to mean that a person who is ill has chosen to be sick. This thinking can lead to unnecessary worry and a damaging sense of guilt.
For example, Dr. Larry Dossey in Beyond Illness: Discovering the Experience of Health presents the idea that thinking about the mind and body separately is fundamentally flawed. In his view, the mind and the body are a single unit and cannot be artificially separated. He emphasizes the importance of making conscious choices in matters relating to health. (1)
He is not saying that we deliberately create diseases, and it is a disservice to those who suffer from one or another physical condition to imply it. No cancer patient needs to be accused of producing the disease. On the other hand, we can take charge of our lives and health without heaping blame on ourselves.
Dr. Dossey presents the case of Martha, who had extensively metastasized ovarian cancer. She was a widow sixty-five years old who had a firm, but not fatalistic, acceptance of her condition and health. An operation removed most, but not all, other cancer. During her recovery she spoke with Dr. Dossey mainly about some tomato plants he was growing.
Her attention focused on the condition and care of those plants. He reported that she responded well to chemotherapy and continued to survive despite some continued presence of the cancer. One day she visited the hospital after her discharge and left a basket of tomatoes on his desk with the note, "Chemotherapy works. So do tomatoes. Thanks—Martha G." (1) To Dossey, her recovery was the result of her acceptance of life and living, not an attempt to fight the cancer. She lived because she had an acceptance of life as it is and a determination to live in the present.
Side Effects of Support Groups
Some patients at Hospital Santa Monica have reported that support groups at other institutions sometimes left them feeling worse about themselves and their prospects. This happened when the meetings consisted of patients recounting one depressing story after another. While patients need to deal with negative emotions, a skilled leader can keep the group from wallowing in misery.
An effective group will give patients the skills they need to cope with current feelings and release any lingering resentment about their condition. It will also increase participants' self-esteem, give them a sense of interest in life, and instill a feeling of purpose.
Support groups for cancer patients are now found in the majority of hospitals in the U.S. The primary goal of the majority of these groups is to reduce the emotional and physical discomfort the cancer is causing. Unfortunately, the underlying purpose of some of these support groups is to ensure that patients follow the doctor's orders. The assumption is that patients who follow the doctor's orders to the letter will do better than those who want to take control of their treatment program.
One of the pioneers in applying psychotherapy to the treatment of cancer, Lawrence LeShan, Ph.D., strongly asserts that patients are guaranteed the right to choose or refuse therapy. He contends, "In many hospitals psychiatrists and psychologists are seen as special disciplinary arms of the medical service. If you ask too many questions, or—horrors above—decide against a procedure that the hospital thinks is right for you, the medical staff is likely to ask for a psychiatrist to visit you.... The department of psychiatry is called in to 'adjust' you." (4) He strongly emphasizes the right of patients to make their own decisions and resist attempts to coerce them into accepting therapy they do not want.
When properly applied, psychological treatment for cancer increases a patient's sense of control over the disease and may offer hope for significant improvement in quality and quantity of life. While this may make things more difficult for the hospital staff, the patient's health should be the primary concern.
The possible side effects of psychotherapy will be covered at the end of the next chapter, along with those of meditation and visualization.