One of the finest studies on emotional states and cancer was reported in A Psychological Study of Cancer, written in 1926 by Dr. Elida Evans, a Jungian psychoanalyst, with an introduction by Carl Jung. Jung wrote that he believed Evans had solved many of the mysteries of cancer-—including why the course of the disease is not always predictable, why the disease can sometimes recur after many years with no sign of illness, and why it is a disease associated with industrialized society.
Based on her analysis of one hundred cancer patients, Evans concluded that many cancer patients had lost an important emotional relationship before the onset of the disease. She saw such patients as people who had invested their identity in one individual object or role (a person, a job, a home) rather than developing their own individuality. When the object or role was threatened or removed, such patients were thrown back on themselves, with few internal resources for coping. (We, too, have found the characteristic of putting others' needs before one's own in our patients, as you will see in the case histories that follow.) Evans also believed that cancer was a symptom of other unresolved problems in a patient's life, and her observations have since been confirmed and elaborated on by a number of other researchers.
Dr. Lawrence LeShan, an experimental psychologist by training and a clinical psychologist by experience, is the foremost theorist of the psychological life history of cancer patients. In his recently published book, You Can Fight for Your Life: Emotional Factors in the Causation of Cancer, he reports findings similar in many ways to those of Evans. LeShan identifies four typical components in his life histories of the more than 500 cancer patients with whom he worked:
- The patient's youth was marked by feelings of isolation, neglect, and despair, with intense interpersonal relationships appearing difficult and dangerous.
- In early adulthood, the patient was able to establish a strong, meaningful relationship with a person, or found great satisfaction in his or her vocation. A tremendous amount of energy was poured into this relationship or role. Indeed, it became the reason for living, the center of the patient's life.
- The relationship or role was then removed—through death, a move, a child leaving home, a retirement, or the like. The result was despair, as though the "bruise" left over from childhood had been painfully struck again.
- One of the fundamental characteristics of these patients was that the despair was "bottled up." These individuals were unable to let other people know when they felt hurt, angry, hostile. Others frequently viewed the cancer patients as unusually wonderful people, saying of them: "He's such a good, sweet man" or "She's a saint." LeShan concludes, "The benign quality, the 'goodness' of these people was in fact a sign of their failure to believe in themselves sufficiently, and their lack of hope."
He describes the emotional state of his patients after they lost the crucial relationship or role as follows:
The growing despair that each of these people faced appear[s] to be strongly connected with the loss that each suffered in childhood. . . . They saw the end of the relationship as a disaster that they had always half expected. They had been waiting for it to end, waiting for rejection. And when it happened, they said to themselves, "Yes, I knew it was too good to be true." . . . From a superficial point of view, all managed to "adjust" to the blow. They continued to function. They went about their daily business. But the "color," the zest, the meaning went out of their lives. They no longer seemed attached to life.
To those around them, even people close to them, they seemed to be coping perfectly well . . . but in fact it was the false peace of despair that they felt. They were simply waiting to die. For that seemed the only way out. They were ready for death. In one very real sense they had already died. One patient said to me, "Last time I hoped, and look what happened. As soon as my defenses were down, of course I was left alone again. I'll never hope again. It's too much. It's better to stay in a shell."
And there they stayed, waiting without hope for death to release them. Within six months to eight years, among my patients, the terminal cancer appeared.
LeShan reports that 76 percent of all the cancer patients he interviewed shared this basic emotional life history. Of the cancer patients who entered into intensive psychotherapy with him, over 95 percent showed this pattern. Only 10 percent of a control group of noncancer patients revealed this pattern.
Although LeShan writes movingly and convincingly of his patients' emotional states, not all facets of his observations have yet been validated by other studies. But several key elements have been confirmed by a thirty-year study by Caroline B. Thomas, a psychologist at The John Hopkins University.
Dr. Thomas began interviewing medical students at Johns Hopkins in the 1940s and evaluating their psychological profiles. Since then, she has interviewed more than 1300 students and followed their history of illness. She reports that the most distinctive psychological profile belonged to students who subsequently developed cancer—more distinctive even than that of students who subsequently committed suicide. In particular, her data showed that students who subsequently developed cancer saw themselves as having experienced a lack of closeness with their parents, seldom demonstrated strong emotions, and were generally low gear.
Another element of LeShan's description, that cancer patients tend to be prone to feelings of hopelessness and helplessness even before the onset of their cancer, has been confirmed by two other studies.
• Drs. A. H. Schmale and H. Iker observed in their female cancer patients a particular kind of giving-up, a sense of hopeless frustration surrounding a conflict for which there was no resolution. Often this conflict occurred approximately six months prior to the cancer diagnosis. Schmale and Iker then studied a group of healthy women who were considered to be biologically predisposed to cancer of the cervix.
Using psychological measures that allowed them to identify a "helplessness-prone personality," in this group Schmale and Iker predicted which women would develop cancer-—and were accurate 73.6 percent of the time. The researchers pointed out that this does not mean that feelings of helplessness cause cancer-—these women appeared to have some predisposition to cervical cancer—but that the helplessness seemed to be an important element.
• Over a period of fifteen years, Dr. W. A. Greene studied the psychological and social experiences of patients who developed leukemia and lymphoma. He too observed that the loss of an important relationship was a significant element in the patient's life history. For both men and women, Green said, the greatest loss was the death or threat of death of a mother; or for men, a "mother figure," such as a wife. Other significant emotional events for women were menopause or a change of home; and for men, the loss or threat of loss of a job, and retirement or the threat of retirement.
Greene concluded that leukemia or lymphoma developed in an environmental setting in which the patient had dealt with a number of losses and separations that produced a psychological state of despair, hopelessness, and discontinuity.
Other studies have confirmed LeShan's description of the difficulty many cancer patients experience in expressing negative feelings and the need to constantly look good to others.
- Dr. D. M. Kissen has observed that the major difference between heavy smokers who get lung cancer and heavy smokers who do not is that the lung cancer patients have "poorly developed outlets for emotional discharge."
- E. M. Blumberg demonstrated that the rate of tumor growth can be predicted based on certain personality traits. The patients with fast-growing tumors attempted to give a good impression of themselves. They were also more defensive and less able to defend themselves against anxiety. In addition, they tended to reject affection, even though they wanted it. The slow-growing tumor group showed a greater ability to absorb emotional shocks and to reduce tension by physical activity. The difficulty for the patients with fast-growing tumors seemed to be that the emotional outlets were blocked by an extreme desire to make a good impression.
- Dr. B. Klopfer conducted a similar study in which tumor type (fast or slow growth) was predicted based on personality profiles. The variables that allowed the researchers to predict rapid growth were patients' ego defensiveness and loyalty to "their own version of reality." Klopfer believes that when too much energy is tied up defending the ego and the patient's way of seeing life, the body will not have the necessary vital energy to fight the cancer.