In his lecture on Friday Dr. Chaoul discussed the paradoxical nature of cancer. Faced with a reminder of their own mortality and possible death, cancer patients often find meaning and satisfaction in their lives where before they had none. Many find this meaning in a religious context, but this phenomenon extends beyond the boundaries of just spirituality.
Mechanistically, this could be explained as an adaptive mental adjustment that combats stress and depression that occur after a cancer diagnosis. As Dr. Chaoul and Dr. Cohen discussed, stress and depression have been shown to inhibit immune function and can contribute to the metastasis of cancer. However, this does not explain why so many people find meaning through religion and faith. A vitalistic explanation for this phenomenon could be that perhaps this renewed spirituality is preparing cancer patients for what is to come after death as they near the end of their life in this world.
As a result of this phenomenon, doctors have begun trying to guide cancer patients through steps with which people may find meaning in their lives after diagnosis. I found several articles that describe stories of individuals who have benefited from this meaning-centered therapy. This new form of psychotherapy aims to ease the emotional suffering that many patients experience during traditional chemotherapy and radiation treatments. Unlike other forms of integrative medicine we discussed such as massage, meditation, or acupuncture, this meaning-centered treatment aims to induce a naturally occurring mental adjustment that many patients may eventually reach. By guiding patients through a series of mental reflections and exercises, cancer patients can achieve a greater appreciation for their past, give meaning to their life while living with cancer, and have a greater acceptance of the future.
One article ends on another paradox, “You’d think that once people have found this new meaning in life, they wouldn’t want to let it go. But knowing their life has meaning and that it will continue beyond them seems to lessen that white-knuckle grip on life and give them a sense of peace.” It is with this attitude that doctors hope to help treat the emotional effects of cancer and prepare patients for whatever will come.
http://online.wsj.com/news/articles/SB10001424052970203547904574276434196118914
http://www.mskcc.org/blog/new-form-psychotherapy-might-ease-emotional-suffering-terminally-ill-patients
Your proposed vitalistic explanation is very interesting; personally, I would use the phrase “letting go,” although it pretty much amounts to the same thing. Ultimately, religions are all about letting go: letting go of your own will so that a higher will might act through you; letting go of your old lifestyle; letting go of old beliefs in light of new experiences; sometimes even letting go of an old religion in favor of a new one; and in this case letting go of material existence in favor of the new post-death spiritual existence to come. After all, when you are told that mechanistically there is nothing you can do to get yourself better, all you can do is submit to the physical treatments of radiation, surgery, etc. The same could be said spiritually, that nothing you can do will heal you, save for letting go and allowing God (or some higher will) in as the spiritual physician to heal you if he sees fit. When a cancer patient examines his/her situation objectively, the natural thing to do is to let go—this is not an admission of defeat though, it is a practical way to conserve energy by not wasting whatever remains of it on stress and despair. Psychotherapy can help a patient see his/her situation objectively whether the disease is cancer or something less serious, thereby helping them naturally and voluntarily to reach this state of letting go.
I find the topic of legacy and death extremely fascinating. The idea that each of us creates something that will last long beyond our own existence is comforting, and empowering. If we look at the annals of history, we might be deceived into thinking that the only men and women who are remembered make radical political decisions, lead armies to victory, push the boundaries of science, or create renowned works of art. The meaning centered therapy approach advances the belief that each of us will have a significant legacy, even if it touches only those closest around us. I was struck during our research of the epidemiologist, George Comstock, by one of his favorite quotes from a commencement speech, which I believe is relevant. “I beseech you to treasure up in your hearts these my parting words: Be ashamed to die until you have won some victory for humanity.” “Most of us aren’t going to win any big victories, but we can win little ones every day, and they mount up.” This is an extremely powerful message. Like the wall street journal article stated, most of us are too busy to sit back and contemplate death and our legacy, although it is one of the only certainties of life. If the purpose of life is to change the world in a positive way, we might wonder if even a minuscule percentage of human lives will contribute to this goal, yet Comstock offers us a beautiful escape from this uneasy uncertainty. He believes our smallest actions have lasting positive affects on the world around us, whether holding a door for someone, or working diligently at your day job, you are slowly but surely contributing to the betterment of humanity. I’m sure Comstock would have believed in meaning centered therapy, as he personally demonstrated the benefits of religious involvement in increasing mortality rates in patients with cardiovascular failure. I believe that meaning centered therapy is not too different, as it emphasizes both a sense of community, and an appreciation for life after death. I was also very interested in the fact that the therapy was based off the writings of a holocaust survivor, who managed to survive by acknowledging that life has meaning and that all the innocent men and women dying around him would leave a legacy behind them, and would contribute to human existence. Meaning centered therapy is proving effective for reducing patient stress and fear, which in turn increases longevity. As of yet there is no mechanism that can directly explain the health benefits of an optimistic and proactive outlook, however it can be seen through a vitalistic perspective, where we are allowing our human soul, tortured by terrible stress, to find peace and fulfillment.
I unfortunately missed Dr. Chaoul’s discussion over this topic, but with the studies and reviews provided I can see how this newly discovered meaning-centered psychotherapy can help a terminal cancer patient cope with the existential crisis that naturally occurs in their situation. Many physicians who possess the typical mechanistic perspective in medicine see this as a waste of time. They see this form of “treatment” as poppy cock used to distract patients from the effects cancer brings. Dr. Chaoul and other physicians like himself believe this program truly helps people in improving their acceptance of death, living a happily between the space of diagnosis and death, forgiving themselves for past mistakes, and forming a comforting basis of knowledge on life after death.
When my aunt was diagnosed with colon cancer, my uncle said, “It’s hard to explain, but everything in your world just kind’ve stops”. Death is a very scary thing with no mechanistically proven evidence that shows we will still remain as some type of being who has the five senses or any senses at all after we have passed. When hearing a bad cancer prognosis, depending on the time you are given, you are suddenly confronted with death at its doorstep and an existential crises naturally follows.You are taken aback and everything stops. It makes perfect sense to me when Chiraag says that the clinical psychologist in the article believes cancer patients are worried more about unresolved issues from the past than they are about actual death. Fist of all who wants to think about their planned death all of the time? I’m sure most people try to avoid it and think about what they need to finish before their time comes. Secondly, no one wants to die alone. Dying alone means that you don’t have people who care for you, and every person has a physical and mental need to be loved by someone or something. It is part of what makes us human. Faulty relationships that are put off to fix for later all of a sudden become something to fix now, so that the patient will have good relationships with other people and support from them when their time comes.
Taking into account Blind Faith and all of the information it has provided me with to take a devil’s advocate viewpoint, I am not sure that these practices have a true mechanistic effect for example increasing a patients’ likely hood of survival or stopping the division of the cancer cells, due to the high possibility of research flaws seen often in this field of study. However, I can definitely see how this program could improve these patient’s lives in other ways. Stress has been proven to have an effect on the metastasis of cancer and causing cancer patients to be more ill as Michelle stated. Connecting with others, reflecting on your life, and all of the other things that come with the comfort and care provided from meaning-centered care can reduce stress and therefore be beneficial. Allowing a person to form new relationships with people who understand their struggle makes it easier to converse with others and participate in activities with people who are on similar physical and mental levels. These relationships can create joy and laughter, raising levels of endorphins resulting in happiness. All in all, I think meaning-centered psychotherapy should be an option for all cancer patients, because it does seem to be having a truly positive affect on the end of their lives.
Dr. Chaoul’s remark that some cancer patients see their affliction as an opportunity to delve into their selves and instigate inner healing. I think, then, that psychotherapy within the context of helping cancer patients can go beyond merely offering them advice on how to gain deal with reality, but rather to frame their illness as a struggle that can encompass any and all other psycho-spiritual imbalances that they are now empowered to deal with. The WSJ blog link mentions a clinical psychologist who remarked that in her experience cancer patients are usually concerned with unresolved issues from the past, rather than confronting death; this fits in neatly with Dr. Chaoul’s assertion.
What implications do these spiritual views on the nature of cancer have on religious discourses centered on morality and karma? Are we in certain ways “forced” through a disease that quite literally “eats” away at our physical selves, to come to terms with personal issues if we consistently ignore a psycho-spiritual problem?
This study reminds me a lot about the case that we read about in the readings we had from Anne Harrington’s book The Cure Within, particularly in Chapter 5 under the section titled “Is love good medicine?”. In this section, David Spiegel’s study on whether participating in support groups could possibly extend the life of the person diagnosed with metastatic breast cancer, while originally gaining much momentum and praise through media outlets, was not supported when the same results were not replicated by a multisite study done in 2001. Although this seems to disprove the initial hypothesis of using support groups using psychotherapy to live longer, I was curious whether or not these results were specific to breast cancer patients. In other words, would the same results hold true for other variant forms of cancer? As it turns out, Spiegel did find promising results in a sub-group where women with estrogen receptive-negative tumors (cancer cells that don’t need estrogen to grow, and typically don’t stop growing when treated with hormones that block estrogen from binding) undergoing psychotherapy had a “median survival of almost 30 months, which was 21 months longer that those who received educational literature alone” (see source below). What can we make of these results? And more importantly, should it be the goal of cancer research to provide an avenue for meaning-making for the lives of cancer patients such as with meaning-centered psychotherapy, while also finding ways to increase the time that patients, as Dr. Poppito puts it, “living with cancer until you pass”?
http://med.stanford.edu/news_releases/2007/july/spiegel.html