Medicine: Can Attitudes Affect Cancer?

• Share

In a 1976 New England Journal of Medicine article called "Anatomy of an Illness," Norman Cousins, then the erudite editor of the Saturday Review, described how he had cured himself of spinal arthritis by adopting a healthy mental attitude, laughing a lot and taking vitamin C. Other diseases, Cousins implied, might also succumb to positive thinking. The article struck a responsive chord. It was reprinted in other medical journals, supported by letters to Cousins from some 3,000 doctors, and eventually expanded by the author into a briskly selling 1979 book of the same name. Despite complaints from other doctors who studied the Cousins case and said that the author had misrepresented the nature and severity of his disease, Cousins' amateur foray into medicine eventually led to his appointment as a senior lecturer on the faculty at the UCLA medical school.

Cousins' writings, along with a glut of similar books, television features and articles -- some by doctors -- have convinced many Americans that a positive mental attitude can help prevent and even cure a variety of ills, including cancer, and, conversely, that a negative outlook can increase vulnerability to disease. Last week the New England Journal published a study and an editorial that cast doubt on that popular view and stirred a tempest in the medical community.

In the study, which began in 1982, a team led by Dr. Barrie Cassileth at the University of Pennsylvania Cancer Center in Philadelphia developed questionnaires for 204 patients with advanced cancer and another 155 who had been treated either for breast cancer or melanoma and were susceptible to a recurrence of the disease. The cancer victims were asked about such attitudes as satisfaction with their jobs and life in general, feelings about their health, and their degree of hopelessness or helplessness -- factors that some studies have shown to affect longevity. Using accepted psychological rating procedures, the team compiled psychosocial scores that measured the patients' outlooks.

In the 3 1/2 years since the study began, 154 of the 204 advanced cancer patients (75%) have died. Of the 155 people treated for melanoma or breast cancer, 41 (26%) have had recurrences. But the researchers could find no relationship between attitude and either the survival or recurrence rate. In general, the more cheerful patients showed no greater capacity than the depressed ones for fighting their cancers, and the pessimists were at no greater risk of death or recurrence than the optimists. Concluded the report: "Our study . . . suggests that the inherent biology of the disease alone determines the prognosis, overriding the potentially mitigating influence of psychosocial factors."

With proper scientific caution, the Pennsylvania team stressed that its conclusions applied only to patients with advanced cancer. It conceded that the study "did not address the possibility that psychosocial factors or events might influence either the cause of disease or the outcome for patients with more favorable cancer diagnoses."