Fighting spirit or denial? Helplessness and hopelessness or stoic acceptance?

Posted August 17th, 2009 by Jane

There’s a whole field of study called psycho-social oncology…dedicated to examining the spiritual, emotional, social aspects of living with cancer. In the absence of a cure for cancer, researchers and scientists have to find alternative ways of lifting their peer reviewed ratings. I think it was in 1990 in the Lancet that Greer et al reported upon their research. They had identified four possible approaches to living with metastatic breast cancer. These they called fighting spirit, denial, helplessness and hopelessness, and stoic acceptance. The authors claimed that those patients exhibiting fighting spirit or denial had bettter ‘outcomes’ and longer survival, than those exhibiting helplessness and hopelessness or stoic acceptance. Greer’s work has been referenced in numerous articles since, together with copious references to the work of David Spiegal. Spiegal carried out research on breast cancer patients who attended group therapy sessions and those who didn’t, finding that the former group lived longer than the latter. (No such difference was identified when he repeated the research 15 years later.)

Both Greer and Spiegal’s research have been contradicted by later studies. In a nutshell, attitudes to cancer may impact on the quality of life experienced by a patient but have no impact on overall survival.

I ponder Greer’s four pronged categories and I don’t fit! I can’t, don’t and won”t adopt a ‘fighting spirit’. Just one reading of Susan Sontag’s brilliant Illness as Metaphor, was enough to convince me that battle metaphors have no place in cancer stories, but they are hard to avoid. In cancerworld there are many pinkbraverypoints to be won for those who ‘fight’. I have personally never quite grasped who or what one is supposed to be fighting. Usually fighting can be reduced to little more than trying another drug treatment, and smiling through its unpleasant side effects.

Denial…denial is difficult. I think there may be more to denial than I once thought. At a superficial level I’d say I was the kind of person least wedded to denial. I’ve always seen myself as simply utterly realistic about the outcomes of my cancer…ie. my eventual and inevitable death. Not for me, hopes of a new wonder drug popping up on the horizon just in time to save me. The pragmatist, the realist, the thinking person in me knows that progress in cancer treatments simply doesn’t happen like that.

To an extent though, each of us does welcome denial, certainly in the short term reality in which we live our lives. If I really did think I’d be dead this time next year (and the odds point to the fact that I will be) then I might well curl up in my bed and refuse to rise. Its not bravery or a fighting spirit of hope which gets me out of bed in the morning but a simple, child like kind of defiance..”yah…boo…sucks…I ain’t go to die.” And the child helps the adult.

Its ‘oh dear’ when it comes to helplessness and hopelessness..the opposite of a fighting spirit…moral criticisms runs wild. But what nonsense this is…I know no one with cancer who hasn’t at some time felt both helpless and hopeless. Even those happy shiny women photographed in the pink pages celebratory literature must surely occasionally feel just a trifle pissed off? Isn’t being pissed off OK any more?

According to Greer it was those poor patients displaying stoic acceptance who did worse in the survival stakes. Is it stoic acceptance which I do most easily? Maybe yes in a way it is…though I’m more accepting than stoical. Thank goodness Greer’s work has been challenged and the categories deemed no longer helpful. So stoic or not, accepting or not, it doesn’t really matter.

In my experience other people like happy cancer patients. Most cancer patients seem to like happy cancer patients too. What a burden this all is. Why can we not just be people living with cancer, best we can, in the ways which suit us best. But no, I don’t want criticism from the warriors or the denial merchants when I confess to a bit of hopelessness, and confirm that yes, cancer will kill me, but not this week or next.