A recent series of articles and letters to the editor published in the The New York Times has become the forum for a debate on the issue of whether personality plays a role in our ability to survive a crisis of traumatic proportions. The discussion began with an article written by Roni Caryn Rabin in The New York Times on January 17th, titled, "Living With Metastatic Breast Cancer."
On the one hand, we often hear that so-called "resilient" people are more likely to come through a crisis -- a job loss, home foreclosure, divorce, death of a child -- less psychologically damaged. But what exactly is resilience, and how might it apply to a crisis such as being diagnosed with a terminal illness like metastatic breast cancer?
One such patient, Suzanne, has been in treatment for six years after being diagnosed with breast cancer that had metastasized to her spine. Suzanne told me, emphatically, that, in her opinion, survivability is not a function of personality, but is strictly a result of the kind of cancer you have and how it responds to medical treatment. "I've been in treatment for six years," she said, adding that the average length of time between diagnosis and death for women in her situation is two years. "I've known women who were no less determined, no less 'courageous' than I am, and they were dead two or three years after being diagnosed. Does that mean that they died because they lacked something in their character? I don't believe that."
Like everyone else I know, I've read obituaries for years that described men and women who'd died "after a long and courageous battle with cancer." I always thought that was a compliment. But Suzanne's comment struck me. Perhaps we should choose a word other that "courageous" to describe the ordeal that cancer patients go through. I have a loved one who survived this ordeal, and she is indeed a courageous woman. However, had she not survived, would that have been because she lacked courage? I think not.
So what do we actually know about the role that personality plays in survivability? Here are some results from research:
Carol Farran, an eldercare expert from Rush University Medical Center in Chicago, sought to understand why some nursing home residents thrived, despite adversity and isolation, while others just withered away. The difference between the two groups, she found, was hope. By "hope" she did not mean the blind or rigid optimism that usually passes for hope. Rather, for Farran, hope meant an openness to possibility (optimism), acceptance of risk and a determination to work things out. Hopeful people, she wrote, face reality in a clear-eyed fashion, doing the best they can. "The hopeful person looks at reality, and then arrives at solutions. If a hoped-for outcome became impossible, the hopeful person would find something else to hope for."
Psychologists at the Royal Marsden Hospital in London studied women with early-stage breast cancer and found that risk of recurrence or death increased significantly among those who lacked hope. There was nothing mysterious or mystical about this. Hopeful patients, for example, were inclined to manage their illness themselves, instead of letting outsiders make all the decisions. They often chose the most aggressive treatments. And envisioning the light at the end of the tunnel helped provide the strength they needed to get through each difficult day.
Once empowered by hope, cancer patients have been known to search out cures in the face of daunting odds. Jerome Groopman, a Harvard cancer specialist and author of "Anatomy of Hope," tells the story of a patient -- a pathologist with advanced metastatic stomach cancer that was considered fatal. Soon word spread around the hospital that the pathologist intended to do something "mad." Without any evidence that his cancer was survivable, he insisted on doses of chemotherapy and radiation so toxic they were, by themselves, probably lethal. To Groopman and other cancer doctors on staff at the time, the effort seemed "like a desperate, wrong-headed, ultimately futile effort to resist the inevitable." Surely the treatment would deprive the pathologist of a peaceful end at home. Indeed, Groopman, stopping by the man's bedside, found him bleeding, as tissues were literally burned away by the strong treatment he had insisted on receiving.
Twenty-five years later, while researching his book on hope, Groopman found that the pathologist was still going strong. "If I'd been treating him, I wouldn't have authorized the therapy and he would have died."
My colleague, Dr. Barbara Okun and I believe in the power of psychological resilience. In our book, "Saying Goodbye: How Families Can Find Renewal through Loss," we define resilience in terms of an out look on life: a belief that life has meaning; a belief that crises are a normal part of life and should be expected; and a belief that the best way to approach a crisis is to marshal resources and attack it. Research has shown that, faced with high stress, people with resilient outlooks are less vulnerable to physical and emotional illness.
But another way to look at resilience is that it is, simply, hope. Hope is powerful. As opposed to its dark cousin, despair, which paralyzes us, hope energizes and mobilizes us. Beyond that, hope affects those around us, lifting them as well as us. The power of hope is evident in the examples given above. That said, will hope alone allow someone like Suzanne to survive cancer forever? Perhaps not. But surely hope makes her life -- and the lives of those around her -- more livable. And perhaps she is correct in saying that surviving cancer is not simply a matter of courage; on the other hand, surely hope is real, and surely hope matters.