Bright-Sided by Barbara Ehrenreich Read Free Book Online
Authors: Barbara Ehrenreich
own—lived longer than those in the control group. Spiegel promptly interrupted the study, deciding that no one should be deprived of the benefits provided by a support group. The dogma was affirmed and remained so at the time I was diagnosed.
You can see its appeal. First, the idea of a link between subjective feelings and the disease gave the breast cancer patient something to do. Instead of waiting passively for the treatments to kick in, she had her own work to do—on herself. She had to monitor her moods and mobilize psychic energy for the war at the cellular level. In the Simontons’ scheme, she was to devote part of each day to drawing cartoonish sketches of battles among buglike cells. If the cancer cells were not depicted as “very weak [and] confused”and the body’s immune cells were not portrayed as “strong and aggressive,” the patient could be courting death, and had more work to do. 13 At the same time, the dogma created expanded opportunities in the cancer research and treatment industry: not only surgeons and oncologists were needed but behavioral scientists, therapists, motivational counselors, and people willing to write exhortatory self-help books.
The dogma, however, did not survive further research. In the nineties, studies began to roll in refuting Spiegel’s 1989 work on the curative value of support groups. The amazing survival rates of women in Spiegel’s first study turned out to be a fluke. Then, in the May 2007 issue of Psychological Bulletin , James Coyne and two coauthors published the results of a systematic review of all the literature on the supposed effects of psychotherapy on cancer. The idea was that psychotherapy, like a support group, should help the patient improve her mood and decrease her level of stress. But Coyne and his coauthors found the existing literature full of “endemic problems.” 14 In fact, there seemed to be no positive effect of therapy at all. A few months later, a team led by David Spiegel himself reported in the journal Cancer that support groups conferred no survival advantage after all, effectively contradicting his earlier finding. Psychotherapy and support groups might improve one’s mood, but they did nothing to overcome cancer. “If cancer patients want psychotherapy or to be in a support group, they should be given the opportunity to do so,” Coyne said in a summary of his research. “There can be lots of emotional and social benefits. But they should not seek such experiences solely on the expectation that they are extending their lives.” 15
When I asked Coyne in early 2009 whether there is a continuing scientific bias in favor of a link between emotions and cancer survival, he said:
To borrow a term used to describe the buildup to the Iraq war, I would say there’s a kind of “incestuous amplification.” It’s very exciting—the idea that the mind can affect the body—and it’s a way for the behavioral scientists to ride the train. There’s a lot at stake here in grants for cancer-related research, and the behavioral scientists are clinging to it. What else do they have to contribute [to the fight against cancer]? Research on how to get people to use sunscreen? That’s not sexy.
He feels that the bias is especially strong in the United States, where skeptics tend to be marginalized. “It’s much easier for me to get speaking gigs in Europe,” he told me.
What about the heroic battles between immune cells and cancer cells that patients are encouraged to visualize? In 1970, the famed Australian medical researcher McFarlane Burnet had proposed that the immune system is engaged in constant “surveillance” for cancer cells, which, supposedly, it would destroy upon detection. Presumably, the immune system was engaged in busily destroying cancer cells—until the day came when it was too exhausted (for example, by stress) to eliminate the renegades. There was at least one a priori problem with this hypothesis: unlike
You can see its appeal. First, the idea of a link between subjective feelings and the disease gave the breast cancer patient something to do. Instead of waiting passively for the treatments to kick in, she had her own work to do—on herself. She had to monitor her moods and mobilize psychic energy for the war at the cellular level. In the Simontons’ scheme, she was to devote part of each day to drawing cartoonish sketches of battles among buglike cells. If the cancer cells were not depicted as “very weak [and] confused”and the body’s immune cells were not portrayed as “strong and aggressive,” the patient could be courting death, and had more work to do. 13 At the same time, the dogma created expanded opportunities in the cancer research and treatment industry: not only surgeons and oncologists were needed but behavioral scientists, therapists, motivational counselors, and people willing to write exhortatory self-help books.
The dogma, however, did not survive further research. In the nineties, studies began to roll in refuting Spiegel’s 1989 work on the curative value of support groups. The amazing survival rates of women in Spiegel’s first study turned out to be a fluke. Then, in the May 2007 issue of Psychological Bulletin , James Coyne and two coauthors published the results of a systematic review of all the literature on the supposed effects of psychotherapy on cancer. The idea was that psychotherapy, like a support group, should help the patient improve her mood and decrease her level of stress. But Coyne and his coauthors found the existing literature full of “endemic problems.” 14 In fact, there seemed to be no positive effect of therapy at all. A few months later, a team led by David Spiegel himself reported in the journal Cancer that support groups conferred no survival advantage after all, effectively contradicting his earlier finding. Psychotherapy and support groups might improve one’s mood, but they did nothing to overcome cancer. “If cancer patients want psychotherapy or to be in a support group, they should be given the opportunity to do so,” Coyne said in a summary of his research. “There can be lots of emotional and social benefits. But they should not seek such experiences solely on the expectation that they are extending their lives.” 15
When I asked Coyne in early 2009 whether there is a continuing scientific bias in favor of a link between emotions and cancer survival, he said:
To borrow a term used to describe the buildup to the Iraq war, I would say there’s a kind of “incestuous amplification.” It’s very exciting—the idea that the mind can affect the body—and it’s a way for the behavioral scientists to ride the train. There’s a lot at stake here in grants for cancer-related research, and the behavioral scientists are clinging to it. What else do they have to contribute [to the fight against cancer]? Research on how to get people to use sunscreen? That’s not sexy.
He feels that the bias is especially strong in the United States, where skeptics tend to be marginalized. “It’s much easier for me to get speaking gigs in Europe,” he told me.
What about the heroic battles between immune cells and cancer cells that patients are encouraged to visualize? In 1970, the famed Australian medical researcher McFarlane Burnet had proposed that the immune system is engaged in constant “surveillance” for cancer cells, which, supposedly, it would destroy upon detection. Presumably, the immune system was engaged in busily destroying cancer cells—until the day came when it was too exhausted (for example, by stress) to eliminate the renegades. There was at least one a priori problem with this hypothesis: unlike