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What kind of life would you be living if you adjusted the world to yourself instead of—as most patients generally have done—adjusting yourself to the world? What kind of life and lifestyle would make you glad to get up in the morning and glad to go to bed at night?

These are questions Dr. LeShan asks his patients in order to open their eyes, to make a difference in their lives—and their cancer treatment. His methods get impressive results: over the past thirty years, approximately half of his patients with poor prognoses have experienced long-term remission and are still alive. Nearly all dramatically improved their emotional state and quality of life. This revised edition of Dr. LeShan’s groundbreaking book shows how you can start to change your life for the better—right now.

LAWRENCE LESHAN, PH.D., has been a research and clinical psychologist for more than half a century. A graduate of William and Mary, he is the author of more than a dozen books, including You Can Fight for Your Life: Emotional Factors in the Treatment of Cancer and The Mechanic and the Gardener: How to Use the Holistic Revolution in Medicine.

ALSO BY LAWRENCE LESHAN

The Psychosomatic Aspects of Neoplastic Disease
(coedited with David Kissen)

Counseling the Dying
(with Jackson, Bowers, and Knight)

You Can Fight for Your Life: Emotional Factors
in the Treatment of Cancer

The Mechanic and the Gardener: How to Use
the Holistic Revolution in Medicine

How to Meditate

The Medium, the Mystic and the Physicist

Alternate Realities

The Science of the Paranormal:
The Last Frontier

Einstein’s Space and Van Gogh’s Sky
(with Henry Margenau)

The Dilemma of Psychology

The Psychology of War

LAWRENCE LESHAN, Ph.D.

CANCER

AS A

TURNING
POINT

A Handbook for People
with Cancer, Their Families,
and Health Professionals

REVISED EDITION

ACKNOWLEDGMENTS

I wish to express my deep gratitude to Frederick Ayer II for his long support of this work. Without him this book would not have been possible. I owe a profound debt to the people with cancer who taught me all that I know over these last thirty-five years. My appreciation also to the increasing number of therapists all over the world who are using this approach.

I’d also like to pay tribute to my wife, Eda LeShan, who shared the joys and pains of this adventure and whose contributions to this book are very great.

PREFACE TO THE
REVISED EDITION

The second edition of Cancer as a Turning Point has been revised to include a special section of paper and pencil exercises. These are ways to evaluate where you are now in your life and to find new ways in which you might wish to change. I suggest you read the first three chapters of the book, then the workbook and, as you read the rest of the book, start doing the workbook exercises according to their instructions. This has been a helpful process for many people. However, if you feel that a different procedure would be better for you (such as reading the entire book first), by all means follow it.

Little new material about research in the field has been added to this new edition. The reason for this is that the book’s primary purpose—to help individuals with cancer mobilize their own self-healing abilities and bring them to the aid of their medical program—is still as much on the cutting edge of our knowledge as it was when the book was first published in 1989. I have added a few new case histories that help to make clear that the critical change needed to stimulate the immune system is an inner change. There must be a change in one’s fundamental attitude toward oneself—toward a strong belief that you are worth fighting for and taking care of as a special, unique person with your own special ways of being, relating, and creating.

The best of the new research that has appeared in recent years has presented results pointing out that psychological factors do play a part in how and when people become sick and how their immune systems function when they are sick. Psychological factors are certainly only one part of the process—no one “makes themselves sick” by how they behave or feel. Other factors such as heredity and the physical environment play a major role as well. It is important to remember that you are not responsible for becoming ill, and you are not responsible for your recovery. What you are responsible for once you are ill is to do your best to get better. This means getting the best medical treatment possible and changing your life so that your inner healing abilities will be stimulated at the highest level possible. I wish you the best in this endeavor.

PREFACE

Those closely involved with cancer—patients, families, friends, health professionals—very rarely have information in one crucial area: how to mobilize the patient’s self-healing abilities and bring them to the aid of the medical program.

This state-of-the-art handbook gathers, for the first time in one place, the known information on this subject. The book comes out of a thirty-five-year research project involving several thousand people with cancer. It is designed to teach those with the illness and their families, friends, physicians, clergymen, and psychotherapists how to use psychological change to help heal the patient’s compromised immune system.

I believe a serious problem has arisen in recent years. Despite professional background in associated areas, some individuals have a very limited knowledge of the field and have interpreted this approach as one that blames the patient for the illness. They say that in addition to the anxiety and pain of cancer, a new guilt has been added—guilt arising from a false idea, guilt that is an intolerable load for the patient.

These critics talk complete nonsense. Thoughts and feelings do not cause cancer and cannot cure cancer. But they are one factor, and an important one, in the total ecology that makes up a human being. Feelings affect body chemistry (which affects the development or regression of a tumor), just as body chemistry affects feelings. The emerging science related to the nature of the immune system has merely reinforced the belief that certain kinds of stress lower the ability of the body’s chemistry to withstand disease. There is, as William James once remarked, no clear dividing line between a person’s philosophy and physiology, between mind and body. All the different aspects of a person interact with, and influence, each other.

What we have learned is that the immune system is strongly affected by feelings, and that taking certain kinds of psychological action can affect the immune system positively. Sometimes this makes a crucial difference in how well the medical program works. To put it in other words, there are certain psychological steps people with cancer can take to increase their self-healing and self-repair abilities and bring these more strongly to the aid of the medical program. Whether or not this will make a crucial difference in a patient’s return to health depends on the total situation, including such factors as genetic endowment and the life experiences the person has had since birth.

In this approach, the patient is not blamed in any way for the cancer. Anyone who even hints that the person with cancer is responsible for getting it and/or for not getting better is not only the rankest amateur and should be completely ignored, but is setting in motion confusion, anxiety, and anger at the self. And those who hint that this approach increases the guilt of the patient simply do not know what they are talking about.

While there is still much to learn about the subject, we do know one additional fact: the same psychological approach that leads to the fullest effectiveness of the immune system is the approach that leads to the fullest and richest life—both during the time a person has cancer and afterward.

The form of this book has been strongly influenced by my experience in five or six dozen seminars on the subject that I have given over the past twenty years. These were from one to three days in length, and each included fifty to one hundred participants. For the first five years I did two kinds of seminars: one for cancer patients and their families, and the other for health professionals. Then, by mistake, a seminar notice was poorly worded and the group that showed up was half patients and family members and half health professionals working in the cancer field. I found this out ten minutes before the meeting started. My anxiety level hit record heights! Not knowing what else to do, I announced to the group that part of the time I planned to work with them as if they were all people with cancer and the rest of the time as if they were all professionals in the field. For all concerned, the seminar was the best and most exciting that I had ever given.

Since then, I have used this format wherever possible and, judging by the reactions of the people involved, it has been highly successful. Because of this rewarding experience in “mixed seminars,” I decided the only way to write this book was for a mixed audience as well.

You will find that in any specific section of this book, I may be more directly addressing the patient, the family member, or the professional. This is deliberate. We do not live in a vacuum. The heart of the modern holistic approach is that all levels of a person’s being, their physical, psychological, spiritual aspects, their relationships and their environment, are important and none can be ignored without peril. It is only by approaching the problem of cancer from the viewpoint of the person who has the illness, of the family, and of the health professional that we can see how to best mobilize the healing and self-healing resources available so that the medical program can be most fully effective.

This is not mere speculation. Over and over again I have seen one of two things happen when the total environment of the person with cancer is mobilized for life and his or her inner ecology is thereby changed in a positive way. For some, the patient’s life is prolonged, not in an arbitrary way, but in order that there may be more experience of the self, self-recognition and the recognition—and often fulfillment—of dreams. And then there were the genuine miracles—not magic, but dedicated devotion and hard work which made the cancer a turning point in the person’s life rather than a sign of its ending. The more we learn about human biology and psychology, the more we learn about how to change and improve the quality and ambience of life both internal and external, the more this second result may become commonplace. That surely is the hope of this book.

1

THIRTY-FIVE YEARS OF MIND-BODY CANCER RESEARCH

. . . let me speak to you regarding the things of which you must most beware. To get angry and shout at times pleases me, for this will keep up your natural heat; but what displeases me is your being grieved and taking all matters to heart. For it is this, as the whole of physic teaches, which destroys our body more than any other cause.

Letter written by
MAESTRO LORENZO SASSOLI, a physician,
to a patient in 1402*

Maria was a Brazilian physician who loved her work as a pediatrician. Her husband was an electrical engineer who wanted only to be a poet. He hated his field of work, at which he was actually quite successful professionally. Their twin daughters, aged fifteen and a half when I first saw Maria, were apparently of very high artistic caliber. Both wanted to be actresses and had already had minor parts on the stage in small theaters.

When the daughters were ten, their talent was recognized by a well-known theatrical director. It crystallized Maria’s decision to leave the Rio de Janeiro she loved so much and emigrate to London, where her daughters could receive the best education in the theater and where her husband could devote himself full time to his poetry. She told me she had not been “back home” since her arrival in England.

Maria could not, however, find work in London as a pediatrician that would bring in the necessary income for the needs of her family. The position she had been promised failed to materialize at the last moment.

She was offered a position with an adequate financial return in an oncology partnership, where she would deal chiefly with children and young people suffering from the childhood leukemias, Wilms’ tumors, and so on. She disliked the work intensely, but continued it in order to support her husband and daughters. She also hated London and constantly missed Rio, where she had grown up. She described with enthusiasm and gusto the lovely beaches, the gentle climate, the easygoing and tolerant attitudes of the people, the striking architecture, and the friends she had had there: “I always felt at home wherever I was in the city. Every street felt like my own living room.” She even missed speaking in her own language, she told me rather shyly.

At the age of forty-eight, she noticed a lump in her breast. She did nothing about this for over a year. By the time she had it examined by a professional colleague, it had grown several times larger. The diagnosis was adenocarcinoma of the breast. In her and her colleague’s opinion, the metastases were too widespread for surgery to be an option. A course of chemotherapy was decided on, but everyone agreed that the prognosis was very poor.

I was speaking at her hospital in London during this period, and afterward she asked me for a professional appointment. We talked for an hour about her history and about her hopes and fears for the future. She saw no possibility of work that she would enjoy, of living where she would like to, or of a life that would make her glad and excited to get out of bed in the morning. Her husband and her children were very happy with their lives and she was successful enough to enable them to continue it. Rather brutally, because I felt I had to shock her into taking some action on her own behalf, I asked her how she planned to continue supporting them in the style to which they had grown accustomed after she was in the cemetery, as her cancer prognosis was so poor. She looked completely defeated. After a long pause she said: “I know I can’t do it anymore. I had hoped that you would know a road for me.” Her sadness and despair moved me deeply, and for a few minutes we both just sat there.

I then said that I could see no reason for her body to work hard to save her life, no reason for it to mobilize her immune system and bring its resources to the aid of the chemotherapy. By her actions, she was telling her body that it was always someone else’s turn and never hers. Everyone else would be taken care of except her. Clearly she was telling herself that she was not worth fighting for. She listened, thought a bit, and then said, “It’s sort of as if I keep telling myself that for me it’s always jam yesterday and jam tomorrow, but never jam today.” We agreed about this message and sat in sad and companionable silence for a while.

It was clearly an emergency situation. She was in very bad shape both physically and emotionally and clearly going downhill on both levels. There was little to lose. I would be leaving London in a few days and I have never been very good working over the telephone or by mail. The philosopher and spiritual leader Edgar Jackson has pointed out that in some situations, the careful man is only a short step away from the paltry man. I told Maria the story of the woman who was sunbathing nude. A lovely chickadee flew down and perched on her ankle. She smiled lovingly at it. Then a great orange-and-black butterfly alighted on her knee. Again she smiled warmly. A magnificent dragonfly with its iridescent wings settled on her shoulder. It also received her welcoming smile, as did a beautiful goldfinch that came down and perched on her toes. Then a mosquito came down, settled on her breast, and bit her. She looked at it and said, “All right. Everybody off!”

At the punchline, Maria laughed much harder than the joke deserved. Then she sat apparently thinking very intently for several minutes. Finally she looked at me and an impish and devilish grin spread across her face. “Do you think I really could?” she asked.

She was as ready for action as a tomcat with its tail up. She had only needed a direction and a trigger. I had provided the direction in my lecture, and our discussion was the trigger. It was a pleasure to watch her move. I had heard of the “fiery, tempestuous Brazilian personality” before but had never expected to see the stereotype in full bloom.

That night Maria called a family conference and announced (apparently in no uncertain terms) that it was her turn now. Changes would have to be made as she could no longer afford to support her entire family. If she died they were all on their own anyway, so they might as well all take a desperate and final chance to help her immune system come to the aid of the chemotherapy. She had, she told them, been an oncologist long enough to know that with a cancer like hers, this was the only chance. In order to help this happen, there needed to be some major changes in her and their life-styles.

First, she said, her husband: quite a number of successful poets had supported themselves by working at regular jobs. If he wanted to follow the example of his particular idol, Edwin Arlington Robinson, and work as a ticket seller in the Underground, this was fine with her, but she felt he would do better as a draftsman or something like that even though he’d been away from engineering for eight years. Then, the children: they were going to leave the special private schools they had been going to and go to regular public schools. They could continue some of their private acting lessons, but would also have to get part-time jobs if this were at all possible, and even if it weren’t! Certainly they could work as salesgirls, waitresses, or whatever during summer and Christmas vacations unless they had professional employment. The maid would go and all of them would pitch in with the housework. She herself was going to give up her job, take a residency in pediatrics in order to catch up with the latest techniques, and then take it from there. Moving back to Brazil when the twins were established and on their own was left as a possibility for the future.

It must have been quite a family meeting. By the end of it everyone had agreed to the new agenda and, Maria told me, “with a lot less upset and resistance than I expected. I found that they cared for me, loved me, even if I couldn’t support them anymore. I’m surprised to find out that this surprised me!”

In the next six months her husband obtained a fairly low-level job in an engineering firm. He said it demanded little of him and left him with a good deal of energy for his poetry. (He had, over the years, been reasonably successful at this—he’d published two volumes of his poems and also poems in a number of magazines. These books paid him the very small amount that books of poetry generally do.) The daughters did get part-time jobs and expressed a good deal of resentment about having to do so. They complained in typically adolescent fashion and constantly had to be reminded about their household chores. Both paid for their acting lessons and also obtained a number of small jobs making television commercials and in obscure, avant-garde theaters. Maria resigned from her oncology position and took a residency in pediatrics. After a year she began working full time in this field. She was paid far less than she had earned in oncology, but enjoyed it far more.

At my suggestion, she had also consulted a nutritionist in order to upgrade her diet and to help both to potentiate the chemotherapy treatment and to avoid the worst negative side effects.

I kept in touch with her. The chemotherapy program worked far beyond expectations. The tumor masses shrank but did not disappear. At present, four years later, the medical situation seems at least temporarily stabilized and is on a watch-and-wait basis. She feels that her life is rich and exciting. Summer vacations have been spent in Rio de Janeiro. Since money is so short she has gone by herself most of the time. They have not yet decided whether or not to move back there in the next few years.

The work that led to this book began in 1947 when a psychologist friend of mine, Dr. Richard Worthington, told me that he had been looking at personality tests of several people with cancer. He felt that their emotional life history somehow played a part in the development of their illness, and that this should be investigated. Dick is the best person with these kinds of personality tests I have ever known—he has a brilliant and profound understanding of them—and I had learned never to ignore anything of this sort that he said. I tucked the idea away in the back of my mind for future exploration.

Two years later I was back in the army.* Working in a very depressing job in an army mental hygiene clinic in Arkansas, I needed something interesting to fill my mind. I went back to Dick’s idea and began to examine it.

The County Medical Society had a library that had been started in the early 1800s. Since then, all the local physicians had willed their books to it. I began to go there evenings. Looking at the data with a psychologist’s eye, it seemed clear that psychological factors might very well have played some part in at least a good percentage of the cancer statistics.

The higher cancer mortality rates for widows and widowers that were not related to age, occupation, reproductive accomplishment, diet, or any other obvious factor were only one example of the evidence that there was something here worth looking into.

When I again left the army two years later, I talked to Dick about what I had found. He was impressed. He called a group of businessmen together, we both made a pitch, formed a foundation, and raised enough money to support me half time for a year. I stayed on the project full time for fourteen years and part time for another twenty-two. This book is the result of that work.

As I began to work intensively, the first thing I found was that up to 1900 the relationship between cancer and psychological factors had been commonly accepted in medical circles. I went through the major cancer textbooks of the nineteenth century (using the old rule of thumb that if it went through three editions, it qualified as a major textbook). All but one of the nineteen I found said the same thing: “Of course, the emotional life history [they used a lot of different phrases for this, but the meaning was the same] plays a major role in the tendency of the person to get cancer and in the progress of the cancer.” In my 1959 review of this literature for the Journal of the National Cancer Institute, my problem was not to find statements of this kind but rather to select which of the many ones to quote.

What had happened was plain. Dedicated nineteenth-century physicians working with cancer patients had none of the sophisticated instruments and devices we have today. Without biochemical tests and without X rays, to say nothing of CAT scans (computerized axial tomography) and the like, they had to listen to their patients in order to learn what was going on. And in this listening, they heard about the patient’s feelings and history. The factors of great emotional loss and of hopelessness occurring before the first signs of the cancer were so repetitive and frequent that they could not be ignored.

Here is not the place to review that extensive literature.* A few quotations from my article are in order, however, to give some of its flavor.

As early as 1759, Gendron stressed the importance in cancer of “Disasters in Life, as occasion much trouble and grief.” He presented a long series of cases, typical of which are the following:

Mrs. Emerson, upon the Death of her Daughter, underwent Great Affliction, and perceived her Breast to swell, which soon after grew Painful; at last broke out in a most inveterate Cancer, which consumed a great Part of it in a short Time. She had always enjoyed a perfect state of Health.

The Wife of Mate of a Ship (who was taken some Time ago by the French and put in Prison) was thereby so much affected that her Breast began to swell, and soon after broke out in a desperate Cancer which had proceeded so far that I could not undertake her case. She never before had any complaint in her Breast.

In 1802 a group of the leading physicians in England and Wales formed an organization with the optimistic and cheerful name of The Society for the Prevention and Cure of Cancer. They published a list of eleven questions, each describing an area in which they felt the need for further research. One of the questions was “Is there a predisposing temperament?”

In 1846 Walter Hoyle Walshe published his treatise The Nature and Treatment of Cancer. This became the definitive work of the period. He covered all that was then known about the subject. Walshe was a highly trained and respected man and “. . . apparently was conversant with all that had been written and said about cancer to his time.” Walshe posed his viewpoint clearly and forcefully:

Much has been written on the influence of mental misery, sudden reverses of fortune, and habitual gloominess of temper on the deposion of carcinomatous matter. If systematic writers can be credited, these constitute the most powerful cause of the disease; . . . although the alleged influence of mental disquietude has never been made a matter of demonstration, it would be vain to deny that facts of a very convincing character in respect to the agency of the mind in the production of this disease are frequently observed. I have myself met with cases in which the connection appeared so clear that I have decided questioning its reality would have seemed a struggle against reason.

Walshe made certain recommendations to members of families with a history of cancer, which illustrate the strength of his belief in this viewpoint. He advised them to use great care in their choice of professions, avoiding those

. . . the active and serious exercise of which entails a more or less constant care and anxiety. The importance of this consideration appears from what I have said on the influence of mental suffering in generating the disease. For this reason, the professions of the Bar, Medicine and Diplomacy should be avoided. . . . All things considered, the professions of the Army, Navy and the Church, unless there be some special objection, offer the best chance of escape from the diseases to individuals predisposed to cancer.

By implication, Walshe was clearly stating that a genetic readiness plus a long-term psychological stress results in cancer.

In this country, Willard Parker summed up in 1885 his fifty-three years of surgical experience with cancer.

It is a fact that grief is especially associated with the disease. If cancer patients were as a rule cheerful before the malignant development made its appearance, the psychological theory, no matter how logical, must fail: but it is otherwise. The fact substantiates what reason points out.

Long before this, Sir James Paget, in his classic Surgical Pathology, had written:

The cases are so frequent in which deep anxiety, deferred hope and disappointment are quickly followed by the growth and increase of cancer, that we can hardly doubt that mental depression is a weighty additive to the other influences favoring the development of the cancerous constitution.

Sir Thomas Watson in 1871, phrased his conclusion as follows:

Great mental stress has been assigned as influential in hastening the development of cancerous disease in persons already predisposed. In my long life of experience, I have so often noticed this sequence that I cannot but think the imputation is true.

Herbert Snow, working at the London Cancer Hospital, was deeply impressed by Paget’s view as well as the reports of other predecessors. In three books written in 1883, 1890, and 1893, he presented in detail his research findings and his concepts. In his last book, he wrote:

We are logically impelled to inquire if the great majority of cases may not own a neurotic origin? . . . We find that the number of instances in which malignant disease of the breast and uterus follows immediately antecedent emotion of a depressing character is too large to be set down to chance, or to that general liability to the buffets of ill fortune which the cancer patients, in their passage through life, share with most other people not so afflicted.

The physicians who wrote these statements were the leading specialists of the time. Their names are even today well known in medical circles.

Thus the fact that cancer and the patient’s emotional life history were linked was commonly accepted in medical circles up to 1900. At that point, this viewpoint began to disappear very rapidly from the textbooks and journals. There are a number of reasons for this. The psychosomatic viewpoint had been going more and more out of fashion for fifty years. Further, surgery that was both painless and antiseptic had been developed in the preceding fifteen years and was now making its big bid as the way to deal with cancer. Surgery focuses our attention on cancer as a local disease of a specific part of the body and not as one aspect of a total human being’s functioning, which is the essence of the psychosomatic view. Radiation, coming along shortly thereafter as a therapy method, reinforced this concept of cancer as a local body problem.

Another reason for the change was that a psychosomatic theory was useless at this time. Psychiatry was barely into the descriptive phase, and there were no tools with which to explore the matter further or to use to try to intervene in the processes involved. There was simply nothing to do with the information on the mind-body relationship in cancer—no techniques available to use to make it useful.

So, gradually, the idea that cancer was related to the total life history of the person disappeared from the literature and from the currently accepted concepts in medicine. A few physicians tried to keep it alive, but to no avail. For half a century it was almost unknown.

The situation has now changed completely. Since 1955 literally dozens of studies have shown conclusively that the emotional life history often does play an important part in determining an individual’s resistance to getting cancer and in how a cancer develops after it appears. It is certainly not the only factor and does not play a part for every person with cancer by a long shot, but every cancer patient’s emotional life history should be considered. Further, we now have the techniques and tools to explore the matter much more deeply, and many such studies have been undertaken. These studies are both retrospective (exploring patients’ emotional life history after the cancer appeared) and prospective (predicting the future from psychological factors) in nature. A good example of the predictive studies is the work of Ronald Greer and his group. Greer interviewed a number of women who had had mastectomies. On the basis of the interview (three months after the operation) he divided them into classes according to their attitudes. He then simply observed what happened to the women for over fifteen years. He found out that, as he had predicted, some classes showed a statistically significantly higher survival rate than others. For example, the “feisty” (I’m going to lick this thing and no one is going to stop me) group showed a far higher survival rate than the “apathetic” (My life is over and nothing is worthwhile any longer) group.

A great many studies are now available. A list of some of the most significant and of some reviews of this literature is presented in the Resource Directory. A recent study by David Spiegel and others reported in The Lancet shows that psychological treatment had a definite, positive effect on women with metastasized breast cancer.

However, at the time I started the research that led to this book, the present-day literature was skimpy indeed. There were no guidelines that could be depended on. All I knew was that there were enough strong clues to make the subject really worth investigation.

In 1952, with a research grant and enough clinical and research training to do legitimate work, I applied to the leading hospitals in New York City. I fully expected to have no difficulty in finding a place to work, since the purpose of the grant was simply to investigate the fruitfulness of looking at cancer as a disease whose presence and development were influenced by personality factors. To my surprise, the first fifteen hospitals I applied to turned me down, sometimes with shocking rapidity. One chief surgeon of a large hospital told me “Even if you prove it [that there is a relationship] in ten years, I won’t believe it!” There seemed no particular reply I could make to that statement.*

Soon, however, I developed an excellent working relationship with Dr. Emanuel Revici and his Institute of Applied Biology, and for the next twelve years I worked full time with his patients.

I started with psychological interviews (of two to eight hours in length) and various kinds of personality tests. As I progressed I reported my work in psychological and psychiatric journals. After a number of years, I moved very gradually into psychotherapy work with the patients of the Institute and of Trafalgar Hospital. It seemed to me then, and it still does, that the best way a professional can get to know people, their history and the world in which they live, is to be involved in a psychotherapy process with them. The stories of people with cancer that I present throughout this book are typical of the people I worked with for over thirty-five years.

The single thing that emerged most clearly during my work was the context in which the cancer developed. In a large majority of the people I saw (certainly not all), there had been, previous to the first noted signs of the cancer, a loss of hope in ever achieving a way of life that would give real and deep satisfaction, that would provide a solid raison d’ětre, the kind of meaning that makes us glad to get out of bed in the morning and glad to go to bed at night—the kind of life that makes us look forward zestfully to each day and to the future.

Often this lack of hope had been brought into being by the loss of the person’s major way of relating and expressing himself or herself and the inability to find a meaningful substitute. Now the meaning of the statistics showing the higher likelihood of cancer in widows and widowers, regardless of age, began to be clear. Among the widowed were many who had made the spouse, the marriage, the central focus of their lives; it was what gave meaning to their existence, and after the spouse died they could find no other way to express themselves. Similar was the explanation for the fact that for men, the highest peak of cancer came shortly after retirement age, whether that age was sixty, sixty-five, seventy, or any other.* In married couples, the cancer mortality rate for both men and women was higher among those who had had no children than it was among those who did. I am certain the explanation of this is that when the relationship between the spouses was lost, but they stayed together for religious or other reasons, the children provided a good way of relating for many. It was also lower among those married couples who made the spouse the beneficiary of their insurance policies than those who did not!

I was able to make over thirty predictions on statistically reliable differences in cancer mortality rates in various groups. I could predict which groups would have a higher rate of loss of a major way of relating; according to my predictions, this group would also have a higher mortality rate. Whenever these predictions could be checked against published statistics, they were proved correct. (The professional publications on these findings are given in the Resource Directory.)

With many other individuals I saw and worked with, there had been no objective loss of a relationship, but there had been a loss of hope that the way that they used to express themselves, and the relationships they had, would ever give the deep satisfaction they wanted so much. No matter how successful they were, no matter how high they climbed in their profession, they found that it did not provide fulfillment. They could not find lasting zest and pleasure in their success and eventually had given up hope of ever finding it. The profound hopelessness was, in many of the people I saw, followed by the appearance of cancer. Over and over again I found that the person I was working with reminded me of the poet W. H. Auden’s definition of cancer. He called it “a foiled creative fire.”

As this pattern became clearer, I also began to work with control groups, people without cancer to whom I gave the same personality tests and worked with in the same way in psychotherapy. Over a period of many years, I found this pattern of loss of hope in between 70 and 80 percent of my cancer patients and in only 10 percent or so of the control group.

Sydney was a successful businessman whose high drive and a wide-ranging and quick intelligence had helped him achieve a very high position in his field. He had always believed in keeping the channels of promotion open in his company for new blood and new ideas, so, at sixty-five when he had been chief executive officer and chairman of the board for five years, he retired. When I asked him several years later what he had expected to do with his still-high energy level, he looked a little blank and said that he had thought tennis and golf would be wonderful and that now he would have had a chance to play as much as he wanted to.

Indeed for a year he did play both of these a good deal. He was a natural athlete and before World War II had played Class A baseball with a good chance of going to the major leagues; the draft and a stint in the paratroops ended this option. Sydney still played well and was much in demand from the members of a number of country clubs to play golf and tennis with them. Although he had looked forward to this life, it still left him unsatisfied and feeling increasingly empty and “drifting.” He couldn’t understand it; all his life he had loved sports and looked forward to the time when he would have enough leisure to spend all his time at them. Now it was somehow not enough. He was hungry for something, but did not know that.

Then Sydney went to Scotland with a group to play at one of the great golf courses there. At a luxurious hotel he played golf with a very congenial group every morning and tennis most afternoons. The weather was pure gold and wonderful. After five days he woke up one morning and found, to his shock and surprise, that he was wishing it would rain so that he would not have to continue his schedule.

At around this time he began to develop some digestive symptoms and after a medical workup was diagnosed as having cancer of the small intestine.

After finishing with both surgery and the course of chemotherapy that followed it, Sydney sat around the house a good deal, watching television and reading newspapers. He felt vaguely depressed and lost. Nothing interested him very much. He felt tired and run-down all the time. A year after the chemotherapy was completed a new metastasis was found and a second course was instituted.

During this period we began to work together. A friend of Sydney’s had suggested a consultation with me and he agreed. We liked each other and began to work in ninety-minute sessions three or four times a month. That seemed to both of us the most useful and meaningful pace for him.

Sydney’s main problem was his constant tiredness. Rest did not seem to help him. We discussed the fact that there are two separate kinds of exhaustion. For acute exhaustion one needs rest and sleep. For chronic exhaustion—such as he was suffering from—an entirely different prescription is needed. What is required here is a change in the person’s complete ecology—a change in energy intake and outflow. Chronic exhaustion is much more likely to be mostly caused by a blocked energy flow than it is by a lack of energy. The tiredness is generally a result of a lack of available energy due to blocked expression channels rather than a result of a lack of energy in the organism. At one point in our talks Sydney said to me: “It’s true that taking it easy does not restore my energy, even after months of it. I just get more tired. I guess one trouble with doing nothing is that you can’t stop and rest!”

As we worked on and explored this area, it became increasingly plain that he had lost the context and meaning of his life. Starting out in the heart of the Depression, and coming from a poor family, he had focused his whole being on business. He had loved it and brought to it a high drive and a high ethical standard. It had been the center of his existence and gave him purpose, a sense of himself, and a reason to get up in the morning. Without this, nothing had any real meaning for him. He felt that he could have borne any other loss and still, after a time at any rate, gone on with his usual zest and enthusiasm. I gave him the great speech of Shakespeare’s Othello to read. Othello has just come to the conclusion that the most meaningful thing in his life, his relationship with Desdemona, was lost and that she had been unfaithful to him. He says that if he had been wounded, unjustly accused of crimes, imprisoned, lost his position as general, or any other thing:

Yet I could bear that too; well, well:

But there, where I have garner’d up my heart,

Where either I must live, or bear no life;

The fountain from the which my current runs,

Or else dries up; To be disgarded thence!

Sydney read it over once, line by line, getting the meaning. Then he read it again with deep feeling. “When you lose what is real for you,” he said, “nothing else matters very much. You might as well be dead.”