Disease Doesn’t Mean You’re A Bad Person

Very early in my career, I participated in a study of young women who were hospitalized and awaiting the results of biopsies to determine if they had cervical cancer. While I was interviewing one of my patients, the biopsy results of the woman in the next bed came back to her — negative. The fortunate woman’s father, who was there with her, said in relief: “We’re good people. We deserve this.” It was a perfectly understandable response, but what should my patient have said to herself when her biopsy came back positive? That she got cancer because she wasn’t a good person?

It is difficult enough to be injured or gravely ill. To add to this the burden of guilt over a supposed failure to have the right attitude toward one’s illness is unconscionable. Linking health to personal virtue and vice not only is bad science, it’s bad medicine.
—- Richard P. Sloan

I understand that people want to believe they have control over their own health.  I understand that choosing a positive attitude can be a coping mechanism.   But we don’t have a duty to have the “correct attitude” about illness.

26 thoughts on “Disease Doesn’t Mean You’re A Bad Person

  1. You’ve touched on a sore point!

    I’m undergoing cancer treatment and I get the ‘just stay positive’ all the time. I know people mean well, but I often think that people peddle the ‘think positive’ mantra because it’s important for THEM that a cancer/sick person stays upbeat. Who wants to cope with someone who is terrified or depressed?

    On top of that, it’s just flat out wrong that right thinking equals health. That’s just believing in magic. I shared a hospital room with a woman who was the most miserable person I’ve ever met. According to her, she had nothing to live for. Yet she thrived, despite having cancer, and I have no doubt she will go on to have a long and miserable life. Yet there are wonderful, positive and vibrant people who die all the time.

    The best way to stay healthy is to be born with a healthy body and try not to mess it up too much.

    • Even that doesn’t help all that much… I mean, you can be born as healthy as a human can be, you can eat the “perfect” diet, exercise the “perfect” amount, and do everything humanly possible to avoid all risk of all sorts… and get killed crossing the street because someone decided he needed to chug a six pack of beer before heading out. Or your house could fall in a sinkhole. Or a meteor could hit your town. Or you could trip and fall down the stairs and break your neck. Etc.

      The best way to stay healthy is to not be born at all… everyone else will eventually be “not healthy” in some way or the other. Because everyone dies.

    • I work for a company that does medical research, and a positive attitude and a loving support system make a huge difference in outcomes from some diseases. It’s not a guarantee of anything – sad or miserable or selfish people can live a very long time and happy or energetic or unselfish people certainly do die quickly. But generally speaking, a positive attitude is just one more helpful influence.

      That said, knowing that a positive attitude helps versus actually maintaining a positive attitude in the face of a terrible illness are two totally separate things.

      • Hang on… you’ve mentioned two separate things there. A positive attitude and a loving support system are completely different.

        Of course a good support system will help in health, particularly where serious diseases are concerned. In fact, it’s crucial. I can honestly say I would have died without my partner, because when I was extremely sick he rushed me to hospital. I was too ill and incoherent to pick up the phone and call an ambulance. He also kept up a stream of cooking and shopping that I was incapable of doing, and monitored my medication and made sure I got to my appointments. Life saving stuff.

        Positive thinking, on the other hand, is a form of magical thinking. It also, can I say from experience, puts an unnecessary burden on cancer sufferers to stay ‘positive’ and twinkly, when it isn’t always appropriate. Also, what does it say about people who die? That they’re not strong minded enough?

        There is no clinical evidence that says patients with a positive attitude do better:
        http://www.nytimes.com/2011/01/25/opinion/25sloan.html?src=me&ref=general

        • I made two mistakes with my previous post. First, the article linked above does make a strong case that attitude makes no difference in cancer survival. I had extrapolated that, and I guess I was wrong. Second, I had misremembered the specifics of the research I was using for my data, and it was not focused on a positive attitude, just the presence or absence of depression.

          I can’t find a free version of the full article, but this is the beginning of one from 2006 on heart disease patients: http://archinte.ama-assn.org/cgi/content/extract/165/11/1214?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=%22Screening+for+Depression%2C+This+is+the+Heart+of+the+Matter%2C%22&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT (The page may pop up an ad, if so I apologize. If WordPress scrubs the link, please do a search on “Screening for Depression: This Is the Heart of the Matter” at the Archives of Internal Medicine website.

          I work at one of the companies involved in the cardiac research presented in the article, and depressed cardiac patients are statistically more likely to be hospitalized than non-depressed cardiac patients. Depression was a more accurate independent predictor of mortality than medical diagnosis (!)

          (Again, depression and the lack of a positive attitude are two very different things.)

  2. If it helps someone get through the day to think that their personal virtue or their relationship with a deity or hell their practice of taping little paper hearts in all four corners of every windowpane in their lives is the reason they survived whatever or didn’t get whatever… fine and dandy by me.

    When I have an issue is when they start claiming that anyone who does get whatever or doesn’t survive whatever is because they “deserved” it. Because they weren’t the right kind of virtuous, or they didn’t bend knee to the right god, or their little paper hearts weren’t the right shade of pink and they forgot the back window in their car.

    Nobody deserves to feel sick, nobody deserves to get cancer or whatever, and nobody deserves to be treated like shit because some other douche thinks they’re not suffering enough.

  3. If you’ll forgive me for going on a political tangent, I think the attitude that good things happen to good people and bad things happen to bad people is very dangerous. Fostering that attitude is what allows politicians to justify cutting social welfare programs.

  4. I have mental health issues, and just like there are supposed to be “good fatties” (the ones who are TRYING SO HARD to lose weight) and “bad fatties” (those who aren’t TRYING SO HARD) there are also “good crazies” (the ones that have an OH SO POSITIVE attitude in spite of their mental illness) and “bad crazies” (the ones who admit to being depressed and angry)
    I guess I fall into the Bad Crazy and Not Particularly Good Fatty category. A lot of the time I feel that being mentally ill is just plain shit, and no, the Magic Medicines don’t work to turn me into a Stepford Crazy. Most of them literally make me psychotic, which I normally am not.
    I have actually had people say to me that if I “just let Jesus into my life” than my mental illness would be cured. Really. I guess that’s why there are no mentally ill Christians. Why didn’t I think of it sooner?

    • I’ve been ridiculously lucky in my life. I had some friends tell me, “God has blessed you.” I respond, “No, I’m just lucky. Because if God explicitly blesses me, then it must mean God explicitly curses the 35,000 people that starve to death every single day.”

      God may well be watching us, and Jesus may well be the true Son of God. But it’s crystal clear that God and Jesus have a strict hands-off approach to humanity. Because if they were directly involved in influencing human events, allowing all of this suffering around the globe would prove them to be evil.

      • “But it’s crystal clear that God and Jesus have a strict hands-off approach to humanity. ” Yes, that’s precisely what I think of religion. I am a die-hard agnostic–nobody can prove or disprove the existence of God to me. But if God does exist, then I totally agree with what you say!

  5. i have lupus, and i have been amazingly lucky in the support i have found from the vast majority of my friends and family, and a WONDERFUL medical team who truly looking out for me. everyone always comments on my positive attitude and how much it must help me deal with the day to day.

    and to a certain extent, it does. it’s one of those situations where you’ll cry if you don’t laugh.

    at the beginning i tried to keep my “game face” on the whole time. i didn’t let anyone see how i really felt. after a few months, i decided to forget about that. i didn’t ask for this disease. it almost killed me. and it has placed pretty severe restrictions about what i can do in the future. i don’t owe it to anyone to be strong and brave in public all the time. thankfully i’m not scared to death ALL THE TIME anymore, but hell, my good days don’t even compare to a healthy person’s bad days. i can be grumpy if want.

    and i don’t owe it to anyone to try to be as healthy as possible. i will exercise when and if i can. i will experiment with a paleo-diet when and if i can. and i will eat cookies for breakfast if i damn well feel like it because all the medicines i’m on make me physically crave sugar, fat, and carbohydrates.

    speaking of doing what i want, i am going to take my lupie butt up to the student lounge and nap on the couch because i barely slept last night and i’m flaring and having a cold. *grump*

  6. To no one in particular: there may or may not be a positive correlation between depression and other diseases, but correlation in itself tells us nothing. People naturally want to believe they (we) have control over the outcomes of events, that our own actions and behaviors (and, apparently, our thoughts) can determine the course of reality. We hope that what we do…matters. The human condition, for all its beauty and tragedy, remains one of vulnerability. We need each other. And sometimes there is no one.

  7. I understand why people so instinctively jump to this kind of thinking. The idea that we are in control of our fates through “right living” or positive thinking gives us the illusion that we are in control of our lives and our health when in fact there are many factors that we have no control over. In my experience, most people like to believe that we are in control of the scariest aspects of our life and that leads to a lot of these potentially harmful beliefs that positive thinking can cure cancer and poverty and so on… and that people who suffer somehow deserve their suffering.
    While I agree that positive thinking can be extremely helpful, life is far more complex and out of our control than most people would like to believe.

  8. I think it was Pattie Thomas who said something the other day that “influence” over health is not the same thing as “control.” Internal stress (stress in response to situations you actually do have control over, or even irrespective of actual events) can definitely exacerbate certain health problems, particularly cardiovascular and digestive. And sure, if you’re the kind of person who’d try anything to beat refractory cancer, no matter how experimental or risky, you might have better odds of survival than somebody who just takes the diagnosis and says, “Well, I’m fucked.”

    But attitude alone? No way. External stressors make a huge difference in health (do you still have to drag yourself to work sick or injured because you can’t afford not to? are you stuck living in a place where there’s a lot of pollution and mold and icky stuff like that? do you have to deal with the daily burden of being rejected constantly because of the stigmatized group(s) you belong to?), but as a society, we’re not yet ready to explore all the ways we make each other sick. So much easier to assign individual blame, it’s like skipping over the crack in the sidewalk and feeling safe for just that precious few minutes.

  9. ” But we don’t have a duty to have the “correct attitude” about illness. ”

    If you do not believe in feeling postive about a terminal illness, that is your perogative (although it can’t hurt to stay positive since negative thinking can and does increase stress which is immunosuppressive). However, this statement that I quoted might have very dangerous implications. As a physician, I would want to know the following: if you do not have the ‘correct’ attitude, are you less likely to comply with your treatment plan?

    — Anonymouse, Fourth Year Medical Student

    • I realise you mean well, but my hackles are rising at the idea that if I don’t have a ‘correct’ attitude, I might not be seen as a ‘good’ patient.

      There is no such thing as a ‘correct’ attitude. We’re human beings, which mean we have a full range of emotional responses. Insisting on some faux emotion, like ‘thinking positive’, in the face of a catastrophic illness, can do great harm, because it denies real feelings.

      I shared a room with a 24 year old student who was riddled with bowel cancer. She lay on her bed crying non-stop. These silent tears just slipping out of her eyes. You know what turned out to be really good treatment for her? A hug from a nurse, and an acknowledgement that she was perfectly entitled to be lying there crying, because there is NOTHING positive or fair about suffering (and possibly dying) from a horrible disease at a young age.

      All these variants on positive thinking: the idea that serious illness brings a ‘gift’ of some sort; the idea that a brush with death will give you some profound new insight into life that will turn your life around; the idea that visualising your cancer cells being defeated can help, are all a form of superstition.

      And as for not complying with treatment – most of us, however grumpy or negative we might be – desperately want to live. That’s the incentive we need to fall in line with treatments.

  10. I’d like to tell you my “positive attitude” story and how I came to the conclusion that it’s a bunch of bull…

    In 2003, while still in my 40s, I had a hip replacement. Although I had an extremely well-known, experienced surgeon who had a waiting list of several years, the surgical approach he used on me was new to him. I knew this and was actually really excited about it since it was supposed to result in faster, easier healing.

    The results were disastrous. He broke my femur (the biggest bone in the body), I was totally immobilized and in horrible pain for a week, and then slowly began what was supposed to be a much longer, but ultimately normal recovery.

    I faithfully did all the exercises, physiotherapy etc. that had been prescribed. I did everything I was supposed to do, but at a certain point, I realized that my recovery had stalled. I put up little post-its around the house affirming that I was “getting better every day”, that my body was healing…all those positive messages that are supposed to be so helpful. Yet not only did the recovery stall, but I actually started getting worse. I graduated backwards from one cane, to two canes and then finally back to crutches. I could not walk at all unassisted.

    The physiotherapists totally negated my worries refused to acknowledge my concerns. There is a special place in hell for these idiots.

    After having a total meltdown at my GP’s office, I got an emergency appointment with the surgeon who took one look at me and started apologizing profusely. He confirmed that I was indeed NOT healing and scheduled revision surgery, which went well.

    Seven years later, I am not as happy with the results of my surgery as many people are, but I walk well and if you didn’t know my story, you would never know that there was a time when I could barely walk.

    Yes, it’s a long story, but it eloquently illustrates the clear limits of “positive thinking”. It also illustrates that despite my perfect compliance with everything I had been told to do, I did not get better. I tried my best, both mentally and physically, but that could not undo a basically flawed outcome. I didn’t need positive thinking. I needed another operation. Period.

  11. i The fortunate woman’s father, who was there with her, said in relief: “We’re good people. We deserve this.” It was a perfectly understandable response,

    It was?! On what planet? Illness doesn’t happen because we’re bad or good, it’s simply a fact of life. Genetics, personal habits, etc. play a part, but in the end it’s a crap shoot.

  12. My family was old world Catholic and very superstitious. There was definitely an idea planted in my long ago that if I was a good enough person (a good enough Catholic) then God would bless me with a good life. I tell you, I went through a lot of years believing that my unhappiness was due to my being a bad/evil person. Turns out that I had undiagnosed type II bipolar disorder which was a cause of a fair bit of my misery.

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