PERSONALITY, STRESS, AND CANCER: A HISTORICAL LOOK AT THE CONNECTION BETWEEN CANCER AND EMOTIONS

The connection between cancer and emotional states has been observed for nearly 2000 years. In fact, it is the separation of cancer from emotional states that is the new and strange idea. Writing nearly 2000 years ago in the second century A.D., the physician Galen observed that cheerful women were less prone to cancer than were women of a depressed nature. Gendron, in a treatise written in 1701 inquiring into the nature and causes of Cancer, cited the influence of the "disasters of life as occasion much trouble and grief." In an example still quoted in medical schools today, Gendron reported that:

Mrs. Emerson, upon the death of their daughter, underwent great affliction and perceived her breast to swell, which soon after grew painful. At last it 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 the Mate of a ship (who was taken some time ago by the French and put ir» 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 I could not Undertake her case. She never before had any complaint in her breast.

In 1783, Burrows, in a comment that sounds remarkably like an early description of chronic stress, attributed the disease to "the uneasy passions of the mind with which the patient is strongly affected for a long time." By 1822., Nunn, in Cancer of the Breast, a widely recognized text, stated that emotional factors influenced the growth of tumors. As an illustration, he noted that a particular case coincided "with a shock to her nervous system caused by the death of her husband. Shortly thereafter the tumor again increased in size and the patient died."

In 1846, Dr. Walter Hyle Walshe published The Nature and Treatment of Cancer, an influential and definitive book covering nearly all that was known about cancer at that time. Walshe stated:

Much has been written on the influence of mental misery, sudden reverses of fortunes, and habitual gloominess of temper on the disposition of carcinomatous matter. If systematic writers can be credited, these constitute the most powerful cause of the disease. . . . 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 . . . questioning its reality would have seemed a struggle against reason.

In 1865, Dr. Claude Bernard wrote a classic text, Experimental Medicine, in which he reported observations similar to our own. Bernard cautioned that a living being must be considered as a harmonious whole. Although separate analysis of body parts was necessary for investigation, he said, the relations among the parts must also be considered. And, in another classic text, Surgical Pathology, published in 1870, Sir James Paget expressed his conviction that depression plays a vital role in the occurrence of cancer:

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.

The first statistical study of emotional states and cancer was undertaken in 1893 by Snow. In reporting this relatively sophisticated research in Cancers and the Cancer-Process, Snow stated:

Of 250 out- and in-patients with cancer of the mammary or uterus at the London Cancer Hospital, 43 gave histories permitting a suspicion of mechanical injury. Fifteen of these 43 also described themselves as having undergone much recent trouble. Thirty-two others spoke of hard work and privation. In 156 there had been much immediate antecedent trouble, often in very poignant form, [such] as the loss of a near relative. In 19, no causation-history could be proved.

Snow concluded that:

Of all causes of the cancer-process in every shape, neurotic agencies are the most powerful. Of the most prevalent kinds, distress of mind is the one most commonly met with; exhausting toil and privation ranking next. These are direct exciting causes that exert a weighty predisposing influence towards the development of the rest. Idiots and lunatics are remarkably exempt from cancer in every shape.

Despite the apparent agreement among late nineteenth- and early twentieth-century experts that there was a connection between emotional states and cancer, interest waned in the face of general anesthesia, newly developing surgical procedures, and radiation therapy. The success of these physical therapies with many medical problems substantially strengthened the viewpoint that physical problems could be solved only with some form of physical treatment. In addition, physicians began to see stresses such as hard work and privation as inevitable; after all, even if they did play a role in the onset of cancer, what could a physician do about them? Finally, until the first third of the twentieth century the tools for dealing with emotional problems were still quite limited.

Yet it is one of the ironies of medical history that, as the emerging sciences of psychology and psychiatry developed the diagnostic tools to test the link between cancer and emotional states scientifically and the therapeutic tools to assist in dealing with emotional problems, medicine lost interest in the problem. The result had been two very distinct bodies of literature and research. The psychological literature is rich with descriptions of the emotional states related to cancer, but it often fails to suggest any physiological mechanisms that might explain this relationship. The medical literature is well grounded in physiology but, perhaps because it does not integrate psychological data into its research, it is unable to explain "spontaneous" remission or major differences in how individuals respond to treatment.

Coming from a medical background, Carl was startled to find substantial evidence of the links between emotional states and cancer in the psychological literature. We have since observed that few physicians are aware of this research. The price of this age of specialization is that persons in different disciplines working on the same problem often have little exchange of information. Each discipline develops its own specialized language, its own values, its own method of communicating information, and important information can be lost because the disciplines do not exchange findings effectively.

We have found that explaining the psychological literature to cancer patients is a particularly sensitive task. If we make a statement that "research indicates that cancer patients have certain traits . . . ," then many patients automatically assume the research says they personally have those traits. But statistical studies, by their very nature, are broad generalizations that apply to groups, not necessarily to a particular individual. In his book Mind as Healer, Mind as Slayer, psychologist Kenneth R. Pelletier suggests that people should exercise caution in applying "personality profiles" to themselves:

At present most of the research in personality and illness is centered around determining the characteristic patterns among people who have already contracted a particular disorder. Some of the personality characteristics typical of people with particular disorders may sound remarkably like your own. You should not be alarmed by this, since it does dot inevitably follow that you will incur the diseases associated with these characteristics. These personality profiles are merely useful guidelines, to make people aware of what potentially hazardous behavior patterns might be. Self-asssessment is seldom accurate, and analysis of behavior patterns should always rely on the interpretation of a skilled clinician. Personality profiles are only one element of diagnosis, and they are inconclusive in and of themselves. It is common among graduate students in any clinical area to imagine themselves sticken by each disorder that they are studying. With further training, they realize that diagnostic assessment is complex and indicative of a direction, rather than being definitive. Anyone approaching the subject area of personality and disease requires a comparable note of caution. [Emphasis added.]

As we review the research on emotional states and cancer, then, we strongly suggest that if you are a cancer patient or someone with a fear of cancer, simply use the research as a starting point for your thinking and be aware of the fact that all of us have a tendency to see aspects of ourselves in these descriptions. People with similar personality traits don't all develop the same illness any more than all people subjected to the same carcinogenic agents develop cancer. Many other factors, as you now know, play a significant role.

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Cancer