Attitude - The Will to Live

How often do you use the expression "the will to live?" Does it have any meaning? Can it prolong your life? Can it bolster your immune system? In our oncology practice, we can unequivocally affirm that the expression does have meaning and that it can vastly improve the quality of life and may even prolong the life of a cancer survivor. However, it will be many years before we know the answer to the third question.

As medical professionals, we have always been fascinated by the power of the will to live. Like all creatures in the animal world, human beings have a fierce instinct for survival. The will to live is a force within all of us to fight for survival when our lives are threatened by a disease such as cancer. Yet this force is stronger in some people than in others..

Sometimes the biology of a cancer will dictate the course of events regardless of the patient's attitude and fighting spirit. These events are often beyond our control. But patients with positive attitudes are better able to cope with disease-related problems and may respond better to therapy. Many physicians have seen how two patients of similar ages and with the same diagnosis, degree of illness and treatment program experience vastly different results. One of the few apparent differences was that one patient was pessimistic and the other optimistic.

We have known for over 2,000 years--from the writings of Plato and Galen--that there is a direct correlation between the mind, the body and one's health. ``The cure of many diseases is unknown to physicians,'' Plato concluded, ``because they are ignorant of the whole. For the part can never be well unless the whole is well.''

Recently, there has been a shift in health care toward recognizing this wisdom, namely that the psychological and the physical elements of a body are not separate, isolated and unrelated, but are vitally linked elements of a total system. Health is increasingly being recognized as a balance of many inputs, including physical and environmental factors, emotional and psychological states, nutritional habits and exercise patterns.

Researchers are now experimenting with methods of actively enlisting the mind in the body's combat with cancer, using techniques such as meditation, biofeedback and visualization (creating in the mind positive images about what is occurring in the body). Some doctors and psychologists now believe that the proper attitude may even have a direct effect on cell function and consequently may be used to arrest, if not cure, cancer. This new field of scientific study, called psychoneuroimmunology, focuses on the effect that mental and emotional activity has on physical well-being, indicating that patients can play a much larger role in their recovery.

It will be many years before we know whether it is possible for the mind to control the immune defense system. Experiments with biofeedback and visualization are helpful in that they encourage positive thinking and provide relaxation, thereby increasing the will to live. But they can also be damaging if a patient puts all of his or her faith in them and ignores conventional therapy.

The mind's role in causing and curing disease has been endlessly debated. No studies have proven in a scientifically valid way that a person can control the course of his or her cancer with the mind, although many individuals attest to the power of positive attitudes and emotions. One patient with high-risk cancer had a mastectomy at age 29. At 31, she had advanced stage IV cancer with widespread massive liver and bone involvement and, subsequently, extensive lung metastases. She also had an amazingly strong will to live.

``I get out of bed every morning as if nothing was wrong,'' she once said. ``I may have known I was going to have to face things and could feel sick during the day, but I never got out of bed that way. There was a lot I was fighting for. I had a three-year-old child, a wonderful life and a magical love affair with my husband.'' Twenty-six years later, she was still alive, still on chemotherapy and still living an active life.

We often ask our patients to explain how they are able to transcend their problems. We have found that however diverse they are in ethnic or cultural background, age, educational level or type of illness, they have all gone through a similar process of psychological recovery. They all consciously made a ``decision to live.'' After an initial period of feeling devastated, they simply decided to assess their new reality and make the most of each day.

Their ``will to live'' means that they really wantto live, whether or not they're afraid to die. They want to enjoy life, they want to get more out of life, they believe that their life is not over and they're willing to do whatever they can to squeeze more out of it.

The threat of death often renews our appreciation of the importance of life, love, friendship and all there is to enjoy. We open up to new possibilities and begin taking risks we didn't have the courage to take before. Many patients say that facing the uncertainties of living with an illness makes life more meaningful. The smallest pleasures are intensified and much of the hypocrisy in life is eliminated. When bitterness and anger begin to dissipate, there is still a capacity for joy.

One patient wrote, ``I love living, I love nature. Being outdoors, feeling the sun on my skin or the wind blowing against my body, hearing birds sing, breathing in the spray of the ocean. I never lose hope that I may somehow stumble upon or be graced with a victory against this disease.''

Unfortunately, and quite understandably, many patients react to the diagnosis of cancer in the same way that people in primitive cultures react to the imposition of a curse or spell: as a sentence to a ghastly death.

This phenomenon, known as ``bone pointing,'' results in a paralytic fear that causes the victim to simply withdraw from the world and await the inevitable end. In modern medical practice a similar phenomenon may occur when, out of ignorance or superstition, a patient believes the diagnosis of cancer to be a death sentence. However, the phenomenon of self-willed death is only effective if the person believes in the power of the curse.

In the treatment of cancer, we've seen patients fail on their first course of chemotherapy, fail again on the second and third treatments, then--with more advanced disease--a fourth treatment is highly successful.

In all things, you have to take a risk if you want to win, to get a remission or recover with the best quality of life. Just the willingness to take a risk seems to generate hope and a positive atmosphere in which the components of the will to live are enhanced. There are many other ways of strengthening the will to live.

As physicians, the best thing we can do to strengthen the will to live is to involve a patient as an active participant in combating their disease. When patients approach their disease in an aggressive fighting posture, they are no longer helpless victims. Instead, they become active partners with their medical support team in the fight for improvement, remission or cure.

This partnership must be based on honesty, open communication, shared responsibility, and education about the nature of the disease, therapy options and rehabilitation. The result of this partnership is an increased ability to cope that, in turn, nurtures the will to live.

A way to strengthen this partnership is to extend the relationship to others. The emotional experience of sharing and enjoying your family and partnerships supports your love for life and your will to survive.

As you make the transition from helpless victim to activist, one of the most important realizations is that you have everything to do with how others perceive you and treat you. If you can accept your condition and hold self-pity at bay, others won't feel sorry for you. If you can discuss your disease and medical therapy in a matter-of-fact manner, they'll respond in kind without fear or awkwardness. You are in charge.

You can subtly and gently put your family, friends and co-workers at ease by being frank about what you want to talk about or not talk about and by being explicit about whether and when you want their help.

Sharing your life with others and receiving aid or support from friends and family will improve your ability to cope and help you fight for your life. A person who is lonely or alone often feels like a helpless victim. There is a need to share your own problems, but helping others find solutions or cope better with the problems of daily living gives strength to both the giver and the receiver. There are few more satisfying experiences in life than helping a person in need.

Patients can also take part in psychological support programs, either through private counseling or group therapy. Sharing frustrations with others in similar circumstances often relieves the sense of isolation, terror and despair cancer patients often feel.

Of all the ingredients in the will to live, hope is the most vital. Hope is the emotional and mental state that motivates you to keep on living, to accomplish things and succeed. A person who lacks hope can give up on life and lose the will to live. Without hope, there is little to live for. But with hope, a positive attitude can be maintained, determination strengthened, coping skills sharpened, and love and support more freely given and received.

Even if a diagnosis is such that the future seems limited, hope must be maintained. Hope is what people have to live on. Take away hope and you take away a chance for the future, which leads to depression. When people fall to that low emotional state, their bodies simply turn off.

Hope can be maintained as long as there is even a remote chance for survival. It is kindled and nurtured by even minor improvements or a remission and maintained when crises or reversals occur.

There may be times when you will feel exhausted and drained by never-ending problems and feel ready to give up the struggle to survive. All too often it seems easier to give up than to keep on fighting. Frustrations and despair can sometimes feel overwhelming. Determination or dogged persistence is needed to accomplish the difficult task of fighting for your health.

The experience of cancer is not only destructive in a physical way but can be a major deterrent to your fighting attitude and will to live. But even during the roughest times, there are often untapped reserves of physical and emotional strength to call upon to help you survive one more day. This reserve can add meaning to your life as well as serve as a lighthouse that leads you to a safe haven during a turbulent storm. Hope has different meanings for each person. It is a component of a positive attitude and acceptance of our fate in life. We use our strengths to gain success to live life to the fullest. Circumstances often limit our hopes of happiness, cure, remission or increased longevity. We also live with fears of poverty, pain, a bad death or other unhappy experiences.

You may worry so much that you lose sight of the possibility of recovery and lose your sense of optimism. On the other hand, you may become so hopeful and confident that you lose sight of reality. Your main challenge is balancing your worry and your hope.

Hope is nourished by the way we live our lives. To achieve the best quality of life requires settling old problems, quarrels and family strife as well as completing current tasks. Problems that have not been resolved need to have completion. New tasks should be undertaken. If the future seems limited, you can achieve the satisfaction of knowing that you have taken care of your affairs and not left the burden to your family or others. By doing so you can achieve peace of mind, which will also help strengthen your will to live. With each passing day, try to complete what you can and have that satisfaction that you have done your best.

Be bold, be venturesome and be willing to experience life to the fullest to enhance your enjoyment of life. As long as fear, suffering and pain can be controlled, life can be lived fully until the last breath.

Each of us has the capacity to live each day a little better, but we need to focus on both purpose and goals and set into action a realistic daily plan--often altered many times--to help us achieve them. These resources are the foundation of the will to live.

Only by using the power of the will to live--nourished by hope--can we achieve the sublime feelings of knowing and experiencing the wonders of life and appreciate its meanings though vital living.

Supportive Cancer Care: by Ernest H. Rosenbaum, MD & Isadora R. Rosenbaum, MA
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