PLENARY
THIRTY YEARS ON THE FRONTIER OF CANCER CARE| Conference Home Page | Presenter Bios | CMBM Home Page |
O. Carl Simonton, M.D.
June 12, 1999The number one risk factor for illness in the developed world is emotional distress. Two studies that demonstrate this point dramatically were sponsored by the NIH. Both studies concluded that the primary risk factor for heart disease in American males is job dissatisfaction. Job dissatisfaction was a more significant risk factor for the development of heart disease than family history, genetics, high blood pressure, obesity, cigarette smoking, and high blood cholesterol combined. The occurrence of heart attacks was clustered on Monday mornings, between eight and nine o’clock. Our creative medical system looked at this information and suggested that perhaps we should restructure the work week.
Currently the medical profession is witnessing an increasing interest in the mind and emotions and how they influence health. This philosophical angle of medicine has been called ‘complementary’ or ‘alternative’ in our culture. However, it is clearly the oldest idea of medicine, much older than the physical model of western medicine--a model that does not fully appreciate the myriad effects the mind has on physiological states. The cave-dweller’s painting some of which date back twenty or thirty thousand years represented the mind and played a part in healing rites. Systematically addressing the mind and emotions is at the heart and soul of medicine, and it is necessary that we reintegrate this ancient piece into modern medical practice.
Obstacles abound to this reintegration. The primary voice of medicine says that emotions are not a significant factor in physical health and certainly not in the course of cancer. The most interesting recent study refuting this point is found in the 1993 Archives of General Psychiatry. The investigator has the courage in this study to state the obvious. He concludes that any intervention that helps patients cope with life’s events and resolve emotional distress impacts tumor growth as well as quality of life. This knowledge is somewhat self-evident, but it needs to be stated in an academic setting at the end of a randomized matched controlled study.
Dr. Simonton asserts that mind/body/spirit counseling should be administered to cancer patients in a systematic way. Those mind/body/spirit techniques which influence Dr. Simonton’s cancer patients also influence his own life. These techniques are based in principles that can lead to greater health in general. We all need to learn how to gain more influence over our mental, emotional and spiritual lives.
If we look at the health of physicians, we see that they have poorer health than the population in general. They have more illness, more alcohol and drug abuse, more divorce, and more suicide than the population. We have a very poor system when the health of the healer is worse than that of the general population. One of the reasons is that from the beginning of a physician’s training, she is taught to abuse herself, not to honor her own needs, and not to take care of herself. If a physician does not know how to care for him or herself, how can she teach others to care for themselves?
In France, Dr. Simonton has run into the most difficulties in working with cancer patients. French psychotherapy is steeped in classical Freudian analysis as their primary counseling mode. Classical Freudian analysis is contra-indicated for counseling cancer patients. Studies that examine the effects of Freudian analysis in counseling cancer patients show that those people who receive Freudian analysis did worse than people who received no counseling at all.
When Dr. Simonton began studying how emotions affected cancer patients, people assumed that working with emotions and illness was innocuous because it could not do any harm. Dr. Simonton assumes the opposite. If the manner in which a physician approaches a patient engenders fear or hopelessness, he does harm to that patient. A physician’s approach does have physical consequences. We want counseling that helps make patients feel more hopeful, calmer, and more confident about their ability to get well. Such counseling has been incorporated in the past in bedside manner. It is the way that the healthcare team presents itself so that the patient feels confident and is able to relax.
It is important that we standardize counseling. In oncology one could get the same treatment in DC, Los Angeles, or Helsinki. However with counseling, it is difficult to find the same type of counseling within the same city. There is no standardization in counseling. There needs to be, especially around the counseling of cancer patients. A group of counselors at a conference in Germany agreed that counseling of the cancer patient needs to be gentle, needs to focus on quality of life issues, and needs to empower the patient as well as engage their imaginations. The patients need to be able to understand the relationships between their thoughts and beliefs and their emotional states. In addition death needs to be addressed.
As a society, we need to address death with our young people. We have grown up in a culture where death is not addressed comfortably. We have a tremendous difficulty when we are confronted with situations where death is likely. The counselor of the cancer patient needs to be very grounded around death. One cannot be grounded around issues of death unless they are grounded around spiritual issues. Counseling of cancer patients must also address these issues of spirituality.
Standardization of counseling will enable us to systematically examine outcomes so that we may proceed with techniques in a more responsible way. Dr. Simonton is now conducting multi-centered studies to investigate the outcomes of mind/body/spirit therapies for cancer patients from the US, Germany, Switzerland, Poland, Japan and Venezuela. His research is uncovering that similar principles are found in all of these cultures.
Central issues of health rely on universal principles. The counseling needs to help people cope more effectively with life events and resolve emotional pain. The same process will not accomplish this end with different people. For some, family relationships is a wonderful way of coping. To another person, family is a reason to die. We cannot generalize a single therapy for all individuals, but we can have general guidelines that fit the individual.
Counselors should also focus on what is right with the patient not on what is wrong. When Dr. Simonton works with a new patient, he asks them to first identify five things that increase the meaning in their lives. He then asks how they can systematically begin to implement these things into their lives. The next consideration is to look at those elements which are obstacles to implementing them. The primary thing that interferes is emotional pain created by unhealthy beliefs. The number one unhealthy belief that comes up in work with cancer patients is the belief they cannot get well. It is most often expressed as "I am going die of my cancer no matter what I or anyone else does." More simply, the belief is "I cannot get well." This obviously interferes with patient’s ability to make long-term plans. The healthier belief is "I can get well" which is the same thing as hope. Hope is defined as the belief that desirable things are obtainable regardless of the probabilities. Translated into the vocabulary of illness, it is the belief "I can get well, no matter how sick I am." When a patient has sat in front of a tumor board of fifteen professors of oncology who pronounce that he or she cannot get well, it becomes hard for that patient to believe otherwise.
When Jeanne Achterberg was researching the history of imagery, she found that the first writings on imagery, which is the use of imagination in the healing process, were in the Greek writings. There were three components which the Greeks outline in using imagery. The first was to imagine the disease as curable. The second was to imagine the treatment as helpful. The third was to imagine the body as capable of healing itself. It is difficult to imagine the first when physicians state that the disease is incurable.
It is important for patients to want to get well and to be clear about why. However, it is also crucial for them to be prepared to die at any moment. If they are not ready, they must explore how they can become prepared and become more comfortable with death. The idea is that we can plan for the most desirable event yet be prepared for the least desirable at the same time. We must live as if we plan to live forever, while being prepared to die today. Most major traditions teach attachment to outcome as the one of most difficult issues in life. The caregiver often gets attached to the outcome, thinking that their patients must get better. On one hand caring is important, and on the other attachment to outcome engenders frustration, fear and anger. When does caring become attachment to outcome? When we use phrases like "has to happen", when physicians think, "They have got to get well." Physicians and patients must learn how to stay involved and connected with the care while not becoming attached to the outcome.
Audience Questions and Answers
There is a paradox in this statement about attachment to outcome. On one hand cancer patients need hope to survive, and on the other they need to be ready to die and be detached from life. Fighting is supposed to be healthy. Statistics show that those that fight have prolonged survival. Yet at the same time, patients are told to let go and let the process of healing take place. Doing these two things together is very difficult.
Ancient peoples agree that this dual outlook is difficult. We should work for what we want, have passion for what we want and at the same time be ready to die. This is the most difficult thing to do. It is important to have passion about life and to have hope about death. It is important to use imagery to envision that what happens after death is desirable.
But then are you losing the hope to survive?
No. We could be excited about our lives and excited about our deaths. We could be doubly excited.
Some patients go to physicians who are belittling complementary therapies. How can CAM practitioners deal with their clients who experience this from their physicians?
Physicians are not trained how to treat people. They are trained how to treat disease. Most have the attitude that if they have not heard about something in medical school, it is probably not worth knowing. It is important to appreciate that this type of medical education is still occurring today. If a physician is saying things that interfere with a patient’s other therapies, the patient must tell the doctor that he or she is interfering. Patients cannot ask their physicians to adapt new beliefs, but they can ask them not to disparage their own beliefs.
How can a practitioner obtain training in Dr. Simonton’s method?
He does training in general and specific cancer treatment. Check out his website at www.simoncenter.com to get more information on Dr. Simonton’s extensive training sessions.