Table of Contents

List of Illustrations ....................................................... vii

Preface ...........................................................................ix
. Can the Mind Heal Cancer? Popular and
Professional Views ........................................................... 
Introduction ............................................................................ 
What Is Healing?.................................................................... 
The “Levels” of a Person ......................................................... 
Rephrasing the Question: “Can the Mind Heal
Cancer?” .............................................................................
Early History of the Idea That Mind Can Influence
Cancer Growth ...................................................................
Claims in Popular Books and the Media, and
Their Impact on the Community ...................................... 
Reactions of the Orthodox Health Care Professions .............
Some Comments on “False Hope” .........................................
Summary............................................................................... 

. A Wider View: Can the Mind Heal the Body? .............. 

Brain and Mind .....................................................................
Pathways Connecting Mind and Body ................................. 
Different Disciplines Study Different “Boxes” ..................... 
Mind Affecting Health and Disease: Examples .................... 
Conditions Where the Mind–Body Link Is Obvious .............. 
Conditions Where There Appears To Be a Contribution
by Mind .......................................................................... 
Conditions Still Usually Thought To Be Independent
of Mind ........................................................................... 
Some Mechanisms by Which Mind Is Known To
Influence Disease .............................................................. 

iii
 The Mind, and Long-range Messengers ............................... 
Short-range or Local Messengers ........................................... 
Healing through Symbols ..................................................... 
Spirituality and Healing ....................................................... 
Summary............................................................................... 

.. Studies on “Remarkable Survivors” from Cancer .......... 

“Spontaneous
eous Remission” of Cancer ...................................... 
How Reliable Are Studies on Remarkable Survivors? .......... 
Berland’s  Study .............................................................. 
An Integration of the Studies on
“Remarkable Survivors” .....................................................
What Can We Conclude from These Studies?..................... 
Summary............................................................................... 


. Cancer and Mind: Current Scientific Views ................. 

Psycho-Oncology
ncology .................................................................. 
Psychological Support To Alleviate the
Emotional Stress ss of Cancer .............................................. 
Research in Psycho-Oncology on the Impact of
Mind on the Disease ........................................................ 
Relationship of “Personality” to Cancer Onset
and Progression.................................................................
Why Has Research on Personality and Cancer
Produced So Little Consensus? .........................................
Testing the Effects of Psychological Therapies
on Lifespan ....................................................................... 
Summary............................................................................... 
. Working Towards Longer Survival:
The Healing Journey Study......................................... 
A Stepwise Program of Therapy: The Healing Journey ....... 
A Research Design To Search for Effects of
Mind on Longevity .......................................................... 

iv
 Results of the Healing Journey Longevity Study.................. 
Illustrating the Differing “Involvement” of Partcipants...... 
Highly Involved People.......................................................  
Moderately Involvedd People .................................................  

Minimally Involved People.................................................  

What Has This Study Taught Us? ......................................
Summary.............................................................................. 

. The Qualities of Long Survivors .................................

What the Long Survivors Told Us........................................
Integration of Studies on Long Survivors .............................
A Developmental Look at Cancer and Healing.................... 
Summary.............................................................................. 

. A Summary, and Future Directions ............................ 

The Spiritual Dimension in Healing aling ................................... 
What About Esoteric Powers of Mind and Spirit? ............... 

Possible Directions for Further Research.............................  
The Key Requirement: Refining Our Understanding of
Mental States That Encourage Healing ........................... 
Outcome Measures ............................................................... 
Subjects for Research ............................................................


The Therapy ....................................................................... 

Overall Conclusions: Can the Mind “Heal” Cancer? .......... 
A Final Word to People with Cancer .................................. 

v
 Illustrations

Figures
. Major Dimensions of the Human Being ................................ 
. Steps in the “Internal” Path ..................................................
. Three Ways in Which Spiritual Phenomena
Might Affect Health ............................................................ 
. Principal Psychological Qualities of “Remarkable
Survivors” ............................................................................. 
. A Cumulative Plot ................................................................ 
. Types of Psychological Therapy............................................. 
. Model of Psychological Response to Cancer .........................
. Impact of “Involvement in Self-Help” on Survival ............... 
. Process of Change in Long Survivors ...................................
. Possible Mental Contributions to the Onset and
Healing of Cancer ............................................................... 

. Symmetry between Promoting and Healing
Influences of the Mind on Cancer ........................................ 

Tables
. Differentt Routes to Healing ................................................... 
. Main Elements of the Healing Journey Program ................. 

. Range of Views on Possible Healing through Mind ............

vii
 Preface

T
his short book is a presentation of the case that people
with cancer, or other serious diseases, who use psycholog-
ical and spiritual methods in the struggle to heal—who
in other words, use their minds—are likely to live much
longer than medically predicted. That is the conclusion I have come
to after some  years in cancer-related research and clinical practice.
Our medical system is admirable in many respects, but there is a vital
element missing from it: the mind of the person with the disease.
Healing can be much more effective if the patient’s mind becomes
involved. It is a potential that we probably all possess but that few
invoke. Our society, and in particular our health care system, does
not endorse it yet. Most critics have not studied the evidence, and it
is not readily available in one place. I have tried to draw the strands
together here.
My own exposure to cancer research began in the s, at the
Australian National University, where I was a researcher in the field
of immunology. At that time, there were high hopes that this disci-
pline was going to provide an eventual cure for many cancers. By the
time I moved to the Ontario Cancer Institute in Toronto, Canada,
in 
, this goal was no closer to realization, and in fact, many of us
could see that it probably would not happen. As a result I began ques-
tioning my own motives and could not avoid the conclusion that the
research I was doing, while interesting in itself, was unlikely to help
any of the cancer patients who surrounded us in the hospital where
I was now located. A period of transition followed, made possible by
the tolerance and support of my superiors, after which I ended up
with a second PhD, in clinical psychology this time, and with a new
ix
 pr eface

line of work—conducting group classes and therapy for cancer pa-

tients, and evaluating their effect. This is the work I’ve been engaged
in for the last  years. During that time I’ve had the opportunity
to observe thousands of people with cancer who have come to our
program wanting help to cope with their disease and to improve their
chances of survival, where possible. Together with a small team of as-
sistants, I have carried out a lot of research on the way peoples’ qual-
ity of life almost always improves, sometimes dramatically, through
learning relatively simple coping skills like deep relaxation, mental
imaging, meditation, and thought management.
More recently we have also examined the effect of self-help work
of this kind on the lifespan in people with medically incurable can-
cers. The heart of this book is a series of studies, conducted over the
last  years, on the mental qualities that people with medically in-
curable cancers develop during their struggle with the disease. Some
individuals become very involved in helping themselves through psy-
chological and spiritual growth or change, and this is often (not al-
ways) associated with surviving much longer than predicted by their
oncologists. Others do not become involved in this way, and tend
to die in about the time predicted by experts. Those who do greatly
outlive their prognoses tend to show a pattern of qualities that is also
described in reports over the last few decades on studies of “remark-
able survivors”: these qualities include autonomy, or achieving a sense
of free choice to live life as desired, the related property of authentic-
ity, or learning one’s true identity through introspective psychological
and spiritual work, and acceptance, an attitude of tolerance, forgive-
ness, and ultimately love for other people, themselves, and all living
things. In fact, we scientists, struggling naively to document healing
change, appear to have rediscovered a “healed” state of mind that is de-
scribed in the major wisdom traditions of humankind. It is perhaps not
surprising that such a healed mental state promotes physical healing.
While the convergence of evidence on the mental correlates of
bodily healing is reassuring, there is another line of evidence that al-
lows us to anchor these findings in a simple, non-technical, and quite
conservative theory. This is the pioneering work of U.S. researcher

x
 Preface

Lydia Temoshok who, with Henry Dreher, described a “Type C” per-

sonality in people susceptible to certain types of cancer. It was found
that poorer outcomes were associated with an attitude of “niceness,”
emotional suppression, and eagerness to placate while denying one’s
own legitimate needs. This is virtually a mirror image of the au-
thentic, autonomous way of life that we, and others, have seen long
survivors develop. The theory then becomes, in outline: if we place
undue stress or strain upon ourselves from an early age, we will be
susceptible to later disease (Temoshok proposed this theory for can-
cer, and it may be true for many chronic diseases, different kinds of
distortion predisposing us to different conditions). And conversely,
if we strive to undo these distortions, to reclaim our authentic selves
when afflicted by cancer, we allow our innate healing mechanisms
the best opportunity to overcome, or at least retard, the disease.
The evidence behind this simple view will need to be reproduced
many times by many scientists before it is generally accepted. This
will take decades. Meanwhile, people are suffering more than is nec-
essary. We can say quite definitely that when people with cancer be-
come involved in helping themselves psychologically and spiritually,
they almost always enjoy a much better quality of life. It is highly
probable, if not yet proven to the satisfaction of all, that some will live
much longer as a result.
A further, important experience has shaped my opinions on all of
this. In  I had a serious (Stage ) colon cancer myself. Surgery and
chemotherapy followed, but I also tried to practise what at that time
I was already preaching, and took myself off to a retreat centre for 
months where, with a group of people learning to be yoga teachers, I
spent  hours a day,  days a week working on my own psychological
and spiritual growth. I was strongly motivated because my progno-
sis was only “one chance in three of long-term survival.” Through
the personal work I confirmed for myself, in a way that no academic
study could do, the truth of what the mystics have expounded on the
authentic self. I also had a number of unusual, “paranormal” experi-
ences around that time. My spiritual (not religious) study intensified,
and has remained central for me to this day. It has spilled over into

xi
 pr eface

our work at the hospital, of course; I now feel that counselling people
who have life-threatening disease without addressing the spiritual
dimension (where they are open to it) is rather like trying to do mari-
tal counselling without talking about sex!
The sum of these experiences—laboratory and clinical research
and practice, the psychological counselling, the insights that my own
cancer and spiritual work have provided—supply the motivation for
writing this book. It’s an unusually broad background that has given
me sympathy for both the clinician and the researcher, for the in-
tuitive layperson, and for the professional. All have a contribution to
make. We need, however, to balance the enthusiasm of the intuitive
lay healer, who may want to claim that anyone can heal himself using
simple psychological strategies, against the cautious conservatism of
the objective professional, who sees the biases in many of the New
Age claims. We must take into account the practical difficulties that
the working clinician encounters in helping the ordinary person get in
touch with his own emotional and spiritual potential. Nevertheless,
the possibility of assisting people much more profoundly than we
usually do is very clear to me now, as it is to a number of other clini-
cians and scientists in the health field.
The book is not written as a technical treatise, but is meant to be
accessible both to thoughtful lay persons and to health care profes-
sionals. I have tried to “digest” the concepts and present them in pal-
atable form. It is not primarily a self-help book for cancer patients—I
have published two other books of this kind, listed in references to
chapter —but a review of ideas and evidence underlying a rational
self-help approach. Nor is it an anthology of stories about individuals
triumphing over disease; these can be inspiring for people with a seri-
ous disease, but there are already many such books on the market.
Beyond the specifics of opposing cancer I am also suggesting new
ways of looking at the mind–body relationship and healing. What is
true for cancer will doubtless be true for many other serious chronic
diseases. And what we may learn from our efforts to heal disease may
teach us a great deal about healing all aspects of our lives.
The Ontario Cancer Institute in Toronto has for many years pro-

xii
 Preface

vided a supportive environment for our efforts to learn more about

how to help people with cancer through psychological and spiritual
work and change. Colleagues who have been particularly involved in
the research, or in organizing our group therapy programs have in-
cluded Dr. Claire Edmonds, Dr. Cathy Phillips, Dr. David Hedley,
Ms. Kim Watson, Ms. Gina Lockwood, Ms. Jan Ferguson, Ms.
Krista Soots, Dr. Joanne Stephen, Mr. Hayman Buwaneswaran and
Ms. Amy Lee. Dr. Edmonds and Ms. Watson assisted with prepara-
tion of the chapter references, and they and Drs. Phillips and Hedley
read part or all of the manuscript. Mr. Ian MacKenzie kindly pre-
pared the manuscript for publication.
My gratitude and respect extend to the many thousands of
patients who have participated in our classes over the years, and
especially to those individuals who have courageously persisted with
their self-healing work, and in doing so taught us what the human
mind and spirit can do. As always, I am deeply grateful to my wife
Margaret, for helping with many of our advanced groups and for her
unwavering love and support.
—Alastair Cunningham, March 

xiii
 Chapter 

Can the Mind Heal Cancer?

Popular and Professional Views



C
an the mind heal cancer? This is a question that often
comes up in the popular press: we read stories of people
who seem to have overcome their disease, and these stories
provide encouragement to some of the many thousands
who are struggling with cancer themselves. Yet health professionals
shake their heads in dismay at the popularization of this notion that
the mind might affect the way cancer progresses: it seems highly im-
probable to most of them that an intangible thing like “mind” could
significantly influence a concrete, organic disease like cancer.
I am caught somewhere in the middle of this debate. As a health
psychologist, scientist. and cancer survivor, I have been professionally
engaged in cancer research for  years, first as an immunologist, then
for the last  years from the point of view of a psychologist studying
the healing potential of mind. I have watched several thousand peo-
ple with cancer attempt to alleviate their suffering and influence their


 can the mind heal cancer?

disease through deliberate mental action, and I’ve worked in this way
with my own disease. My team and I are one of a small number of
groups around the world who are doing systematic research on this
question. We belong to a new field, a branch of health psychology,
called “psycho-oncology,” which is concerned with both the impact
of cancer on people’s minds and with the reverse, the influence of
psychological states on the suffering cancer causes and on the disease
itself. As a result of our research and that of others, I believe it is
now possible to make a plausible case, based on evidence, that certain
kinds of mental change may oppose the progression of at least some
cancers. This book makes that case, in largely non-technical language
so as to be accessible to both laypersons and professionals.
After a general introduction to the topic of mind-assisted heal-
ing of cancer in this chapter, I discuss, in chapter , how the impact
of mind on body may be understood in simple terms, and will of-
fer examples from medicine and health psychology. In chapter , we
will briefly review some fairly old research on “remarkable survivors,”
people with cancer who seem to have greatly outlived their expected
survival time. There are flaws in this research that are very obvious to
health professionals, as will be acknowledged. In chapter  I review
recent attempts to see whether psychological therapy can extend life
in cancer patients. The results of these experiments have been disap-
pointing, but I argue that this is because the methods used have not
been suited to detecting prolonged survival in a minority of excep-
tional patients. Then in chapters  and  I provide a fairly detailed
description of our own recent research in this area, using methods
that are able to detect the exceptional patients who make significant
efforts to affect the outcome of their disease. We have demonstrated
a clear relationship between what we call “involvement in self-help”
and significantly longer survival from advanced cancers. This new
evidence fits well with the older studies on “remarkable survivors,”
flawed though these early studies may be, and with certain earlier
work on the relationship between coping style and cancer susceptibil-
ity. The result of this synthesis is a simple, practical, and evidence-
based view of what people can do themselves to aid their healing. I


 Popular and Professional Views

end, in chapter , with an attempt to show that healing at the spir-
itual level may be understood in much the same way as “mind–body”
healing, but at a more profound level, namely as the recovery of an
authentic sense of self.

     

“Can the mind heal cancer?” is a very broad question, with a range of
possible meanings. The questioner might intend to ask, “Is there some
simple mental trick that will reverse and remove a cancer?” Or she
might mean, “If I change my behaviours (which begin in the mind),
and get my life in order—for example, by changing my diet, doing
more exercise, and working less—will that cure my cancer?” Another
possible meaning is, “Did my ‘personality,’ or my attitudes to life,
cause my cancer, and if so, can I heal by changing them?” We need
first to define what we mean by “healing” before we can approach
these questions. This step is all the more necessary because there is
so much misunderstanding around the whole subject of mind–body
healing, a confusion that contributes to the strong emotions and po-
larization of opinions, as we shall see.
“Healing” has many facets. The medical view is perhaps the
dominant one: Dorland’s Medical Dictionary (th edition) describes
healing as “the restoration of wounded parts,” the focus being mainly
on the physical body. The Oxford English Dictionary offers a broader
definition: “to make whole or sound, to cure (a disease or wound), and
also to save, purify, cleanse, repair, amend.” Thus although healing
involves the restoration of physical health, it can be given a broader
meaning, “amending” or putting things to rights. It implies the res-
toration of harmony, balance, and optimal functioning at all levels of
a person (we will expand on this point shortly). There is obviously
room for some difference in opinion as to what might be “optimal,”
but I think most of us would agree on what a healed state would feel
like.
Healing can be divided into two broad categories, which we may
call “spontaneous” and “assisted.” The first is what the body does by

 can the mind heal cancer?

itself, without any deliberate intervention by the owner of the body, or

by others. There are many spontaneous or automatic healing mecha-
nisms operating constantly in the body and mind; for example, heal-
ing of wounds, the immune response to foreign micro-organisms, or,
at the mental level, the lessening of anxiety or depression with the
passage of time. Assisted healing, by contrast, denotes some kind of
active intervention, by the person herself, or by others.
Assisted healing can usefully be divided into two further catego-
ries (as shown in Table .). The first is healing promoted by interven-
tions from outside the individual, such as the introduction of foreign
materials (food, drugs) to the body. The second is healing caused
by changes initiated within the person, which means, essentially, by
changes in thoughts and emotional reactions. Some examples may
clarify this distinction between externally and internally assisted
healing. The former grouping covers almost all standard Western
medical practices, and also much of what is called “alternative” medi-
cine, that is, the administration of drugs or procedures by an external
person, or by the individual herself. This would include diets or ad-
ditives used as treatments. Internally assisted healing, by contrast,
involves the deliberate invoking, by the individual, of the potentials
of his or her own mind and spirit, to facilitate a restoring of harmony
and good functioning. We could also call this “mind-mediated,”
“mind–body,” “self-directed” healing, or “self-healing” for short.
Assisted healing can involve both external and internal routes or
processes at the same time. Changing behaviours obviously includes
both kinds. For example, if someone goes to a dietitian for advice,
then adopts a new and healthier diet, he is obviously receiving exter-
nal assistance and using externally applied agents (food), but much
of his healing depends on the internal resolve to monitor the mind’s
cravings and control them. Another example of overlap would be the
help supplied by a psychotherapist (external), leading to inner change
by the client (internal).
This distinction between external and internal is a critical one.
Externally assisted healing entails looking to some other person or
some external agent for relief. Internally assisted healing is what is


 Popular and Professional Views

   .  Different Routes to Healing

Spontaneous Healing: What the body and mind can do without any
deliberate intervention by anyone, e.g., healing of wounds, immune
responses, the lessening of suffering over time.
Assisted Healing: Healing aided by active intervention
. Externally Assisted: Agents or procedures are applied to the
sufferer from outside, either by oneself or by others (e.g.,
drugs, surgery, healthy behaviours like exercise and good
diet)
. Internally Assisted: The individual sufferer makes voluntary
mental changes to try to affect the health of the body or
mind.
Note that  and  can overlap; thus, adopting a special diet in-
volves introducing external agents (foods), but there is also a
large component of voluntary mental change required, which is
internal.

normally meant when people speak of “healing through the mind”

or “self-healing”: it implies a looking within, at one’s own attitudes,
beliefs, and experiences. The emphasis in self-healing is on changing
states of mind rather than simple behavioural change or on manipu-
lating external circumstances. Various techniques (described in two
earlier books) 1 are used in healing through the mind: monitoring and
controlling one’s thoughts, relaxation, mental imagery, meditation,
goal setting, as well as techniques from various schools of psycho-
therapy and spiritual traditions. It is healing by the internal route that
is the subject of this book.

 “”   

I want now to introduce a simple diagram (Figure .) that we have

found very useful in our work with cancer patients. The five circles of


 can the mind heal cancer?

Body nd
Co

ns i
cious M
De
eper Mind

Social

Spiritual

       .  A simple “map” showing major levels or dimensions of the

human being

the diagram represent five major human functions or levels: the body,
which is our material substrate, or “hardware”; the conscious mind,
meaning the stream of thoughts; the deeper mind, a non-technical
term intended to lump together our emotions, images, dreams, and
impulses operating outside of our awareness; the social level, that
part of us that connects in a vital web of relationships to other people;
and a spiritual dimension, meaning our connection to a non-material,
transcendent substrate or Divine Ground (discussed further in chap-


 Popular and Professional Views

ter ). This subdivision can help us understand the variety of events
often referred to under the heading of “healing.” At the level of the
body, it is clear enough: healing means restoring normal balance and
function, or what is often called “cure.” Healing of the mind means,
likewise, that mental functioning is brought back to normal, suffer-
ing being relieved. When we talk about healing of suffering, we are,
as a moment’s reflection will show, really speaking of changes in the
mind rather than the body. The suffering caused by cancer, or other
serious disease, comes from our horrified reaction to the diagnosis
and its implications, and to any unwanted changes that take place in
the body. Even pain, although the sensations may arise in the body,
is ultimately a mental phenomenon. Healing of our emotional and
social levels are likewise intimately connected to whatever is hap-
pening in the mind. Healing at the spiritual level is less obvious, and
discussion of it will be pursued later; we can say, for the present, that
it entails making a strong connection with a transcendent or spiritual
order.
The levels in Figure . are not, of course, really separate; each
affects all of the others. A physical change may alter one’s think-
ing and emotions profoundly. Similarly, a change originating in the
mind, such as anxiety, may dramatically alter behaviours and ulti-
mately general health status. The mind, as will be seen, tends to be
the key level: suffering occurs there, as do the positive experiences
of joy, peace, and love. The satisfaction we get from social interac-
tions depends on how we construe them with our minds. The state of
mind radiates, as it were, to all other levels. When we refer to healing
through the mind, we mean that some other part of the individual,
usually the body, is being returned to a healthier state by an action of
the mind. Likewise healing through the spirit—an unconventional,
not to say esoteric idea—would apply if it was thought that some non-
material spiritual agency acted upon a person.
I hope this is clear. The definitions are necessary so that we know
just what kinds of phenomena we are referring to when we discuss
healing. While the principal topic of this book is healing of the body
through the mind (internally assisted healing), we will also be con-


 can the mind heal cancer?

cerned with the healing or relief of mental suffering, which is of at

least equal importance, and is particularly amenable to change by
voluntary mental action on the part of the affected person.

   :

“                ”

Let us now examine, in a more precise way, some of the questions

that are often asked about what the people can do with their minds
to assist themselves in the struggle with cancer:
. The first might be, “Can the suffering that cancer brings be
lessened by voluntary mental action?” The answer to this
question is an emphatic yes. Many professionals have con-
cluded that people in such dire trouble can be taught simple
methods to help themselves substantially (and we will see
that the same holds true for other conditions, like chronic
pain), although such education is not usually a part of regular
health care.
. A second question, “Can our behaviours (which originate in
our minds) affect the onset of cancer, or the course of an
existing cancer?” We can say yes to the first part of this ques-
tion: an extensive range of scientific literature shows that the
risk of getting cancer can be reduced by as much as two-
thirds to three-quarters by adopting healthy habits, such as
avoiding smoking, eating a healthy diet, and making other
lifestyle adjustments (avoiding sunburn, using appropriate
protection during sexual contact, avoiding industrial cancer-
producing agents). Many things are already being done at
a societal level about this; much more is obviously possible
(making tobacco an illegal drug, for example). To the sec-
ond part of this question—do such behaviours affect existing
cancers—we would have to say that there is no conclusive
evidence or consensus among experts yet that simple behav-


 Popular and Professional Views

ioural change affects cancer progression, beyond affecting

general health. This in spite of the fact that many people
with cancer attach great hopes to diet, in particular.
. A third question is much more controversial: “Can we use
our minds to beneficially affect the course of an existing can-
cer?” In other words, is internally assisted healing of physical
cancer possible, through the agency of mind? This is what
people usually mean when they ask, “Can the mind heal
cancer?” It is perhaps the most intellectually fascinating and
emotionally compelling issue in the modern research field of
“psycho-oncology,” which deals with all aspects of the rela-
tionship between cancer and the mind, and it is the subject
of this book.
Here, again, we must be more specific if we want to be able to
offer a meaningful answer. “Cancer” is a term that embraces many
types and stages of disease, whose common feature is that cells, again
of many different kinds, are proliferating to an excessive degree and
settling in places where they disrupt the normal functions of the body.
Certain cancers may be more susceptible than others to mental influ-
ence (for instance, those known to be affected by hormones, which
are in turn influenced by the mind, such as some breast cancers), and
it almost certainly makes a difference whether a cancer is a single,
primary tumour or a widespread, late-stage disease. The qualities of
the person with the cancer may also be decisive, as we will see later.

          

  

How did the idea that the mind can affect cancer arise in the first
place? Most of the scientific or systematic clinical work has been done
only in the last  decades or so. This has never been a popular area
of scientific study, in the way that, for example, immune responses to
cancer or the impact of diet on cancer incidence have been, probably
because it has been perceived as both difficult and somewhat radical.

 can the mind heal cancer?

Very few scientists have devoted any substantial part of their careers
to it, funding has been hard to get, and progress therefore slow. Even
within the area, most workers have confined their investigations to
possible links between certain types of personality or mental state and
the onset or progression of cancer, and only a minority have directly
addressed the more practically important issue of using the mind as a
potential therapeutic tool to affect cancer progression.
I am going to discuss first some earlier, exploratory studies, done
between about  and , work that is now not considered de-
finitive for technical reasons, as will be briefly explained. However,
it has prompted a great deal of speculation in the popular press and
media, which have seized upon the idea of a mind–cancer link, often
simplifying and exaggerating it to a point where orthodox physicians
and researchers have tended to dismiss the whole notion in angry
reaction.
Modern views on the possible connection between mind and
cancer can be traced back to Sigmund Freud, who proposed that un-
conscious mental conflicts could be expressed as symptoms in the
body. A number of psychoanalytically oriented psychiatrists have
since speculated that this kind of mechanism might be responsible
for some cancers, which would provide a rationale for using psycho-
therapy as a treatment. Few professionals now give this idea much
credence, however; the whole notion of bodily ailments as expressions
of mental conflict is unpopular today (although the specialty field
of psychosomatic medicine deals with some unarguable examples
of mentally induced body symptoms, such as certain patterns of an-
esthesia, skin wheals, and others). If the mind-cancer-psychotherapy
field has a “father,” he would probably be Lawrence LeShan, a New
York psychologist, who conducted scientific experiments in the s
suggesting that a severe loss or bereavement could prompt subsequent
development of cancer. This idea has been reinvestigated a number of
times since, without any consensus being reached. LeShan is a schol-
arly and wide-ranging thinker who in recent decades has not been
much involved with the scientific community but has addressed him-
self directly to interested laypersons in a number of valuable books.


 Popular and Professional Views

One of the latest is Cancer as a Turning Point

Point,2 whose main theme is
that people with cancer may benefit most from pursuing not what is
“wrong with” them (as tends to happen in conventional psychother-
apy), but what particularly excites and interests them. Cancer is seen
as an opportunity or motivating circumstance, time to reappraise life
and make important changes. This idea occurs frequently, often in
distorted form, in New Age publications.
The group that has perhaps had the greatest influence on the
views of the general public toward mind and cancer was headed by
Carl Simonton, a radiation oncologist, who worked with Stephanie
Mathews-Simonton and James Creighton, and was associated with
colleagues Jean Achterberg and Frank Lawlis. During daily relaxa-
tion periods, this group advised patients to imagine their immune
defence systems overcoming the cancer cells in their bodies. The im-
agery chosen by patients was sometimes quasi-realistic, for example,
white blood cells engulfing cancer cells, and sometimes more sym-
bolic, for example, large dogs, representing the defences, eating up
piles of meat (the cancer). Personal responsibility for healthy habits,
the development of goals, and other lifestyle adjustments was also
advocated. The book by the Simontons and J. Creighton Getting Well
Again3 has had a wide audience among people concerned with cancer.
Drs. Achterberg and Lawlis also contributed scientific papers and
books to the area, and Jean Achterberg has since written a number of
more general books demonstrating the wide-ranging importance of
mental imagery. The Simonton group found that the median survival
time for patients taking part in a program using their approaches (in
conjunction with conventional medical treatment) was about twice
that of people with similar diseases at several major U.S. treatment
centres. Critics have been quick to point out that one cannot infer,
from this, that the imagery-related treatment caused prolongation of
life, since the patients coming to the Simonton clinic were a highly
selected sample—more motivated, better educated, and wealthier
than average—and might have done better than most patients any-
way. I would agree that this criticism is technically correct, although
it does not disprove that the effect was real, and we will see in chapter


 can the mind heal cancer?

 that the size of the effect they observed was similar to what we saw
in a more controlled experiment.
Two rather similar accounts appeared at around the same time as
the Simontons’ (late s and early s). Bernauer Newton and his
team4 showed that of  cancer patients studied, those who received
 or more sessions of psychological therapy that employed hypnosis
were likely to live much longer than those who had fewer therapy ses-
sions. Again, unfortunately, to draw definite conclusions from such
an experiment it is necessary to demonstrate that the groups getting
more or less help had disease of equal seriousness, and this was not
done. In another study, Ainslie Meares,5 an Australian psychiatrist,
used intensive daily meditation with  cancer patients and reported
complete remission of the disease in  of them, with  more having
some remission of growth “in the absence of any organic treatment
which could possibly account for it.” He also published detailed case
studies of some of his patients who survived unexpectedly. As for
the Newton experiment, an unbiased reader would have to say that
this is very interesting, but that independent data is needed to sup-
port the claim that this minority of patients would not have survived
anyway.
These were all quite large studies, aimed at testing whether a
psychological intervention could prolong the life of cancer patients.
There were other accounts of similar attempts during this early pe-
riod, but less systematic in character. At the same time publications
were appearing on possible associations between patients’ personali-
ties and their survival; we will consider these in the fourth chapter.

      ,

           

Over the last  to  decades a swelling flood of popular books has

appeared offering medical and psychological advice to people with
serious health problems, advice that ranges in value from helpful to
questionable to downright dangerous (in the last category would be
advocacy that a cancer patient should never accept chemotherapy).

 Popular and Professional Views

Some of the best of these works are by physicians or other health pro-
fessionals who have become disenchanted with the exclusively ma-
terialistic emphasis of modern medicine and attempt to offer a more
holistic approach (involving the patient’s mind and spirit as well as
the body). Many of them have been highly influential among peo-
ple with cancer, although they are generally disliked by mainstream
medical professionals. The main reason for this negative reaction is
probably that the reality is much more complex and uncertain than it
is made to appear.
Lay people reading books of this kind can gain the impression
that by being optimistic, being in control, being active, making a
decision to love themselves, they are likely to get well again. While
there is some truth behind that view, as we will see in chapters  and
, the claims are often sweeping and based on impressions, rather
than evidence. Impressions can easily be mistaken; for example,
when a scientific analysis of groups was conducted according to the
principles espoused in Love, Medicine and Miracles, by Bernie Siegel,6
participants failed to live longer than people in a comparison group
who did not attend.7 Errors commonly found in these more popu-
lar accounts include misconceptions about the state of research in
mechanisms of cancer control; for example, attributing a major role
to the immune system—a position that immunologists have not sup-
ported for at least  decades. There are often claims about powers of
the mind that may be latent within us, but that almost none of us
can exhibit, such as the ability to direct chemotherapy to a cancer
or divert blood and starve a tumour. The psychological qualities of
people who are likely to develop cancer tend to be spoken of as es-
tablished, whereas scientists who have actually studied this issue are
much less certain; see for example, the work discussed in chapter
. Researchers who spend many years painstakingly dissecting com-
plex questions like these have a right to be resentful about sweeping
claims. In a related manner, the qualities that characterize survivors
are often confidently asserted, on the basis of impressions, and on
non-rigorous studies by others (which we will examine in chapter ).
The reality is again more complex. The implication that cancer pa-


 can the mind heal cancer?

tients often unconsciously “need” their illness is also a common claim

that is unsupported by evidence, and is insulting to many. Books that
uncritically extol the power of our mind may inspire hope, but they
may also provoke despair. Two colleagues of mine, Brian Doan and
Ross Gray,8 have described the guilt and disillusionment that many
of their patients feel when they try to live up to such recommenda-
tions, yet find that their cancer continues to progress.
It is, of course, particularly appealing to cancer patients to read
accounts of patients who have unexpectedly recovered from serious
disease, especially if that condition resembles their own. There are
two main categories of books of this kind: studies by health profes-
sionals of patients who did well (chapter ); and what we might call
the “heroic survivor” accounts. The latter describe, usually in great
detail, the struggles of an individual with his or her disease (cancer
seems to attract more of these accounts than other diseases, in part
because it is so often resistant to medical treatment). Such books can
inspire hope and can reassure the reader that it is humanly possible
to triumph, in spirit at least, over such severe challenges; the reader,
whether lay or professional, can only respect the author’s courage and
resourcefulness. The danger in such accounts comes when it is stated
or implied that what the writer did was what caused him or her to
survive beyond medical expectation. We will meet this logical er-
ror again, in studies of remarkable survivors, but briefly, just because
one person survived longer than predicted, and also engaged in some
practice thought to be healing (perhaps followed a special diet), it
cannot be inferred that the diet caused the long survival. We never
hear from the many people who adopted the same diet and failed to
survive! However, the stories may well point to healing strategies that
deserve further investigation. I’ll briefly mention now several books
of this kind that, in my opinion, are responsible and helpful.
Claude Dosdall was a hospital administrator who developed a
brain cancer, which was presumed fatal, but inspired him to inves-
tigate all aspects of his life and make changes. He lived for  years
longer than predicted, and in that time founded an organization in
Vancouver called , which offered support and education in self-


 Popular and Professional Views

help to thousands of people with cancer, and continues to operate

long after his death. Claude’s book, in typical humorous fashion, is
entitled My God, I Thought You’d Died
Died,9 which is what a friend said on
meeting him some time after his diagnosis!
Well, by Judy Edwards Allen,10 is an-
The Five Stages of Getting Well
other example of the best kind of survivor book. At the age of  she
contracted a breast cancer that spread and became incurable, and, like
Claude, she examined all aspects of her life and changed them to aid
healing. Judy described how she gained a great deal from a profound
spiritual text A Course in Miracles, and she passes on to others the
understanding that she came to on the surrender of personal, ego-
driven ambition as a route to healing.
The book by Alice Hopper Epstein, Mind, Fantasy and Healing
Healing,11
is unusual and fascinating. She recovered from a kidney cancer that
had spread to the lung, in parallel with undertaking an inner journey
to become acquainted with aspects of her personality that she “saw,” in
her imagination as little figures. There was “Baby Alice,” a child rep-
resenting the author’s fearfulness; a crab that later turned into a bird,
representing aspects of her relationship to a mother who would not
“let her fly”; then “Amanda, the builder,” a source of strength; “Little
One,” a volatile, feisty, personification of the author’s hostility; and
finally “Mickey,” a complicated little girl who was a manifestation of
jealousy. Alice (the author) had various imaginary encounters with
these sub-personalities, which she came to understand and accept as
outlets for emotions and behaviours that were difficult to express in
real life. The figures all changed and matured during the course of
her therapy with someone who must have been a very enlightened
and supportive therapist. A single story does not constitute proof (in
this case, that such imagery work can affect cancer progression), but
an account like this does bring to our attention a possible route to
healing for some people that obviously deserves much more investi-
gation (there have been no such studies published, to my knowledge,
since Alice’s book appeared in ).
Finally, Ian Gawler, a veterinarian, wrote You Can Conquer
Cancer12 some years after surviving a malignant bone cancer that had


 can the mind heal cancer?

spread to his lungs. Ian and his wife Gayle explored many unconven-
tional routes to healing (conventional medicine had no cure for him),
including attending meditation sessions with psychiatrist Ainslie
Meares, whose study was mentioned earlier. His recovery seems truly
remarkable: Dr. Meares published photos of Ian with bony growths
in the lungs that protruded through the chest wall; Ian himself says
he was spitting out bone at the time! However, he became healed,
and has since devoted himself to running a large centre for cancer
patients in Australia.
In addition to books such as these (and there are many more),
one finds, sometimes it seems in almost every issue of certain popular
magazines, accounts of people who “beat” cancer or another serious
disease. These accounts are usually simplistic and often misleading.
They may sell magazines, but they have the unfortunate effect of
causing many health professionals to lump together and dismiss all
attempts to study the potential of mind to influence healing of physi-
cal disease. Funding thus becomes difficult to obtain, and young in-
vestigators are discouraged from entering the field.
One very positive and concrete result of popular books and arti-
cles, however, is increased public awareness of the unmet needs that
cancer patients and others have for emotional support. Community
organizations may be set up to provide it; I’ve already mentioned the
Gawler and HOPE centres. Often, as in these cases, it is the experi-
ence and drive of one dedicated survivor that stimulates the creation
of such an institution; Gilda’s Club, fuelled by the energy of a well-
known comedienne, Gilda Radner, is another example. In my city of
Toronto, Canada, the Wellspring organization was set in motion by
Anne Gibson, who became enthusiastic after attending our Healing
Journey program (chapter ); Wellspring has since expanded to a
number of other communities. Sometimes a centre will be initiated
by people who have not themselves suffered from cancer but have
become convinced of the value of such support; the Wellness com-
munity for cancer patients, founded by Harold Benjamin, has been a
very successful example of this kind, with many centres now in the
United States.


 Popular and Professional Views

   

  

In spite of the obvious value that cancer patients place on the sup-
port they get at community centres like these, this kind of care is not
yet strongly advocated by many oncologist physicians. We can only
speculate why this is so, in the absence of any in-depth investiga-
tion of physician attitudes. In part it may be a carryover of historical
beliefs. Until  or  years ago in North America (and still in some
European countries, apparently), physicians seldom informed their
patients of a cancer diagnosis. This reticence was no doubt kindly
meant—sparing the “victim” distress in her last months—but today
it seems patronizing and misguided. At the very least, patients need
the opportunity to plan their remaining time, if death is inevitable,
and those who are interested in doing so should be given the chance
to help themselves. More recently, around the s, there was much
argument about the value of support groups, where cancer patients
could meet with one another and a leader, to share feelings and expe-
riences. Those objecting claimed, presumably without the experience
that would likely have convinced them otherwise, that such interac-
tions would be depressing; for example, that if a group member died,
it would harm other members emotionally. A small group of psychia-
trists and psychologists showed that such was not the case, and ar-
gued for more open communication and emotional support for cancer
patients generally; these included Irvin Yalom and David Spiegel of
Stanford University, Jimmie Holland of the Sloan Kettering Institute,
New York, William Worden and Avery Weisman of Project Omega
at the Massachusetts General Hospital, and others.13 This battle is
now won: it seems incredible, in retrospect, that it could ever have
been the subject of dispute. There is now ample empirical evidence to
bolster the commonsense idea that emotional support is valuable for
many cancer patients. However, by no means all express a wish for it,
and why many don’t is a question that needs in-depth investigation.
Part of the reason is certainly unawareness of what group support can


 can the mind heal cancer?

do, and apprehension about the benefits of talking frankly to other

people with similar disease.
Although emotional support may be accepted, if seldom strongly
advocated, by professionals, a further possibility is less widely ac-
cepted: that patients can do more than share experiences and emo-
tions; they can learn active coping strategies, like thought manage-
ment, deep relaxation, and meditation. Some of us who have explored
these methods claim first that they can almost always help people
cope better with the stress of cancer; and second, if they are pursued
in depth (chapter ), they may affect its course. While most oncolo-
gists, if pressed, would probably acknowledge the benefits of stress
reduction, even this relatively conservative goal is not highly valued,
judging by the scarcity of referrals and relevant programs. (Support
groups are quite common in cancer centres, while programs teach-
ing such active strategies are not). There is good evidence now that
learning psychological skills helps patients enjoy a better quality of
life, better in fact than simply meeting for support alone. Resistance
may stem in part from lack of familiarity with the benefits of such
help, coupled with a fear that it may lead patients to believe that the
work can actually prolong their lives. And it is this second potential
goal of self-help philosophy that, even when not openly expressed,
raises fears among many professionals. Their frequent objection is
that if anyone suggests that what we do with our minds might affect
cancer (practising internally assisted healing, in our terminology),
that suggestion generates “false hope,” presumably meaning hope the
speaker believes is unwarranted. For example, a committee examin-
ing the Simontons’ work published a critique that simply dismissed
their very interesting clinical observations, rather than seeing them
as a basis for further investigation.14

      “ ”

Since the value of “hope” is presumably not really in dispute, a more

accurate term would be “false expectations.” It is undoubtedly true
that irresponsible advice—whether for psychological techniques,

 Popular and Professional Views

diets, other unconventional remedies, or even conventional medical

treatment itself—can stimulate unwarranted or unrealistic expecta-
tions. For this reason, and in pursuance of honest communication
generally, doctors tend to be conservative (patients would often say
“pessimistic”) in their claims. There is a cost to such pessimism: I
have heard over and over again from patients complaining that what
their doctors told them “robbed them of hope” or “plunged them into
despair,” often by saying something like “There is nothing more we
can do.” There is always something that can be done for people, if
“only” psychological and spiritual support, and communications can
be put in a more positive way without being dishonest; for example,
“There are no known cures for your kind of cancer at present, Mrs.
X, and you must be prepared for the possibility that you will die, but
there is always room for hope; new remedies are constantly being
tested, and I’ve seen occasional individuals live for many years with
what you have.”
As a guide to presenting psychological approaches to helping
oneself both feel better and perhaps live longer, I would offer the
following suggestions. First, the professional can only advocate what
he or she understands and believes, on the basis of thorough exami-
nation, to have some support from scientific evidence or systematic
clinical observation. (Usually there is some degree of uncertainty, and
this should be conveyed to the patient). It is dishonest to make claims
that one can’t support, but it is also dishonest and prejudiced to dis-
miss or disparage possibilities of which one has no experience, when
there is some evidence for their value. Second, on the patient’s side,
the advice given should be only what that individual can understand;
it has to make sense to her. Thus it is irresponsible to say to someone,
“You must just love yourself and all will be well,” if she doesn’t have
the remotest idea how to accomplish such a feat. Yet the same advice,
coupled with psychotherapeutic help, might be valuable to a person
who is able to see its point.
Current widespread medical resistance to the notion that patients
can be taught to help themselves by psychological means may have
deeper roots than “false hope.” The view, which is an old one, that we


 can the mind heal cancer?

can determine our biological destiny by voluntary means, to at least

some extent, contradicts the whole philosophy of modern medicine,
which is based on materialism. It regards the body as a machine,
whose parts can be fi xed from the outside by trained experts, and in
which a mind exists somewhere but is largely isolated from the host
body. However, buried within us all is a knowledge of potentials of
this kind that we rarely access; health care professionals, like other
people, have a distant intuitive awareness of these potentials, but are
generally not trained to use it. Thus a sense of guilt, inadequacy as
a healer, may often be present below conscious awareness, and may
provoke an over-reaction when the possibility of mind–body healing
comes up.



Healing is broadly defined as restoration of, and ultimately improve-

ment in, harmony, balance, and optimal functioning, within and
between all parts of the person: body, mind, and spirit. It may be
brought about by external agents and procedures (“externally as-
sisted”) or by changes from within a person’s own mind (“internally
assisted”). The latter is the main subject of this book.
We briefly explored early history of the idea that psychological
healing methods could affect the progression of cancer, which has
been widely advocated in the popular media but is still largely re-
jected by conventional medicine. Stimulating “false hope” is often
cited by professionals as a damaging consequence of advocating use
of the mind to assist healing; I suggest that such advocacy must be
guided by knowledge of relevant evidence, without prejudice in either
direction. What a professional can do for her patients in this way will
depend upon both her understanding and that of the person receiving
the assistance.


 Popular and Professional Views



. Two books by the author designed to help cancer patients help themselves:
Cunningham, A. J. (). The healing journey: Overcoming the crisis of cancer.
(nd ed.). Toronto: Key Porter.
Cunningham, A. J. (). Bringing spirituality into your healing journey.
Toronto: Key Porter.
. LeShan, L. (). Cancer as a turning point. New York: Dutton.
. Simonton, C., Matthews-Simonton, S., & Creighton, J. L. (). Getting well
again. New York: Bantam.
. Newton, B. W. (). The use of hypnosis in the treatment of cancer patients.
American Journal of Clinical Hypnosis, , –
–
  .
. Meares, A. (). What can a patient expect from intensive meditation?
Australian Family Physician, , – .
 
– 
. Siegel, B. (1986). Love, medicine and miracles. New York: Harper and Row.
. Morganstern, H., Gellert, G. A., Walter, S. D., Ostgeld, A. M., & Siegel,
B. S. (). The impact of a psychosocial support program on survival with
breast cancer: The importance of selection bias in program evaluation. Journal
of Chronic Disease, ,
 –.
. Doan, B. D., & Gray, R. E. (). The heroic cancer patient: A critical analy-
sis of the relationship between illusion and mental health. Canadian Journal of
Behavioural Science, , –.
. Dosdale, C. (). My God I thought you’d died: One man’s personal triumph over
cancer. Toronto: McClelland and Stewart–Bantam.
. Edwards Allen, J. (). Five stages of getting well. Portland: Lifetime.
. Hopper Epstein, A. (). Mind, fantasy and healing: One woman’s journey from
conflict and illness to wholeness and health. New York: Delacourt.
. Gawler, I. (). You can conquer cancer. Melbourne: Hill of Content.
. Holland, J. (). Historical context. In J. Holland and J. H. Rowland (Eds.),
Psycho-Oncology. Oxford: Oxford University.
. A critical editorial on the idea that mental techniques can affect survival:
American Cancer Society (). Editorial. CA: A Cancer Journal for Clinicians,
, –.


 Chapter 

A Wider View: Can the Mind

Heal the Body?

I
n this chapter I attempt to show that a case can be made for a
mind–body link in many areas of health and disease. Against
this background, it becomes reasonable to propose that cancer
is in no way exceptional, and that the mind might affect cancer
growth. The chapter is unavoidably more technical than the others in
this book, although I’ve tried to make the discussion as simple as pos-
sible. I’ll be introducing a way of thinking about the relationship be-
tween mind and body that is common sense and easily understood by
anyone familiar with computers. However, readers who don’t doubt
the mind–body connection and who have little interest in the mecha-
nisms by which it operates could bypass this chapter, or read only the
first part of it; all subsequent chapters will be much more digestible
for the layperson.

  

The human brain is obviously a highly complex organ—in fact, it has

been described as the most complex known structure in the universe.


 can the mind heal cancer?

This complexity grew as animals evolved; we can see anatomical

evidence of, for example, the “reptilian brain” within our own. The
function of the brain is to provide an overarching control of virtually
everything that happens in the body. Lower levels of the brain, the
“older” parts of the organ, maintain our blood pressure, heart rate,
and breathing, and influence movements of our digestive system and
much of the hormonal activity in our bodies. All of this would con-
tinue if we were in a coma.
With evolution came the ability to take some voluntary control
over our actions, beyond reflexive responding. More elaborate func-
tions depend on the cerebral cortex in the brain, and as this part
developed, the ability emerged for communication through symbols,
principally speech, and hence for reflective thought. Partly as a re-
sult of our more complex brains, and partly because of our cultural
achievements, we humans have the capacity for sophisticated think-
ing including self-awareness and ability to manipulate and respond to
abstract symbols and ideas (“mother,” “love,” “guilt”).
The brain exercises its control over the body through physical
pathways. A brain-initiated action begins when nerve cells, called
neurones, “fire” (produce electrochemical impulses) in some part of
the cortex. This activity spreads through various parts of the organ:
the brain cells are all interconnected in a huge web or net. From the
brain, nerve impulses may be passed down the spinal cord and along
nerves issuing from the cord, to muscles or other organs in the body.
A thought, in physical terms, is simply a particular pattern of nervous
activity in the brain. How these physical events give rise to the ex-
perience we have of conscious awareness nobody really knows. Some
nerve firings lead to sensations, like pain, others lead to thoughts.
This is where we come to the difficulty many medical scientists
have with the idea that the mind might influence disease. Nobody
has trouble believing that a physical event, like lots of nerves firing,
has an impact on other parts of the body. But the mind, a psychological
experience? How could such an intangible thing exert force on con-
crete structures in the body? In spite of the fact that we all know that
a thought or intention can lead to immediate physical action, I think


 Can the Mind Heal the Body?

that the apparent incompatibility of thoughts and physical events has

deterred many from taking seriously the possibility that mind could
affect disease. The solution is clear: “thoughts” and “nerve cells fir-
ing” are just two ways of describing the same thing. They are two
different languages, if you like (I discuss all of this more fully in
a journal article cited at the end of this chapter). “Mind,” the sum
of our thinking and sensing, is like software in a machine whose
hardware is brain and body. We can influence the workings of a com-
puter by making small physical adjustments to its internal wiring,
but it is a lot easier and more efficient to operate through the soft-
ware. Analogously, much of what the body does can be manipulated
through the software of the mind. In the case of deciding to move a
limb, we all know this. In the case of changing the course of a dis-
ease, we have barely begun to explore the potential.
Of course the body is a very complex machine, many of whose
functions have evolved to function automatically without deliberate
mental input, and will continue to operate in animals or people in a
coma. Furthermore, some parts of the body are much more directly
affected by the mind than others. As in the example just cited, we
translate an idea into muscle action very easily and skilfully. Other
parts are less accessible. Few if any of us can alter our heart rate sim-
ply by issuing an internal command to the heart. However, we can all
learn to do it indirectly—by vividly imagining a frightening scene,
for example. In recent years it has been found that many parts or
functions of the body can be influenced that were previously thought
to be entirely outside voluntary control. When I began research in
immunology  years ago, the immune system was held to be quite
autonomous; now we know it is very sensitive to psychological states,
and that in fact the nervous and immune systems communicate con-
stantly. On a more mundane level, distribution of blood flow seems
to be quite readily affected by the conscious mind—this may be what
Bernie Siegel was referring to when he suggested, as reported in
chapter , that we have the potential to deliberately starve a tumour
of blood. He may be right; it needs and deserves investigation. We do
know that, with training, using techniques like biofeedback and hyp-


 can the mind heal cancer?

nosis, most of us can learn some control of heart rate, blood pressure,
skin temperature, patterns of electrical activity in the brain, even
the firing of individual nerve cells. A beginning level of control over
muscle tension allows people to achieve a depth of relaxation that
they may never before have experienced (see chapter ). And in peo-
ple who have devoted time and study to personal control, remarkable
feats have been documented, like enduring large puncture wounds
from metal skewers without subsequent bleeding or infection. No
doubt there are many barriers to direct translation of thoughts into
physical change in the body, but there are ways around some of these
barriers.
To summarize, in terms of theoretical possibilities, once we rec-
ognize that “mind” and “brain activity” are two ways of describing
the same thing, it is no longer surprising that we might have the
potential to affect many body functions through conscious thought.
And in terms of practical evidence, we already know that sophis-
ticated mind–body connections can be made, even if they are not
within the repertoire of most of us as yet. It seems important to keep
an open mind, and to explore further.

               

Just as we can decide, in examining the brain, to focus our analysis

either on its detailed anatomical mechanisms or on the way informa-
tion is passed through it, so we can look at mind–body connections
in terms of mechanisms of information transfer. The former is what
usually has been the concern of medical scientists. The latter, focus-
ing on the “logic” of the connections, will be more useful to us here,
and has the advantage of being readily understood without a techni-
cal background.
A diagram will show how the mind transmits “messages” that
promote or heal disease (Figure .). Events in our environment,
meaning social interactions and life circumstances generally, are per-
ceived and appraised by us in ways that depend on a host of factors,
such as our cultural background, our individual history, the context

 Can the Mind Heal the Body?

Ex ter nal Circ um s tances

Perception

1 . M ind
Apprai s al �
• tho ughts �
• feel i ngs

I nter nal Path B ehav io ur s �

(Ex ter nal Path)

2 . Long -rang e “M es s eng er s”

• ner ve pathways �
• ho rmo nes

3 . Shor t-rang e ( Tis s ue)�

R eg ul ato r s
• c yto ki nes, growth f ac to rs, �
i nter fero ns, angi o genes i s f ac to rs, �
i mm une s ys tem , o thers

4 . Cells in Tis s ues

• no rm al + c ancer cel l s �
• events wi thi n cel l s

H ealth o r D is eas e

       .  Some of the steps in the “internal” path between events

in the mind (thoughts, feelings, perceptions) and their ultimate impact on
bodily health.

 can the mind heal cancer?

of the events, and our state of mind at the time. Perhaps the most
basic appraisal is, “Does it threaten me, or does it seem desirable?”
This appraisal, in combination with other mental events of which we
are unconscious, determines our emotional reaction (experienced as
a “feeling” in both mind and body). This is the most crucial step in
the chain (and, incidentally, the one over which we can exert most
voluntary control). I’ve shown it as a “mind” box. Thoughts can be
viewed as packets of information.
As a result of these events in the mind, messages are sent to all
parts of the body. It is important to distinguish two kinds of result,
as in Figure .: externally observable behaviours that indirectly af-
fect health, and internal changes that do so more directly. These
correspond to the externally and internally assisted healing routes
of chapter . Nobody doubts the external route of disease causation.
For example, a frequent appraisal such as, “I can’t stand this situa-
tion, pass me the bottle,” might lead to developing a harmful addic-
tion. The external/behavioural path to causing disease might involve
smoking, overeating, alcoholism, failure to exercise, non-compliance
with medical advice, dangerous driving, and many other kinds of be-
haviour. If the appraisal is, “I have a disease, I need to do something
about it,” then the external loop on the diagram represents externally
assisted efforts to heal the condition, such as seeking medical advice,
taking medication, adopting healthier habits, and so on.
The “internal” path refers to changes in distant parts of the body
as a direct effect of messages generated in the mind/brain, not medi-
ated through externally observable behaviours. This is what is usually
meant by “healing through the mind,” and provides another route
through which the onset or progress of ill health might be deliber-
ately affected. In broad outline, as we react psychologically to our en-
vironment through our thoughts, we signal the body to be prepared
to adapt accordingly. For example, a perceived threat might stimulate
a raised heart rate, tensing of muscles, and other expressions of readi-
ness for action. This signalling is done through two major channels:
the nervous (electrochemical) system and the endocrine (hormonal,
chemical) system. The electrical or chemical signals are physical in


 Can the Mind Heal the Body?

nature, but carry information, just as an electrical signal in a tel-

ephone wire may do. This long-distance communication (acting over
the whole extent of the body) affects specific tissues; in our example,
a signal to prepare for action, transmitted down a chain of nerve cells,
could cause muscle fibres to contract. The long-range signalling sys-
tems, though nerves and hormones, affect the local systems of regu-
lation in most organs of the body.
These processes of local regulation, which I’ve labelled “short-
range messengers” in the figure, have the task of maintaining healthy
functioning in their immediate vicinity. It is an axiom of modern
biology that virtually all cells in the body are constantly being acted
upon by their neighbours and by molecules (hormones, nutrients,
other signals) in the fluids that bathe them. Cells that divide fre-
quently, like those in the lining of the gut or parts of the skin, are
in particular need of constant monitoring and control of this kind,
or they will simply continue to divide, and may generate cancerous
tumours. We will discuss later in the chapter the little that is known
about the mechanisms by which incipient cancerous growths are con-
trolled. To anticipate the later discussion: we now know that cancers
emerge not only because the cells comprising them are genetically
abnormal, but also because of some failure of this local regulation.
As the final step in the pathway, I’ve shown a box for the cells
that are the target of all this control or regulation: this includes both
normal (dividing) cells and cancer cells. To sum up this section then,
messages originating in the brain/mind affect, through long-range
and short-range messenger-regulators, the behaviour of cells in most
tissues of the body; if this regulation is impaired, disease may fol-
low.

  

 “”

The diagram also helps us see why the division of mind from body has
been perpetuated, and, I hope, how we can begin to heal the breach.
Biomedical science as I’ve said is concerned mostly with mechanisms,

 can the mind heal cancer?

particularly at the bottom of the pathway. This focus has led to an

understanding of the cellular and molecular changes accompanying
disease, and has often allowed development of procedures and drugs
to reverse some of these changes. For example, if we observe that
plaque builds up in coronary arteries and may block them, provoking
heart attacks, this leads to surgical methods of treatment; when the
biochemical basis of plaque development is understood (for example,
the contribution of excess cholesterol), drugs are designed to coun-
teract the problem.
When we look at box , however, we enter a territory in which the
appropriate research methods, and even the language, are quite dif-
ferent; it is the province of health psychology and mind–body medi-
cine. Psychologists have to observe what is going on in the mind/
brain indirectly, relying on subjects’ self-report and behaviours, then
describe this in terms of “information,” that is, as patterns of words
and actions, rather than in structural or biochemical terms (while
modern neurology is developing scanning methods to detect activity
in the brain, they detect only relatively gross changes). These pat-
terns can then sometimes be related to ultimate health or disease. The
social determinants of health-related behaviours are also of interest
to health psychologists, and draw upon a further set of concepts; to
know how to induce young people not to smoke, for example, we
need to understand not only individual psychology but also the cul-
ture that encourages this behaviour. The situation is similar when
helping people change such behaviours as abusing alcohol and drugs,
overeating, practising unsafe sex, driving danerously, even commit-
ting suicide.
In this book we are mainly concerned to examine aspects of box
 and test their impact on progress of disease. Don’t we need to know
all the intermediary steps, as some researchers insist, before we ac-
cept that mind and body are, in fact, connected? This is not logically
necessary: if we find a consistent pattern of thought and behaviour
associated with a disease, and if changing the mental state corrects
the disease, we have the required evidence. Furthermore, the events
connecting mind/brain and body are so complex that complete un-


 Can the Mind Heal the Body?

derstanding is still a long way off. Most researchers are fully extended
learning the concepts and methods in one part of a single box, and
have to rely on other specialists for information about the rest. Of
course it is always valuable to know as much as possible about the
pathways by which a treatment works; our knowledge is obviously
more complete if we can say, “The psychotherapy produced a drop in
levels of circulating stress hormones, and enhancement of immune
function, and as an apparent result, a clearing of the infection”! We
will have a brief look at what we know of such mechanisms later in
the chapter. One value of a detailed understanding is that we can
begin to use drugs to repair the ravages of unhealthy thoughts and
behaviours or to substitute for healthy mental change (a mixed bless-
ing, however; for example, over-reliance on analgesics like Aspirin
may prevent us from recognizing behaviours that are ultimately self-
destructive; furthermore, most drugs have unwelcome side effects).

     :



We will look briefly now at the evidence for involvement of mind in

a number of specific symptoms and diseases. This is not intended to
be a technical or definitive review. My purpose here is to provide an
overview showing that the contribution of mind is already known in
many cases. It will also become clear that illnesses can be placed on
a spectrum: those with obvious psychological links at one end, and
those where any mental involvement is relatively obscure at the other.
I’ve clustered diseases or symptoms into three broad categories, based
on the degree to which this link is manifest.
The evidence for involvement of mind, where it exists, is of two
main kinds: observations showing that a condition is prompted or
made worse by state of mind (usually “stress” in some form), and
evidence that psychological intervention alleviates the problem. The
first kind is much more common, I think, because the usual con-
servative view of health scientists is that we need to see evidence for a
connection before being justified in trying mental remedies. In fact,

 can the mind heal cancer?

alleviation through psychological change is the most practically use-

ful, and often the most powerful, evidence one can get for a mind–
disease link.

Conditions Where the Mind–Body Link Is Obvious,

and Alleviation or Reversal Is Clearly Possible through Mind

Many of the conditions in this cluster are not dramatic, yet together
they are probably responsible for the bulk of the health-related suf-
fering in the world (at least in those countries where famine, war, or
endemic plagues are uncommon).
We can start with the suffering brought about by what I will call
“harmful self-talk.” Anxiety, sadness, anger, and much depression
are to a large extent a result of such self-talk, although it is common
to blame external circumstances, such as difficulties in relationships,
for our unpleasant thoughts and moods. They can bring about such
“physical” symptoms as fatigue, headaches, insomnia, sexual dys-
function, and disturbed appetite (I use quotation marks to highlight
the artificiality of the distinction between “physical” or “organic”
on the one hand and “mental/psychological” on the other). Many
of these problems can be alleviated by a shift in patterns of think-
ing—assisted, where necessary, by psychotherapy—which can help
us see that it is not our circumstances but mental reactions to them
that cause distress. The Buddha pointed out this fact  years ago!
Much the same applies to unhealthy addictive behaviours such as
smoking, using street drugs, drinking alcohol, practising unsafe sex,
overeating, even driving unsafely or risking trauma in dangerous oc-
cupations and sports. This is not to claim that shifts in perspective
are easy—often they are not, and harmful habits of thought and re-
action may become ingrained as a result of early life experiences and
later reinforcement. Nevertheless, the possibility of reversing them by
mental means exposes their psychological origins. Clinical depres-
sion, one of the most widespread and costly disorders in the mod-
ern West, is sometimes represented as an “organic” problem (several
types are recognized by experts), implying that it was visited upon

 Can the Mind Heal the Body?

the sufferer, with no contribution from his mind or behaviour. It is

true that there is a biochemical basis for the disease (as there is for all
functions of mind)—for example, there may be insufficient amounts
or inadequate distribution of certain neurotransmitters (chemicals) in
the brain. However, this defect may often be restored either by drugs
or by psychotherapy, the latter route producing the longer-lasting
effects, as the depressed person learns to control his own mood. For
some other serious mental diseases—schizophrenia, for example—it
does appear that there is no realistic possibility of voluntary control,
and that drug treatments are the only choice.
Chronic pain, often without obvious physical causes, is another
example of a condition that seems to be “physical” in origin, yet it
can be both exacerbated and alleviated through the mind. It afflicts
millions of people—chronic low back pain, for example, is the lead-
ing cause of workplace disability in the province of Ontario, Canada.
Both medical and lay people tend to act as if such pain were susceptible
only to physical remedies, but there is abundant research to show that
psychological methods can often alleviate it. For example, a panel
of experts brought together by the American National Institutes of
Health, whose findings were published in the conservative Journal of
the American Medical Association in , concluded that “a number of
well-defined behavioral and relaxation interventions now exist and
are effective in the treatment of chronic pain and insomnia.” It also
noted that this approach to therapy is seldom employed.
“Stress” is a useful term for a definite state of reaction in body
and mind to challenging circumstances (usually it occurs when we
are afraid we can’t cope with a situation). The external circumstances
are the “stressors,” our reaction the stress. Being or feeling stressed
seems to make us more vulnerable to many medical conditions. For
example, susceptibility to the common cold has long been associated,
in folklore, with stress. So it is gratifying to see evidence for it, in an
article published in a prestigious medical journal in  by Cohen,
Tyrell, and Smith. Just under  subjects were inoculated with cold
viruses, and it was found that the likelihood of contracting an acute
respiratory illness increased in proportion to the degree of stress sub-


 can the mind heal cancer?

jects were experiencing in their lives (assessed using a series of ques-

tionnaires). Some other common infectious illnesses (that is, caused
by micro-organisms) are also acknowledged to occur more often or
with more severity under stress, such as those caused by the herpes
viruses (cold sores, genital herpes, shingles), some fungal infections,
some types of viral hepatitis, and -.
It is probable that stress promotes infections, by diminishing
our immune responses to the foreign organisms. Other important
conditions that are not caused by viruses or bacteria are also widely
acknowledged by experts to be worsened by stress, such as hyperten-
sion (elevated blood pressure), which is a risk factor for heart attacks.
On the “healing” side, there is evidence that psychological treatments
such as relaxation training decrease the risk of heart attack. There is
also abundant evidence that psychological interventions can speed
healing after surgery.
Social circumstances, acting through the mind (through our per-
ception of their importance to us, and the emotions they invoke, the
top box in Figure .), are a potent source of both stress and heal-
ing. There is a consensus on the life-sparing benefits of good social
support, and on the harmful effects of social isolation (as may oc-
cur following bereavement, for example). More dramatically, it has
been well documented that people whose life expectancy is short tend
to live until important anniversary dates, such as their birthdays or
other culturally significant dates, and then die soon afterwards. And
on the other side of the coin, equally dramatic, is the phenomenon of
“voodoo” or “hex” death, where anthropologists have described the
deaths, within days, of members of a tribe who were placed under a
lethal curse or spell by their witch doctor.
In summary, we already know that many of our most prevalent
health-related problems in the West are largely induced by our minds
(that is, by patterns of thinking), and can be alleviated or cured by
changes in the mind. This being so, it would seem logical, as many
writers in this field have noted, to use therapy or treatment at this
level (Figure ., box ) to solve the problems.


 Can the Mind Heal the Body?

Conditions Where There Appears To Be a

Contribution by Mind, although Less Widely Acknowledged

This category overlaps with the last, and includes many important
diseases for which there is some evidence that the mind plays a role
(internally promoted or assisted). Medical opinions vary (the evidence
is seldom irrefutable); more materialistically oriented physicians fo-
cus entirely on physical aspects of cause, while health psychologists
and more holistically oriented physicians see a contribution from the
mind. In almost all cases, however, standard treatments are physical
(external) in nature.
A list of the major conditions would include: myocardial infarc-
tion (heart attacks), peptic ulcer (but see below), and chronic disorders
of the bowel like irritable bowel syndrome and Crohn’s disease, bron-
chial asthma, rheumatic diseases and arthritis, some dermatological
conditions like psoriasis, endocrine disorders like diabetes mellitus
and thyroid disease, infectious diseases, including those mentioned
in category  above, progression of , autoimmune diseases, such
as lupus erythematosus, and others.
Let us look at some examples from this list. Coronary heart
disease (blockage of coronary arteries leading to heart attack) is the
leading cause of death in Western cultures. While diet and exercise
play a role, there is a large body of research demonstrating that hos-
tile thoughts and feelings translate into higher susceptibility to this
disease (and probably to many other serious illnesses). The evidence
is strongest for the consistent association of hostility and anger with
incidence of heart disease, but there are also intervention studies,
showing that incidence of disease and death can be substantially
reduced by teaching people how to reduce time urgency, competi-
tiveness, and hostility, and replace them with beliefs and behaviours
rooted in patience, tranquillity, and empathy. A determined critic
can say, however, that the counselling did not produce an “internally
assisted” healing, but acted solely by changing the behaviours of the
individuals whose health improved, for example, by persuading them
to adopt healthier habits (externally assisted healing).


 can the mind heal cancer?

It is probable that both paths of pathogenesis (disease production)

and healing are involved in many diseases, as is well illustrated when
we consider another important chronic condition, diabetes mellitus.
To slow the progression of this disease and avoid serious complica-
tions, like blindness or loss of limbs, it is vital to have good manage-
ment of blood glucose levels, which requires a disciplined regime of
insulin injection, and also control of diet and exercise. Maintaining
adequate self-care behaviours is usually dependent in turn on a healthy
emotional state and good support from family and medical teams. In
other words, the internal state influences the external/behavioural
loop. In addition, there is undoubtedly a direct, internally mediated
effect of mind, through emotional state, on blood glucose levels and
carbohydrate metabolism generally. Emotional stress mobilizes blood
sugar, and periods of relaxation and rest can decrease the amount of
insulin needed. Similar remarks would apply to many chronic dis-
eases: there is a need for behavioural management, and also a likely
direct effect of mental-emotional state on the disease. Peptic ulcer,
for example, has long been attributed to stress; the recent discovery
of a bacterium as a causal agent does not disprove the importance
of mental state, but rather shows that several factors are important,
including mind. In a similar way, any widespread outbreak of infec-
tious disease always fails to affect a proportion of the population, and
mental factors are likely to be among the reasons for this resistance.
An example of mind acting in a beneficial way through internal
mechanisms only, comes from the healing of wounds. There is con-
sistent evidence, in both animals and humans, that stress of various
kinds slows wound healing significantly. Conversely, healing after
surgery is accelerated by psychological stress management. A second
example is the intriguing recent series of experiments showing that
simply writing about stressful life experiences relieved anxiety, and
provided prolonged relief of symptoms from two “physical” condi-
tions: rheumatoid arthritis and bronchial asthma. A third example
is the phenomenon of classical conditioning, familiar to all through
Pavlov’s dogs, who learned to salivate at the sound of a bell, which
had become associated with the expectation of receiving food. We


 Can the Mind Heal the Body?

humans do this too—try imagining a delicious apple pie, baking in

the oven! We are conditioned in many ways to respond bodily to
things our minds perceive. Classical conditioning—for example, au-
tomatic fearful responses to some stressors—undoubtedly plays a role
in health and disease. In all these cases the pathway from mind to
body appears to be purely internal.
This brief discussion will have given some indication about
the difficulty of establishing a direct influence of mind on disease.
Modern medical theory is very materialistically oriented, preferring
to find objective, external causes for illness. Faced with evidence for
a role of mind, a materialist’s next line of defence is to insist that
the mind is not really acting internally, but merely instructing the
body’s musculature to act in certain ways, to bring helpful external
agents to bear. The interested reader might like to consult a fasci-
nating exchange, published in Psychosomatic Medicine. Two protago-
nists, Redford Williams and Neil Schneiderman, argued that there
was good evidence for mind–disease links, and gave examples. Two
others, Arnold Relman and Marcia Angell, both eminent members
of the American medical establishment and editors of the prestig-
ious New England Journal of Medicine, disputed this evidence. Several
things emerge from this debate. First, its polarized, antagonistic tone
(a far cry from disinterested seeking for truth). Second, the New
England Journal people have a point: irrefutable evidence is hard to
come by. Third, there is a deep ideological resistance, masquerading
as scientific rigour, to seriously considering a significant role for mind
in disease, at least in some quarters. Dr. Relman is quoted as saying,
“The power of mind and thought to change physical matter and heal
organic disease [is] a concept which basically contradicts the laws of
physics in the modern scientific view of nature.” In other words, he has
overlooked the fact that information affects matter, which we see all
around us, in the workings of our computers as well as in our bodies.
Does it matter whether mind affects disease through external
or internal routes or loops? Perhaps not to the suffering individual
who, in a given instance, simply wants relief. But the distinction is
important for its impact on our research and treatment methods. To


 can the mind heal cancer?

the extent that we deny mind, we will focus on ever more elaborate
external, technical methods for treating disease. At the same time,
we take away from the individual what is possibly a considerable po-
tential to help herself. We will come back to this crucial point at a
number of places later in this book.

Conditions Still Usually Thought To Be Independent of Mind

Most experts in cancer medicine or research would place the dis-

ease in this category. All acknowledge that the majority of cancers
are mentally induced through the “external” pathway, by unhealthy
behaviours, notably smoking and poor diet. However, the internal
pathway, the person’s thoughts and feelings, are not generally consid-
ered to have any potential direct effect, either in causing or alleviat-
ing the disease (we will examine this further in subsequent chapters).
In fact, cancer research seems to be focusing more and more on the
genetic changes that cause cells to become potentially cancerous.
While most cancers seem to arise as a result of spontaneous changes
in the genetic material of a single cell after birth, in other cases people
inherit specific defective genes that make development of cancer very
much more likely. It is now estimated that % of all cases of newly di-
agnosed breast, ovarian, endometrial, colorectal, and prostate cancers
are inherited in this way. For example, in the case of breast cancer,
two such genes ( and ) have been identified. Somewhat
more than half of the women inheriting defects in one of these genes
will get cancer (unless the breasts are removed as a preventive meas-
ure). Of interest to us here, however, is that not all women who have
these genes do get cancer—other factors, possibly including the psy-
chological, must also be operating. This highlights a more general
principle. Although cancer is often described as a “genetic disease,”
and diseases caused by micro-organisms as “infectious diseases,” all
maladies are the result of contributions from all of the “levels” we
portrayed in Figure .. There are always social influences (for exam-
ple, choice of a mate in genetic disorders, local sanitary conditions in
an infectious disease), always physical factors, and inevitably always

 Can the Mind Heal the Body?

psychological influences acting either through behaviours, or by what

I’ve called the internal route, or both.
What about the fact that animals get many of the same kinds of
disease we do (as a former veterinarian, I am particularly aware of
this)? Does it not disprove that mind is necessary? And what about
diseases in very young children; how can their minds have had time
to contribute? I would respond that mind can have an impact only to
the extent that it is developed in an individual, animal or human. I
am not arguing against the importance of genetic or other physical/
biological determinants of disease, but am simply saying that when a
conscious mind exists, it will inevitably exert a effect on the more au-
tomatic functions of the brain, and hence on the body (see next sec-
tion). This will both foster disease and provide an avenue for alleviat-
ing it in many cases. However, when a person is born with a disease,
genetically induced or otherwise, direct effects of her own conscious
mind can presumably be ruled out. An example is Huntingdon’s dis-
ease, caused by a single gene, whose inheritance invariably brings
about brain degeneration and death, the symptoms usually beginning
in mid-life, although even here, the variable age of onset points to an
influence of factors other than the purely genetic.

     

   

We have couched our discussion to this point in terms of the flow of

information from one part to another, rather than in concrete terms
of molecules, and nerves firing. As pointed out earlier, the logic of the
interactions is more important to our purposes here than the detailed
mechanisms. Once we know that certain kinds of message under-
mine or promote health, we can immediately apply this knowledge,
like operating a computer from a knowledge of the logic of its soft-
ware, without needing to know the electrical and mechanical basis
for its operation. However, it is reassuring to know something about
the molecular and cellular events that carry these messages. Let us
therefore have a brief look at the nature of the long-range messages

 can the mind heal cancer?

influencing health, about which quite a lot is known, then at con-

trolling cancer growth through short-range messages, which are still
poorly understood.

The Mind and Long-range Messengers

The mechanical connections between the body and the aware or con-
scious mind are of three kinds. The first is called the voluntary part
of the nervous system. Ideas or sensations in the mind, which are
a reflection of masses of nerve cells (neurons) firing in the cerebral
cortex, can be directly channelled into messages (electrical impulses,
generated in turn by flow of certain molecules called neurotransmit-
ters) down specialized motor neurons in the spinal cord and along the
nerves leading to our “voluntary” or striated muscles, meaning most
of the large muscle groups. We decide to move, we move, thanks to
this chemical flow of intention. Second, and distinct from all of this,
is the involuntary or autonomic nervous system, which controls the
functions of organs other than the striated muscles. Thus autonomic
control (involving both “sympathetic” and “parasympathetic” parts,
which balance each other), affects heart rate, patterns of blood flow,
respiration, digestion, liberation of energy molecules from the liver,
aspects of sexual behaviour, and other functions. This more primi-
tive part of the nervous system also interacts with the endocrine or
hormonal system, which constitutes a third major link between mind
and body.
When we are “stressed”—whenever there is a challenge of any
sort, any perception of events requiring a response beyond the most
routine—our minds must decide how to react. The most basic kinds
of reaction are what the famous medical researcher Walter Cannon
called, in the early s, “fight” or “flight.” As we realize that a re-
sponse is needed, two main sets of events take place: first the sympa-
thetic nervous system sends nerve impulses to the heart, increasing
the rate of its cycle of contraction, and to blood vessels, directing blood
to the muscles, and to the energy system, mobilizing glucose. It also
sends impulses to the core of the adrenal glands, situated above the

 Can the Mind Heal the Body?

kidneys on either side of the body. These glands then immediately se-
crete adrenaline, which increases the general arousal. Simultaneously
the endocrine system contributes directly: as the perception of threat
or challenge fi lters through various levels of the brain, it reaches the
hypothalamus, which is a primitive part controlling most hormonal
activity. The hypothalamus signals the pituitary gland, sometimes
called the master gland, which is situated beneath it. This gland,
in turn, releases hormones into the blood that can have many ef-
fects, particularly on other glands in parts of the body like thyroid,
pancreas, and testes or ovaries. During the response to stress, the
most important hormones from the pituitary are those that stimulate
another part of the external part of the adrenals, to release corticos-
teroid hormones. These also have widespread effects, for example, on
inflammation and on the immune system (see below).
This is a bare outline of the stress response, but if it seems techni-
cal, the important point is that we know how thoughts and feelings in
our conscious minds can induce profound changes in the rest of the
body through these long-range messenger nerves and molecules. It
thus makes biological sense to speak of mind affecting the body. We
also know that if this sort of adaptive response is provoked continu-
ously over a long time, harmful effects on many of the body’s organs
are likely. The exact pattern of such breakdown varies from person
to person, depending on their physical status, their coping resources,
and other factors.

Short-range or Local Messengers, and Local Control of Cancer

The control of the growth and differentiation of dividing cells of

many kinds, including cancer cells, is an exceedingly complex proc-
ess. Research on it is currently fragmented into many specialized
area, and integrative reviews are difficult to find. What follows is a
tentative outline. In general, we can say that the local environment
in which a cell finds itself is very important in determining whether
and how often it can divide, whether there is a change in character
of the progeny as they divide and multiply, and whether or when the

 can the mind heal cancer?

cells finally die. The immediate neighbours of a given cell exert an

influence. Locally produced protein molecules called growth factors
or cytokines bind to its outer surface, the resulting balance of positive
and negative signals determining whether or not division occurs.
The development of clinical cancer usually begins with a muta-
tion, a change in the genetic material or , of a single cell. When
this cell divides, some of its progeny may undergo further changes,
giving rise, after months or even years, to a family of cancerous cells
that are less susceptible than normal cells to local control mecha-
nisms—hence their dangerous tendency to proliferate in an unre-
strained way. Many types of dividing cells in the body, such as skin,
muscle, various glands, lymphocytes, bone, blood-forming cells,
and supportive tissues in the brain (but not the normally inert nerve
cells), may undergo this kind of transformation, leading to the more
than  kinds of cancer that are currently described. Cancer cells
also may produce molecules that promote the development of blood
vessels around the growing tumour, which is limited, as are normal
tissues, by the supply of available nutrients. As these pathways be-
come better understood, this knowledge should suggest biochemical
ways to control cancer. Exploration of possible therapeutic effects of
some of these regulator molecules has already begun: lymphokines,
a type of cytokine produced by lymphocytes, have shown promise in
treating malignant skin cancer and renal cancer, and another class of
regulator molecules called interferons, which are made by a variety of
cell types, has also proved to have anti-cancer activity.
Another type of regulator that has long been investigated for its
powers to control both infectious disease and cancer is the immune
system. It is really an organ in itself, but one whose cells are not in
constant contact with one another; many of its cells, the most impor-
tant being lymphocytes, circulate freely around the body, while oth-
ers, such as macrophages and dendritic cells, are often stationary, and
line vessels within lymph nodes, the spleen, and other organs. Among
the lymphoctyes are a category called cytotoxic (cell-killing) T lym-
phocytes, which are able, under some conditions, to attach to and
destroy cancer cells. This potential is also exhibited by other cells of


 Can the Mind Heal the Body?

the immune system at times, including so-called natural killer cells,

although their clinical importance is not yet clear. Lymphocytes also
produce lymphokines, as just discussed, and these molecules can en-
hance the cytotoxic effects of other lymphocytes. One effect of mind
on the immune system that is quite well understood is that if a sense
of threat or stress is persistent, it causes lymphocytes to be shunted
out of the blood circulation, and hence to be less available to fight
infectious disease or cancer. While the immune system undoubtedly
is a major mechanism for controlling infectious disease, its impor-
tance in cancer control is much more doubtful: for example, if it were
crucial, we would expect that experimental animals born without a
functioning immune system would quickly succumb to one of the
common cancers, but this is not observed. This is a pity from the
point of view of those of us wishing to argue that mind may affect
cancer, because it is now well established that mind events, such as
the perception of stress, may significantly depress immune responses!
In the mind–immune system–cancer pathway, then, the second link
may not be of much clinical significance.
What evidence is there that mind-stimulated changes in the long-
range messengers influence patterns of local control of cell prolifera-
tion in a way that might affect cancer? To my knowledge, there is very
little such evidence yet in terms of detailed mechanisms. However,
we can make quite a strong case on more general grounds. First, the
passage of information or messages from a central organizing sys-
tem (brain, nervous system, and endocrines) to local environments,
is simply the way the body works. (It is also the way any organized
entity, such as a complex machine, or a corporation, works.) More
specifically, certain common observations on the behaviour of can-
cers imply that they, like all other dividing cells, are not autonomous
but are subject to at least some regulation, and where there is regula-
tion there is potential mental influence. For example, when autopsies
are done on people dying of non-cancer causes, a high incidence of
small, precursor cancers is found in tissues like breast or prostate,
many more than would ever have become clinical tumours. These
must have been controlled in some way while the person was alive. A


 can the mind heal cancer?

related observation is that some cancers, notably those originating in

the breast, may remain dormant for a long time, even decades, then
suddenly appear at multiple sites. Something must have held them
in check during that time. Spontaneous remissions are occasionally
seen (see next chapter), implying regulation, without indicating how
it may have occurred. Many cancers are sensitive to natural hormones
such as estrogen, allowing for mental influence, since all such hor-
mones are affected directly or indirectly by the mind. There is other,
more technical evidence, which in sum is sufficient to convince can-
cer scientists and clinicians that the old view of a cancer as an auton-
omous invader, immune to local conditions, is incorrect. However,
while most would now agree that the development of clinical cancer
is caused both by genetic changes in the cancer cells themselves, and
with a failure of the host to regulate the growth of those cells, few
would yet consider that the mind of the host matters very much, once
cancer has been found, which is, of course, the case I am trying to
make in this book.

  

These last two sections will be more speculative. I will outline a way
of interrelating and understanding several puzzling phenomena, such
as the role of expectancy in healing, the power of suggestion, and
possible effects of spirituality on healing.
Let us start with the placebo effect, which is a phenomenon very
familiar to Western medicine. Placebos are substances or procedures
without known specific activities, which nevertheless cause healing
change. The actual agents may be sugar pills, injections of distilled
water, sham surgeries, physical manipulations, prescribed diets or
other regimens, even conversation with someone assumed to have an-
swers for the sufferer. The common factor seems to be that the agent
has meaning for the patient; it or he or she is a symbol
symbol, something that
stands for something else, in this case, for a potential transition to a
healed state. Placebos affect many kinds of physical condition, such
as pain, breathing problems, fevers, skin conditions, and wound heal-

 Can the Mind Heal the Body?

ing. They can also induce negative physiological states, like weakness,
nausea, rashes, or pain. These effects are not “all in the mind”; actual
physical change can often be seen and measured, as, for example,
when such interventions have been shown to stimulate production by
the brain of endorphins, substances that help the body control pain.
The proportion of those treated showing effects from a placebo var-
ies, in different studies, from % to % (and is commonly around
%). Modern trials of new drugs almost always include a placebo
control, meaning patients who receive, without knowing it, an inert
substance in place of the active drug; specific activity attributable to
the drug is then considered to be any effects it produces over and
above what the placebo does. At times the placebo is as effective, or
almost as effective, as the drug! This phenomenon is clearly an exam-
ple of the mind affecting the health of the body.
The placebo effect is the best-studied of a group of phenomena
that may in fact all have a similar basis. In brief: an object, person,
or procedure acts a symbol, inspiring hope, and perhaps mobilizing
normally dormant potentials, in a person desiring healing. Thus the
symbol suggests to the sufferer that healing is possible, and the sug-
gestion brings about mental changes, which in turn stimulate benefi-
cial physical change.
We can list a number of examples where suggestion, or placebo
effect, appear to be operating. Symptoms can be induced by sugges-
tion; at a mundane level, most of us are familiar with feeling nau-
seated by thoughts of revolting foods or activities. The psychiatric
literature describes patients who display symptoms for no known
physical reasons, symptoms like strange patterns of pain or anesthe-
sia, paralysis, false pregnancies, and others. Conventional research
methods have established that positive expectancy is associated with
better outcomes in cancer, -, and other diseases. Faith heal-
ing, which seems to promise miraculous cures by charismatic figures,
is probably a form of suggestion. In earlier and less technological so-
cieties, the healer was often a shaman who would manipulate objects
and perform procedures that seem quite irrational to modern Western
people, yet at times alleviated disease. The wide variety of special di-


 can the mind heal cancer?

ets and injectable substances offered to cancer patients and others by

non-traditional therapists seem to be an example of remedies related
to those used by shamans, and likewise capable of inspiring hope, if
not physical cures (research is needed to test whether such agents do
have a placebo effect in cancer). Hypnosis can be characterized as a
procedure that helps patients suspend their normal, rational way of
experiencing the world, leaving room, as it were, for new potentials
to be activated. Even social support may act in part through sugges-
tion, by creating in the sufferer a sense of being cared for, of being
important to others. Dramatic examples of the impact of suggestion,
already discussed, are voodoo death (a negative placebo), and the way
people are sometimes able to postpone their death until an impor-
tant date has been reached. And finally, self-image, which is in turn
largely created through interactions with others, also has a potent
impact on both the care that a person will take of herself and on the
whole range of thoughts and emotions she has about her prospects for
recovery and her life generally.
All of these phenomena appear to be mediated by symbols to
which the person in distress attaches significance and emotion. These
symbols are manipulated or changed during the healing ceremony or
interactions: the witch doctor shakes his animal skulls, the commu-
nity rallies around and expresses caring, the faith healer performs a
ritual, the modern physician brings high-tech apparatus and power-
ful drugs to bear, the unconventional dietitian proposes a diet that,
it is claimed, “has cured others.” The patient ideally becomes an ac-
tive participant in, and subscriber to, the process of manipulating the
symbols, and invests time, belief, and often money, in them. She then
sees the operation of the symbols as an indicator of actual change in
herself. To put it another way, change in the symbolic world has spo-
ken deeply to the mind of the patient, and allowed her to change her
perception of the real world. To the extent that mind does affect body,
this symbolic process may actually cause change in health status.
This process is well known to anthropologists (see, for example,
an article by J. Dow). It would probably appear fanciful to many
Western-trained health care professionals. However, the power of


 Can the Mind Heal the Body?

suggestion is susceptible to scientific investigation; placebo research

is a good example of such work. Note that it does not require any eso-
teric mechanisms, anything thought intrinsically impossible by the
laws of physics—simply a relaxing of the severe limitations that the
biomedical world currently places on the effects it deems the mind
can have on the body. As we turn now to the final section we will,
however, touch on realms beyond the strict Newtonian universe that
still informs most theory-building in health care.

   

Religious and spiritual ideas and experiences have been important to

many suffering people throughout human history. I will return to this
point in a slightly different way in chapter , but for the present we
need to define the two labels: “religion” refers to an organized social
structure of belief and ritual; “spirituality” refers to an individual’s
experience of being connected in some way to an order, intelligence,
or divine being that transcends the material world, and is all-embrac-
ing. The two terms, formerly closely related, are now increasingly
differentiated, although both describe aspects of the human search
for ultimate purpose or meaning.
To portray the various ways in which either religious observance
or spiritual experience might affect health, I have added another box
to our earlier diagram (see Figure .). A sense of connection to a
transcendent order might influence behaviours, such as self-care, that
contribute to externally assisted healing. Alternatively, it could exert
an influence through the internal pathway, by enhancing a person’s
sense of hope, or of being loved and worthwhile. In this way it might
resemble social support in its effects. A third possibility is more radi-
cal: spiritual connection might have a direct impact on the body and
on health, by mechanisms unknown.
Research on the relationship between spirituality and healing is
at an early stage, just coming out of the closet, so to speak. To take
the spiritual dimension seriously it is probably necessary to have one’s
own experience of it: without this experience, the ideas can seem ab-

 can the mind heal cancer?

M ater ial O rd er /� ? Trans cend ent/ �

R eal it y Spir itual O rd er

Perception Ex p er ience

M ental Ex p er ience
• apprai s al �
• reac ti o n

I nter nal Path Ex ter nal Path

Ef fec t on B o d y

H ealth or D i s eas e

       .  Three ways in which spiritual phenomena or experiences

might affect health: by changing thoughts and feelings in a way that leads
to either behavioural change (“external path”) or an alteration of “internal
pathways”; or alternatively, by some direct—as yet unknown—mechanism,
independent of thought.

surd; with it, there is no doubting its central relevance and meaning
in life. However, objective scientific study of a possible relationship
to health can be carried out by treating spirituality in the same way
as any other set of psychosocial variables, which usually means giving
subjects one of the available questionnaires, and relating their re-
sponses to some measure of health status. There are a lot of stud-


 Can the Mind Heal the Body?

ies showing that religious observances, such as attending church or

synagogue, correlate with enjoying better than average health, but
authors are always careful to point out that this could be a result of
healthier behaviours—our “externally assisted” pathway—or simply
a reflection of the fact that people who are intrinsically more healthy
are more likely to attend church. Little has been done to assess the
impact of deep, personal, spiritual experience on health. Particularly
needed are systematic longitudinal studies (that is, following people
over time as they receive training or therapy and develop their spir-
itual awareness). There are already many anecdotes relating improve-
ments in health to development of a spiritual connection, as we will
see in the next chapter. There has also been some research on -step
programs for addiction, which certainly help at least some partici-
pants, and have a strong spiritual component.
Surprisingly, some recent, technically sound studies support the
existence of a direct influence of prayer on health, through what ap-
pears to be an example of the third pathway shown in Figure .:
a direct link between the spiritual dimension and the body. Two
large, randomized controlled trials (see chapter  for an explanation
of this technique), have demonstrated that there is a significant ten-
dency to recover better from a heart attack when the patient is prayed
for, without his knowledge, by other individuals who did not know
him and had only his name and a few other details to “direct” their
prayers. There are some other smaller positive studies of the same
kind, and also some that gave negative results. Analyses of the field
as a whole conclude that there is likely to be a real effect; it is easy to
imagine ways in which such studies could fail to produce a result, but
very difficult to see how a “false positive” could occur. This is indeed
a puzzling phenomenon, inexplicable by current theories.



It can help us understand the often contentious idea that an intangi-

ble “mind” affects a concrete “body” if we consider a computer anal-
ogy: mind is like the software of a computer, and body the hard-

 can the mind heal cancer?

ware. Mind–body connections can thus be described either in terms

of the passage of information, or as physical mechanisms. A mental
appraisal, such as response to threat, sets in train two kinds of event:
first, an external pathway of behavioural change, and second, an
internal path comprising a definite series of “messages” to many parts
of the body, the messages being carried by quite well-understood
nervous and hormonal pathways.
We surveyed the evidence that mind can promote disease, not-
ing there is a spectrum of conditions ranging from those obviously
mind-influenced, like clinical depression, to others, like coronary
heart disease, where the connection is highly probable, if not uni-
versally accepted, and to still others, like inherited genetic disorders,
where there is presumably no such effect. We looked also at some of
the related but scantier evidence for the power of mental change to
alleviate disease.
Finally, we considered evidence for the effect of symbols, such as
placebo treatments, acting through the mind, to influence the body,
and for the possible routes by which spiritual experience or connec-
tion might affect health.



. A discussion of how thoughts can be viewed as the software that influences the
physical hardware of the body:
Cunningham, A. J. (). Pies, levels and languages: Why the contribution of
the mind to health and disease has been underestimated. Advances: Journal of
Mind–Body Health, ,  –
 .
. A review of the research studying effects of meditation in expert meditators:
Davidson, R. J., & Harrington, A. (Eds.). (). Visions of compassion: Western
scientists and Tibetan Buddhists examine human nature. Oxford: Oxford University
Press.
. A review of the efficacy of psychotherapy in the treatment of depression com-
pared to anti-depressant medication:
Antonuccio, D. O., Danton, W. G., & DeNelsky, G. Y. (). Psychotherapy
versus medication for depression: Challenging the conventional wisdom with
data. Professional Psychology: Research and Practice, (), –
 .
. Johnson, W. G., Baldwin, M. L., & Butler, R. J. (). Back pain and the need


 Can the Mind Heal the Body?

for a new paradigm. Industrial Relations, (), –.

.  Technology Assessment Panel on Integration of Behavioral and Relaxation
Approaches into the Treatment of Chronic Pain and Insomnia. Journal of the
American Medical Association, ,
 –.
. Cohen, S., Tyrrell, D. A., and Smith, A. P. (). Psychological stress and sus-
ceptibility to the common cold. New England Journal of Medicine, , –.
. Kiecolt-Glaser, J. K., McGuire, L., Robles, T. F. & Glaser, R. ().
Psychoneuroimmunology and psychosomatic medicine: Back to the future.
Psychosomatic Medicine, (), –.
Marsland, A. L., Bachen, E. A., Cohen, S., Rabin, B., & Manuck, S. B. ().
Stress, immune reactivity and susceptibility to infectious disease. Physiology and
Behavior, ,
 –
 .
Stowell, J. R., McGuire, L., Robles, T., Glaser, R., & Kiecolt-Glaser, J. K.
(). Psychoneuroimmunology. In A. M. Nezu, C. M. Nezu, & P.A. Geller
(Eds.), Handbook of psychology: Vol. . Health psychology. New York: John Wiley
& Sons.
. Phillips, D. P., & Feldman, F. A. (). A dip in deaths before ceremonial
occasions: Some new relationships between social integration and mortality.
American Sociological Review, , –.
. Any comprehensive textbook on health psychology will review the relevant re-
search linking psychological factors and various diseases and conditions. Two
such texts are:
Bellack, A. S., & Hersen, M. (). Comprehensive clinical psychology: Vol. . 
Health psychology. D. W. Johnston & M. Johnston (Vol. eds.) Oxford: Elsevier.
Nezu, A. M., Nezu, C. M., & Geller, P. A. (). Handbook of psychology: Vol.
. Health psychology. New York: John Wiley & Sons.
. Krantz, D. S., & Lundgren, N. R. (). Cardiovascular disorders. In Bellack,
A. S. and Hersen, M. (Eds.). Comprehensive Clinical Psychology: Vol. . Health
Psychology. D. W. Johnston and M. Johnston (Vol. eds.) Oxford: Elsevier Press.
Rozanski, A., Blumenthal, J. A., & Kaplan, J. (). Impact of psychologi-
cal factors on the pathogenesis of cardiovascular disease and implications for
therapy. Circulation, (), –
 .

Ornish, D. M., Brown, S. E., Schwartz, L. W., et al. (). Can lifestyle
changes reverse coronary disease? The lifestyle heart trial. Lancet, ,
 –.
. Smythe, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (). Effects of writ-
ing about stressful experiences on symptom reduction in patients with asthma
or rheumatoid arthritis: A randomized trial. Journal of the American Medical
Association, (), –
 .
. Markowitz, J. H. (). Resolved: Psychological interventions can improve
clinical outcomes in organic disease; Moderator introduction. Psychosomatic
Medicine, , –.


 can the mind heal cancer?

. Lagarde, A. (). Genetics of common hereditary cancers. Oncology Exchange,

‒. Wooster, R., & Weber, B. L. (). Breast and ovarian cancer.
(), ‒
Genomic Medicine, ,
 –.

.
. A series of articles in Advances in Mind–Body Medicine, ,  . Also well dis-
 –
cussed in Benson, H. (). Timeless healing: The power and biology of hope. New
York: Scribner.
. Dow, J. (). Universal aspects of symbolic healing: A theoretical synthesis.
American Anthropologist, ,
 –.


 Chapter 

Studies on “Remarkable Survivors”

from Cancer

“                  ”        

C
ancer is traditionally considered to be a group of diseases
that progress inexorably and overwhelm the host unless
the responsible cells are entirely removed. Yet some can-
cers, like lymphomas (cancers of lymphoid tissue) may
pursue an erratic course, waxing and waning for years. Others—
breast cancer is an example—may lie dormant for years, then sud-
denly appear and grow at many sites simultaneously. Occasionally,
cancers regress completely without treatment, and this may be ei-
ther temporary or long-lasting (many years, or permanently). This
phenomenon has been called “spontaneous remission/regression,”
an unfortunate term, since it implies lack of cause, when in fact the
cause is simply unknown. While dismissed by some, because it is rare
and unpredictable, it has been hailed by others as an indication that
some kind of internal control of cancer must exist, an understanding
of which might lead to ways of boosting the body’s intrinsic pow-
ers of resistance. It has been noted that certain types of cancer are

 can the mind heal cancer?

more likely than others to disappear “spontaneously,” for example,

tumours originating in the kidney (hypernephroma) or skin (ma-
lignant melanoma). Possible explanations of the phenomenon have
been framed almost entirely in terms of biological mechanisms: for
example, activation of suppressor genes, hormonal changes, immune
responses, or interference with nutrition (blood supply) of tumours.
Some such process is presumably responsible at the tissue level, but
the possibility that it is precipitated by an initial psychological event
has rarely been considered.
People from whom all signs of cancer have disappeared in a last-
ing way, not attributable to medical treatment, or who have greatly
outlived their predicted lifespan, are sometimes called “remarkable
survivors”; they are the subject of this section. As in the last chapter,
we are not as much concerned with the specific biological mechanisms
that might bring about such remission as with the psychological pat-
terns they display. If common features can be found, this suggests
(although it does not prove) that adopting some of these attitudes
might be protective in other cancer patients. It will also be interest-
ing to compare the results of these studies with those obtained in the
more rigorous experiments described in chapters  and .

    

   

It would seem a commonsense notion that we could find what psy-

chological qualities, if any, promote survival in patients with cancers
that are normally fatal, by seeking out and interviewing individuals
who survive much longer than expected. If we could identify some
whose cancer had gone into complete remission, so much the better.
However, there is one unavoidable and serious limitation to conclu-
sions that can be drawn from this approach, which is perhaps why it
has been seldom adopted by investigators. With a backward-look-
ing design like this, we might find a particular pattern, say a strong
fighting spirit, among remarkable survivors, but if we interview only


 ““Remarkable Survivors”

these people, we cannot know how common this pattern was among
those who failed to survive. To make this point more concrete, im-
agine that someone followed a diet consisting of nothing but grapes,
and recovered from serious cancer. That individual is likely to swear
that the diet cured him. Yet there may have been  or  others
who used the same diet but failed to outlive their prognosis. Against
this background, the first individual would seem much less like a
“remarkable survivor” and more like someone who was lucky for un-
known reasons: perhaps his disease was misdiagnosed, or was less
serious than was initially thought. Of course the diet (or the mental
attitude, if that was the proposed mechanism of cure) might have
been effective for him, but we can’t be sure of that. For this reason,
“prospective” studies are much more highly valued, meaning those in
which we make the assessments of mental attitude, or diet, or what-
ever else we are interested in as investigators, before the survival out-
come is known. This is likely to be difficult to do because, if an event
is very rare, we may need to follow hundreds or even thousands of
people in order to end up with one or two who show the phenomenon
of interest, in this case lengthy survival (we will see in chapter  how
this problem can be circumvented).
There are other technical problems with the available studies on
remarkable survivors. In most cases, little effort was made to establish
that the individuals did, in fact, have a medically incurable cancer in
the first place; at times it is clear that some of them did not. And the
methods used to describe their psychological attitudes usually have
not come up to the kinds of standard required in modern medical-
social research; the studies I will allude to are often more impression-
istic than scientific. However, there is a feature of the studies in this
field that may prompt even a skeptical reader to take them seriously:
a remarkable consistency in the qualities reported among people who
survived when apparently they should have died. We will look at the
details of one of the studies, then put together a pattern emerging
from them all. This analysis will later be compared with the results
of the more rigorous prospective study described in chapter .


 can the mind heal cancer?

      ’         

Berland’s is one of the best of the small number of published studies;

the author interviewed  individuals who had lived well past their
medical prognosis, and reports his results as an indication of why
these people believed they had survived, rather than as proof of quali-
ties that promote survival. In fact, this is all one can confidently de-
duce from data of this type; yet just beneath the surface, and of much
greater interest, is the implication that these psychological qualities
actually help people live longer. My critical comments here are in-
tended to illustrate how difficult it is to draw this latter conclusion, by
referring to limitations in this investigation and other similar ones.
Selecting subjects is the first requirement:  were obtained, more
than usual in this type of study, mainly from physicians’ referrals.
Most had lived  years or more since diagnosis. Evidence of “remark-
able survivor” status was simply an opinion from their health care
provider that the chances of such lengthy survival had been consid-
ered small (less than % in all cases, less than % in  of them).
No information was given on the types or stages of cancer. Without
this reassurance, and without knowing the expertise of the health
care diagnosticians (and even non-specialist physicians are unlikely
to have a sound idea of probable survival times), we cannot have great
confidence that each subject was suitable for the study. It is even pos-
sible that some had medically curable diseases, as was the case in
some other reports of this kind. However, let us assume that most
were relevant.
The next and most important task is obtaining from participants
an account of what they believed was important to their recovery. All
were interviewed and were also asked to list the activities and atti-
tudes to which they attributed their recovery. This list of attributions
provided some interesting results, in particular that spiritual, attitu-
dinal, and behavioural qualities, plus support of family and friends,
were viewed, on average, as twice as important as medical treatment!
Only  of the  gave % or more of the credit for their recovery to
medical or alternative material treatments. The interviews provided


 ““Remarkable Survivors”

more data: unfortunately, little information is given about them be-

yond the statement that they were “structured and unstructured” (it
is not clear whether each participant was interviewed once or twice).
Tables are provided showing how many interviewees responded to
questions about their attitudes and behaviours, although no detail is
available on how what the subjects said was recorded and analyzed.
The value of the study would have been enhanced by the use of well-
developed methods of qualitative analysis, in order to draw inferences
in as unbiased a fashion as possible from such interviews, as was done
in some of the other similar reports. However, by an informal process
Berland defined three categories of “survivor”:  men with “fighting
spirit,”  participants who were “attitudinally and behaviourally fo-
cussed,” and  who were “spiritually and existentially oriented.” All
but  of the  in the last  groups were women, an interesting fact
in accord with our own experience that women are much more likely
than men to try to help themselves psychologically against cancer (al-
though there are exceptions, women tend to be more aware than men
of what is happening in their minds and bodies, and less concerned
with maintaining a facade of being in control).
The  men in the first subgroup differed markedly from the rest.
They denied that the disease would kill them and professed a “fight-
ing spirit.” The other  subgroups exhibited quite a different range of
qualities, and seem, to my reading, to have been quite similar to one
another. Survival was attributed to taking an active role in changing
attitudes and behaviours. There was a strong emphasis on learning
to have one’s own needs met, on an altered sense of self, and often
on an increased connection with a spiritual source (especially in the
third subgroup), all leading to a much improved, more secure, and
emotionally authentic life (I offer below a more detailed “map” of the
development of these qualities, taking all the studies into account).
A characteristic statement by one woman: “It’s the commitment, 
per cent to never not live your truth . . . to live fully.” The difference
between subgroup  (the  men) and the rest is so marked as to sug-
gest that, if survival was related to psychology for those in groups 
and , this was not the case for the men in subgroup .


 can the mind heal cancer?

Berland provides an entirely reasonable and insightful discussion

based on his findings. He points to the importance of attending to
the psychosocial and spiritual issues that patients value, and describes
similar findings made by others. Because of the technical limitations
of this report, any implication that such factors are relevant to re-
covery is not likely to be taken seriously by researchers in the field
of psycho-oncology or health psychology generally. This possibility
does become more important when we relate Berland’s work to that
of other investigators, as we shall see.

         

“   ”

In preparation for writing this chapter I read or reread (having first

done so  to  years ago) most of the available papers and books on
this subject that seemed to have at least some pretension to objectiv-
ity. I had always tended to downplay the importance of this evidence,
because of the technical problems we have discussed, particularly the
issue of not knowing how many individuals displayed qualities like
determination or recovery of self-esteem, but failed to survive. Yet on
this rereading, I was struck by two things: first, by the agreement be-
tween accounts, and second—and to be honest, probably more strong-
ly by—the concordance between these reports and what my team and
I have found in the more rigorous prospective work in which we have
been engaged for the last  years (chapters  and ). I’ll now try to
draw the remarkable survivor studies together, and offer a scheme
showing the relationship of the various qualities to one another,
which has not, as far as I know, been done in this way before. The
most important papers reviewed are by Ikemi, Nakagawa, Nakagawa,
and Sugita,  ; plus some later unpublished work from this group;
Achterberg, Mathews-Simonton, and Simonton,  ; Roud,  (he
has also published a book on his work)  ; Huebscher,  ; Berland,
 (discussed above); and Denz-Penhey, . Two other reports
of high quality available in unpublished form were from a group in
the Netherlands by Schilder, de Vries, Goodkin, & Antoni. Of non-

 ““Remarkable Survivors”

technical books, the most relevant is LeShan’s Cancer as a Turning

Point (see chapter ). I also reviewed Healing Yourself by Pennington,
and (in part) Remarkable Recovery by Hirshberg and Barasch, and
a compendium of cases and commentary on spontaneous remission
by O’Reagan and Hirschberg. In a different category (much more
definitive) is The Type C Connection by Temoshok and Dreher, which
will be referred to in chapters  and . Many more journalistic stories
or anecdotes on this subject exist in the trade press; such casual, after-
the-fact accounts are completely unreliable.
Figure . is an attempt to interrelate the principal psychological
qualities described as associated with prolonged survival from life-
threatening cancers. It is a dynamic model, in that certain attributes
are proposed as leading to others, in other words as a hypothesis
about the kinds of change that make survival more likely. There are 
main parts. Starting qualities are those that a person needs to be able
to initiate the deep psychological change indicated in the square box.
These changes lead to the development of a second tier of qualities,
 related, personal attributes, almost always described as prominent
in people who outlive their life expectancy from cancer: autonomy,
meaning the perception of having free choice of one’s actions, and
acceptance of self as worthy, as . The triangle formed by open-
ness, leading through psychological change to increased autonomy
and self-acceptance, lies at the heart of self-healing, at least as retro-
spectively described. The development of what we may call this “au-
thenticity” of the self brings further benefits, shown under mental/
emotional outcome at the bottom of the diagram: better relation-
ships with others, often a shift towards a more spiritual orientation,
and a zestful, more joyous appreciation of life. As these qualities de-
velop, they encourage still more change; to keep the diagram simple,
I haven’t shown such positive feedback.
The starting qualities are hardly surprising. One needs open-
ness or flexibility of views to contemplate change, coupled with a
determination to do what one can to help oneself. This must in turn
be supported by a belief, both in one’s ability to make appropriate
changes and in the methods employed. This pattern is in agreement


 can the mind heal cancer?

Star ting Q ual iti es

• o pennes s to change
• determi nati o n / wi l l to l i ve
• bel i ef heal i ng i s po s s i bl e

D eep Ps yc ho lo g i c al Chang e
• us e o f s el f -hel p techni ques �
• acceptance o f s uppo r t�
• s pi ri tual / exi s tenti al s hi f t

Auto no my S elf -ac ceptance

• res po ns i bi l i t y taken � • expres s i o n o f needs, feel i ngs �

fo r own l i fe� • acceptance o f o thers
• f reedo m to make ow n �
cho i ces

M ental / E m o tio nal �

O utcom e
• s ens e o f f ul f i l l ment, �
val ue, meani ng i n l i fe�
• zes t, j oy, i nteres t, �
appreci ati o n

       .  The principal psychological qualities described in published

accounts of “remarkable survivors,” and the likely interrelationships
between them.

 ““Remarkable Survivors”

with a great deal of research on the process of change in other areas

of psychology, such as the giving up of unhealthy habits. The specific
methods that cancer patients used varied widely, often within a single
report. Among the most common were meditation, prayer, affirma-
tions, mental imaging, psychotherapy for insight, body therapies, and
a range of alternative remedies (“externally assisted healing” in the
terminology of chapter ) such as diets and dietary supplements. The
variety suggests that the specifics may be less important than the
sense of control developed by using them.
The outstanding new qualities that long survivors reported in
almost all studies were autonomy coupled with a better acceptance of
self. They described becoming content with themselves: “I am who
I am,” as one participant related. This acceptance allowed, or was
promoted by (the two categories in the diagram reinforce one an-
other) the taking of more responsibility for one’s life and living as
desired, doing what one had always wanted to but had perhaps felt
inhibited from pursuing because of a distorted sense of obligation
to others. Now these obligations mattered much less; it was not so
much a shedding of necessary roles as a healthy freedom to act upon
what was felt to be best for oneself. As is well known in general clini-
cal psychology, acceptance of oneself allows tolerance of the vagaries
of others, and may lead to greater love and appreciation for them.
Conflicts tend to be resolved in such a mental climate. Finally, for
many but not all participants in these studies, there was what au-
thors have often described as an existential shift, meaning a change
in perception of one’s relationship to the world, with greater sense of
purpose or meaning in life, and often an increased spiritual sense of
being part of a larger, non-material or transcendent order or God.
Epiphanies, mystical experiences, or sudden transformations were
not uncommon.
The overarching impression is that these people set themselves to
combat their poor prognosis in a determined, energetic, and coura-
geous way, and the result was what we might call a recovery or dis-
covery of a more authentic self. Not surprisingly, life became much


 can the mind heal cancer?

improved for virtually all of these people. A typical quote would be,
“I’m just having the best time of my life!”

       

  

A skeptical person might say that the publications on remarkable sur-

vivors prove nothing, that the results can be explained in ways other
than by assuming that the changed mental state caused regression of
the cancer. Technically speaking, such critics are correct. It is pos-
sible that some other, unknown factor caused, simultaneously, the
consistent change in psychology and the cancer regression. This was
the kind of argument advanced for many years against the idea that
smoking cigarettes causes lung cancer. Another objection is that these
unusual people may have survived for purely biological reasons (per-
haps the cancer was misdiagnosed), and the fact of surviving, being
such a profound relief, induced the psychological change. This flies
in the face of clinical experience: when people are let off the hook by
a remission or cure of disease, the tendency is to return to old habits,
to put it all behind them, and rarely to make the effort to maintain
a changed life. We see this in many people recovering from primary
cancers: the motivation for change is quickly lost. We would have
expected a majority of remarkable survivors to show such unchanged
patterns if the remissions were independent of mental state. Thus the
most likely explanation is that profound psychological change, in the
direction shown by these studies, promotes remission of cancer at
times. One thing that these experiments cannot tell us, however, is
the frequency with which becoming “authentic” promotes healing. It
cannot be ruled out, from retrospective studies like these, that many
more individuals made the same kinds of psychological shift but did
not survive. A reasonable interim hypothesis would be that the men-
tal changes make survival more probable, but that much depends on
the nature of the specific cancer as well.


 ““Remarkable Survivors”



Cancers very occasionally regress in the absence of any apparent

physical cause. People who had a terminal diagnosis but whose can-
cers have gone into long-term remission have been interviewed in
a number of studies aimed at relating psychological qualities and
changes to the unanticipated survival. While such backward-look-
ing studies are technically weak—since it is impossible to know
how many individuals with similar psychological attributes did not
survive—they have yielded highly consistent patterns. “Remarkable
survivors” had common qualities that would assist change: openness
or flexibility, determination to live, and belief in the possibility of
their recovery. They reported substantial psychological shifts leading
to a greatly increased sense of autonomy and self-acceptance—the
freedom to live their lives as desired, rather than as constrained by
imposed obligations. The changes also greatly improved the quality
of emotional life, with joy, interest, peace, fulfi llment, and zest for
life being commonly reported.



. Berland, W. (). Can the self affect the course of cancer? Advances: The Journal
of Mind–Body Health, (), –.
. Ikemi Y., Nakagawa, S., Nakagawa, J., & Sugita, M. (). Psychosomatic
consideration on cancer patients who have made a narrow escape from death.
Dynamic Psychiatry, ,
 –
 .
. Achterberg, J., Matthews-Simonton, S., & Simonton, O. C. (). ). Psychology

of the exceptional cancer patient: A description of patients who outlive predicted
life expectancies. Psychotherapy: Theory, Research and Practice, (), –
– .
–
. Roud, P. C. (). Psychosocial variables associated with the exceptional
survival of patients with advanced malignant disease. International Journal of
Psychiatry in Medicine, (), –.
Roud, P. C. (). Making miracles: An exploration into the dynamics of self-heal-
ing. New York: Warner.
. Huebscher, R. (). Spontaneous remission: An example of health promotion.
Nurse Practitioner Forum, (), –.


 can the mind heal cancer?

. Denz-Penhey, H. (). Poor prognosis, quality outcomes. Unpublished doctoral

dissertation, University of Otago, New Zealand.
. Schilder, J. N., deVries, M. J., Goodkin, K., & Antoni, M. (). Psychological
changes preceding spontaneous remission of cancer. Clinical Case Studies, ():
–.
. Pennington, S. (). Healing yourself: Understanding how your mind can heal
your body. Toronto: McGraw-Hill Ryerson.
. Hirschberg, C., & Barasch, M. I. (). Remarkable recovery: What extraordi-
nary healings tell us about getting well and staying well. New York: Riverhead.
. O’Regan, B., & Hirshberg, C. (). Spontaneous remission: An annotated bibli-
ography. Sausalito, CA: Institute of Noetic Sciences.
. Temoshok, L., & Dreher, H. (). The Type C connection: The behavioral links to
cancer and your health. New York: Random House.


 Chapter 

Cancer and Mind:

Current Scientific Views

I
n chapter  we took a snapshot of lay and professional attitudes
to the idea that one’s state of mind might affect the progression
of cancer. The reader will have gathered that the lay enthusiasm
expressed in certain quarters has not been matched by profes-
sional endorsement! However, having declared that there is a case to
be made for a mind–cancer link, I embarked on an attempt to present
this argument, beginning, in chapter , with some background evi-
dence and ideas on the impact of mind on health generally. We saw
that the mind is important in many disease processes, although there
is as yet little effort to incorporate into the regular medical manage-
ment of disease any mobilization of whatever potential patients may
have to help themselves. Then in chapter  we examined the first kind
of evidence relating specifically to cancer: interviews with remarkable
survivors. The technical weakness of this evidence is compensated for
to some extent by the very consistent picture that emerges from most
of these studies: survivors demonstrate a pattern that I called “authen-
ticity.” In the present chapter we will examine the broader field of psy-
cho-oncology, which is concerned with all aspects of the mind–cancer
relationship, and see if research under this umbrella can shed any light
on whether or not mental state influences survival from cancer.

 can the mind heal cancer?

-

This specialty area may be thought of as a branch of health psy-

chology, or of “behavioural medicine” (whose main concern is, as the
name implies, with the impact of behaviours on health). Psycho-on-
cology has recently been elevated into a vigorous and popular disci-
pline in its own right through the efforts of a number of prominent
clinical scientists, in particular Jimmie Holland, a psychiatrist at the
Sloane-Kettering Institute in New York. A wide range of profes-
sionals work in the area including psychiatrists, psychologists, social
workers, nurses, pastoral counsellors, and others.
Psycho-oncology is interested in both directions of the mind–
cancer interaction: how having cancer affects mental state, and how
events in the mind might affect cancer development and progression.
The former has received much more attention, perhaps because it
is easier to study; the extent and kinds of distress caused by cancer
have been extensively documented. The ways in which oncologists
and patients communicate is another important practical area that
has been the subject of many papers. Much attention has also been
given to developing self-report questionnaires to assess cancer-related
distress—in part with the aim of efficiently detecting those most
needing help. As one might expect, there has also been considerable
work on how to alleviate this distress, an area that overlaps with our
concerns here, and thus deserves some further discussion.

        

    

Cancer patients with severe depression, suicidal thoughts, or psy-

chotic reactions, or who for other reasons find the diagnosis par-
ticularly difficult to cope with are often referred to mental health
professionals for individual consultations, and possible psychiatric
treatments (anti-depressant drugs, for example). However, the great
majority of people who contract cancer are psychologically “normal,”
and able to handle the distress, although likely to experience addi-

 Cancer and Mind

tional anxiety and depression as a result of the diagnosis. In recent

years, it has become quite common for community organizations and
treatment centres to offer group meetings to support these people
and their families through the crisis of cancer (similar groups also
exist for people with other diseases). These support groups tend to
operate outside the medical mainstream; that is, patients elect to at-
tend them, and they are seldom a prescribed part of medical man-
agement of the disease. There is now good evidence that, as might
be expected, attending such support groups helps relieve emotional
distress and improve quality of life, although for many years this fact
was not generally accepted by health care professionals, the concern
being that contact with other ill people would be too discouraging or
depressing for participants.
Participating in a support group—sharing experiences with oth-
ers who are able to understand and empathize—is, in effect, a very
basic way of enlisting potentials of the mind. It brings about some
healing, in the sense of relieving suffering. Yet only a minority of
people with cancer avail themselves of such support. Reasons for this
reticence are unclear; it is a least partly due to lack of awareness of
how sharing can ease distress, or fear of what a group discussion might
involve. These groups can move beyond emotional support: a number
of clinical scientists (including my own team) believe that they may,
indeed should, incorporate training in active coping skills, as will
be described in chapter . There is evidence that this helps patients
more than support alone; for example, learning coping methods like
relaxation has been shown to alleviate such symptoms as anxiety and
depression, or the nausea that chemotherapy often induces.

  -  

         

Although the main emphasis of psycho-oncology has been docu-

menting and alleviating the mental distress that cancer causes, the
possible impact of mind on the physical disease has also been con-
sidered. There have been two main kinds of investigation. The first

 can the mind heal cancer?

really belongs to the broader field of public health, and is the study
of behaviours that promote cancer, and how these behaviours may
be modified. This is an example of what we described, in chapter ,
as the “external” route to causing or healing disease. In the modern
Western world, most ill-health is now attributable to harmful be-
haviours, and in the case of cancer, it is estimated by experts that the
incidence of disease could be reduced by about two-thirds through
not smoking, making dietary change (avoiding obesity, high-fat di-
ets, and excessive alcohol consumption), taking better care to prevent
sunburn, avoiding environmental and industrial carcinogens (can-
cer-producing agents) like asbestos, and not engaging in unprotected
sex with multiple partners (which can spread viruses responsible for
AIDS and some gynecological cancers). Perhaps the most important
single contribution that could be made to cancer care would be find-
ing a way to dissuade young people from taking up smoking. Not
surprisingly, much research is devoted to this aim.
The second kind of research on mind affecting cancer is con-
cerned with a possible “internal” route through which mind could
influence onset of the disease, or affect its progression once acquired.
This approach is not usually of interest to public health officials, but
has a minority following, so to speak, in the subspecialty of psycho-
oncology. There are what we may call descriptive and therapeutic
approaches to this subject. The descriptive approach involves looking
for relationships between mental qualities (often described as “per-
sonality”) and the incidence or progression of cancer. Do people with
certain psychological qualities tend to get the disease more often, and
does the disease progress more readily in those with particular traits?
We will look further at this question below, and I will try to explain
why this kind of research has taught us very little. The therapeutic
approach is the more obvious one: why not provide a psychological
therapy to cancer patients, and see if they do better than a compara-
ble group not receiving such help? This strategy has been explored
much less than a lay reader might expect, given the obvious central
importance of the question to psycho-oncology. We have already en-
countered some of the reasons for this modest exploration—basically,


 Cancer and Mind

a cultural assumption that it’s not possible, coupled with the (related)
objection that one should not inspire “false hope” by making the at-
tempt (chapter ). However, in the last  years or so, there have been
a number of experiments of this kind, which we will also examine in
a moment.

    “   ” 

   

The possibility of a relationship between aspects of one’s personality

and the risk of getting cancer has been a matter of fascinated specu-
lation for at least a century, although reliable investigations extend
back only for the last  years or so. A number of investigators (myself
included) have published technical reviews of this literature, but we
need only a brief overview here. In a word, the results of this work
have been disappointing. There is much inconsistency: research group
A finds that stress of some kind promotes cancer, and group B then
publishes a paper saying the opposite. This variability is presumably
the result of different conditions between experiments: in the can-
cer patients involved, in their diseases, and in the measurement tools
used. It is impossible to replicate studies with human beings exactly.
No overwhelmingly strong associations have emerged between men-
tal attributes (often loosely called “personality”) and risk of getting
cancer, or doing poorly once you have it. However, two factors do
occur in a relatively consistent way in different studies. Repression of
emotion, as a style of coping with problems in life, seems to favour
cancer onset and progression (repression means that unpleasant emo-
tions are blocked from awareness, and is more profound than suppres-
sion, where the person is aware of his or her deliberate non-expres-
sion). Secondly, having strong social support seems to be somewhat
protective, as it is for many diseases. These results do not mean that,
for example, an emotionally repressed person will necessarily con-
tract cancer, or that all cancer patients are emotionally repressed! It
simply indicates that having a repressed style is one of probably many


 can the mind heal cancer?

factors—psychological, social and biological—that make cancer more

likely to appear, and perhaps progress more rapidly.
It is worthwhile to take a closer look at some of the psychological
factors whose possible impact on cancer have been studied. Stress of
various kinds, including bereavement and other losses, is a factor that
many patients cite as possible “causes” for their own cancer. Animal
studies lend some support to this theory: it is possible to set up ex-
periments with lab animals in a very controlled, consistent way, and
to show that under certain conditions, a stress will reliably promote
cancer growth. For example, in a fascinating series of experiments,
Lawrence Sklar and Hymie Anisman showed that in mice with tu-
mours who received an electric shock, those animals who were able
to escape from the shock had slower tumour growth than control
mice who received exactly the same shock but had no control over
it!  We have to be cautious in extrapolating from mice to people, but
this discovery at least points to the possible value of having some
personal control over one’s environment. Human stress studies have
given frustratingly variable results, however. One of the first was by
Lawrence LeShan (cited in chapter  as a pioneer in the field), in .
He interviewed several hundred people, some with cancer and some
without, and found that the cancer patients were much more likely
to report severe life stressors in the years immediately preceding the
interview. This would not now be acceptable as evidence (although
it was standard for the time), mainly on the grounds that other dif-
ferences between the patients and non-patients may have explained
the different results, or that having cancer led to a difference in ret-
rospective recall of life events. Many contrary results have been re-
ported since. A prospective (looking-forward) investigation would
obviously be more reliable—but this would seem to require assessing
stress in thousands of people in order to find a small number, perhaps
a few dozen, who developed cancer over some manageable period of
time, say the next  to  years.
This latter kind of investigation has in fact been done to test the
association between clinical depression and subsequently developing
cancer. Depression is one of the qualities often measured in surveys


 Cancer and Mind

of the health of large numbers of people for other reasons. In studies

of this kind, scientists can follow people for many years, and relate
the appearance of cancer, or other disease, to earlier mental qualities.
An early investigation appeared to show that depressed individuals
were more at risk  —but several large, later experiments contradicted
this finding.
Social support—for example, being married—is, however, a con-
sistent protective factor against dying from many causes, and it ap-
pears to help in cancer as well. Here we do meet a difficulty of inter-
pretation that we have already discussed, when distinguishing effects
of the mind that act directly or “internally” on cancer, and others that
might act indirectly or “externally” (chapter ). It is difficult to know
whether having good support means that one’s physical needs are
better cared for, or whether it is the conviction that others care that
translates into a healthier state of mind and body that opposes cancer
growth more effectively. One well-known study that seems to sup-
port the latter pathway was done by Bedell-Thomas and associates,
who in  gave a number of questionnaires to medical students,
then followed them for up to  years (!) to see who developed vari-
ous disease conditions. Subjects contracting cancer reported lack of
closeness to parents at the early phase of life. This is an extremely
interesting point, but a skeptic could reasonably say that this early
lack of support translated into later difficulties in forming close re-
lationships, and hence poorer physical care in later life! Personally, I
think it much more likely that distance from important family mem-
bers while growing up generates a way of coping in the world that
substantially affects one’s physiology.
This latter interpretation is supported by the work of a brilliant
researcher, Lydia Temoshok, who has developed a comprehensive,
evidence-based theory linking early life events, subsequent adaptive
style, and the risk of later cancer. Temoshok was working in the late
s with people who had malignant melanoma (a dangerous skin
cancer), and was struck by their unusual tendency to repress expres-
sion of emotions. In a series of experiments she demonstrated a cor-
relation between such repression and higher risk for development or


 can the mind heal cancer?

faster growth of cancer. Her interviews showed that this appeared

to be a lifelong way of coping. Temoshok described a “Type C” per-
sonality, or as she prefers to call it, adaptive style, which is differ-
ent in almost every way from the well-known hard-driving, hostile,
impatient Type A personality believed to be associated with heart
disease (chapter ). Type C’s (as described in the book by Temoshok
and Dreher, The Type C Connection), are unassertive, patient, appeas-
ing, often unaware of any “negative” emotions, particularly anger, not
likely to experience or express anxiety, fear, or sadness, and tending
to be overly concerned with meeting the needs of others, to the ne-
glect of their own. The perceptive reader may begin to see a familiar
pattern here: these people are living “inauthentic” lives, opposite to
the free expression and permission to live as desired that we found
to be characteristic of remarkable survivors. Temoshok hypothesized
that the Type C style developed early in life as a way of coping with
powerful figures like parents (recall Bedell-Thomas’s medical stu-
dents). She found that a crisis like cancer could lead, in these people,
to one of three broad kinds of response: the path of transformation,
or change to a more expressive (authentic) way of being; to entrench-
ment or maintaining the style, often more fiercely than before; or
to resignation, giving up in hopelessness. These differing responses
were shown to correlate in the expected way, not with lifespan in
these early studies, but to differing seriousness of disease. Earlier in-
vestigations had indicated a relationship of repression to more severe
disease, and there have been more since, so her ideas are consistent
with findings of others; as I said, this is one area in which some
general agreement can be found, although few in the field have paid
Temoshok’s hypothesis the attention it deserves.
The hopelessness aspect of the theory has also been borne out
in other work: the idea that if a person learns early that she has no
right to assert her needs, then a crisis like cancer will often cause
a general giving up. This had previously been noted in connection
with tendency to other psychosomatic (mind–body) disease. In the
cancer field, Steven Greer, a psychiatrist working in London in the


 Cancer and Mind

mid s, interviewed women who recently underwent a mastectomy

as treatment for primary cancer. He found that those patients who
displayed a “fighting spirit,” or who tended to minimize the serious-
ness of the disease, were significantly more likely to be alive  years
later than others in the study who reacted with “stoic acceptance” or
helplessness/hopelessness. These last two kinds of response seem to
be an aspect of the Type C pattern.

     

     

The case for adjusting psychological state as part of the regular treat-
ment of cancer would be greatly strengthened if researchers could
agree on psychological factors that affect the disease. Although the
data suggest that repression of emotions, hopelessness, and lack of
social support may increase the risk of getting cancer and allow faster
progression, results are not consistent or strong enough to be con-
vincing to a skeptical person. For anyone who wishes to argue, as I
do, that care of the patient’s mind may be relevant to the course of his
or her disease, it is important to account for negative or inconsistent
results like these. I will point out here some of the reasons why many
of the experiments carried out in the “personality–cancer” field are,
in fact, poorly suited to uncovering a relationship. A more potent way
of investigating the question (using psychological therapies to modify
lifespan) will be discussed in the next section.
The first obstacle to demonstrating that one’s state of mind might
influence the progression of cancer derives from the particular scien-
tific approach now in vogue. An excellent example is a study carried
out by a first-rate researcher, Maggie Watson, who was also a col-
league of Greer’s. Watson and colleagues gave a series of question-
naires to  women with early-stage breast cancer, and then noted
their survival over at least  years. They found that women scoring
high on helplessness and hopelessness had a small but significantly
greater tendency than others to die during this time. “Fighting spirit”


 can the mind heal cancer?

had no apparent effect on survival, in contradiction to the results of

the earlier Greer report.
This type of study is currently most admired in the field, and
indeed across much of the social sciences. The large number of
women, the rigorous design, the cautious presentation and discus-
sion of conclusions, even, perhaps, the finding that “fighting spirit”
was not important to survival, allowed the acceptance of the paper by
a top medical journal (Lancet).
Lancet). In their discussion, the authors sug-
Lancet
gested that “women can be relieved of the burden of guilt that occurs
when they find it difficult to maintain a fighting spirit,” a conclusion
that was picked up by prominent news media. (Obviously this also
implies that there is no clinical rationale for encouraging people to
“fight” the disease, which flies in the face of much clinical experi-
ence and common sense). Yet when one looks closely at the paper, it
really tells us very little about what does or does not help people live
longer. Participants were asked to register their “fighting spirit” by
endorsing items like “I keep quite busy, so I don’t have time to think
about it,” “I count my blessings,” as well as others that seem more
germane like “I try to fight the illness.” This kind of casual self-re-
port can give only a very superficial impression of what people were
really thinking. Subjects will often provide invalid responses, either
because they want to be socially acceptable, or because their defen-
siveness prevents them from recognizing what they really feel (Type
C individuals are especially prone to this tendency). By contrast, the
earlier Greer study, which did show benefits to fighting spirit, incor-
porated one-to-one interviews with its subjects. Any clinician knows
that skilled interviewing, although not infallible, can give a much
more valid picture of what an individual is really thinking and feel-
ing. Nevertheless, the usual practice in much of health psychology,
including psycho-oncology, is to avoid the time-consuming work of
interviewing patients and to rely instead on superficial self-report
data, obtained at a single point in time, and readily translatable into
impressive statistics. I have done this myself, for many years, but my
later experience with the kind of detailed note taking and interview-
ing of patients over a period of time (chapters  and ) has convinced


 Cancer and Mind

me that this more hands-on approach is necessary if we truly want to

understand how psychological factors are influencing health.
A second limitation of the Watson study, common to most in
the area, is that the assessment was done at only one point in time.
People’s moods may, of course, vary widely from one day to the next.
To uncover habitual attitudes to life, we need to hear from individu-
als on a number of occasions; we need to get to know them. Again,
this is an expensive approach, in terms of professional time and re-
search money, although all would agree that repeated contacts pro-
vide a more reliable estimate. Thus in both the method of assessment
commonly used, and the frequency with which it is done, the norm
is to favour inexpensive but superficial methods, allowing the use of a
larger number of subjects, over more in-depth and repeated analyses
with relatively few subjects. Although the Greer study, using inter-
views, had one-tenth the number of subjects of the Watson study, it
is much more likely, I believe, to be uncovering valid relationships
between psychology and disease progression.
A third reason why experiments relating psychological properties
to survival in cancer patients are unlikely to demonstrate a relationship
is perhaps the most important of all, yet it has been almost univer-
sally ignored in this literature. To understand it we need to consider
the biology of cancer. When a tumour is found, it has already been
growing for months or even years, as was pointed out in chapter .
The cells comprising it have been subject to constant selection—only
those that find the internal environment of the host person tolerable
will have survived. This internal environment has been influenced
by many factors, among them the psychological makeup of the host
person. So the cancer has, as it were, learned to grow in that person,
regardless of whether he or she is repressed or not, whether she has
a fighting spirit or not, how emotionally close she is to other people,
and so on. Thus assessments made at a single point in time are not
only unreliable, as already argued, but also largely irrelevant, once
a cancer has adapted to its host: whatever the person’s psychologi-
cal profile, his cancer is accustomed to it, and will continue to grow
in it. For the mind to influence an established cancer, there must


 can the mind heal cancer?

logically be mental change, and change sufficient to affect the mol-

ecules that ultimately regulate cancer growth—acting through the
long-range (neuro-endocrine) and short-range messenger pathways
that we alluded to in chapter . Very few experiments indeed have at-
tempted to look at such change (which is again more demanding than
single-point assessment). This point cogently suggests that our best
chance of describing an impact of mind on cancer progression will
be in studies where a therapy is introduced to promote psychological
change. We turn now to such experiments.

    

        

If we accept the logical necessity for change if the mind is to affect

cancer progression, then the most direct way to test it would be to see
whether a psychological therapy, designed to induce change, can pro-
long survival. We have seen in chapter  that “remarkable survivors”
tend to say that they have changed considerably as a reaction to their
diagnosis, but we have also discussed how difficult it is to rely on this
kind of subjective self-report. Investigators have begun to test the
possible impact of psychological interventions on lifespan in cancer
patients. This is still a very new endeavour, since it is only recently
that the possibility of life extension through such therapy has been
taken at all seriously by people equipped to test it.
The credit for this interest belongs mainly to a Stanford psy-
chiatrist, David Spiegel. Spiegel trained with a renowned psycho-
therapist, Irvin Yalom, in the s, and in collaboration with him
and other colleagues, showed that support groups for women with
metastatic breast cancer were not, as had been feared, frightening
and possibly harmful to participants, but were in fact very useful in
helping them cope with the distress caused by their situation. This
was already a pioneering finding, which helped secure the current
acceptance of such groups. These experiments were designed to test
only relatively short-term effects on quality of life. However, in ,


 Cancer and Mind

some  years later, Spiegel took the further step of examining the
survival data on the people from the earlier experiments. To his ap-
parent surprise, he and his colleagues found that women who had
been in a support group for a year or more had lived approximately
twice as long after their diagnosis as similar women who had not
been in the therapy. This result created a quite a stir in New Age
and other circles! It appeared to confirm what many had hoped—the
power of the mind to influence the course of a serious disease. Now,
 years later, and after a number of similar experiments, the picture
is less clear. At the time of writing there are  such trials published,
to my knowledge,  giving positive results (some prolongation of life)
and  with negative results. To understand this ambiguity we need to
examine the methods used in these studies.
The currently preferred way to test the therapeutic value of any
agent or procedure, whether a drug or a psychological approach, is to
enter subjects into a randomized controlled trial. The “controlled” part
means that some of the patients get the intervention, while others do
not, so that a comparison of outcomes can be made. “Randomizing”
means that subjects are assigned to either intervention or control on a
random or chance basis. This is the best method we have of ensuring
that other factors (variables) which, although unrecognized, might
have an important influence on outcome, are on average similar in
the  groups. Most of the published trials have used randomization;
a minority have assigned patients to the two comparison groups in
other ways. This technology was developed by the eminent statisti-
cian R. A. Fisher early in the last century, as a way of testing the ef-
fect of fertilizers on agricultural plots, and it has been widely adopted
to test the effectiveness of drugs in medical research. Essentially it
works well for drug research, but there are important limitations in
applying it to testing the effects of a psychological therapy.
The principal limiting factor in using randomized controlled tri-
als (s) to test whether or not psychological therapies prolong life
is that subjects are lumped into  large groups: those who get the
intervention, and those who do not. The experimenter then plots,
on a graph, the rate at which subjects die in each group. In essence,


 can the mind heal cancer?

averages or median survival times are calculated for each group. The
experiment tests only whether or not the survival of the group as a
whole is enhanced by the therapy. It is not very sensitive to effects of
the therapy on a small minority; if a minority do something unusual,
and enhance their survival, it would usually be lost in the comparison
of group means. For example, in an experiment in which  cancer
patients received an intervention, and  did not, if  of the inter-
vention subjects made the kinds of personal transformation that the
“remarkable survivors” of chapter  report, and lived twice as long
as expected, this fact would in most cases be undetectable statisti-
cally in an . This problem is much more important in assessing
psychotherapies than in testing drugs, because the variability in the
way people react to or make use of psychotherapy is much greater
than the variability in response to drugs. Provided a drug is taken,
one can be reasonably sure that it will have a certain definable physi-
ological effect. But attendance at psychotherapy sessions provides no
such guarantee. In fact, many of those attending make no use of the
therapy at all, while others may transform their lives. Thus the very
subjects of most interest to those of us looking for a potential effect of
psychological change on survival may be hidden behind a majority of
“non-compliers.” A study with a relatively large percentage of people
who made good use of the intervention might score “positive,” while
one in which most did not would likely be “negative.”
A related problem is that, not surprisingly, people don’t like to be
randomly assigned to one group or another—they prefer to choose.
So, many individuals with cancer refuse to enter studies like these. It
is likely that among those refusing are the people most determined
to help themselves. Even worse, from the point of view of the in-
vestigators, they might join the study but if assigned to the control
group, venture out and find an alternative source of the intervention
elsewhere (this happens a lot—it goes by the technical name of “con-
tamination”!).
A third limitation of studies in this area so far has been that
the interventions used have not been designed to induce profound
psychological change. They have also been highly variable in nature,


 Cancer and Mind

ranging from  weekly sessions of “behavioural therapy” to a year of

weekly group supportive discussions. This variation has contributed,
no doubt, to the variety in results obtained. Most important, to reit-
erate what has been pointed out already, for a valid test of the impact
of mind, the psychological change must be sufficient to alter the in-
ternal regulators of cancer growth (chapter ) if we are to expect an
effect on lifespan.
Perhaps the most inoffensive way to illustrate how these problems
affect results is to show an experiment conducted by our own group
and published in  (Figure .). This was an  designed specifi-
cally to test whether an intervention could prolong life in cancer pa-
tients (most prior results, like Spiegel’s, were retrospective analyses,
performed as an afterthought, which for technical reasons diminishes
their credibility). The subjects involved in our study were women
with medically incurable metastatic breast cancers. They did not, as a
rule, seek out the intervention, but were identified from the hospital
clinic records and asked to participate; thus they were not particu-
larly highly motivated. The intervention was basically a supportive
one, with some training in coping skills, provided by a skilled group
therapist. Subjects attended a weekly group for one year. Most did
very little healing work at home (again indicating little real motiva-
tion for change—see chapter ). As the figure shows, there may have
been a slight tendency for those in the intervention to do better than
the controls, but this was not statistically significant. Subsequently
there has been a much larger, similar experiment by Goodwin and
colleagues with the same result.
We were, of course, disappointed with our result—the experi-
ment was an attempt to replicate Spiegel’s encouraging finding, as
was Goodwin’s. In other published trials where a positive effect has
been found, the size of this effect has been small. The  technically
most reliable s designed specifically to test life extension (ours,
Goodwin’s, and another by Edelman and colleagues in ), have
all yielded negative results. In retrospect, this finding is perhaps
not surprising, given the limitations of this experimental approach
that I have noted above. The consensus now is that interventions


 can the mind heal cancer?

1 .0 AB
A B
A A
B
A
A
B A AB
A B
0 .8 A B B
A A B B
A A B B
A A
Proportion Surviving

A A B
A BB
AA BB
0 .6 A B
A A B B
A B B
A A
AA BB
A A B B
A A
0 .4 A A B B
A A
A A B B
AA
A A B

A A
0 .2 A

0 .0
0 5 10 15 20 25 30 35 40 45 50 55
Time (Months)

       .  A cumulative plot of the number of women surviving at

different times after enrolling in the randomized controlled study conducted
by Cunningham et al. (( ). The group receiving the intervention is
).

shown as “B,” and the controls as “A.” (Reproduced with permission from
John Wiley and Sons Ltd.)

of this kind do not increase average survival among such patients.

Unfortunately, this has been taken, in some quarters, to indicate that
the issue is closed—that psychological help and change generally
can prolong life for no cancer patients, and that the mind cannot
affect cancer progression. While many scientifically oriented physi-
cians and some psychologists would, perhaps unthinkingly, draw this
negative conclusion at present, I hope it is clear that such a sweeping


 Cancer and Mind

generalization would be unjustified on the evidence. We can only say,

from these trials, that therapy of the types employed appears to have no
significant average effect on the lifespan of the particular (usually not
highly motivated) patients tested.
In common with most who do relatively intensive and long-term
psychological therapy with cancer patients, I was unhappy with the
state of play resulting from the clinical trials approach, including
the results of our own study. It seemed obvious to me that some pa-
tients, particularly those who got strongly involved in trying to help
themselves psychologically and spiritually, lived much longer than
expected. Other therapists to whom I have spoken about this have
generally agreed. Perhaps we were missing these people in our trials,
“losing” their good survivals in the calculated averages? How could
they be identified among a majority of less involved people?
This problem, of course, is not new, and has been addressed by
many scientists trying to assess the outcomes of psychotherapies of
various kinds. Instead of comparing group means we may need to
look at what patients do individually, and relate each person’s efforts
to his or her ultimate survival. This may seem like common sense—it
is the kind of assessment we make in ordinary life, after all—but it
is a strategy that has been largely disregarded in medical science. A
person highly involved in self-healing might tend to live much longer,
other things being equal, than another individual not so involved. It
is an approach that is essential, I would argue, if we are going to un-
derstand how to help people live longer in the face of serious disease.
We must study first those who make an all-out effort, learn from
them, and then apply what we have learned to help others who do not
currently get very involved, but might well do so if they were assured
of a path that could bring results for them. The conclusions reached
by people like LeShan and the Simontons (chapter ) were based on
this kind of observation, although they did not have a reliable way of
determining whether individuals had outlived their life expectancies.
Is it possible to do a rigorous, prospective, experiment of this type? In
the next chapter I will describe our efforts in this direction.


 can the mind heal cancer?



After describing some of the questions addressed by the new disci-

pline of “psycho-oncology,” including its focus on how cancer influ-
ences mental state, I moved to a discussion of research on the reverse
effect, how the mind may affect onset and progression of cancer.
There is an enormous and undoubted impact of unhealthy behav-
iours, such as smoking and aspects of diet, on incidence of cancer. Of
more relevance to us here, however, is the possible impact of mental
change on progression of existing cancers by some “internal” path-
way, that is, by affecting the inner state of the body in such a way as
to oppose the growth of a cancer.
The two main approaches to this question were discussed. The
first comprises half a century of efforts to correlate aspects of “per-
sonality” or adaptive styles to the growth of cancer. Results have
been inconsistent, although there is some consensus that repression
of emotions makes development of cancer more likely, and that so-
cial support may impede its progression. We looked at some of the
reasons why it may be difficult to detect a real effect using this kind
of method. The second approach is experimental: can psychological
therapies prolong life in cancer patients? Again, results have been
mixed; of  published studies,  have given (mostly very small) posi-
tive effects, and , including those most technically reliable, have
yielded negative findings. These studies were designed to look for
overall impact on the average survival of participants; they were not
designed to detect any impact on lifespan of an unusual degree of
mental change in a minority of highly motivated patients. All also
employed therapies that were basically supportive, rather than aiming
at inducing change. However, the upshot of these inconsistent find-
ings is that most health professionals would currently regard a poten-
tial therapeutic effect of mind on cancer as unproven and unlikely.



. Andersen, B. L., & gy. In A. M Nezu & C. M. Nezu (Eds.), Handbook of psy-
chology: Vol. .. Health Psychology (pp. –
 ). New York: John Wiley & Sons.


 Cancer and Mind

. Dalton, S. O., Boesen, E. H., Ross, L., Shapiro, I. R., & Johansen, C. ().
Mind and cancer: Do psychological factors cause cancer? European Journal of
Cancer, (), –.
Edelman, S., & Kidman, A. D. ().). Mind and cancer: Is there a relation-

ship? A review of evidence. Australian Psychologist, (), –.
Fox, B. H. (). Psychosocial factors in cancer incidence and prognosis. In J.
C. Holland (Ed.), Psycho-Oncology (pp. –). New York: Oxford University.
Kreitler, S., Chaitchik, S., & Kreitler, H. (). Repression: Cause or result of
cancer? Psycho-Oncology, , –.
McKenna, M. C., Zevon, M. A., Corn, B., & Rounds, J. (). Psychosocial
factors and the development of breast cancer: A meta-analysis. Health
Psychology, ,
 –.
. Sklar, L. S., & Anisman, H. (). Stress and coping factors influence tumor
growth. Science, (), –; Sklar, L. S., & Anisman, H. (). Social
stress influences tumor growth. Psychosomatic Medicine, (), –
 .
. Shekelle, R. B., Raynor, W. J., Ostfeld, A. M., Garron, D. C., Bieliauskas, L.
A., Liu, S. C., et al. Psychological depression and -year risk of death from
cancer. Psychosomatic Medicine, (), –
 .
. Dalton, S. O., Mellemkjaer, L., Olsen, J. H., Mortensen, P. B., & Johansen,
C. (). Depression and cancer risk: A register-based study of patients hos-
pitalized with affective disorders, Denmark, –. American Journal of
Epidemiology, (), –.
Fox, B. H. (). A hypothesis to reconcile confl icting conclusions in studies
relating depressed mood to later cancer. In M. Stein & A. Baum (Eds.), Chronic
diseases. Mahwah, NJ: Lawrence Erlbaum Associates.
Mathe, G. (). Depression, stressful events and the risk of cancer (Editorial).
Biomedicine & Pharmacotherapy, (), –  .
. Shaffer, J. W., Duszynski, K. R., & Thomas, C. B. (). Family attitudes in
youth as a possible precursor of cancer among physicians: A search for explana-
tory mechanisms. Journal of Behavioral Medicine, (), –.
Thomas, C. B. (). Cancer and the youthful mind: A forty-year perspective.
 ; Thomas, C. B., Duszynksi, K. R., & Shaffer, J. W. ().
Advances, (), –
Family attitudes reported in youth as potential predictors of cancer. Psychosomatic
Medicine, ,
 –
 .
. Temoshok, L., & Dreher, H. (). The Type C connection: The behavioral links to
cancer and your health. New York: Random House.
Temoshok, L. (). Complex coping patterns and their role in adaptation and
neuroimmunomodulation: Theory, methodology, and research. Annals of the
New York Academy of Sciences, , – .
–
 –
Temoshok, L. (). Connecting the dots linking mind, behavior, and disease:
The biological concomitants of coping patterns: Commentary on “Attachment


 can the mind heal cancer?

and cancer: A conceptual integration.” Integrative Cancer Therapies, (), -.

. Greer, S., Morris, T., & Pettingale, K. W. (). Psychological response to
breast cancer: Effect on outcome. Lancet, (), –.

.
Greer, S., Morris, T., Pettingale, K. W., & Haybittle, J. (). Psychological
response to breast cancer and -year outcome. Lancet, (), –.
. Watson, M., Haviland, J. S., Greer, S., Davidson, J., & Bliss, J. M. ().
Influence of psychological response on survival in breast cancer: A population-
based cohort study. Lancet, , –
 .
. Spiegel, D., Bloom, J., Kraemer, H. C., & Gottleib, E. (). Effect of psycho-
social treatment on survival of patients with metastatic breast cancer. Lancet,
(), –.
. Goodwin, P. J., Leszcz, M., Ennis, M., Koopmans, J., Vincent, L., Guther, H.,
et al. (). The effect of group psychosocial support on survival in metastatic
breast cancer. New England Journal of Medicine, (), –.


 Chapter 

Working Towards Longer Survival:

The Healing Journey Study

W
e come now to what has been the main stimulus for
writing this book: a series of systematic clinical and
research investigations that we have carried out over
the last  years, on the kinds of psychological prop-
erties and change that appear to promote longer survival in people
with serious cancers. The reader should be aware that this is very
much a work in progress, and a minority view at present; no other
group has yet undertaken the kind of rigorous, prospective experi-
mental test of the qualities favouring survival that I will outline, and
replication by others will be needed for the ideas to gain acceptance.
I present them here because they mesh so well with clinical observa-
tions by ourselves and by a large number of other professionals, with
the studies on remarkable survivors (chapter ), and with the evi-
dence on Type C adaptation and repression as a risk factor in cancer
(chapter ). When all of these results are put together, and notwith-
standing the conflicting results from clinical trials presented in the
last chapter, I believe we can sketch a plausible picture of the role the
mind may play in assisting healing from cancer, and I will devote the


 can the mind heal cancer?

rest of the book to discussing it. If we wait for certainty, we may wait
a long time.
There are two main features of the experimental work I am going
to describe that are unusual in the field of psycho-oncology, yet nec-
essary to overcome the limitations of the more popular “randomized
trials” approach that was discussed in the last chapter:
. the development and use of a form of psychological therapy
for cancer patients that can provide a structure to guide those
people who are motivated to work towards substantial per-
sonal change
. the use of a correlative design, rather than a comparison of
group means, so that the efforts and changes made by each
individual can be related to his or her life extension (ex-
plained below)
I will first describe our Healing Journey therapy program, which
has been developed over the last  years. The basic aim of the pro-
gram is to help patients cope better with their disease, and to improve
the quality of their life. A secondary aim, often uppermost in the
minds of those who have attended, is to prolong life. I’ll then describe
a completed experiment that strongly suggests an impact of dedicated
psychological self-help work on survival in at least some people with
medically incurable cancers. A replication of this experiment is cur-
rently underway. In the following chapter I will document interviews
conducted with  people from our program many years after they
had survived a medical prediction of early death, contrasting what
they said with statements made by other cancer patients who failed
to outlive their prognoses, and with members of a third group inter-
viewed before entering a course of therapy.

      :

  

While some people with cancer need individual psychiatric or psy-

chotherapy treatments, the majority are psychologically healthy, but


 Working Toward Longer Survival

highly stressed by the diagnosis. As discussed in the last chapter,

many can be greatly helped by meeting in groups with other cancer
patients; such meetings diminish the sense of isolation, allow sharing
of emotions (with peers who understand and can listen), and pro-
vide a venue for learning from others and solving problems, such as
how best to relate to family, doctors, and friends. Groups are to be
preferred for these reasons, and because they are obviously more eco-
nomical than one-to-one consultations with health care professionals.
They are also a convenient forum for learning and practising specific
coping techniques; among those we teach are deep relaxation, various
kinds of mental imaging and drawing, watching one’s thoughts, set-
ting goals, meditating, consulting a source of “inner wisdom,” keep-
ing a journal, reading appropriate books on healing and spirituality,
and other methods.
Our efforts to provide a group program for cancer patients and
interested family members began in . For some years, meetings
were held mostly in private homes and in rooms generously made
available by the Canadian Cancer Society, but in recent times most of
the work has been done at the cancer hospital where I am employed.
As we learned what helps most, we gradually refined the methods
and ways of presenting them. It became evident fairly quickly that
many people, on “graduating” from a basic course of what was then
six to nine weekly sessions, wanted further support and more ad-
vanced instruction. We added a second level or stage to the program
in , and soon after followed that with a third, these two higher
levels usually involving eight weekly meetings, in small (– mem-
ber) groups. The third level was, for many years, a process of writing
one’s “life story,” and then presenting it to the rest of the group—an
uplifting experience (once the initial trepidation was overcome!), and
one that often clarified for the participant what the main themes of
her life had been, and what was of top priority now. More recently,
the third-level agenda has changed to eight sessions on spiritual as-
pects of healing. For the last  years or so, a limited number of pa-
tients with metastatic cancers have been enrolled in a fourth level,
consisting of weekly therapy groups in which the emphasis has been


 can the mind heal cancer?

on further psychological and spiritual growth. These more intensive

and long-running groups, restricted to small numbers of patients be-
cause of our limited resources, have been the main source of infor-
mation for the work on prolongation of life described below. Steps 
to  thus constitute our “core” program, with Level  as an extra, for
patients with terminal prognoses. Table . summarizes the content
of the program in its current form.
At present, we enrol  to  new patients every year, with all
kinds and stages of cancer. About half are accompanied by a fam-
ily member to the Level  course (which is now shortened to four
sessions, delivered in a small auditorium to groups of  or so, and
repeated five or more times per year). About half of the patients in
Level  elect to move on to Level ; at this stage, smaller groups are
used for at least part of the sessions, to allow sharing, and the family
members have a separate group of their own. Most of these people
proceed to Level : whether or not people continue through the pro-
gram depends on many factors, in addition to their health and pref-
erences—for example, availability of staff and rooms, and the vigour
with which continuing is advocated!
Those wanting details on the content of the program, and the
many research papers that have been written based on its work, can
find information on our website www.healingjourney.ca, or in our
papers cited in the references for this chapter. For the present, our
focus will be on the properties of this kind of program that make
it especially suited to investigating our main question: can mental
change affect the progression of cancer?
The first thing to emphasize about the Healing Journey is its
stepwise nature. This allows participants to try a short exposure in
Level , then either proceed to the next step, or drop out if they have
had as much help as they want. Remarkably, this kind of structure is
still virtually unknown in psycho-oncology (although used in other ar-
eas, like addiction counselling). Almost all other therapies in common
use are single stage, and typically of  to  weeks’ duration (although
some, as in the Spiegel study cited earlier, involve a year or more of
group support for a small number of patients). For research purposes,


 Working Toward Longer Survival

      .  Main Elements of the Healing Journey Program

Level : Taking Control: Coping with Cancer Stress (four sessions)

• Communicating feelings
• Deep relaxation
• Thought monitoring and changing
• Mental imagery
• Setting goals

Level : Getting Connected: Skills for Healing (eight sessions)

• Journalling (self-examination)
• Consulting “inner wisdom”: the “Inner Healer” technique
• Meditation: mind quieting
• Dropping resentments
• Setting goals

Level : Finding Meaning: Steps to Spiritual Healing (eight

sessions)
• Understanding spirituality
• Identifying and dropping the obstacles to spiritual
connection
• Spiritual practices (meditation, prayer, chanting, reading,
meeting with others)
Level : Long-term group therapy (psychological and spiritual
content)
• Discussion group for graduates of Levels  and  (ongoing)

the stepped structure acts as a kind of filter, concentrating, so to speak,

the people who wish to become most engaged with the work.
A second point about the Healing Journey is that it presents
self-healing as a learning process. Support is valued, but seen as not


 can the mind heal cancer?

enough if the participant wishes to gain some control over his or her
experience. Appropriate and effective techniques, like those I listed
above, can be learned and practised. As a simple example, someone
who constantly wakes through the night with anxious thoughts may
be greatly helped by knowing how to “watch” her mind, counter some
of the frightening thoughts, and use a relaxation technique to get back
to sleep. A more sophisticated example is the “Inner Healer” imagery
method in which people learn to contact a previously unrecognized
source of wisdom within themselves, personified as a spiritual or an-
cestral figure who can often provide answers to troubling questions.
A third feature of the program is its emphasis, in the later stages,
on spirituality and healing. Spiritual or existential concerns are abso-
lutely central in the minds of many cancer patients (“Is this the end?
Is there a God, and if so, why did this happen to me?”), and some
answers may come through meditation, prayer, or spiritual discussion
and reflection. Figure . arranges various techniques and therapeutic
approaches as a hierarchy, becoming more demanding as one ascends,
but also potentially more life-transforming. It is emphasized that no
guarantees can be offered for effects on the physical disease, only that
work of this kind will improve quality of life and may have an effect
on progression, depending on many factors, including the nature of
the cancer itself. Thus there is no cause for blaming oneself if the
cancer continues to grow at the same rate in the face of one’s best
efforts.
While our program attempts to help people progress through
various stages of healing, we would certainly not claim that our pro-
gram is the only or even necessarily the best way to do so; the struc-
ture we present is simply one form, adapted over the years to the
people seeking help from us, of a fairly widely understood process of
psychological and spiritual growth. We have ample documentation
of its ability to improve quality of life; for the purpose of investigat-
ing possible extension of life, it will be seen that it provides us with a
way to both select and encourage motivated cancer patients, a kind of
framework for personal evolution. The keenest participants typically
seek out additional things to do to help themselves at other locations,


 Working Toward Longer Survival

Psychospiritual
Therapy
(Integrated Psychological
Aim: and Spiritual Work)
Psychological
and Spiritual Psychotherapy Proper
Development Spiritual Practice

Coping Skills Training

Advanced Meditation; Inner “Wisdom”;
Reflection & Journalling

Aim:
Coping Coping Skills Training
Basic: Stress Management; CBT

Aim:
Comfort Support
(Caring, Expression of Emotion, Problem Solving)

       .  Types of psychological therapy, arranged in order of

increasing demands made on the participant as the pyramid is ascended.
CBT = cognitive behavioural therapy. (Reproduced from A.J. Cunningham
(
( ), Group psychological therapy: An integral part of care for cancer
),
patients, Integrative Cancer Therapies, , -
-, with permission, Sage
Publications Inc.)

and are encouraged to do so (something we took into account in the

study described below).
Before moving to a discussion of research design, I would like
here to acknowledge the collaboration of many dedicated health


 can the mind heal cancer?

professionals in the operation of this program over the last  years

of its existence. Claire Edmonds and Cathy Phillips, both initially
graduate students in my team and now with doctoral degrees in psy-
chology, have been superb therapists and researchers. Many other
professionals have either observed the program or contributed (by
leading small groups) over this time. Among our devoted course co-
ordinators (front-line workers who staff the phones and try to help
people who call in great distress) have been Heather Hanson, Gwen
Jenkins, Nancy Folk, and Jan Ferguson. Gina Lockwood has been
a valued statistical consultant over the years, and David Hedley has
been prominent among the medical staff who have assisted us.

     

    

Armed with an ongoing therapy program that seems clinically to

encourage substantial psychological change in at least some partici-
pants, and brings to the fore a steady stream of people with an interest
in self-healing, how might we best design an experiment to test our
question? Simply observing the patients passing through a program
and forming an impression is obviously not enough—we are all too
prone to seeing what we want to believe. For a rigorous study, certain
requirements must be satisfied. The study should ideally be prospec-
tive and longitudinal, technical terms meaning that we want to enrol
patients, make some prediction of their likely survival, and follow
them over time to see how well they do, as opposed to identifying
survivors long after their experience and asking them what they did
in the past (as in the studies of chapter ). To obtain an indication of
the impact of self-help on survival, we need first to get the best pos-
sible expert prediction of likely survival duration, and then compare
it with actual survival time. As a result we will be able to say, for
example, this person survived , , or  times longer than medically
predicted. The therapy needs to be as intense as we can make it. And
finally, we need a comprehensive characterization of the psychologi-


 Working Toward Longer Survival

cal state of participants, to identify those qualities that are associated

with longer survival.
Details of our experiment can be found in our published papers
and on our website. In brief, our first experiment of this kind involved
 patients with medically incurable cancers (the types most com-
monly represented were metastatic breast cancer, metastatic colo-rec-
tal cancer, and pancreatic cancer). These people entered the Healing
Journey therapy groups for a year (a few dropped out before the year
was over). Relevant data from the medical charts for each patient at
the time of entry were examined independently by between  and
 oncologists at the Princess Margaret Hospital; each expert made
a prediction of likely lifespan, and a median (mid-range) estimate
was calculated. Psychological descriptions were made from analysis
of verbal “data,” meaning regular written homework assignments and
therapists’ notes, which were collected each week for each participant
(sometimes  pages or more in total). These data were subjected
to a standard process called qualitative analysis, from which a large
number of themes was derived, themes like “dedication to self-help
work” or “awareness of the changes needed.”
The qualitative analysis was done using special computer soft-
ware that facilitated the clustering of each piece of verbal text under
appropriate thematic headings (called “coding”). Thus all the mate-
rial illustrating each theme could be swiftly drawn together. We then
had to relate the strength of expression of each of these themes to
survival, and for this purpose, numbers had to be assigned to them.
Each of four psychologically trained raters inspected a summary of
the data for each theme and provided a rating estimate, on a scale
of  to . For example, under “dedication to self-help work,” a rat-
ing of  indicated that there was little or no dedication displayed,
and  meant that the person largely devoted his or her life to the
healing work. The team debated (often vigorously!) what the final
rating should be for each theme. To give the lay reader some idea of
the exhaustive thoroughness of this analysis, coding the data for one
subject might take  or more person-days. Inspecting it and deciding


 can the mind heal cancer?

on a rating was a little easier: perhaps up to  day per subject, for

each of the raters. Discussing and finalizing the rating for some 
sub-themes—a day per subject. In addition was a lot of clerical work
in arranging material, writing and refining scenarios to illustrate the
scores of  to  on each theme. Thus the whole process took many
thousands of person-hours of work. This contrasts with the relative
ease of obtaining psychometric data (from self-report questionnaires)
of the kind described in the last chapter, but having used both meth-
ods I can state that there is no comparison between the confidence
one has in the conclusions. In fact, we used some standard self-report
questionnaires as well, the scores on which failed to correlate with
survival. We came to know our subjects intimately, and the team rat-
ing process assured a degree of objectivity. As a later refinement, we
have had “blind” raters, who did not know the patients, examine an
edited version of the data from which all mention of health matters,
and all therapists’ inferences, had been removed, in order to counter
the possibility that we, the therapists, might have known from physi-
cal clues how long a person might be expected to survive.
Before looking at the results, I want to emphasize some of the
differences between this study and the investigations that we have
previously discussed. It differs from studies of “remarkable survivors”
in several ways, most critically in being prospective. Rather than start-
ing with known survivors, without having any idea how many others
like them had not survived (chapter ), we enrolled eligible people as
they presented themselves, and followed all of them, noting survival
for each. Another important point of difference is the care taken to
obtain the best possible estimate of likely survival time for each pa-
tient, in contrast with the remarkable survivor studies where there
were only retrospective and superficial estimates of likely survival.
Note that we did not set up the experiment to detect only “cures” or
“spontaneous remissions” (although we saw two of these). Instead,
we focused on prolongation of lifespan beyond that expected, assisted
by the stepwise therapy program. Under these conditions, it becomes
possible to detect relatively modest effects, such as prolongation of


 Working Toward Longer Survival

life by a year or so (and see Figure .). As discussed in chapter ,

cases of complete remissions of disease, especially where there has
been no psychological help, are likely to be quite rare, so a prospective
experiment that will detect nothing less than this is almost certain
to fail.
Experiments using an  (controlled trials) design are currently
regarded more highly in medical research, as I have said, because at
least in principle they allow us to be more certain that an intervention
causes an effect (in practice, this often is not the case—note the am-
biguity surrounding results of trials in this area, as discussed in the
last chapter). By contrast, if we find that a certain set of psychological
qualities is associated with longer survival, we cannot formally con-
clude that these qualities caused the longer life, although, as we will
see, it may be the most probable explanation. However, to reiterate,
a correlative experiment like ours has the distinct advantage that the
“performance” (survival beyond that predicted) for each person can
be related to the psychological qualities he or she displayed. Because
a small number of people were studied minutely, rather than a large
number en masse, we obtained a detailed picture of what each indi-
vidual did, and thus added to our knowledge about self-healing (there
is no such learning in a trial, which is intended only to confirm or
deny an effect of a therapy on an outcome). We were able to define
a “dose–response” relationship between the qualities we were inter-
ested in and the outcome; in this case, survival. And we did not have
to assign anyone randomly to a control group, which is a most un-
pleasant procedure, unacceptable to many of the patients, but instead
were able to do the experiment under “real life” clinical conditions.
Almost all decisions in everyday life are made from correlations,
which is also the way we accumulate clinical experience and indeed
most medical knowledge. Unfortunately, there is a current fashion
in medical research to look down upon correlative evidence, which
diminishes the attention some health care professionals are willing to
pay to findings from experiments like this.


 can the mind heal cancer?

    

 

From the qualitative analysis of what participants wrote in their

homework over a year, and notes taken by the group therapists at
each weekly session, we developed a “model” or map of the process of
changing in response to the threat to life, which agrees quite well with
other research in the area of personal change, and is also a picture that
makes sense. The model is shown in Figure .. Each box encloses a
major theme, which in turn comprises a number of sub-themes (not
shown in the diagram). Thus people’s “appraisal of threat” includes
their perception of the need to change, awareness of what specifi-
cally they might do about it, and other sub-themes. The efforts that
individuals make depend on this appraisal; then, given an awareness
that change was necessary, the next step is the degree of willingness
to actually do something, a theme that includes as sub-themes the
abilities they think they have, and the outcomes they expect from
their efforts. “Downstream” from this was the work actually done,
and the dedication with which it is embraced: it is quite possible for
someone to believe that work and change are needed, yet to lack mo-
tivation, or to have the motivation and not translate that into action
for various reasons (such as lack of support at home). And influencing
everything in this pathway is “ability to act and change,” an assess-
ment of pre-existing qualities in each person that to varying degrees
paved the way to action or, in some cases, effectively prevented the
individual from accomplishing much (examples of the latter would be
a strong sense of inferiority or inadequacy, or a world view that was
rather concrete and did not allow for mind–body effects). Ill health
at the time of joining the study was not a factor that prevented the
self-help work; all those enrolled had to be able to function relatively
normally, although of course some had symptoms, like pain or weight
loss as a result of their illness. All received standard medical care dur-
ing the time with us, and that was taken into account by the oncolo-
gists in making their estimates of likely survival.


 Working Toward Longer Survival

Abi l i t y to Ac t R el ati o ns
and Change Wi th O thers

Apprai s al Wi l l i ngnes s Appl i c ati o n Q ual i t y

o f Threat to Ac t and Change to S el f -hel p Wo rk o f E xperi ence

Percei ved I m pac t o f S ur v i val

Li fe Ci rcum s tances D urati o n

       .  A model of the psychological response to cancer, derived

from the qualitative analysis of the Healing Journey study described in
the text. (From Cunningham, Phillips, Stephen, and Edmonds, .
Reproduced with permission from Sage Publications Inc.)

Dedicated application of self-help work (practice of the techniques

taught, coupled with reflection and efforts to change), brought about
a substantial improvement in what we called “quality of experience”
(Figure .). But did it prolong survival? There were various ways of
testing this. One was to relate each theme to survival, using a tech-
nique called regression analysis, which basically means plotting sur-
vival duration and the theme scores on a graph, and seeing how close
the results are to a theoretical line representing a perfect relationship.
All the major themes except “Appraisal” correlated significantly with
survival. This remained the case when the individual health status of
each subject was taken into account; in effect, we were then plotting
psychological theme scores against the extent to which individuals
outlived their medically predicted survival.


 can the mind heal cancer?

Regression analysis is a bit technical (the results obtained with

it are described in our papers, referred to in the references to this
chapter for those who want them). I will present a simpler way of
looking at the outcome here. We added the scores for all the themes
in the boxes in Figure . except for “quality of experience” and called
this comprehensive score a measure of “involvement in self-help.” We
could then write down these scores, in rank order, for all  subjects.
We divided this list into thirds, representing “high,” “medium,” and
“low” involvement respectively. We could now plot on a graph the
median survival for each of these three subgroups against their sur-
vival (Figure .).
The results were highly significant statistically, and really quite
dramatic for work of this kind ((p = . on the graph means that one
could expect a result as strong as this by chance only once in about
 repeat attempts). As you can see from the right-hand panel on
the graph, the “high” involved subgroup, that is, the top  in terms
of involvement, lived for a median time of nearly  years, and  of
these people have had complete remissions of (supposedly fatal) dis-
ease for about  years now. By contrast, the “low” subgroup died at
 year. The “medium” subgroup survived for an intermediate length
of time. Was this difference caused by differences in their degree of
illness? We can be fairly sure that it was not, for two main reasons.
First, the left panel of the graph shows the median medical estimates
of survival for all three subgroups at the time of entering the study:
these were identical; in other words, people who later demonstrated
low involvement were no sicker, on average, than those who later be-
came highly involved. Second, the attendance at therapy sessions, a
fair measure of health status, was not significantly different for the
three subgroups; it was not the case that the “low involved” people
suddenly became ill after joining the study—they were simply less
enthusiastic from the start.
The most likely explanation for the results is that involvement in
self-help promotes longer survival. Technically speaking, it is possible
that some unidentified factor other than involvement was responsible
for it, but nobody has been able to say what this might plausibly be.


 Working Toward Longer Survival

4.0

3.0
Year s

2.0

1.0

P =0 . 7 9 P =0 . 0 0 6
0

Pred ic ted S ur v i val O bs er ved S ur v ival

       .  The impact of “involvement in self-help” on survival.

The left-hand panel shows the survival predicted by a panel of oncolo-
gists for the  subgroups of patients, with “ low,” “medium,” and “ high”
involvement. The right-hand panel shows the actual survival of patients
in these  categories. The diamond-shaped dots show that in a control group
of  similar patients, the median survival predicted by the oncologists
(left-hand panel) was similar to what was actually observed (right-hand
panel). ((From Cunningham, Phillips, Lockwood, Hedley, and Edmonds,
. Reproduced with permission, Innovision Communications.)


 can the mind heal cancer?

We would not wish to conclude that the therapy “caused” the longer
survival, but rather that a combination of the personal qualities of the
subjects, encouraged by the therapy, was probably responsible for it.
Without the therapy, however, such large effects are unlikely, given
the history of small and inconsistent results uncovered by the cross-
sectional analyses I described in the last chapter.

    

“    ”     

Let us look now in a more descriptive way at some of the contrast-

ing qualities of people who were “high,” “medium,” or “low” in their
involvement with self-help work. The process of ranking the 
patients allowed us to see a number of clusters of similar attitudes,
members of the same cluster generally being adjacent to one another,
or nearly so. (Note that in this clinical description we classed  as
“highly involved,” because of the similarities they displayed in their
behaviours,  as “moderately,” and , the lowest, as “low.”)

Highly Involved People

Nine of the  subjects could be said to have been “highly involved”

(the dividing lines between high, medium, and low were, of course,
not sharp). These participants all developed a program for themselves
that incorporated substantial changes in lifestyle, and included regu-
lar relaxation, imagery and thought monitoring, and a meditative or
other spiritual practice. They were open to exploring new ways of
thinking and behaving, and were disciplined in their work. Obstacles
that they faced—demanding medical treatments, pain, deteriorating
health status, family and work demands—were not allowed to inter-
fere substantially with their personal program. All of these partici-
pants appeared to use what they learned from the therapy as a means
of changing their lives.
The four persons ranked highest in their involvement stood out


 Working Toward Longer Survival

because they immersed themselves fully in the work, without reser-

vation (we called them “wholeheartedly involved”). They found the
psychological and spiritual exploration of compelling interest for its
own sake, not simply as a means to a possible cure. They also initiated
and explored self-help activities beyond those offered in the program.
Examples:
“I find self-exploration really exciting . . . There is true joy in this
process along with the challenges. I welcome the challenge, as this
is where the change takes place.”
“I do my relaxation exercises prior to my meditation/prayer/im-
aging sessions, which I do about : each a.m. As well, I do re-
laxation each afternoon before a (shorter) meditation and a nap
. . . I am trying to add additional meditation and visualization
sessions in the late afternoon and in the evening, which are pre-
ceded by relaxation. I have also started doing a tai chi routine at
various intervals during the day.”
“I spend up to  hours a day in meditation, prayer, visualization,
and spiritual reading; most days. If I miss mornings, I do some at
night.”
“I am working through the Course in Miracles workbook [a modern
spiritual text], which is giving me a tremendous dose of spiritual-
ity. . . . I meditate for  minutes every morning on the lesson for
the day, and think about it when I can during the day. I lose my
awareness of time when I meditate on these phrases; they feel like
they are being poured inside of me.”

Effort of this kind brought substantial rewards. All of the people

at the top end of the involvement scale enjoyed relatively good quality
of life experience. An example:
“Spiritual oneness stays with me. Anything that isn’t done with
love feels like an insult to everything. I have deep feelings of rever-
ence. Right now I feel better than ever in my life.”


 can the mind heal cancer?

Unlike the wholeheartedly involved, the next  people in order

of involvement (Numbers , , and  in our ranked list) tended not to
be as passionate about the work for its own sake, viewing it more as
a duty necessitated by the threat of cancer. Nevertheless, these peo-
ple routinely followed their personal program, and over time brought
about pronounced psychological change. These  differed from one
another in their personality and style of work. Number  was a re-
served person, conscientious, without being excited by the work, al-
though she valued it highly:
“I wake up each morning thinking what am I going to do today
for myself (relaxing, meditation, etc.) and when shall I do it. I
know it is the most important thing to do in my life at the mo-
ment.”

She experienced considerable personal change, describing im-

proved self-worth, greater ability to balance her own needs with
those of others, more self-expression and awareness, and improved
relationships.
“I feel I have confronted certain bad habits (such as being a perfec-
tionist, always wanting to have control over my life, and keeping
busy all the time) already and am working on many other things.”

She was one of  patients in the study (the other being Number
 on the involvement scale), who, against medical expectations, have
had complete remissions of their cancer for some  years.
A second member of this cluster was highly anxious, and fear
about his disease drove him to dedicated and regular self-help prac-
tice (Number ). By contrast, the third member (Number ) appeared
highly self-confident and calm in face of difficult news and successive
surgeries. She chose to avoid overt expression of emotion or psycho-
logical self-analysis, but maintained a regular practice of meditation
and related techniques, such as relaxation and visualization.
The defining feature of the remaining  members in the “highly
involved” group (Numbers  and  on the list) was a tendency to pursue
their own agendas. Although dedicated to their self-help practice, they

 Working Toward Longer Survival

were less open than the other highly involved people to investigating all
aspects of their lives. For example, although the homework of Number
 suggested serious conflicts with her children, she was unwilling to
discuss it in any depth with the group. She also considered herself a
spiritual person, but was not open to discussions on the topic.
“Some of my contempt for a certain kind of ‘spirituality’ is not only
about its pretentiousness, but also because it seems closed to me.”

Moderately Involved People

The next  patients in the ranked list were classed as “moderately

involved.” They were still active in applying self-help strategies but
had less ability or willingness to apply themselves. Two of them
(Numbers  and ) had difficulty sustaining self-help work beyond
an intermittent involvement. Number  seesawed between enthusi-
astic outbursts of activity and periods of depleted relapse. Her most
active work was in the spiritual area, where she gained a very strong
spiritual feeling and sense of connection. The other member of this
cluster (Number ), felt victimized by her cancer. She believed it
“should have not happened to her,” and these feelings periodically
undermined her resolve to stick with her program:
“Disappointment is the main theme of my life: [my husband] dy-
ing, getting cancer, not being cured. I must turn that around.”

The remaining  “moderately involved” people were all women

who had evident blocks to emotional self-expression that seemed to
restrict their openness and willingness to change.
“I don’t seem to be able to believe that my life is threatened.”
“I wouldn’t be prepared to take  months and do only this self-heal-
ing work; the benefits are not sufficiently clear. . . . If there was
anything that guaranteed healing, I would probably do that all
the time,” but I’m “unwilling to devote 8 hours a day on self-help
work.”

 can the mind heal cancer?

All had a tendency to approach things in a very rational way,

were not emotionally expressive in the group or in their homework,
and tended to withdraw in potentially emotional situations. For ex-
ample, Number  was unable or unwilling to look for any negativity
in her thinking. She was reluctant to try drawing, reporting that she
“didn’t see the need” for fantasy or guided imagery, was ambivalent
about asking friends for support, and felt she “shouldn’t need” the
support of the group.

Minimally Involved People

Eight of the patients were minimally involved in self-help work and

were clustered into three further subgroups. “Rejecters” were  high-
achieving professionals who rejected the need to change, and the no-
tion that the state of their minds could make a difference to their
experience, let alone to the physiological regulation of their cancers
(both, however, continued to attend and value the emotional support
of the group). Three quotes from the writings of Number :
“I’m not going to be a new person . . . I don’t have any faith in the
process. I am far from unhappy with my current balance of mind
and spirit, so why change what works quite well?”
“I chose not to do this exercise since I see no more point in it for me
than previously. . . . . It is just that I believe such problems do not
refract upon my illness.”
“Once I go out into the world, I tend to become absorbed by it, to
the detriment of homework.”

Two further members of the low involvement group, whom we

labelled “detached” (Numbers  and ), also seemed skeptical of
the power of their minds to make a difference, although they did not
actively reject the approach. Their skepticism prevented their getting
seriously involved, however. One (Number ) had pancreatic cancer
and died early, although only after several months of fair health. The
other (Number ) represents the only exception to the rule that all

 Working Toward Longer Survival

in the “low involvement” group died within  years of study entry.

She had an infant daughter, to whom she wished to devote as much
time as possible, although she would do her meditation daily, without
apparent enthusiasm.
“I use her [daughter] as my excuse for not doing more self-help
[work].”

The remaining  individuals appeared to be unable to focus ef-

fectively on their healing work because of longstanding patterns of
behaviour that were apparent at entry to the study. Two struggled
with self-esteem (Numbers  and ); a sense of helplessness and pro-
found feelings of personal unworthiness undermined their efforts.
For example,
“I think I am up against a personal trait that I have had for as
long as I can remember, which is to study an endeavour some-
times to the point of exhaustion before attempting anything. I’m
afraid I may do something wrong, or may fail in my attempt,
thereby making myself look foolish or stupid . . . despite all of the
encouragement I get from you and the group, I continue in this
pattern.”

However, in spite of his self doubts, this man still reported “see-
ing great changes in [my] life with family; everyone is closer, showing
concern for one another.”
After his death, his wife told us,
“The last weeks and months were wonderful; there was much love
between [us].”

Two others (Numbers  and ) expressed high levels of anger

and resentment, which appeared to block their openness to change
and ability to work. For example,
“I wish my sister and friends would visit me more often. I would
like our nanny to stop telling me about all of her problems and
make more of an effort to resolve her differences with my husband.


 can the mind heal cancer?

The related stress about these things takes away a lot of energy that
I could direct toward healing. I wish my husband would recognize
and stop hindering offers of help from others and be more sympa-
thetic and compassionate when I’m not feeling well.”

                 

I hope the excerpts quoted above from patients’ writings (homework)

have conveyed some idea of the richness of the picture that can be
built up when we use this approach to study how people may adapt to
a cancer diagnosis when offered psychological help. Imagine  to 
pages of such self-revelation from most subjects, coupled with weekly
.-hour meetings over a year, and you will see that we investigators
were privileged to get a rather intimate look at the lives of individu-
als striving to cope with and survive cancer. In comparison, I believe
it is fair to say we have learned very little from the  published tri-
als, discussed in chapter , on the effects of different therapies on
survival. I would include our own randomized trial, one of the , in
that criticism. Such trials will eventually be needed, to confirm that
the therapy is a causal factor, but for the present, we need much more
exploratory work of this kind. From this small, Healing Journey
study, we have learned many of the qualities that may well promote
longer survival. Favourable patterns are: having sufficient flexibility
and dedication to make an active response to the diagnosis, which
entails changes in habits of thought and activity; practising self-con-
trol strategies like relaxation, meditation, mental imaging, cognitive
monitoring, and becoming involved in a search for meaning in one’s
life. Obstacles to doing well can be found at a number of points on
the model (Figure .). Patients’ defensive style may leave little room
for change; such inflexibility is commonly associated with low self-
esteem or, alternatively, with a fi xed world view that the subject sees
no reason to alter. There may be skepticism about the potential im-
pact of psychological self-regulation techniques, or about one’s ability
to apply them. Application to the work is often pre-empted by other


 Working Toward Longer Survival

activities seen to be more important or more immediately appealing.

Positive experiences from applying the techniques may be lacking,
diminishing motivation. A need for personal control can be so strong
as to lead to the rejection of recommended changes. Meaning may
be habitually sought outside the person, rather than through internal
searching, and there may be strong contrary views about the validity
of spiritual ideas.
Caveats must be noted. This is one small experiment requiring
replication. We are currently engaged in another similar, although
larger, study for which the final analysis is planned for –;
current indications are that the life-prolonging effect is still present,
although not as strongly as in the experiment just described. It is al-
ready clear that there are, once again, several “remarkable survivors.”
Confirmation is needed from other scientists as well. However, I am
confident that the relationship between the mental attitudes we have
described and living longer is a real one, not only from this study, but
because the findings agree so well with extensive clinical observations
by ourselves and other clinicians. My personal experience of cancer
and with psychological and spiritual self-help buttress this under-
standing. The lay reader, perhaps desperate for ways to help herself,
should note carefully that we have described a small group of people,
some of whom were willing to make healing work the top priority of
their lives. Our conclusions cannot be generalized to less-motivated
people, and you must be clear that even high dedication to this kind
of self-help does not guarantee prolongation of life, let alone “cure”;
such desirable outcomes can be seen only as possibilities as yet, and
much more work is needed to understand the process of mind-as-
sisted healing and its limitations. However, you can be assured that,
with responsible guidance, your quality of life (and dying, it needs to
be said), are almost certain to be much enhanced.
In speaking about this work I often encounter quite angry reac-
tions from professionals of various backgrounds. The problem is not
usually the data, although some do not accept that we have adequately
accounted for medical factors, even with the “blind raters,” who pre-
dicted survival just as well as the main rating team, but without


 can the mind heal cancer?

knowing the patients or their medical histories. Instead the objection

is along the lines sketched out in chapter : that we should not offer
“false hope,” encouraging people to try to help themselves, in case
they try and “fail,” or blame themselves for not trying hard enough.
I think there are a number of factors contributing to this criticism.
First is likely to be ignorance of the potential that we all have for psy-
chological and spiritual growth, and of the immense personal value
of this work, cancer or no cancer. Many in the culture do understand
this, but we are still a minority, and it is likely that the only sure
way to realize the benefits of, for example, regular meditation, is to
do it. Second, as suggested in chapter , a lot of people in the men-
tal health professions may, in fact, have an inkling that a degree of
healing is possible through the mind, but feel that it is not practical
or appealing to try to invoke this potential in clients. Of course the
philosophy of self-help must be responsibly presented, without mak-
ing unsupportable claims. It is true that people in desperate need will
often place unwarranted reliance on any method that seems to offer
a chance of cure; this problem applies as much to medical treatments
as to psychological help. Yet the mental benefits of teaching people to
help themselves through their own minds are indisputable, by con-
trast with the often harsh side effects of medical treatment. I would
say to critics, please be open-minded; investigate the field before con-
demning it; try the mind–body techniques for yourself; be aware that
by ridiculing this approach to patients you may fall into the opposite
error of “false disempowerment”!
Finally, let us recognize that we have barely begun to investigate
the larger issue of the possible impact of mental change on physical
disease. In our experiments I have adopted the strategy of working
with highly motivated people who will “take the ball and run with
it.” The aim has been to demonstrate potential
potential. Once that is accepted,
many more will be interested and motivated to try to help themselves.
Obviously, many people in the community will need much more help
to achieve a level of self-help comparable to the “highly involved”
individuals I have described here. For example, we could envisage a
-month retreat in a country setting staffed by knowledgeable help-


 Working Toward Longer Survival

ers, life for that time being devoted to healing work. It may sound
utopian; it is what I did myself on receiving a diagnosis of cancer,
and it would be within the reach of many people, if the value of this
kind of dedicated action were understood. The expense is less than
that of spending more than a few days in hospital, and most would
accept the disruption to their affairs if it brought months or years of
extra life.



I have outlined a stepwise program of psychological therapy, the

Healing Journey program, that offers instruction in how to help one-
self when faced with cancer (or other serious disease). A research
study was conducted with  patients in this program, using a de-
sign that was different from that of the trials approach reported in
the last chapter. We related the efforts that individuals made to the
duration of their survival. With this method it was possible to dem-
onstrate that those people with serious cancers who became highly
involved in self-help lived much longer than medically expected. Two
had complete, - to -year remissions of disease. Other individuals
who were not strongly committed to self-help died about as medically
predicted. The difference in attitudes between “highly involved” and
less involved people was quite striking, and has been illustrated with
quotes from the writings of the study subjects. This formal study
supports several decades of clinical observations that have come to a
similar conclusion: psychological and spiritual growth work seems to
prolong life, for at least some people. However, conclusions must be
guarded at present: I’ve discussed some of the limitations of the work,
and the reactions it sometimes provokes.



. Cunningham, A. J. (). The healing journey: Overcoming the crisis of cancer.

(nd ed.). Toronto: Key Porter.
Cunningham, A. J. (). Bringing spirituality into your healing journey.


 can the mind heal cancer?

Toronto: Key Porter.

. Cunningham, A. J., Edmonds, C. V. I., Phillips, C., Soots, K. I., Hedley, D.,
& Lockwood, G. A. (). A prospective, longitudinal study of the relation-
ship of psychological work to duration of survival in patients with metastatic
cancer. Psycho-oncology, , –.
Cunningham, A. J., Phillips, C., Lockwood, G. A., Hedley, D., & Edmonds,
C. V. I. (). Association of involvement in psychological self help with
longer survival in patients with metastatic cancer: An exploratory study.
Advances in Mind–Body Medicine, ,  –.
Cunningham, A. J., Phillips, C., Stephen, J., & Edmonds, C. (). Fighting
for life: A qualitative analysis of the process of psychotherapy-assisted self-help
in patients with metastatic cancer. Integrative Cancer Therapies, (), –.
. Details of our experiment can be found on our website www.healingjourney.ca,
and the papers can be located by clicking on the “Research” link.
. A more detailed account, with information about the medical conditions of the
participants, is given in Cunningham, Phillips, Stephen, & Edmonds ().


 Chapter 

The Qualities of Long Survivors

T
he  subjects in the last chapter afforded us a privileged
insight into their fight for life against disease diagnosed as
terminal. We were able, in the study, to meet with most
of them every week for a year, and to read and hear inti-
mate descriptions of their feelings, reflections on their condition, and
accounts of self-help efforts. Those clinicians who undertake long-
term psychological therapy with people who have metastatic cancers
may gain similar insights, but there are features of a rigorous study
like this that enable us to go beyond the usual clinical impressions
and derive conclusions with some confidence. While we are currently
undertaking another study of this kind, it is my hope that other re-
searchers will also see the advantages of following individuals in such
an intensive way, and will provide their own descriptions of any rela-
tionship they uncover between psychological adaptive styles and sur-
vival. What is the next step? We might ask, “What would be an ideal
experiment designed to document the kinds of psychological change,
and the eventual state of mind achieved, that assist people with life-
threatening cancers (or other disease) to live substantially longer?”
An ideal study might begin by recruiting a large number (hun-
dreds) of patients just diagnosed with incurable cancers. Careful


 can the mind heal cancer?

medical histories would be compiled for each individual at the time

of entry to the study, and predictions as to likely survival time made
by experts for each participant. Psychological therapy would be pro-
vided, and a dynamic psychological “profi le” obtained for everyone,
by collecting data from interviews or therapy sessions (chapter ) over
a period of years. Those who greatly outlived their predicted lifespan
would be of special interest, of course. The data from the interviews
with these people after they had achieved this “exceptional” status
would yield insights into the kinds of change that accompanied pro-
longed survival, and could be contrasted with the profi les of others
who had not been so fortunate. Given a framework like this, it would
be possible to determine whether, or in what respects, long-surviv-
ing patients were unusual or unique, and while it would not prove
that the psychology caused the long survival, there would be a strong
indication that it did in fact make a difference. Such an experiment
is obviously extremely costly, perhaps impossible to do completely,
but it is feasible to attempt parts of it. The study reported in the last
chapter was one part, albeit on a small scale: it involved describing
the psychological adjustments made by a relatively small number of
patients over a year, and as we saw, there appeared to be a relation-
ship between the nature of the adjustments and survival duration.
The study I want to report in this chapter explores another piece of
the ideal—interviews with individuals many years after they have
outlived their prognoses. This time, instead of following the process
of striving to heal, we are viewing their healing through a different
window, by taking a snapshot of the state they eventually achieve.
The subjects we have recruited for this purpose are all graduates from
our Healing Journey therapy program, and most were in the study of
chapter  or are participants in its current replication, so it is possible
to contrast them with their peers who have not outlived expectan-
cies.
To understand how this is an advance over the interview studies
on remarkable survivors described in chapter , let us review some of
the limitations of those earlier, more anecdotal reports, weaknesses


 The Qualities of Long Survivors

that are important because they have caused the work to be dismissed
by most professionals in the field.
. The most serious difficulty, often cited by critics, is that if
we interview only “remarkable survivors” plucked, as it were,
out of a much larger population of unknown size, we can’t
tell if they are in any way unusual psychologically. We need
some comparison with the profi les of others who fail to sur-
vive. If we can determine that long survivors have unusual
or unique psychological attributes from the start, it becomes
much more probable that these attributes contributed to their
fortunate outcomes, whereas if many other people share these
qualities, this is much less likely to be the case. We encoun-
tered a similar problem in chapter  when briefly discussing
claims for magical dietary or other “alternative” remedies: if
someone ingests substance X and recovers unexpectedly, he
or she is likely to attribute the cure to that substance; but if
we learn that  other people took the same remedy and
failed to survive, we see that the first person’s happy outcome
was probably not caused by X.
. There was, in most cases, no thorough documentation of
the medical histories of the interviewees. When the subjects
for interview are obtained by advertising for them, there is a
risk of attracting a tiny minority of people who are medically
unusual, perhaps with mistaken diagnoses or anomalous dis-
ease; hence the need for thorough checks. Although such
people are probably rare, there may well be a few of them
among the thousands of people who have at some time been
diagnosed with metastatic cancer in any large metropolitan
centre. Some of these people may have survived a long time
because they did not, in fact, have a serious cancer, in which
case it would be misleading to link their psychological adap-
tation with their good outcome.
. In the early studies, subjects were not known to the investiga-
tors apart from a single interview, or at most a small number


 can the mind heal cancer?

of interviews, conducted long after their diagnosis and recov-

ery. It is difficult to be sure, under these circumstances, that
what people report accurately represents their thoughts and
actions during previous years.
These design weaknesses do not disprove the idea that the men-
tal state found in these patients was related to their long survival, but
do make that inference much less compelling. However, the common
factors found among such long-surviving individuals suggest some
kind of true relationship, as I discussed in chapter . Could we do a
more reliable experiment of this kind, and compare the results with
those of the earlier, more impressionistic accounts?
I’m going to describe the results of current, ongoing research in
which we interviewed and analyzed the statements of  long-sur-
viving graduates of the Healing Journey program (and I acknowl-
edge here the skilled help of Kim Watson, psychological associate).
A technical report on this study has recently been published, with
details on the nature of their cancers, and duration of survival beyond
that predicted by the panel, as well as a qualitative analysis of what
they said in their interviews. We also interviewed two comparison
groups. The first of these included  subjects who had metastatic dis-
ease, and had applied to enter the program, but had not yet begun
in it, or had done similar work elsewhere. We expected that these
people would reflect a state of mind more usual in the population,
which we were interested to compare with that of our  exceptional
program graduates. The second comparison group comprised the 
individuals who were at the bottom end of our “observed/expected”
hierarchy from the experiment of the last chapter; that is, they were
the  individuals who showed the lowest survival, in comparison with
that medically predicted, out of the  studied. Since all died many
years ago, we examined their home assignment writings and therapist
notes from the period when they attended the weekly group therapy
sessions. We expected that the psychological profi les of these indi-
viduals would also contrast with those of the long survivors.
In brief, the  people with extended survival have, at the time
of writing, lived from  to about  years longer than predicted by


 The Qualities of Long Survivors

a panel of experts. They have had a range of medically incurable,

usually metastatic diagnoses: breast cancer ( cases), and one each of
colorectal, malignant melanoma, multiple myeloma, lymphoma, and
uterine cancers. The picture we will derive from this investigation
applies most directly to groups of people like the cancer patients we
interviewed: all were middle-class people, all Caucasian, and all in
the age range of  to  years of age. Nine were women. We can’t
necessarily assume that other groups of survivors would show similar
characteristics, although as we will see, there was good agreement
between what was found with these people and the various anecdotal
reports in the literature.
While this is by no means an ideal investigation, many of the
earlier design problems have been solved: in particular, these peo-
ple were all survivors from the Healing Journey program and well
known to us, in most cases over many years, before the interviews
were done. Thus we can be confident that what they said reflected
their enduring attitudes. Six were participants in the study described
in chapter , or in its current replication. Thus we can also be con-
fident, from the chart reviews by a panel of experts, that they were
not medically anomalous at the time when we enrolled them—they
were not identified as “unusual” or “exceptional” until several years
later, by which time they had substantially outlived their predicted
life expectancies.
Perhaps most important, we can document that the long-sur-
viving interviewees in the present study were psychologically un-
like most of their non-surviving peers during the first year of their
struggles with cancer, being much more involved in their self-help
than those who failed to survive. This strengthens the likelihood
that their long survival was somehow related to their psychology, an
argument for which there was no independent evidence in the early
studies. Nevertheless, they were not unique psychologically: some
other equally involved people did not outlive their prognosis to the
same extent, although such individuals were not numerous. The fact
that we do not find an invariable association between high involve-
ment and prolonged survival is hardly surprising; other factors must


 can the mind heal cancer?

also play a role, perhaps psychological attributes that we do not yet

recognize, and also, most certainly, the biology of the disease. As
noted earlier, the medical/biological aspects of a cancer may be so
strong in many cases as to rapidly overwhelm the patient, regardless
of psychological adjustment.
Because our long survivors were part of a larger study group,
we are also able to test whether people with relatively low involve-
ment ever outlive their predicted lifespan. The case for an associa-
tion between involvement and survival would be stronger if they do
not. In the study reported in the last chapter we found that patients
with involvement scores in the lowest third do not live much longer
than medically predicted, only  having outlived the prediction by as
much as  years. Exceptional survival thus seems not to be an entirely
chance event, but to correlate strongly with certain psychological at-
tributes.
Thus from our data so far, we can say that patients who survive
in “remarkable” fashion are not average psychologically; they tend to
have demonstrated high involvement early in (and throughout) their
struggle with cancer. Although such involvement does not guarantee
long survival, highly involved people seem to live longer than average,
and low involvement is almost always associated with relatively short
survival. In all previous investigations of this kind, there was no pos-
sibility of relating long survival to unusual psychological characteris-
tics in this way. Now, as we move to the next stage of the work, de-
scribing the qualities of people at a point where they have outlived life
expectancies by many years, we can be more confident that some real
association exists between their psychological profi les and their long
survival. In all probability, their engagement with their own healing
has contributed to the mental state they have ultimately reached. We
will see that there are many common features among these people, and
that they do in fact resemble closely the remarkable survivors described
in chapter , lending credibility to the growing picture of mental states
contributing to favourable medical outcome. Later in the chapter we
will put these observations together with a theory by L. Temoshok, to


 The Qualities of Long Survivors

generate a simple but evidence-based account of the psychological fac-

tors that may contribute to disease and healing.

        

In the interviews, which were  to  minutes long, we wanted peo-

ple to tell us what was important to them, without imposing our own
ideas. So my first question was simply, “What are your thoughts and
feelings as you review your cancer experience, and how has it af-
fected your life?” after which the interviewee spoke for as long as he
or she liked. I would ask for clarification and elaboration of specific
points, but was basically guided by the person I was interviewing.
The conversations were taped, and a summary transcription made. A
technical paper based on this study is in preparation; I offer a sum-
mary here.
A dominant theme emerging from a comparison of transcripts
was that these people felt they were now living as they wanted to live,
in contrast to a more obligation-driven existence before cancer. All
 asserted that they were doing what they valued in life, and making
their own choices. Examples of this autonomy:
“My life is different now, and many of the differences are quite
positive ones for me, resting more, doing the things I love, spend-
ing time with people I love. Those are things I had difficulty mak-
ing time for before.”
“I certainly gave up things that I was doing because I felt I ought
to, and I think that it propelled me to a new level of self-examina-
tion and self-awareness.”
“I don’t see it as a gift, but it certainly was cancer that made me
step back and reflect on what I want to do, and why I want to do
it, and to make better choices for myself and enjoy life a little bit
more.”
“I really feel I used to put a lot of demands on myself. I used to worry
about being perfect in everything that I did. I’m still somewhat of


 can the mind heal cancer?

a person that wants to please, and I’m being very selective in terms
of what I’m doing right now.”

In  of the , the point was made that life had been simplified to
allow this pursuit of the desired way of being:
“I’ve decided not to go back to work. I’ve never really given myself
the opportunity to heal in the sense that I’m noncommittal to any-
body, that I can just devote the time to myself. In doing that, my
direction has changed.”

By contrast, these themes were much more weakly expressed in

the comparison groups of people interviewed before starting the ther-
apy, or among those from the Healing Journey experiment (chapter )
whose survival was not prolonged. More characteristic among these
individuals was a sense of confusion, or lack of direction:
“I have a hard time even identifying what I need and then putting
it into place.”
“The constant certainty has been being frightened, being terrified,
feeling helpless and hopeless.”

The self-help techniques that had been learned in the Healing

Journey program were highly valued and were used by all the long
survivors, although they tended to be employed “as needed,” that is,
as stressful circumstances arose, rather than daily:
“I’ve realized that what works for us today is a changing thing;
sometimes meditation is where I need to be, sometimes it’s jour-
nalling, sometimes it’s just quiet reflection, sometimes walking
meditation. I’ve learned to look and say, ‘Is this what I need right
now?’”
“Visualization and meditation helped me at that time, and I still
do it, not faithfully every day, but it’s a great help a couple of times
a week, or anytime you feel stressed you can meditate and try to
still your mind.”


 The Qualities of Long Survivors

Meditation was singled out as a technique of particular value:

“Now when I can quiet my mind and I meditate and I’m still,
what comes through is more direction, peacefulness, a feeling of
love. That inner space is very valuable to me. I think that’s where
I connect with what’s beyond myself.”

Eight of the survivors volunteered that cancer itself was now

much less important in their lives, and although all but  of them
still had some evidence of active disease, medical advice was viewed
as only one facet of their continuing health maintenance. They had
learned to take responsibility for their health themselves, and tended
to see the cancer diagnosis as more of a motivator than a threat:
“One thing that I have learned is how important it is to have a
sense of control about my treatment process. I need to know what’s
going on, and I need to know that what I do can affect that and
that I have part in the decision-making process.”
“I seem to be telling myself it doesn’t matter what the doctors say,
you’ve got your own journey. You can’t rely on them to tell you what
you’re going to do when you really do know what you’re going to
do in your own mind.”

The experience of overcoming a serious cancer, for at least some

years, left all of these individuals with a sense that their lives had
changed profoundly for the better. Among the improvements de-
scribed were increased peacefulness, joy, more self-understanding,
and an ability to take obstacles in their stride:
“I’ve experienced a peacefulness and a joy that I’m not having to
run after the whole world and catch it by the tail. I don’t have to
do anymore, I just have to learn to be.”
“It [cancer] truly, truly was one of the richest things that ever hap-
pened to me. If I hadn’t gotten cancer I would still be racing through
life doing everything perfectly, and everything so well organized,
and life is so much richer and meaningful.”


 can the mind heal cancer?

Relations with other people were much improved, tolerance and

loving acceptance being frequently mentioned, a lessening of their
need to control others, more ready expression of feelings, and often a
specific motivation to help others:
“There are patterns that I see in myself now that I didn’t see before,
and I think I’m able slowly, slowly to notice the patterns that I get
stuck in more quickly when they happen, especially in relationships
with other people. Right now I’m at a point where I frequently
notice it, and I sometimes can respond differently or create space in
there to let myself react without jumping in a habitual way that
I always did.”
“Since the cancer I’ve been able to talk about things as opposed to
holding them in. I guess maybe I used to feel that what I had to say
wasn’t that important, and now maybe it is.”

Finally, a greater sense of meaning in life and connection to a

larger order or spiritual dimension was noted by almost all the long
survivors. Gratitude, as much for the greatly improved quality of life
as for the long survival, was expressed in almost all cases:
“When I started on my journey, I knew God was there, but I
hadn’t connected in the sense that I could communicate with him.
I wasn’t aware of what was going on around me. Now a lot more
things come naturally to me, in the sense of giving and being able
to sit alone and connect with God, being able to talk to him, being
able to see messages that are sent to me.”
“I’ve been given so much from friends and people, the doctors I’ve
had, that this coping skills course was here in Toronto: it could have
been in Alaska and I wouldn’t have had access to it. I couldn’t have
gotten the groundwork then that I need. I’m grateful just about
every day.”

At this point I have to admit to an initial feeling of disappoint-

ment with the results of these interviews. Being someone who sees
the spiritual search, and personal growth generally, as the major pur-


 The Qualities of Long Survivors

pose of life, I hoped, even expected, that this would be the dominant
theme in our subjects. What we did find was less elevated: people
living the way they wanted to live. However, in no instance did this
mean a life of mindless pleasure-seeking! There was evidence of a
greater meaning in life, or self-transcendence in the form of stronger
relationship to something beyond the self, which for some took the
form of spiritual connection, and for others was more aesthetic or in-
terpersonal. Using their enhanced knowledge of inner psychological
processes, these people were able to maintain a pattern to their days
that brought peace and satisfaction. On reflection, I see that this re-
sult, which at first appeared a bit pedestrian, is actually hopeful, be-
cause if it is true that the approach to life that our subjects displayed is
life-sparing, then it is within the reach of almost any motivated per-
son. It is also, incidentally, the pattern described as healing by the very
perceptive and experienced clinical psychologist Lawrence LeShan in
his book Cancer as a Turning Point (referred to in chapter ).

       

  

I’ve already alluded to the close similarity in results between the in-
terviews of long survivors from our program and the various inter-
view studies describing people who claim prolonged survival (chapter
). The reader may wish to refer back to Figure .. Increased “auton-
omy,” meaning perceiving the freedom to make one’s own choices in
life, predominated in both sets of analyses. The enhanced experience
of joy, self-understanding, appreciation of life and sense of its value
were also common to both. The “remarkable survivor” studies often
reported that their participants had greater self-acceptance and es-
teem; this achievement is difficult to deduce from a single interview,
but is an attribute we can confirm from our acquaintance with our
interviewees over a prolonged time. Greater tolerance, and love for
others, and freer expression of feelings—attributes that are closely
tied to self–esteem—were found both by us and in the earlier reports.
Substantial change, assisted by a variety of self-help techniques,

 can the mind heal cancer?

was almost always noted, although the “spiritual-existential” shift

remarked on in a number of the earlier descriptions of remarkable
survivors, while present, was less dramatic in our interviews. It may
be that when people fighting for their lives can access a structured
program, the healing change becomes more gradual and reliable,
whereas in people not given such help, a more sudden and perhaps
less common kind of sudden shift in attitudes is needed to generate
the same impact on the physiology. Overall, it seems fair to say that
the central change in the people described in all of these studies is
towards greater authenticity in their lives.
We can add to this growing picture of survivorship the infor-
mation from the prospective study reported in chapter . There the
perspective was slightly different: we were following people with pre-
sumed fatal disease at a relatively early stage of their struggle. Because
of the opportunity for intensive observation of these patients over a
prolonged period, we were able to directly observe the qualities they
brought with them at the start: their openness to change, expectancy
that healing was possible, determination to help themselves—atti-
tudes about which we are less certain when they are simply reported
years after the fact, as in retrospective interviews. The focus in the
Healing Journey study was then on what people actually thought and
did over the year of observation, and we documented the degree to
which they were motivated to apply the psychological and spiritual
methods taught. Already at the end of the year, however, many of the
same benefits were seen as in the later interviews of those who subse-
quently survived a long time, such as increased joy, peace, acceptance
of others, and discovery of increased meaningfulness of life.
Figure . is an integration of the results from reports on “remark-
able survivors” (chapter ), from the Healing Journey study of chapter
, and from the interviews of long survivors described in this chap-
ter. Those who enjoy prolonged survival exhibit an initial openness
and determination that drives them to help themselves. The Healing
Journey study charted the dedicated efforts that resulted. As a result
of these efforts, a more “authentic” self emerged, already evident after


 The Qualities of Long Survivors

Star ting Po int

( o f ten authenti c, unaware)

O p en to Chang e No t O p en to Chang e

Pro ces s o f Chang e S ur v i val as �

( do cumented i n H J s tudy) � M ed ic all y Pred ic ted
• apprai s al �
• m o ti vati o n�
• appl i c ati o n

Chang ed State Ac hieved

• authenti ci t y�
• auto no my�
• acceptance

Lo ng er S ur v i val

       .  The process of change in long survivors: an integration

of the results from reports on “remarkable survivors,” from the Healing
Journey study of chapter , and from the interviews of long survivors
described in this chapter.


 can the mind heal cancer?

 year of healing work, and more fully documented in the interviews

of survivors some years later, or of people from the wider community
who claimed to have greatly outlived their prognoses. The changed
individual now feels entitled to choose how to live, displays much
greater acceptance of others (without allowing herself to be imposed
upon), and enjoys a more peaceful and meaningful life. These quali-
ties reinforce one another, of course: learning to accept others aids
self-acceptance, which enhances the sense of autonomy. Learning to
make one’s own choices increases the experience of the authenticity
of one’s life.
What would a critic say to all this? That these studies are small,
have a subjective component (the interviewer often needs to interpret
what the subject says), and are restricted in their generalizability to
a rather unusual sub-population of people with cancer. How would
I respond? That convergence of evidence from several studies is al-
ways compelling in science. That the Healing Journey studies and
the “interview study” reported above, although small, do not suf-
fer from serious technical weaknesses, as a detailed reading of our
peer-reviewed, published papers will show. We acknowledge that it
is not possible to be sure that the psychological changes caused the
longer survival, although no convincing alternatives have been of-
fered by critics. The generalizability of all of these studies is certainly
low, meaning that conclusions apply most directly to people similar
to those who presented themselves, and results may or may not be
reproducible in different populations. Studies of long survivors and
the process of healing change need to be done in many settings, with
differing groups of patients; when so little is known in a field, this
kind of discovery-oriented or theory-building approach is much more
appropriate than the theory-testing imperative that drives much cur-
rent medical research (see chapter ). No doubt, modifications and
extensions of the current description will unfold. I will be very sur-
prised if the overall conclusion is wrong, however, because it makes
such good, developmental sense, a point to which we now turn.


 The Qualities of Long Survivors

                       


There is one more, important set of evidence to add to our growing,

integrative picture. Recall the work of Lydia Temoshok (chapter ),
who defined a Type C adaptive style, an attitude of “niceness” and de-
nial of one’s own needs, common among people with cancer, and as-
sociated with faster progression of the disease. We can add to this the
reasonably consistent evidence for a link between repression of emo-
tion and higher risk of cancer progression. Temoshok’s view of the
role of mind in development of cancer is that the early development
of this self-protective, placatory style of relating to the world puts a
great strain on the regulator systems of the body, such as the immune
system. This demand makes the body less able to resist or control
later onset of disease. She also suggests that the logical way to use
the mind to fight cancer is to try to reverse the harmful elements of
this self-denying style. That is also the conclusion Lawrence LeShan
draws from his clinical experience, as we have seen. Now, note how
this is precisely what the long survivors have done, in the studies just
described. They have become determined to live life as they wished
to, as opposed to always trying to please others. Through their work
and change they have understood the load they were imposing on
themselves, seen its irrationality, and worked hard to reverse it. As a
result, far from becoming selfish monsters, they achieved an accept-
ance of self and others, a joyful appreciation of life, and a sense of
meaning and fulfi lment in life that most “well” people would envy.
This is what I mean by the model or hypothesis “making sense.”
There is a mirrored symmetry between the concepts of what pro-
motes cancer and the evidence on what prolongs survival (Figure .
puts together diagrammatically the development and the reversing
of mental states that promote cancer). Furthermore, the model does
not depend on the correctness of the specific details of mental states
that are proposed as promoting development or later retardation of
cancer growth. The predisposing psychological factors might not


 can the mind heal cancer?

Child ho o d
devel o pm ent o f a pro tec ti ve�
adaptati o n ( t ype C )

H ig h Allo s tatic (s tres s ) Lo ad

Ad ult
devel o pment o f di s eas e

Pro ces s o f H eal ing

(revers al o f us ual adaptati o n) �
• i ni ti al o pennes s �
• dedi c ated wo rk �
• em ergence o f “authenti c ” s el f

Lo ng er S ur v i val L i kel y

       .  A simple developmental chart of possible mental

contributions to the onset and healing of cancer

 The Qualities of Long Survivors

always be Type C. The important point is that some early distor-

tion of the healthy, authentic adaptation to life occurs, and that this
causes strain. The neurophysiologist Bruce McEwen calls this “allo-
static load.” If we grow up unduly fearful, or for that matter with any
other kind of maladaptation, like constant anger or depression, we
may place a lifelong stress on the regulators of our health, in particu-
lar the cardiovascular, immune, respiratory, nervous, and detoxifica-
tion systems of the body, and on the cellular-level micro-regulators
that they influence in turn (chapter ). Note that this is a general
theory, applicable to many diseases, not just to cancer. For example,
the theory would predict that the Type A personality develops early
and places strain particularly on the cardiovascular system. It would
further predict that diminishing the heightened risk of heart disease
(although probably not established damage) could be accomplished
by reversing the distorted adaptation—learning to react to challenges
with tolerance instead of anger. There is some evidence for the suc-
cess of this approach, not yet universally accepted (chapter ). This
explanation of events is simple and makes sense. It does not claim,
simplistically, that “the mind cures cancer” or any other disease: the
prediction merely is that to the extent that the mind and its distor-
tions are important, reversal of the harmful adaptation will be help-
ful. The extent of the contribution of mind has to be established by
experiment, and one way to do this is to evaluate the effects of psy-
chological change, assisted by therapy.
There should be nothing in this model to offend even the most
materialistic of readers, or to generate any feelings of blame or guilt
among people with cancer. I am not invoking any esoteric “pow-
ers of mind,” simply suggesting that bodily health is promoted by
optimizing the health of the mind, a return to an equilibrium that
has been disrupted early in life for reasons outside one’s individual
control. This trait is more marked in some people than in others;
those individuals carrying the greatest allostatic (stress) load may be
more likely to contract a variety of diseases in adult life. Many factors
(such as genetic, environmental, and infectious) contribute to disease,


 can the mind heal cancer?

and consequently, many modes of treatment may be helpful; working

through the mind to reduce strain is one important mode.



While chapter  focused on the thoughts and actions of individuals as

they were fighting for their lives against metastatic cancer, this chap-
ter examines the influence of mental states on prolongation of life in a
different way, through interviews with patients some years after they
have outlived their medically predicted lifespan. I report on our own
interview study of survivors who have taken the Healing Journey
program, then show the strong similarities that exist between what
these individuals report and the various accounts from “remarkable
survivors” discussed in chapter . We then put this information to-
gether with Temoshok’s theory, that cancer is more likely to occur in
those people who developed, in childhood, a particular kind of placa-
tory and emotionally repressed coping style. We see that what the
long survivors appear to have done is to reverse this way of adapting
to the world, claiming instead their right to make their own decisions
about how to live their lives. This enhanced authenticity is associated
with greater acceptance of others, and of oneself, and leads to a more
peaceful and meaningful experience of life. It also appears to help
people live longer, as well as better.



. Cunningham, A.J., & Watson, K. (). How psychological therapy may pro-
long survival in cancer patients: New evidence and a simple theory. Integrative
Cancer Therapies, , –
 .
. McEwen, B. S. (). Protective and damaging effects of stress mediators:
Allostasis and allostatic load. New England Journal of Medicine, ,
 –
 .
McEwen, B. S., & Lasley, E. N. (). The end of stress as we know it. Washington,
: Joseph Henry.


 Chapter 

A Summary, and Future Directions

T
he discussion to this point about a possible impact of mind
on healing from cancer has been based on what we know
or can reasonably infer from available evidence. In this last
section I want to be more speculative. We will look first at
how spiritual influences may fit into the simple model of mind–can-
cer discussed in the last chapter, since many people, both throughout
history and at present, have viewed this dimension as very important
in healing. My earlier book Bringing Spirituality into Your Healing
Journey is a detailed account of this kind of healing, including many
practical exercises. Then we will summarize what we have learned
in  decades of this healing work, and offer suggestions for further
investigation, both by people seeking to help themselves and by those
wanting to help others.

    

The spiritual search is an attempt to gain direct experience of our

place in, and our relationship to, a transcendent, non-material order,
dimension, matrix, intelligence, or power. This order has been given
a great variety of names, at different times and in different cultures:


 can the mind heal cancer?

the Universal Mind, the Divine, Brahman, the One, the Tao, the
Eternal, Yahwe, God. To “transcend” means, literally, to rise above
or extend beyond, and the implication here is that the non-mate-
rial spiritual reality not only goes far beyond what we can perceive
with our ordinary senses but also profoundly affects our everyday life.
Spirituality is distinguishable from religion, the latter referring to
institutionalized systems of ritual, faith, and worship, which are not
necessarily concerned with the attempt to gain direct experience of
the transcendent.
Spiritual or mystical experience has manifested in similar forms
in many cultures in all parts of the world, giving rise to a description
of “the perennial philosophy” (a term coined by Spinoza), for which
Happold, in his book Mysticism, lists the following common features
(paraphrased here):
• The world of matter and individual consciousness is only a
partial reality and is the manifestation of a Divine Ground
or God in which all partial realities have their being.
• Man (humankind) can know this Divine Ground by direct
intuition, which is superior to discursive reasoning.
• Although we are chiefly conscious of the separate ego, we can
identify with the spark of our divinity within, that is, with
that eternal aspect of ourselves, which is part of the Divine
Ground.
• It is the chief end of our earthly existence to discover this
eternal self.
Traditionally, it has been claimed that being connected to the
spiritual realm, to one’s “eternal self,” promotes healing—of body as
well as mind. The problem for those attempting to study healing in a
scientific/rational way, the approach we are adopting in this book, is
that we currently do not understand how a non-material level or en-
tity could influence events on the material plane. Perhaps the aware-
ness of one’s spiritual nature is simply so comforting that it brings
about a mental state ideal for healing. Or perhaps there are interac-
tions between the spiritual and the material that use pathways (“sub-


 A Summary, and Future Directions

tle energies” is one popular expression) that we don’t yet know how to
measure. More radically, consciousness may be the “primary” reality,
as maintained in some Eastern philosophies, and matter a projec-
tion of this consciousness (Table .). In the absence of an agreed
conceptual framework, is there something scientists can do at present
to investigate the possible importance of spirituality in healing? The
most obvious course would seem to be to look for evidence that self-
reported spiritual experience is health-promoting—in other words,
to treat this as we might any other psychological attribute. There is
growing interest in this approach, although most published research
to date has used religious observance behaviours (like attendance at
church) as a surrogate for spirituality. In the experiments we have
been considering in chapters  to , spirituality was indeed regarded
as important by most of the long survivors, and by the most highly
involved people in our Healing Journey study. However, it is not pos-
sible to disentangle it, in these or other studies so far, from other
psychological properties, that is, we cannot be sure that becoming
involved in the spiritual search was an essential element, over and
above psychological change, in the healing of these people.
Another way to assess the plausibility of the idea that spiritual-
ity aids healing is to ask if it fits with our data and evolving theory
(shown in Figure .) that the mind promotes healing by reversing
earlier psychological habits. The spiritual search, so the mystics tell
us, is an attempt to reverse our estrangement from the very ground
of our being, which occurs as we grow up into little independent
entities, preoccupied with our separate needs. This separation rep-
resents the loss of awareness of our true identity. Healing has always
been seen, in spiritual traditions, as a process of finding out who we
are, rediscovering this identity. This sounds very similar to what our
long-surviving patients have been telling us: their central motif was
an uncovering of the true self, living according to what was felt most
fulfi lling, rather than according to old, unexamined habits and dic-
tates. It is also exactly what the spiritual search involves: finding out
who we are, and living according to that awareness, only in this case
the revelation strikes even deeper; we find that we are not simply


 can the mind heal cancer?

  .  Range of Views on Possible Healing through Mind

View of Mind How Mind Is Related View of Cancer, and

to Body and Illness Potential Healing
Impact of Mind

. Mind is All is given, “out Cancer is caused by

separate, there.” Mind is simply chance or external
unimportant. a by-product of brain. agencies. Only
external, physical
manipulations can
affect it. Mind has no
effect.

. Mind creates The mind observes As above. Mental

experience. and interprets, change can
controls behaviour, improve our coping
but affects physiology experience, however.
only in small ways.

. Mind is Mind and body are Mental change makes

informational intimately related, conditions more or
correlate of not separate; thus less favourable for
matter events in mind affect cancer development.
physiology.

. Mind creates Mind, which is Mind can create

reality. part of an infinite a different world
order (the Divine), (apparent “physical”
creates the world by laws, e.g., time
projection, including and space, are not
body, illness. absolute). Thus it
may cure illness.


 A Summary, and Future Directions

material beings but have an essential non-material, or spiritual, na-

ture. In other words, it is the ultimate re-establishing of authenticity!
It seems to be the same kind of process that occurs psychologically,
as people learn and grow, but transferred to the spiritual dimension.
Our theory about healing as recovery of authenticity, based on psy-
chological data, thus connects nicely with a philosophy that extends
back over millennia. In Figure . I have added the spiritual dimen-
sion to a simplified version of the earlier flow chart to show this sym-
metry.

           

  

Are there potentials for healing through the mind that lie outside
what we currently understand about mind–body operations. Of
course there are: Western psychology, physics, and biology provide
only one very limited view of what is possible in the world. Any ex-
ample of mind affecting matter is potentially relevant to healing; for
example, there are many excellent controlled experiments to show
that mental intention can affect the output of a computer generat-
ing supposedly random numbers (well described in Margins of Reality
by R. Jahn and B. Dunne). Likewise, instances of mind apparently
dissociating from matter (excluding pathological dissociation) may
have implications for healing. In my clinical practice I quite fre-
quently hear accounts of people having the experience of “leaving
their bodies,” often while meditating, or around the time of surgery.
Analogous “near death experiences” have been documented by many
authors. Other paranormal events, like telepathy, precognition, and
remote vision—essentially seeing through the eyes of someone at a
distance—are also well documented, and point to possibilities for
healing by non-Newtonian means, even if skeptics scoff at them. As
I described in chapter , there are now several good, scientifically
acceptable experiments showing a degree of healing in people who
are prayed for, without their knowledge (there are also some studies
with negative results). Larry Dossey is the physician who has perhaps

 can the mind heal cancer?

done most to champion what he calls non-local healing, in a series

of books and in his excellent editorials for the new scientific journal
Alternative Therapies.
Our ideas on what the mind can do to heal the body reflect the
prevailing ideology, which in turn is based on metaphysical views
(on the nature of reality). Table . sets out a range of such views.
That most commonly held at present is number , sometimes called
“naive physicalism” or materialism. I have subscribed to number  in
this book. View number  is the mystical position, that our material
reality is some kind of projection from our consciousness or mind. It
is fascinating, but although esoteric modes of healing may become
important to us eventually, as they are already in some cultures (such
as through shamanic healing), they are of little practical use unless
we can invoke them reliably. Since this approach is not yet acceptable
to most Western health care providers, it makes more sense (at least
to me) to focus on what we can bring about in a dependable way. The
modest degree of healing through making changes in one’s mental
state that I’ve described in this book is achievable by most people. It
is true that few avail themselves of it as yet, but the pathway towards
doing so is reasonably clear, and will become clearer with further
research. However, it is unfortunately also the case that personal ex-
perience is needed to gain an appreciation of the great power that
psychological and spiritual methods have to change our lives. This
limitation can set up an initial barrier: one needs the experience of
benefit to commit to the self-help work, yet without commitment, it
is hard to discover its value.
As I suggested in my earlier book on spirituality and healing,
our ability to use our various dimensions in the service of healing de-
pends directly on our awareness and connection with these levels of
our being. To use our minds therapeutically, we must be aware of our
thoughts and have at least some sense of how they affect our physiol-
ogy. To invoke spiritual healing, we must be connected spiritually.
There is no call to adopt beliefs uncritically—the point is to seek
our own understanding and experience, after which we can use it to


 A Summary, and Future Directions

Ac quir i ng a�
Pred is p o s i ti on� Pro ces s of H eali ng
to D i s eas e

Earl y l o s s o f aware co nnec ti o n� R eco nnec ts to s pi ri tual nature

to s pi ri tual gro und

Earl y devel o pm ent o f � R ecl ai ms authenti c�

i nauthenti c adaptati o n ps ycho l o gi c al s el f

Adul t-l i abl e to di s eas e B egi ns s el f -heal i ng wo rk

S er io us D i s eas e

       .  The symmetry between possible promoting and healing

influences of the mind on cancer. Spiritual disconnection, almost universal
among humans, and reconnection as spiritual growth proceeds, can be
placed at either end of this pathway.

help ourselves. We must also accept the fact, of course, that there are
practical limits to what we can achieve with our minds—the body is
a type of machine that will eventually degenerate and die, no matter
what we do.


 can the mind heal cancer?

    

While few would deny that the mind has some effect on the body,
there is certainly debate about the extent of the effect that any heal-
ing of the mind can have on the body. Medicine as an organization
still tends to downplay, even totally ignore, the possibility that the
patient’s state of mind is important, although many individual physi-
cians would endorse the idea. Other emerging disciplines, like health
psychology or “mind–body medicine,” are much more open to it.
Some “alternative” practitioners bring the whole idea of mind–body
healing into disrepute by making exaggerated claims, unsupported by
evidence. In the end it is, or should be, an empirical question, to be
settled by investigation, not prejudice. In this next section I want to
suggest what might be done next. Here I am addressing primarily the
reader who is a health care provider or researcher.

The Key Requirement: Refining Our Understanding of

Mental States That Encourage Healing

We need to know much more about the kinds of mental states, and
the changes leading up to them, that oppose progression of disease,
in cancer and in other chronic conditions. We have barely begun to
investigate this matter; discussions on health psychology tend to cen-
tre on healthy behaviours, which are only the most obvious expres-
sions of mind–body influences on health (and recall the discussion
in chapter  about “external” and “internal” pathways). Yet there is a
wealth of knowledge, both in the mental health field and in spiritual
traditions, about what constitutes a healthy way of being in the world,
in other words healthy thinking. We need to connect this with physi-
cal well-being, in my opinion.
Since we know very little as yet, we need to put much more of
our effort into exploratory approaches. This means remaining open-
minded about what is important in people’s response to disease, and
documenting it by listening closely to them over extended periods,
then relating what they say to physical outcomes. Multiple studies

 A Summary, and Future Directions

of this kind will be needed to build up a reliable picture of healthy

mind–body relationships. Anecdotal approaches are not sufficient:
we need some variant of the approach outlined in chapters  and :
regular contact and note-taking, followed by qualitative analysis of
the verbal data, and by rating these data (putting numbers to them)
where we wish to draw quantitative conclusions. Research methods
that rely solely on comparing average differences between treatment
and control groups are likely to continue to give mixed or null results,
because, as I pointed out in chapter , people’s response to psycho-
logical therapy is so variable. However, once we have a better un-
derstanding of what helps whom, and how, it will be possible to use
statistical methods to control for this variability, and the standard
methods used in clinical trials of drugs will then be appropriate to
confirm (or deny) a causal role of the therapy.
Our focus at present will thus be more on what people do with
any therapeutic help they receive, and much less on the nature of the
therapy itself. As we learn more, we will gradually refine our ideas
about the undoubtedly complex combinations of mental qualities that
matter. Hand in hand with this learning will go the development of
methods or plans of assessment that document the extent to which
different people make healing changes. Eventually, we should be able
to perform a “mind scan” analogous to the current  scan, that is,
to diagnose the extent to which the mental state of people with a
chronic disease is helping or hindering them, and recommend ap-
propriate changes! I foresee a time when such monitoring of people’s
progress towards optimizing the mental aspects of their healing will
become routine, just as it is now with physical measurements such as
white blood cell counts or liver function tests.

Outcome Measures

To assess the impact of psychological change on disease, one may use

a variety of markers, depending on the specific condition: for cancer,
blood tests are sometimes available to track tumour growth, or X-ray
imagery to determine the size of tumours. These surrogate measures

 can the mind heal cancer?

do bring their own uncertainties; we chose lifespan as the most un-

ambiguous index of effect. I would reiterate here, though, that length
of life is not necessarily the most important outcome of providing
psychological help; the quality of people’s lives, their emotional state,
their relationships with other people, may matter more in the end.
However, if it becomes widely believed that life can be prolonged
by the kinds of mental work discussed here, it may have a more per-
suasive influence on many people—physicians, insurance companies,
family members—and the patients themselves, when they are consid-
ering whether or not to undertake a program of self-help.
One of the more challenging aspects of research on the ability of
mind to affect progression of disease is that it must be longitudinal,
that is, we must follow and document what people do over relatively
long periods of time, years rather than months (dramatic, sudden
healings are so rare as to be almost inaccessible to study). I’ve put
forward the relatively conservative view that the mind has the po-
tential to affect growth of some cancers by changing the hormonal
and cellular micro-environment in which the cancer cells strive to
multiply (chapters  and ). A logical consequence of this view is that
while some cancer cells may die in the new surroundings, others that
can tolerate the new, changed environment will survive; thus the tu-
mours, after a period of remission, may begin to grow again. This is
of course what happens in many cases in patients treated with chemo-
therapy—there is a selection of cells resistant to the drug. As with
chemotherapy, so with psychotherapy: patients may need to “keep on
the move,” continuing to evolve and grow psychologically and spir-
itually, to outpace or outwit their evolving cancer cell populations!
While some people may reach a point where they are sufficiently
“healed” to shake off their disease, others, either because they reach a
plateau in their healing efforts or because they have more resistant and
aggressive cancers, may simply buy themselves some time, of the order
of a year or two. This is what we think we observe in our program
participants. However, data are much too scant to be sure, and a great
deal of painstaking research is needed to test ideas such as these.


 A Summary, and Future Directions

Subjects for Research

Because the benefits of psychological work are not yet clear enough
to induce most people to become involved in it, we need to focus first
on that minority of patients who are willing and able to make an ef-
fort. Relevant change can be achieved through a stepwise program
like the one I described in chapter , in which those individuals who
are most keen on self-healing identify themselves. These people will
teach us what is possible. Armed with that knowledge, we will have
a better chance of convincing more skeptical individuals that psycho-
logical and spiritual self-help are worth attempting. The methods
will also need to be tailored to fit populations differing in educational
and cultural backgrounds.

The Therapy

Self-healing is a learned process; thus the first requirement for work

of this kind is that it provide education as well as support. Many
community centres for cancer patients miss this point, and offer only
the supportive function. Incorporating a guiding structure for the
patient’s growth is essential, I believe, because without that, relatively
few will mount a truly constructive and potentially healing response.
This statement is based on decades of watching people struggle to
understand how to help themselves. Like education in other areas,
self-healing is progressive: one learns simple things first, like relaxa-
tion and keeping the mind relatively quiet, then builds on them with
more sophisticated ideas. The stepwise program I outlined in chapter
 is one way of providing a progressive, educational structure, one
that allows participants to determine for themselves how much of the
work they will do.
As in most areas of human endeavour, it is only sensible to seek
help from more experienced people. These teacher/therapists need to
have training in both the process of psychological therapy for the phys-
ically ill, and experience in the techniques they teach. As teachers, we
must practise what we preach. This requirement can deter some health


 can the mind heal cancer?

care professionals who are accustomed to being less personally involved

with their ministrations. Training others in self-help is in many ways
analogous to teaching a foreign language, or a musical instrument,
where it is taken for granted that the teacher will be proficient.
The patients themselves will generally be psychologically normal
(apart from some anxiety or depression, caused by their disease), so
there is no need for the exclusive focus on psychopathology that is
common in counselling—instead, we can follow LeShan’s advice and
concentrate on “what would be right for the person,” an approach
validated by our research results. The widely varying needs and abili-
ties of different individuals must be respected; some may need to
spend longer at different “levels” of a therapy program, while oth-
ers (particularly any with long-standing psychopathology) may need
supplementary one-to-one therapy.
Professionally led groups, rather than individual (one-to-one)
meetings, are particularly useful, both for reasons of economy and be-
cause the interaction and support between peers is an important part
of the healing. In a well-led group with people who are at ease with
one another, there is some healing at work at a sub-verbal level that I
don’t pretend to understand, but have often felt; perhaps it is a form
of loving connection, like that operating in the distant prayer experi-
ments cited above. Currently, many people with cancer don’t want
to join a therapeutic group; research is needed to clarify the reasons
for this reluctance, but from my observation I think that most people
are unfamiliar with the group process, and afraid of what they might
be asked to expose about themselves. Stoical attitudes are common
(“I should handle this by myself ”), and seeking psychological help
is sometimes taken as indicating mental illness or weakness in the
recipient. These anxieties and misconceptions usually vanish rapidly
with experience, and are replaced by warm appreciation for the other
group members. Initial reluctance to take part can be minimized if
the educational and stress reduction aims are emphasized (for exam-
ple, we call our first-level group “Coping with Cancer Stress”).
The essence of our approach is to provide a structured, stepwise
educational program including a variety of techniques, presented in a


 A Summary, and Future Directions

graded fashion, and relying on the patient taking considerable initia-

tive. People with cancer who want more information on the specific
material we cover will find it in my earlier books. It is likely that there
are many other routes to physical healing, just as there are many kinds
of psychotherapy that lead to mental healing, but claims do need to
be documented. We can be guided by our growing knowledge of the
main psychological qualities accompanying healing, which I’ve ten-
tatively described as authenticity, autonomy, and acceptance; meth-
ods should logically be used that help people attain these states of
mind. Whatever approach is adopted needs to bring about changes
relatively quickly, if the cancer is serious; thus intensity is important.
We ask participants to do a lot of introspective work at home and
write about it, submitting copies for our comments, and this greatly
accelerates the learning. Lengthy retreats in places providing suitable
guidance are another way of increasing intensity. There is an advan-
tage to offering a smorgasbord of methods, since it allows people to
choose which techniques help them most. And the process must be
flexible enough to support the varied ways in which people learn and
operate.

  :
          “    ”       

Can the mind heal cancer? We discussed, in chapter , the need to

clarify what we mean by this question. There is no doubt that much
of the mental suffering caused by cancer can be alleviated by deliber-
ate mental action on the part of the suffering person—something as
simple as practising a relaxation technique can relieve anxiety and
pain. But what the person asking this question usually means is, “Can
a person with cancer make changes within her mind that lead to bet-
ter conditions in the body for healing an existing cancer?” meaning
slowing or even reversing the growth of tumours. This is the main
topic addressed in this book. It is one that has stirred a lot of New
Age passion and much adverse reaction from many medical authori-


 can the mind heal cancer?

ties. My attempt here has been to put forward a synthesis of new

evidence and older theory and clinical observation that I think shows
there are real possibilities for a degree of healing through the mind,
although the process is by no means as simple as some popular ac-
counts would claim.
We saw that there is already a lot of evidence for mind affecting
disease, and that this may be understood in terms of mental “software”
influencing body “hardware.” Some of the mechanisms by which this
might happen are known; for example, we have a fair understanding
of the effects of psychological stress on hormone production and sub-
sequently on the functions of the immune system (chapter ). More
generally, it seems reasonable to propose that diminishing a habit of
constant defensiveness will allow those systems of the body that are
responsible for maintaining health to operate more effectively. Then
we reviewed the descriptive studies on remarkable survivors, which
have generated a rather consistent picture of the qualities associated
with healing, in spite of the weakness of that approach. By contrast,
more orthodox studies in modern psycho-oncology have failed to
tell us much so far, and I explain why: basically, the methods used
have not been very appropriate to the questions asked. The core of
the book was devoted to a new approach, outlined in chapters  and
, its essence being the case-by-case documentation of what people
with serious cancers think and do over a prolonged period, then relat-
ing these psychological data to the subsequent duration of survival.
This demonstrated a highly significant relationship between degree
of involvement in psychological and spiritual self-help methods, and
survival. We also interviewed a number of long survivors, under rela-
tively controlled conditions, obtaining results very similar to the more
informal “remarkable survivor” studies published earlier.
Putting all of this together with a theory first advanced some 
years ago by scientist Lydia Temoshok, and seminal clinical obser-
vations by the psycho-oncology pioneer Lawrence LeShan, we ar-
rive at the following synthesis: cancer seems to progress more rapidly
in people who adopt a placatory, self-denying style of thinking and
acting (Temoshok’s data, discussed in chapter ). Those individuals


 A Summary, and Future Directions

who overcome a serious cancer show a precise reversal of this pat-

tern, claiming instead the right to live in ways that they decide are
fulfi lling for them. There is a mirrored symmetry here between the
mental characteristics that may promote cancer and those that may
oppose it, and there is good agreement about the latter between our
own investigations and those of other authors. Thus although no one
piece of evidence is conclusive by itself, these strands converge. What
is more, they add up to a hypothesis that makes good sense: simply
put, relieve longstanding strain on your mind, and it will free up the
body to oppose disease more effectively.

      

If you have read through this short text, you will see that there is con-
siderable evidence for a potential healing effect of your state of mind on
cancer, in a way that can be rationally explained. You will meet people
who make much grander claims, who perhaps have magical remedies
on offer. In evaluating them, you may wish to ask three questions:
• Is there evidence for the effectiveness of these remedies or
procedures?
• Is there a consensus that they work (among people who have
studied them)?
• Is there some way of understanding how they might work—
do they make sense?
You will find, unfortunately, that most of the “alternative rem-
edies” fail all three tests, as I discuss further in The Healing Journey.
The situation is quite different when we consider the healing impact
of directed mental change—as you have seen, we can answer a quali-
fied “yes” to all three questions. You may encounter opposition to this
assertion from orthodox health care professionals, in which case it is
fair to ask them what study they have made of the effects of mind on
disease. Give them this book: I don’t believe that any nurse, doctor,
social worker, or other trained health professional could find it unrea-
sonable—the worst verdict they might return is “insufficient evidence


 can the mind heal cancer?

to convince me.”
If you have cancer, or some other serious health condition, should
you try to do this mental healing work? Obviously I think so. Try to
find an experienced guide; if there is nobody available who works
with clients who have your kind of medical condition, then consider
attending a school of “personal growth” or spirituality that aims to
help people escape from the limitations of habitual thinking. A lot of
books on psychological change are available these days. Look around
for a psychotherapist with an interest in this kind of work. Avoid peo-
ple charging very high prices or making dogmatic claims. You may
have to put together your own “program”—to construct a patchwork
quilt, rather than hoping to find a ready-made coverall.
In the end, it is an individual decision how to respond to life-
threatening illness. We can choose to be active or passive. If we are
afraid to try and “fail,” then we may never get started. Consider other
areas of your life, where you may have been willing to attempt some-
thing challenging, even when success was far from assured. Self-
healing is not different in this respect. There is no need for blam-
ing oneself if we try to assist our healing, yet the disease continues
to progress: we know very little about the process as yet, and many
cancers may be resistant to even the greatest efforts, either medical
or mental. What we can be sure of is that our experience of cancer
or other life-threatening disease will be very different if we respond
actively, rather than remaining a passive victim of events. Our quality
of life, our self-respect, will be enhanced. We may also come to un-
derstand that physical well-being is not necessarily the primary aim
of life, and we may gain, from spiritual searching, an awareness that
we are much more than just our bodies or our minds.



. Cunningham, A. J. (). Bringing spirituality into your healing journey.

Toronto: Key Porter.
. Happold, H. C. (). Mysticism: A study and an anthology (Rev. ed.). London:
Penguin, .


 A Summary, and Future Directions

. Aldridge, D. (). Is there evidence for spiritual healing? Advances, (), – .
Levin, J. S. (). Esoteric vs. exoteric explanations for findings linking spir-
ituality and health. Advances, (), –
 .
Powell, L. H., Shahabi, L., & Thoresen, C. E. (). Religion and spiritual-
ity: Linkages to physical health. American Psychologist, (), –.
Seeman, T. E., Dubin, L. F., & Seeman, J. (). Religiosity/spirituality and
health: A critical review of the evidence for biological pathways. American
Psychologist, (), –.
Thoresen, C. E., & Harris, A. H. S. (). Spirituality and health: What’s
the evidence and what’s needed? Annals of Behavioral Medicine, (), –.
. Jahn, R. G., & Dunne, B. J. ().
 Margins of reality: The role of consciousness in
).
world. New York: Harcourt Brace Jovanovich.
the physical world
. Larry Dossey is the physician who has perhaps done most to champion what
he calls “non-local healing,” in a series of books and in his excellent editorials
for the new scientific journal Alternative Therapies.
Some of Dr. Dossey’s many books:
Dossey, L. (). Space, time and medicine. Boston: Shambhala.
Dossey, L. (). Recovering the soul: A scientific and spiritual search. New York:
Bantam.
Dossey, L. (). Reinventing medicine: Beyond mind–body to a new era of heal-
ing. San Francisco: Harper.
ing

