Tag Archives: breast cancer

The Ups and Downs of Positivity

The only thing making you unhappy are your own thoughts. Change them. 

When it rains, it pours…but soon, the sun shines again. Stay positive.

I see lots of posts and pass-alongs like these on Facebook: memes claiming that all our problems are in our heads and that we have the ability to change our circumstances by changing our thoughts.

With apologies to Norman Vincent Peale and Joel Osteen, I have trouble with the whole positive thinking movement. My back pain makes me unhappy. My brain chemistry won’t let me control my thoughts (I’m bipolar). Thinking about being rich does not attract money to me. Ordinarily I view positive thinking as wishful thinking.

But I know many people believe in positive thinking and its ability to change their lives. So I set up a little hypothetical dialogue. On one side is Barbara Ehrenreich, author of Bright-Sided: How Positive Thinking Is Undermining America. I have selected quotations from her book, particularly those dealing with health, and juxtaposed them with comments from Leslie Larkins, who embraces positive thinking.

Larkins, a former scientist, has always been extremely rational, so it surprised me that her outlook is informed by positive thinking. And she has plenty that she could be negative about. Larkins has been diagnosed with multiple sclerosis (MS), and had a bout with breast cancer and a surgical mistake that (if not caught) would have subjected her to a completely unnecessary mastectomy. At various times in her life, she has also been treated for depression.

Larkins says that her embrace of positivity came with her MS diagnosis: “When I realized that the problems I had been having at work – trouble with focus, forgetting things – had an actual cause and I accepted that I couldn’t continue to do my job, it was actually a little bit of a relief because I had been feeling out of control for a year or so and couldn’t understand why….I did a lot of research on MS and realized that I could end up in a wheelchair any time, so if I wanted to do something in my life, I shouldn’t put it off. That thought was actually quite empowering to me.”

Ehrenreich, in the first part of Bright-Sided, focuses on the breast cancer movement, particularly the pink-ribbon side of things: “Positive thinking seems to be mandatory in the breast cancer world, to the point that unhappiness requires a kind of apology….The cheerfulness of breast cancer culture goes beyond mere absence of anger to what looks, all too often, like a positive embrace of the disease….[I]t requires the denial of understandable feelings of anger and fear, all of which must be buried under a cosmetic layer of cheer.”

She quotes Cindy Cherry, who stated in The Washington Post: “If I had to do it over, would I want breast cancer? Absolutely. I’m not the same person I was, and I’m glad I’m not. Money doesn’t matter anymore. I’ve met the most phenomenal people in my life through this. Your friends and family are what matter now.”

Larkins responds: “Thankfully I did not have to have the ‘full cancer experience’ because I didn’t have chemo and therefore didn’t lose my hair, so I was kind of a stealth cancer patient and could only tell people who I wanted to know. I wasn’t forced into ‘breast cancer culture.’ I also was in a place where I could handle the emotional issues myself, so I didn’t encounter the support groups and such. I think the ‘Cheer up, it’s good for you’ comes from people who don’t know what to do or say, trying to help when they have no idea what’s going on.”

She adds, “I definitely would not want cancer and I would not want MS, but I do really understand this one. I sometimes joke that being diagnosed with MS was the best thing that ever happened to me. It forced/allowed me to focus on the present, not the sins of the past and not the possible mistakes or failed plans of the future. Once I started doing that and it became a habit, it became much less likely that I would fall into the despair of those worries. It was definitely a paradigm shift for my outlook.”

Larkins’s scientific rationality may have helped her as much as or more than the positive thinking movement. At least it gave her a logical base for embracing positivity. “I think having the medical background and a good handle on statistics and human psychological reactions to probability helped me think clearly about all of it, rather than letting it bury me in despair,” she says. “I think it mostly allowed me to stand back and see what I was doing in my head from an objective view.”

Larkins and Ehrenreich also disagree on the benefits of psychology and support groups. According to Ehrenreich, “Psychotherapy and support groups might improve one’s mood, but they did nothing to overcome [my] cancer.” Indeed, a claim that a psychological uplift can cause a remission in cancer seems (to me, at least) both unwarranted and unprovable.

Larkins, however, swears by Cognitive Behavioral Therapy, not for its cancer-killing results (if any), but for its influence on her ability to deal with her various diagnoses. She does see a distinction between “positive thinking” and CBT (don’t Google the acronym, she warns).

“Positive thinking can be a result of CBT,” she says, “but if you just say ‘I’m going to think positive thoughts’ you will end up frustrated. CBT is the method for changing how your brain functions, and it does, indeed, change your brain physically.”

She explains the process: “The more you think about something – an event or a problem – the stronger the neural connections that make up that memory become. My analogy is that it’s like carving a groove or rut in a path by going over and over it again and again …. As the groove gets deeper, it’s easier to fall into it any time you get close to it. By consciously stopping yourself from treading that same neural path, and actively carving another one that has more positive, pleasurable feelings associated with it, you allow that groove to smooth out and the new, positive one to take its place ….

“It’s not that I never fall into a repeating loop of self-recrimination, but if I catch myself there, I consciously tell myself to go down another path, one that I’ve predetermined so as to have it ready and at hand when I need it. It has gotten much easier with practice….”

Back over to Ehrenreich: “Breast cancer… gave me, if you want to call this a ‘gift,’ …  a very personal, agonizing encounter with an ideological force in American culture that I had not been aware of before – one that encourages us to deny reality, submit cheerfully to misfortune, and blame only ourselves for our fate.”

“[I]f you’re denying feelings, you’re doing psychotherapy wrong,” Larkins insists. “You’re also doing meditation and CBT wrong. It’s not about denying, it’s about experiencing them, evaluating them and deciding consciously if they are doing you good or harm.”

Nor is positive thinking the only method Larkins used for alleviating her depression. “Medication definitely helped!” she says. “When I’ve gone off the SSRIs [antidepressants] entirely, I found myself getting weepy and feeling out of control, even though I could see, objectively, that I was OK and even reasonably happy. The meds allow me to control my brain enough to take control of my brain, if that makes sense.”

What about other areas of life? Positive thinking has been touted as an answer for everything from poverty to relationship issues. Ehrenreich explains, “People who had been laid off from their jobs and were spiraling down toward poverty were told to see their condition as an ‘opportunity’ to be embraced, just as breast cancer is often depicted as a ‘gift.’…In fact, there is no kind of problem or obstacle for which positive thinking or a positive attitude has not been proposed as a cure.”

“This,” says Larkins, “I see as a struggle to make sense of and control an uncontrollable world. The same way that religious people call everything ‘God’s will’ or less religious folks say ‘[E]verything happens for a reason’ as a way to feel better about bad things….I think a lot of the ‘positive thinking’ rhetoric is more [a way] of actively distracting yourself from dwelling on the bad things. If you’re not predisposed to depression, that may be a workable method. If you already have malfunctioning brain chemistry, it’s not likely to help, but concentrated cognitive therapy can.”

As for me, I try to notice positive things in the world (which means not watching very much news); I try to add positivity to the world by thanking servers, clerks, cashiers, my husband – anyone who helps me in the course of a day; I appreciate things that make me laugh; I try to find some little thing I can agree with, even if I disagree with most of what a person says. I give myself permission to feel rotten when I feel rotten, but know that it won’t last forever. I do the best I can.

 

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Mammograms – Why?

I had a mammogram today and it raised questions in my mind. Not about whether mammograms are a good thing, despite the new study in the British Medical Journal that said they don’t really help. My mother had breast cancer and a mastectomy. She survived. A dear friend had a lumpectomy. (Digression: By accident, it almost became a complete boobectomy. Her breast survived.)

When my doctor told me to schedule the test, I  admitted to him that I don’t do the breast self-exam thing every month. I told him I couldn’t feel anything out of the ordinary, not even after another doctor gave me the fake boob with the different sized lumps to practice on. “My breasts are weird and lumpy,” I told him. “All women’s breasts are weird and lumpy,” he replied. Good to know. And, yes, there have been plenty of volunteers who’ve offered to help. So don’t even go there.

I dutifully scheduled the test, especially since I think that now, thanks to the ACA, insurance has to pay for the whole thing. (Further digression: The thing that caused the most resistance to the ACA, in my opinion, was letting its opponents get away with calling it “Obamacare.” That and not emphasizing that it wasn’t health care reform, which scares people. It was insurance reform, which only scares insurance companies.)

(I think I was working up to making a point somewhere. What was it? Oh, yeah, mammograms. Questions. That was it.) My questions were not about the actual test, but about the process.

When I entered the elaborate medical photo booth, the tech asked me, as usual, to remove my clothing above the waist and put on a cloth gown with the opening in the front. She told me to open the door a bit when I was ready.

Leave me alone with nothing to read and I start thinking.

I said to myself, “Self, why does she want me to put on that extremely fashionable gown when she’s going to see my weird, lumpy breasts anyway?”

When I discussed this with my husband later, he said that some people are modest.

“About what?” I asked. “They know the tech is going to see their boobs.”

I thought some more. “When the mammogrammers snap the pics, the techs ask you to uncover one breast at a time. Why is that? Are modest people okay with exposing one boob to a stranger, but not two at once? Plus, the tech touches them. If they’re going to be modest, isn’t that the bigger issue?”

I was on a roll. “And that whole leaving the room while I change is silly. They could save time – and laundry bills for the gowns – if they just said, ‘Strip to the waist and stick ’em in the machine.’

“They should reserve that delicate sensibility crap for first-timers. Everyone else just wants to get it over with as quickly as possible. Am I right?”

My husband said he didn’t know, which is probably true, since he’s never had a mammogram.

So, what’s the take-away here?

When I have a mammogram, I already know that someone will see and touch my breasts. And I’m okay with that.

But if I see my pictures on the Internet, I’ll really be pissed.

UPDATE (IRONY ALERT)

The mammogram I was so flippant about revealed a cyst, which has gotten larger. Tuesday I go for a follow-up mammogram and ultrasound. Even more people will see my breasts, and I’m still OK with that.