How Relentless Optimism Can Hurt Sick People

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Photo: Ali Goldstein/NBC/NBCU Photo Bank via Getty Images

Let’s say you get cancer or some other illness — a life-threatening one. What are the most important things for you to do to maximize your chances of surviving? If you made a list, it’s pretty likely a phrase like Maintain a positive attitude would be on it. Our culture, after all, places a premium on optimism, and in recent years there’s been a great deal of coverage of studies that appear to show a link between optimism and well-being.

But what if this view leaves behind the very people it’s supposed to help? What if it forces patients to play a part that doesn’t feel right to them, compounding the stress they’re experiencing as a result of their illness rather than helping them to relieve it? In a really interesting Globe and Mail article, Wency Leung explains why some people are pushing back against relentless optimism in such medical settings.

That case is perhaps best summed up by Judy Segal, a University of British Columbia professor who studies “the rhetoric of health and illness.” As she explains to Leung, cultural scripts involving upbeat, happy, relentlessly optimistic patients make it “much harder for people who are going through difficult times and who feel like complaining or crying — which are things people do, it’s just that they don’t do it very much in public or even in some close relationships because they feel those things are disallowed or dispreferred.” Whether or not you yourself have dealt with a serious health problem, it isn’t hard to imagine how frustrating this dynamic might be: Just imagine any situation where you haven’t been able to express how you feel, because it wouldn’t be deemed socially proper.

American and Canadian cultures already have issues talking openly about death, suffering, and sadness, but the bias toward positivity might make only make things worse. The first part of Leung’s article, for example, focuses on Suzanne Urpecz, a 35-year-old Torontonian who, after being diagnosed with cancer, struggled with the fact that everyone responded to the news with such optimism — they would tell her “You got this,” or “‘that her six months of treatment were ‘going by so fast.’” While Urpecz appreciated what her friends and loved ones were trying to do, she tells Leung that “trying all the time to sort of be very positive or very warrior-like … it sort of undermines some of the grief you have to go through.”

As Leung explains, this stuff is culturally contingent. In Russia, for example, “having a full range of emotions is considered authentic or realistic,” and she paraphrases one researcher explaining that “it can sometimes be difficult to detect depression in Russians because it’s accepted as part of life that people experience tough times.” In North America — to oversimplify and overgeneralize — we’ve got that can-do, pioneer spirit, and pessimism is more frowned upon than it is elsewhere in the world.

In recent years, science has appeared to cement the case for optimism — wouldn’t you know it, but our cultural values actually line up with what’s scientifically proven! That is, there have been a seeming cavalcade of studies suggesting that adopting a positive mind-set can have beneficial psychological and health effects.

Except according to Leung’s sources, a lot of this research has been overblown:

[W]hile some research indicates that one’s outlook may have physical effects on one’s health, [Ari Zaretsky, psychiatrist-in-chief at Toronto’s Sunnybrook Health Sciences Centre] says the findings are limited:

Studies have shown, for example, that strategies aimed at mitigating stress may have an indirect impact on the immune system, observed through measures such as reduced levels of the stress hormone cortisol or the functioning of T-cells, Zaretsky says.

But to make the leap to suggest positive thinking can help people live longer, “that is not at all what the science shows,” he says.

Madeline Li, a psychiatrist at the Princess Margaret Cancer Centre in Toronto, adds that more recent, larger and better-designed studies have “pretty clearly showed there is neither a health outcome benefit to survival … for being optimistic nor psychological therapies, like support groups, that reduce stress.”

Li also makes what might be the most important point in all of this: Even if reducing stress can boost the immune system, expecting cancer patients who aren’t feeling peppy to act peppy, or to respond to your own peppiness, could itself be stressful. Again: Think about any situation in which you’re forced to act in a way that doesn’t line up with how you’re feeling, or to validate someone else’s emotional energy despite being on an entirely different wavelength.

As Leung points out, part of the reason people fall back on positive platitudes is that illness and death make people uncomfortable, so when they don’t want to face it head-on they reach into their cliché grab bag. This is a perfectly normal, human thing to do.

What’s the alternative? If you’re visiting a friend, loved one, or co-worker with a serious illness, how should you act? A common-sense answer — and I’m moving past Leung’s article here — is to let them take the lead. In addition to the illness itself, your friend is also dealing with everyone else’s emotions about their illness, which can often be exhausting. Depending on their personality, where they’re at in their treatment, and even how rough the last day or the last few hours have been, they could be looking for any one of a number of things. Maybe they want to rant about the medical bureaucracy. Maybe they want to cry about how chemotherapy sucks, or to just be alone for awhile if they’ve had a lot of visitors or are naturally introverted. Maybe, on the other hand, they do want to crack jokes about the crappiness of their situation, and to adopt a football player’s attitude toward fighting their illness.

The only way to find out is to ask them “How are you feeling?” in a way that makes it clear you don’t have any particular expectations about what the answer is. That will probably increase the odds that they will feel like they can respond honestly and lead the visit where it might benefit them the most. All you have to do is listen to what they say, make it clear you’re there for them, and let them express whatever they want to express in an open, nonjudgmental manner. The one human universal that cuts across culture and illness and everything else is a desire to be heard.

If, on the other hand, you arrive at your visit viewing it as your job to cheer your friend up and make sure they stay inspired and that they don’t lose hope, and so on, you may be inadvertently putting a lot of pressure on them. Especially if their illness has been a long, drawn-out process, they may feel like they need to lose hope, at least for a few hours, to break down and cry. That can be emotionally recharging. If you’re there to help your friend, you should realize that help can take a lot of different forms, and not all of them wear a cheery grin.