October 14, 2014 — Hospice and the Elephant in the Living Room

OK, this is something of a grim subject. But it need not be.

The subject is conversations about dying and end-of-life care. I’m writing, now, more as a pastor than as a cancer survivor reflecting on my own situation. (Thankfully, my health has been good, and there’s been no sign of recurring lymphoma.) My wife, Claire, is a minister who’s worked for more than 15 years in hospice ministry, so this is a subject that does come up at the dinner table from time to time.

I’ve seen a number of moving news articles on this subject recently.

Atul Gawande has written in the New York Times, summarizing the goal of palliative care in hospice programs as providing patients with “the best possible day.” Hospice has got that wonderful here-and-now focus. Not tomorrow. Not next week. But today. Carpe diem.

Nina Bernstein has written in that same newspaper about a situation in which offering a patient the best possible day seemed to be the last thing on medical caregivers’ minds. She tells the story of Maureen Stefanides, who worked without letup to find a way to get her dying father, Joseph Andrey, out of a nursing home and back to her home so he could die with dignity. Tragically, a web of competing health and financial regulations — coupled with a shortage of home-care nurses and aides (a singularly low-salary occupation) in high-rolling New York City — made that impossible. As it was, the poor man was simply falling apart with multiple age-related issues, and no one seemed willing to stop the aggressive-treatment train. Stopping it in his case was all the more difficult because the nursing home stood to lose profits if they discharged him to home hospice care. (“The nursing home collect[ed] $682.48 a day from Medicare, about five times the cost of a day of home care.”) There’s really got to be a better way to run a healthcare system.

In Ms. Bernstein’s case, talking about hospice care was not the issue, but for many families it’s the proverbial elephant in the living room. Family members tiptoe around the subject, thinking it’s important to keep a relentlessly positive attitude, fearing that if their loved one knew he or she were “terminal,” the terminus would arrive all the sooner. In reality, the sick person is likely very aware of the imminent end, and may have strong feelings about what sort of end-of-life care is the best. Yet, on their side, seriously-ill patients sometimes hesitate to raise the subject with their families, out of deference to their feelings. Such “after you, Alphonse” hesitation often leads to an unwanted final few days in a medically-invasive intensive-care unit.

An article about President Obama’s recent signing of the Impact Act, which will lead to greater Federal scrutiny of hospice programs, observes that “The median length of stay for hospice patients in recent years has been fewer than 20 days — probably much too short, in many cases — so a hospice that provides six months’ care for half its patients is a true outlier.” Claire has shared, from her experience in hospice chaplaincy and bereavement support, that a shockingly large number of patients in her program live less than 48 hours after their admission to the program. This has nothing to do with the quality of care; it's just that so many patients aren't even recommended for hospice until they're just days (sometimes hours) from the end. I’m told hospice team members have a name for that sort of patient: “on and gones” - as in "on the program and gone." In some cases, the program barely has an opportunity to provide any of their excellent services, because the patient doesn’t live long enough to receive them.

The heightened Federal regulation is important, because there’s been a proliferation of for-profit hospice programs, taking advantage of Medicare payment policies that can make palliative care financially lucrative for the providers, especially if they can pick and choose which cases they accept. Some of these for-profit programs are heavy on the marketing and light on the services provided. Claire works for a non-profit program associated with our local hospital system. They have a lower profile but provide better, more comprehensive services than some of the for-profits.

A few years ago, Sarah Palin got the whole nation into a fit of agita over her made-up “death panels” campaign issue. I think this is one of the most reprehensible things any politician has ever done, because the government’s failure to work the end-of-life conversation into Medicare payment regulations has led to a great many patients missing out on hospice care they would have very much wanted. Political opportunism at its worst.  For shame.

Too many patients today are paying a heavy cost for her death-panels diversion.

We’ve simply got to find a better way, as a society, to talk about this particular elephant in the living room.

August 27, 2012 – The Downside of Up Life-Expectancy

Here’s a jaw-dropping statistic: “Since 1900, the life expectancy of Americans has jumped to just shy of 80 from 47 years.”

Among so many significant developments of the 20th Century, this may be one of the most far-reaching: and it gets so little press, compared to advances in transportation, communications, electrical power, data-processing and all the rest.

Walk through any older graveyard, and take note of the lifespans cut into the 19th century headstones. Stroll over into the newer section, and do the same for the stones from the last decade or so.  Then, do the math.

You’ll experience your own little “Wow!” moment.

We’ve been making huge progress, as a society, fighting cancer – which partly explains the increase in life expectancy, of course. Yet, those numbers also do their part to blunt the remarkable gains in cancer prevention and treatment.  They make them seem less impressive than they really are.

Here’s why. 

We all know cancer is an old person’s disease.  Not every cancer, of course. Small numbers of the young can be afflicted as well, and it’s especially heartbreaking when that happens.  Yet, the chances of getting most cancers go up with each decade of life: way up, once you pass 60 or so.

In 1900, when people were dying at the age of 47, on the average, most of them were succumbing to other maladies before they even made it into the prime cancer years. So many cancers are influenced by genetics: at a certain age, some mysterious, pre-programmed switch in the DNA gets thrown into the “on” position. Then, some of our cells start morphing into predators and lunching on those around them.

Sometimes, I hear people of my generation comment with alarm on how many of their friends are getting moles cut off, or undergoing mastectomies, or following the same chemotherapy path I and a few others of us have unintentionally pioneered. The cancer rate must surely be going up, they exclaim!

It’s not – at least, not if the effects of aging are controlled for.  What’s going up is their age, and the age of their contemporaries.  That, in itself, accounts for a whole lot of cancers.

Want to know what the leading cause of cancer really is?  It’s getting old.

What a paradox! With each new advance in cancer treatment, average life expectancy goes up.  Yet, for all those cancers that are prevented or successfully treated, the chances of getting other cancers increase, due to the demographics.

You’ve really got to feel for the cancer researchers.  They work so hard, and they announce their latest successes in triumph, but their numbers don’t look nearly so good as they would, were the average lifespan not also increasing.  They’re walking up the down escalator.

In the August 25th New York Times, David Ewing Duncan poses the very reasonable, but creepy, question of whether some of these medical advances are really worth it. He says he’s in the habit of polling his lecture audiences, asking for a show of hands as to how long they truly want to live. “I provided,” he says, “four possible answers: 80 years, currently the average life span in the West; 120 years, close to the maximum anyone has lived; 150 years, which would require a biotech breakthrough; and forever, which rejects the idea that life span has to have any limit at all.”

Before voting, he tells his audiences, they should assume that aging, as we know it, would continue. His question is simply about longevity that could be gained through eliminating life-threatening illnesses, not a matter of freezing the normal aging process. He’s not offering the opportunity, in his thought-experiment, for people to remain forever 30, or 40, or whatever ideal degree of physical maturity they’d care to name.

The majority — 60% — say they don’t want to live past 80. Another 30% declare they’re willing to power on through all the usual infirmities of aging, finally dying at 120. Nearly another 10% want to boldly go where no one has gone before, and live to 150. Only a tiny fraction put up their hands to say they want to live longer than that.

Duncan goes on to report that medical researchers are on the verge of a number of breakthroughs that could push the average life expectancy up even higher. Among these are medications to reduce inflammation of the coronary arteries, as well as various stem-cell therapies. The growing field of bionics — developing replacement hardware for the body, like cardiac pacemakers, brain implants for Parkinson’s sufferers, even artificial hearts — offers to add even more years to the average age at death.

“Curiously,” Duncan goes on, “after learning about these possibilities, few people wanted to change their votes. Even if I asked them to imagine that a pill had been invented to slow aging down by one-half, allowing a person who is, say, 60 years old to have the body of a 30-year-old, only about 10 percent of audiences switched to favoring a life span of 150 years.”

For many of those who don’t want to change their vote, it’s the various infirmities of aging that scare them off.  For others, it’s concern for younger generations, who would find the staircases to so many joys and achievements blocked by their elders, shuffling around on the landings above them. For still others, it’s about worry for the environment — whether the earth can truly sustain very many more people than are already here.

The tiny minority who do want to live longer speculate that we have no way of knowing what such super-centenarians could accomplish, with their added wisdom and life-experience. What new gizmo could a genius like Steve Jobs come out with, if he lived to 150?

We do know, Duncan concludes, that Albert Einstein was very clear about his own wishes, near the end of his life: “As he lay dying of an abdominal aortic aneurysm in 1955, he refused surgery, saying: ‘It is tasteless to prolong life artificially. I have done my share, it is time to go. I will do it elegantly.’”

Let’s hear it for everyone being given the opportunity to live long enough to still die elegantly!

June 12, 2012 – Huh?

Every once in a while you run across a news story, and the only possible reaction to it is.... “Huh?”

That’s how I responded when I read a news article just out, that claims there’s conclusive evidence that overweight men have a better chance of surviving diffuse large B-cell lymphoma than those of more normal weight.

Like I said: Huh?

That news runs counter to every bit of medical advice I’ve been hearing for most of my life.

The article is of particular interest to me because (1) I’m a man, (2) I’m considerably overweight, and was so at the time of my lymphoma diagnosis, and (3) I have something very similar to diffuse large B-cell lymphoma.

OK, my grading was actually “B-cell, diffuse mixed large and small cell.”  That means I had some less-dangerous small cells – the kind present in indolent, “follicular” lymphoma – mixed in with the large ones.  It was the presence of the aggressive larger cells, as discovered by the second-opinion pathologists at Memorial Sloan-Kettering as they reviewed my biopsy slides, that put me on the chemotherapy bandwagon straightaway (do not pass GO, do not collect $200).  Otherwise, watchful waiting would have been a viable option.

The only time in my life when I’ve been of statistically normal weight was a period of time in my very late teens and early-to-mid-20s.  Both before and after that time, I’ve struggled constantly with my weight.  My failure to turn around my tendency towards obesity has been one of the greatest sources of guilt and shame in my life.

Ever since cancer has come onto the scene, it’s been even worse.  It’s hard to marshal the emotional energy to change my eating patterns when I’ve been through the sort of struggle I have.  There’s a part of me that says to the rest of me: “Why should you suffer through a diet when you’ve already suffered through so much else?  Live a little!”

Then this article comes along, suggesting that the spare tire I’ve been carrying could very possibly have been my life-preserver.  Go figure.

The article’s appropriately cautious about the study’s results.  The researchers don’t want anyone to go out and start lobbying for hot-fudge sundaes to be included in the treatment protocols.  Quite sensibly, it makes the point that obesity is a proven risk factor for all manner of very bad things that could happen to a person, medically, and that there’s every reason to lose those extra pounds.

But still, it makes you think.

And this one I’ll be thinking about for a very long time.

May 2, 2012 - Are You Running for Me?

A few months ago, our friend Thelma – also a cancer survivor – told me of a local organization called Kick Cancer Overboard, that has an unusual mission: offering free cruises to cancer survivors and their families.  Thelma told us she’s going on one of those cruises, in this case to Bermuda.  About a hundred other survivors and family members would be joining her.  What’s more, she wanted to recommend my name as well.

“OK, why not?” I said to her, not thinking it would amount to anything.

Well, come to find out, Kick Cancer Overboard is offering a place on the same cruise to Claire and me.

Not only that, a friend of Thelma’s by the name of Ginny is running in a half-marathon this weekend, and is doing so to raise money for Kick Cancer Overboard in my name.

Our cruise tickets are already paid-for by other donors, so – strictly speaking – Ginny’s not raising money so we can go. It is true, though, that the money she raises will replenish the organization’s coffers, allowing others to take advantage of the organization’s kindness in the future.

Ginny’s set a goal of $2,000 in pledges.  Already, Thelma tells me, $600 in gifts have come in.  Never before have I asked readers of this blog to make any financial contribution, but in this case I’d like to extend the opportunity to honor Ginny’s efforts this Saturday and support Kick Cancer Overboard.  If you like what I’ve written here over the years, it would warm my heart if you’d be willing to make a gift – small or large, it doesn’t matter – to allow other survivors to get a little respite from what they’re going through.

There’s a special web page devoted to Ginny’s efforts, where you can make your gift.

I realize that, in the great constellation of efforts out there to support and heal those with cancer, giving away cruises may seem trivial and even a little wacky.  Yet, having been through the cancer experience twice now – first lymphoma, then thyroid cancer – I know very well how unrelenting this all can be.  Taking a little break, a little sabbath, in the midst of it all, can be therapeutic in itself.

I’d love to see Ginny reach her goal, and am honored she’s doing it in my name, a person she’s never met.

At the end of the day, there’s still a lot of kindness in this world.  Why not perform a random act of kindness and make a contribution to extend some kindness to another cancer survivor, who can enjoy this sort of break in the future?

Thanks for even considering it!

July 7, 2011 – Unbending Our Thoughts

Brian Stabler is a psychologist at the University of North Carolina, Chapel Hill, and a lymphoma survivor. In a helpful 2004 article, he speculates that a good deal of the trouble we go through in dealing with cancer is a result of unrealistic or “bent” thinking. The technical psychological term is “cognitive distortions.”

What are some of these bent thoughts? Stabler explains:

“For instance, when asked, many cancer patients report that they believe cancer is a foreign invader substance, such as a virus. This underlies the common misconception that you can actually ‘catch’ cancer from someone else. Obviously, this distorted belief could work against optimal outcomes, because it encourages the patient to rely on others – as if medicine, and a doctor or nurse is all that is needed to make things better. Not so: the patient is the most important part of the equation, and must learn to deal positively with cancer.”

Stabler encourages a technique of dealing with destructive thinking that requires immediately identifying the presenting thought that caused the negative emotional state, then “sweeping” it so it can do no more harm.

He suggests a learning exercise in which we keep a piece of paper close at hand, divided into three columns. The first is labeled “SITUATION,” the second, “REACTION” and the third, “THOUGHT.” When you find yourself reacting negatively, he explains, make a note of the situation that precipitated it, then try to capture the thought you were thinking just before you became aware of the depressive or anxious or angry emotion that ensued.

Stabler suggests several common categories of distorted thinking:

1. Black and white thinking – this is the all-or-nothing style where everything is simple and concrete, and there are no shades of grey.

2. Catastrophizing – where an individual interprets even the smallest problem as a potential disaster and reacts accordingly.

3. Fortune telling – the tendency to believe that we know what the future holds, and it generally is not pleasant.

4. Emotional reasoning – the belief that the feelings you experience represent reality, as in, "I feel bad all the time, so this must mean that things in my life are pretty bad."

If just one or two of these thinking styles is present, a cancer patient could have a poorer life quality, increased stress, and perhaps even negative changes in the course of [the] illness. Research has shown that if patients learn to journal their thoughts, and actively begin to challenge and adjust their ‘hot thoughts’ and distortions, they can anticipate improvements in their quality of life. I've come to firmly believe that keeping psychologically fit is every bit as important as keeping physically fit.”

Because cancer is generally not caused by some foreign-invader virus or bacterium, but is in fact an erroneous response of our own genes, our patterns of thought may well have a great deal of influence on how successfully we manage to live with this disease. We can’t think ourselves well by utilizing our minds alone, but our thought processes do have something significant to do with our well-being. It’s all part of the healing process. Every little bit helps.

June 7, 2010 - Is Google Making Us Ignore God?

Came across a thought-provoking article today by Ernesto Tinajero on Sojourners Magazine’s “God’s Politics” blog. It's called "Is Google Making Us Ignore God?"

Here’s an excerpt:

“God calls on us to meditate on God and God’s word. However, does the fast intake of information from TV, film, and especially the Internet make us less likely to experience God? According to new research, electronic gadgets actually change how we think and focus. Nicholas Carr famously asked ‘Is Google Making Us Stupid?’ Will it also make us ignore God?...

The theological perspective is that this busyness of the business of modern life draws us into the world of Martha and away from sitting at the feet of Jesus. We are being called to distraction, and the quiet, still voice of God goes unnoticed – unnoticed in the flood of ever new links to follow, unnoticed in the hectic pace of modern life, unnoticed in the flood of events, information, and distractions. Through it all, God continues to call us to sweet voice of prayer. Yes, the call I am heeding –returning to simplicity and healthier life – may seem too simple to make a difference. Yet, does it make it any less true?”

I wonder what the implications of this 24/7 deluge of distractions are for our immune system, and for the cancers like lymphoma that sometimes beset it?

Judaeo-Christian religion has a time-honored solution: it’s known as sabbath. Periodically creating for ourselves islands of spiritual peace – places and times for encountering the divine – ought to be central to any long-term program of recovery.

June 6, 2010 - Our Most Elusive Possession

Great column a couple days ago, from New York Times columnist Nicholas Kristof. Instead of gallivanting around Africa or someplace crusading against injustice, as he often is, his June 4th column is very personal.

That’s because he’s had a cancer scare: diagnosis of a kidney tumor 90% likely to be malignant, then surgery – and then, against the odds, a biopsy revealing he’s in the lucky 10%. The tumor was benign.

Still – and understandably – Nicholas had a scare, that led him (as cancer has led so many of us) to examine his life a little more closely. Here’s the result:

“This is trite but also so, so true: A brush with mortality turns out to be the best way to appreciate how blue the sky is, how sensuous grass feels underfoot, how melodious kids' voices are. Even teenagers' voices. A friend and colleague, David E. Sanger, who conquered cancer a decade ago, says, "No matter how bad a day you're having, you say to yourself: `I've had worse....’

I don't mean to wax lyrical about the joys of tumors. But maybe the most elusive possession is contentment with what we have. There's no better way to attain that than a glimpse of our mortality.”

Preach it, brother!

A few verses from the First Letter to Timothy come to mind:

"Of course, there is great gain in godliness combined with contentment; for we brought nothing into the world, so that we can take nothing out of it; but if we have food and clothing, we will be content with these."

- 1 Timothy 6:6-8

April 3, 2010 - When All You Have Left Is Yourself

Today I’m reading an unusual article in Cure magazine online, "Keeping the Faith," by Kathy Latour. What’s unusual about it is that it deals with the topic of cancer and spirituality with attention to spiritual community.

I find that refreshing, because there’s lots of talk about a sort of generic spirituality when it comes to cancer survivorship. “If it makes you feel good, do it” is the all-purpose mantra. The problem with this sort of approach is that it ends up being a do-it-yourself activity, like trimming your nose-hairs or working out with a Thighmaster.

I think this individualism comes out of good old American separation-of-church-and-state thinking – something I’m in favor of when it comes to politics, but which is woefully inadequate in all but the most superficial discussions of religious faith. Take that line of thinking to its extreme, and you’ll end up like poor old President Eisenhower – who supposedly let himself be quoted saying: “Our government has no sense unless it is founded in a deeply felt religious faith, and I don’t care what it is.”

Some presidential scholars insist that’s an apocryphal remark, and it may well be – but, it catches the spirit of the age. (Eisenhower was a Presbyterian, by the way – though, if he really said that, I suppose he missed Sunday School the day they were teaching Calvin’s high conception of the church.)

In cancer support groups, “guided meditations” abound – those stress-relieving exercises that begin: “Close your eyes, pay attention to your breathing, and imagine yourself walking across a grassy field...”

Now, I can understand the appeal of that approach, to those who arrange chairs in a circle for their cancer-and-spirituality workshops. You can be Christian, Muslim, Buddhist, Jew or South Sea Islands cargo cultist, and still get something out of a guided meditation exercise. Whether the glowing figure walking towards you across that grassy field is Jesus or the Bodhisattva Maitreya makes little difference, because it’s happening in your own, private mental world. No muss, no fuss, no cross-denominational misunderstandings. Everybody leaves happy.

Outside of houses of worship, spiritual support groups are often led by people without any strong (or strongly evident) religious affiliation – the “I’m spiritual but not religious” sort of person. You’d think hospitals and agencies would seek out seasoned religious professionals – nuns who work as spiritual directors, say, or Muslim teachers of Sufi prayer – as long as they’re committed to interfaith dialogue. But, no. Charitable-organization program directors aren’t known for sticking their necks out, so they smile beneficently on psychiatric social workers with no theological background who say, “I can do that,” or on generic “interfaith ministers” holding degrees from unaccredited seminaries (or, God forbid, even internet “ordinations”).

That’s why the article I’ve been reading is so refreshing. The author, Kathy Latour, interviews Harold G. Koenig, M.D., of the Center for Spirituality, Theology and Health at Duke University – a prostate-cancer survivor himself – as he describes a discussion group he co-facilitated called “Engaging the Spirit.” It was a place “where cancer patients and survivors explored spiritual and faith questions as they traveled the cancer journey.” Knowing his group was composed of people from a variety of faith traditions, Harold began each discussion with a simple question: “How’s your spirit?”

OK, that’s a workable generic opening question, but Harold’s point is that the discussion need not remain in that level: “I learned from those who took part that no matter how someone defines his or her faith, in a group of cancer survivors there exists a common quest to understand existential questions about life and death.” When that quest is pursued through religious community, there comes an awareness that “God has a purpose for them and is in control and they don’t have to be. This is where mental health comes from.” Such a strongly-held conviction, the article continues, “frees them and reminds them that their illness can result in ‘something good.’”

From his own experience as a survivor, Harold upholds the value of “a belief system that frames your diagnosis in the context of your life and what you believe happens after life. If you have no framework to place that in, all you have left is yourself and it isn't enough. You can't carry the full load – you weren't meant to.”

A great many recent research studies of spirituality and health, Harold maintains, conclude that people who follow a particular faith tradition “need and use fewer health care services because they are healthier, more likely to have intact families to care for them, and have greater social support.”

The Rev. Isabel Docampo, associate professor of supervised ministry at Perkins School of Theology, “says her fear and depression after facing surgery for life-threatening cancer of the salivary gland came not from a crisis of faith, but from the pain and sadness that she felt from the idea she might leave her 21-year-old son, Ben, and her husband of 18 months, Scott Somers, also an ordained minister.”

“The way I have always looked at life is that it is what it is,” Isabel reflects. “Life is a struggle and God has been there for all the blessings and all the bad stuff, and God is going to be here for the cancer.”

Amen to that.

I wouldn’t want to face cancer knowing that “all I have left is myself” – nor some individualized spirituality I’d made up out of whole cloth, either. One of the great strengths of submitting oneself to the discipline of a particular religious tradition is knowing it’s not all about me, nor will it ever be so.

Now, on to my Easter sermon...

December 1, 2009 - The Glad Game

Many people have heard the name “Pollyanna.” Her full name is Pollyanna Whittier, and she’s the title character in a classic series of children’s novels. The first one was published in 1913 by Eleanor H. Porter.

In the grim little New England town where the orphan Pollyanna goes to live with her aunt, she teaches others to play a little game her late father taught her. She calls it “The Glad Game.” It has one simple rule: find something to be happy about in every situation, no matter how dark or desperate.

The game’s origins go back to one particular Christmas. Digging deep in the charity barrel, hoping to find a doll for her present, Pollyanna finds only a pair of crutches. A poor kid without a toy at Christmas? What could be more pathetic than that? Pollyanna’s father teaches her, then, how The Glad Game works: be happy you found the crutches, he tells her, because “we don’t need ‘em!”



The Wikipedia article on Pollyanna gives a few examples of how adept the little waif becomes at playing The Glad Game:

“When Aunt Polly puts her in a stuffy attic room without carpets or pictures, she exults at the beautiful view from the high window; when she tries to ‘punish’ her niece for being late to dinner by sentencing her to a meal of bread and milk in the kitchen with the servant, Nancy, Pollyanna thanks her rapturously because she likes bread and milk, and she likes Nancy.”

Pollyanna becomes an evangelist for The Glad Game, bringing a treacly sweetness to her little town, until further misfortune in her own life forces her to practice what she preaches:

“Eventually, however, even Pollyanna’s robust optimism is put to the test when she is struck down by a motorcar while crossing a street and loses the use of her legs. At first she doesn’t realize the seriousness of her situation, but her spirits plummet when she accidentally overhears an eminent specialist say that she’ll never walk again. After that, she lies in bed, unable to find anything to be glad about. Then the townspeople begin calling at Aunt Polly’s house, eager to let Pollyanna know how much her encouragement has improved their lives; and Pollyanna decides she can still be glad that she has legs. The novel ends with Aunt Polly marrying her former lover Dr. Chilton and Pollyanna being sent to a hospital where she learns to walk again and is able to appreciate the use of her legs far more as a result of being temporarily disabled.”

We cancer survivors hear a lot about the importance of maintaining a positive attitude. In many ways, that advice is but a warmed-over version of Pollyanna’s Glad Game. The problem is, no real person can be as relentless in playing the game as the fictional Pollyanna. Feelings of sadness and dejection sometimes present themselves, and that’s OK. They come with the territory.

If we take the “think positive” advice too seriously, we can end up denying the existence of those negative thoughts – which are only natural, after all. Sure, maintaining a positive attitude is important, but that doesn’t mean we can never give ourselves permission to feel anger, or sadness, or frustration or any of the other negative emotions that come from this kind of protracted struggle.

There’s a lot of emphasis, in some cancer-treatment circles, on mental exercises like meditation and visualization as practical ways of calming the spirit. These practices are of proven usefulness and have their place, but it’s possible to take them too far. Some of the more enthusiastic promoters of these techniques claim they stimulate the immune system, actually unleashing the body’s healing energies – as though they were a treatment modality in themselves. It’s easy to see where such exaggerated claims can lead: to the belief that, unless we devote enough time each day to pulling ourselves up by our own endorphins, we’re giving up altogether.

Dr. Jimmie C. Holland, a psychologist at Memorial Sloan-Kettering Cancer Center, touches on this in her book, The Human Side of Cancer. She tells of a patient of hers named Jane, who had been successfully treated for breast cancer, but who felt troubled by the fact that she sometimes worried about a relapse. Could her worries in fact be a self-fulfilling prophecy, Jane wondered? This caused her to worry even more. The doctor comments:

“Jane was echoing a refrain I often hear from people with cancer: the notion that feeling sad, scared, upset, or angry is unacceptable and that emotions can somehow make your tumor grow. And the sense that if the person is not in control on the emotional plane all the time, the battle against the disease will be lost. Of course, patients like Jane didn’t come up with this notion on their own. It's everywhere in our culture: in popular books and tabloids on every newsstand, on talk shows, in TV movies.

For most patients, cancer is the most difficult and frightening experience they have ever encountered. All this hype claiming that if you don’t have a positive attitude and that if you get depressed you are making your tumor grow faster invalidates people’s natural and understandable reactions to a threat to their lives. That’s what I mean by the tyranny of positive thinking.”

Sometimes we just don’t feel like playing The Glad Game. Sometimes, we shouldn’t have to.

August 22, 2009 - Laughter Yoga

This little video is endearing – and not just because it features the always-amusing John Cleese as narrator. I’ve heard of India’s “laughter yoga,” but have never actually seen it before, in action.

I figure this stuff has got to be therapeutic – but, if nothing else, it looks like great fun:



I’m especially intrigued by the observation that it doesn’t seem to matter whether the laughter is forced or natural: the therapeutic benefit is the same.

Of course, as the doctor points out in the video, even if participants are forcing their laughter at first, after a few moments of looking at all those goofy faces, only a rock could keep from laughing in response.

Maybe laughter really is the best medicine.

August 19, 2009 - Resilience

A New York Times article speaks of a new sort of training the U.S. Army is implementing for more than a million of its soldiers: training meant to encourage emotional resilience.

The goal is to reduce the incidences of post-traumatic stress disorder in soldiers returning home from combat. The Army’s going ahead with the training program, even though some have expressed doubt that the service’s macho, just-suck-it-up culture is compatible with such a touchy-feely approach.

Behind the training is Dr. Martin Seligman of the University of Pennsylvania, a proponent of “positive psychology” – an approach that focuses more on wellness and prevention than on treating pathology.

“Psychology,” he explains, “has given us this whole language of pathology, so that a soldier in tears after seeing someone killed thinks, ‘Something's wrong with me; I have post-traumatic stress.’ The idea here is to give people a new vocabulary, to speak in terms of resilience. Most people who experience trauma don’t end up with P.T.S.D.; many experience post-traumatic growth.”

I find that remark of Dr. Seligman’s interesting with respect to cancer survivorship. For many people, the effect of cancer treatment seems similar to that of a soldier in combat. The key is to slow the logical progression from thinking of one’s life as normal to seeing it as utterly devastated. In reality, there’s a whole spectrum of possibilities between those two extremes. Cancer need not be a life-shattering experience, no more than a tour of duty in a war zone needs to be. Both experiences are difficult, even life-changing. Yet, both are survivable, psychologically speaking.

Many of us cancer patients, at the time of diagnosis, operate from a stereotypical, worst-case understanding of the disease. Our minds leap to the assumption that it’s a death sentence. We imagine the next words out of the doctor’s mouth, after “You have cancer,” will be “I advise you to get your affairs in order.” It’s not that way, of course, and is becoming less and less so as time goes by, as new treatment protocols emerge from the laboratories.

Cancer survivorship is no picnic. But, it’s not death row either.

Elizabeth Edwards’ latest book is titled, Resilience: Reflections on the Burdens and Gifts of Facing Life's Adversities. I haven’t read it yet, although I did read her autobiography, Saving Graces: Finding Solace and Strength from Friends and Strangers. I find it interesting that Elizabeth has latched onto this word “resilience,” in light of all the trials she’s been through: losing a son, getting cancer, responding to her husband’s marital infidelity in the glare of national publicity.

I found an excerpt from the book online, in which Elizabeth tells of meeting a fellow cancer survivor named Mark Gorman. He carries around with him a slip of paper from a fortune cookie that says, “You cannot change the wind, but you can adjust the sails.”

So true.

Resilience. It’s a good word.

July 20, 2009 - Where Not to Get Sick

If you haven’t yet read Atul Gawande’s article in the June 1, 2009 New Yorker about the high cost of health care in McAllen, Texas, you should. It’s a must-read for anyone who’s following the health care funding debate.

Why McAllen? Why should that dusty burg at the southern tip of Texas have the highest per capita health care costs in America? Gawande’s article is a detective story, chronicling his efforts to answer that question.

The answer he comes up with is that McAllen’s doctors are responsible for many of these elevated costs. They order up a whole lot of costly, high-tech medical tests, more than most other doctors around the country:

“The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. And, as a rule, hospital executives don’t own the pen caps. Doctors do.”

Remarkably, the highly-tested patients of McAllen are no healthier than patients elsewhere. Compared to some cities with lower medical costs, they actually do worse.

It’s not that McAllen’s doctors are less competent than doctors elsewhere, or that they’re morally challenged. Gawande’s explanation is that the entire medical system in McAllen is engineered – to a degree not typical of many other communities – to encourage doctors to order marginally-necessary, or even unnecessary, tests, and to prescribe costly treatments that may be no more effective than cheaper alternatives.

There are lots of reasons for this. According to Gawande, it’s a complex constellation of factors, including:

- a high rate of for-profit, physician-owned medical facilities;
- an entrepreneurial culture that sees doctors as businessmen and -women, rather than healers;
- a well-founded fear of lawsuits that leads to defensive medicine;
- comparatively less coordination of care than in other places, leading to duplication of services.

“Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coordination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.”

It’s the system’s fault, says Gawande. This is a classic example of a systemic problem.

Gawande compares McAllen to another town that’s in the lowest 15 percent of health care costs, nationwide: Rochester, Minnesota, home of the world-famous Mayo Clinic. The most significant difference is that a high percentage of doctors in Rochester are employees of the clinic, rather than entrepreneurial owners of their own little medical businesses. Success in that setting is measured in healthy patients, not the number of patients served. The medical system in Rochester is engineered to maximize health outcomes rather than profits.

They say this article has become required reading in the White House, by staffers tasked with proposing to Congress a workable fix for the health-care funding crisis.

No wonder.

The American solution to medical cost-containment, until now, has been to rely on the insurance companies to ride herd on all this Wild West confusion. The only problem is, the insurance companies are no more concerned with positive health outcomes than physicians are. The insurance companies work for their stockholders, not for the patients.

We need to develop a health-care system that does work for the patients. Other countries (Britain, Canada, France) seem to know how do this better than we. This is a rare opportunity for our national leaders to think outside the box and develop a funding system that truly serves the greatest number of people.

Just don’t blow it, politicians. Take the lobbyists’ hands out of your pockets and pay attention to your constituents. We’re hurtin’ out here – especially in places like McAllen, Texas.

July 6, 2009 - A Week in Rivendell

Claire and I are spending the week at the Presbyterian House in Chautauqua, New York. Part of the venerable Chautauqua Institution, the Presbyterian House is an old-fashioned guesthouse that accommodates about 65 people. It’s adjacent to the 5,000-seat open-air Auditorium that’s the site of the principal concert, lecture and worship events that take place here.

I’m serving as Chaplain at the Presbyterian House. My duties are pretty light: I preached a sermon on Sunday, offer grace at meals and will conduct a program of my choice on Thursday evening (I’ll lead a discussion on John Calvin, since his 500th birthday is the next day). For this, Claire and I get free room and board for a week, as well as a “gate pass” that gets us into most of the concerts and events that take place here. A generous offer on the part of the Presbyterian House board, for which we’re very grateful.

Chautauqua’s quite an experience: a throwback, in many ways, to the early years of the 20th Century. It’s a picturesque lakeside village filled with Victorian-gingerbread houses. Cars are pretty much banned 7 days a week; the whole place is surrounded by a fence, and – except for Sundays – you have to have a gate pass (admission ticket) to get in. Some people own homes here, and others either rent places or stay in the many hotels and guest houses. Lots of people we’ve met have been coming here for decades.

Sitting in the Auditorium on Sunday, listening to Samuel Wells, chaplain of Duke University (the preacher for the week) give an excellent sermon, I was struck by how insular Chautauqua is. Introducing Sam was Joan Brown Campbell, former director of the National Council of Churches, who’s now head of the Department of Religion here.

Chautauqua is a bastion of old-time, liberal mainline Protestantism. While most historians agree the Protestant Ascendancy in America reached its high-water mark decades ago, in the Eisenhower era, you’d never know it here in this place. Looking out at the nearly-full auditorium, listening to the spirited singing of classic hymns accompanied by a massive pipe organ, I was struck by how much the place feels like a protected island in the storm.

Out there, mainline Protestant churches are struggling against fearsome cultural tides that threaten to sweep us away. Many local churches are enmeshed in “worship wars” that pit fans of guitar-accompanied praise songs against those who love organ-accompanied hymns. We’re beset by interminable, destructive debates over sexual ethics. My own baby boomer generation seems to be the first generation of Christians ever that doesn’t understand what committed, regular financial stewardship is all about, so many churches are cutting budgets and downsizing (and were doing so even before the present recession began). Out there, these are tough days to try to pastor a mainline Protestant church.

In here, though – inside the Chautauqua bubble – it’s as though none of this were happening. Life goes on here, as it has for generations. The faces of the preachers, lecturers and musicians change, of course, but the overall program is much as it’s always been.

Bill, a friend of mine, describes it as "Disneyland for intellectuals."

A literary metaphor occurred to me, as I was sitting there that first day, that to me describes the role Chautauqua plays in the mainline church. This place is Rivendell.

In J.R.R. Tolkien’s The Hobbit and The Lord of the Rings trilogy, Rivendell is the sheltered community of elves, whose powerful magic keeps creeping evil at bay. Much of Middle Earth is quaking in fear at the advancing armies of Saruman, and his more-powerful ally, the Dark Lord of Mordor, but in Rivendell, all is peaceful. When Frodo Baggins and his band of travelers reach Rivendell after facing all manner of perils, they know they are safe for as long as they tarry within the elves’ circle of protection.

Eventually, even the elves themselves will depart their “last homely house,” and somberly sail off in their elegantly-crafted sailboats to eternal life in the Grey Havens – which seems to function, in the Tolkien novels, as something like heaven. But, for the present, Rivendell is a haven in the storm, a place of rest, refreshment, and re-equipping for the battle.

I can use this sort of R&R in a personal sense, of course. I haven’t been thinking about cancer much, while I’m here – although a few Presbyterian House residents, knowing of my history with lymphoma, have come up to me to share their own struggles with the disease. I’ve been thinking a good deal more about how wonderful life in the mainline Protestant church would be if all our congregations were filled with members and ministers like the good folks here. There’s a real spirit of caring and openness and generosity that permeates the place. Would that we could recreate it in our own communities back home!

Looking out over the auditorium congregation, I was also struck by how much gray and white hair there is. This place is teeming with AARP members. Many of the younger folks we’ve met – twenty- and thirty-somethings with kids in tow – are here with their parents and grandparents. It’s a popular spot for family reunions. Would the younger ones choose to come on their own?

All of which raises the question.... Whither mainline Protestantism? Will this congenial crowd return to their home churches, refreshed and renewed, equipped to bear witness to the gospel in edgy, new ways? Or, will they hang around spiritual oases like this a while longer, before packing it in and sailing off to the Grey Havens one day?

I’ve got a feeling the renewal of the mainline church won’t be sparked in places like Chautauqua. As wonderful as this place feels, it’s more about the past than the future.

But even so, it feels good to rest here a little while. Even the Fellowship of the Ring had to take a breather in Rivendell.

June 11, 2009 - At CREDO

I realize it’s been quite a while since my last post. Life has been more than busy – bordering on overwhelming, at times. Each year, I always underestimate how hectic the month of June is, in parish ministry. June is the month when most church programs make ready to go into hibernation for the summer (yes, even here in a beachfront resort community). There are lots of end-of-the-year special events to occupy a pastor’s time.

Not only that, I’ve been away from home since Monday, at a continuing-education event called CREDO (an acronym for Clergy Reflection Education Discernment Opportunity, which also happens to spell out the Latin word for “I believe” – or, as some have more poetically pondered, “I give my heart to”). The invitation-only program is put on (and heavily subsidized, financially) by the Board of Pensions of the Presbyterian Church (U.S.A.), although they borrowed its design from the Episcopalians, who pioneered this concept of ministry support. We’re meeting at Beaver Hollow, a well-appointed executive conference center in a rustic, woodsy setting near Buffalo, New York.

It’s an unusually long continuing education conference: eight days. It’s kind of a mid-career tune-up for ministers who have been at this work for a long time and who’ve perhaps have not had an opportunity for a while to get away from the daily grind and reflect on the experiences that led us into this line of work in the first place.

It’s a wonderful group of people: gifted men and women from all over the country who are, for the most part, quite good at what they do. The ages range from 40-55. Few of us have ever met before, but the bonding was instantaneous and we’ve been having a great time.

It’s a wholistic sort of approach, focusing on finances, health, spirituality and vocation. Mostly we’ve been listening to presentations so far, with some small group work. Later in the event, there will be some time set aside for writing our personal “CREDO Plan,” a sort of personal to-do list for strengthening our spiritual life and ministry.

I’d like to share something from a CREDO handout on the subject of health. It has a lot to say to cancer survivors, and to everyone else as well:

A VIEW OF HEALTH

1. Health means a sufficient absence of injury or disease processes so that my basic functioning operates without impairment (This is the traditional view of health).

2. Health means having an awareness of and reliance upon the life force within each one of us, which makes for growth and in the event of illness, for recuperation (we call it a positive attitude).

3. Health means having a sense that each of us belongs to others, and a desire to contribute to the common good (we call it an other-centered attitude).

4. Health means having an understanding that each of us is more than a product of history; that as individuals, we cannot only cope with the flow of events, but we also participate in shaping them (we are co-creators).

5. Health means interacting with others in such a way that our self-constancy, stability and individuality are not dissolved; even under threat (our egos are intact).

6. Health means having a sense of integrity. That is, we function as a unit and are not self-destructing (we have direction, focus, purpose).

7. Health means having a sense of the value of life and of living as a steward, not an owner (we are optimistic and free because nothing belongs to us individually. We have nothing to lose. We can live sacrificially).

8. Health means having a view of life that acknowledges dependency as a part of reality and rejoices in it; which recognizes gifts, including the gift of God’s love, mercy and ever-present Spirit and gratefully accepts them; which accepts creaturehood, as befits children of God.

9. Health means having an appreciation of living from the aspect of eternity that allows us to find security in the hope and expectation of life everlasting, not everlasting life (We can hang loose through all adversities of life because our perspective is eternal).

10. Health means embracing mystery and ambiguity as welcome friends.

Source: Adapted from Richard P. Ellerbrake’s remarks, Helen J. Westberg Lecture, Sixteenth Annual Westberg Symposium, September 11, 2002.

What I like about this statement is the way it integrates the medical and the spiritual. We need more of that sort of thing.

April 25, 2009 - Take a Little Wine

“No longer drink only water, but take a little wine for the sake of your stomach and your frequent ailments.” So says 1 Timothy 5:23 – a little practical advice, in the midst of some miscellaneous exhortations at the end of this New Testament letter.

Who woulda thunk it? Who could imagine this homey, first-century medical advice would surface at a 21st Century cancer research conference?

It has, though – at least, according to a recently-released research study. From a news article describing it:

“Pre-diagnostic wine consumption may reduce the risk of death and relapse among non-Hodgkin's lymphoma patients, according to an epidemiology study presented at the American Association for Cancer Research 100th Annual Meeting 2009.... [The researchers] analyzed data about 546 women with non-Hodgkin's lymphoma. They found that those who drank wine had a 76 percent five-year survival compared with 68 percent for non-wine drinkers. Further research found five-year, disease-free survival was 70 percent among those who drank wine compared with 65 percent among non-wine drinkers.” (“Drinking Wine May Increase Survival Among Non-Hodgkin's Lymphoma Patients,” ScienceDaily, April 24, 2009.)

Admittedly, those numbers aren’t all that startling. The wine-bibbers get a mild statistical bump, that’s all. Draining Bacchus’ cup is clearly no panacea, but it does seem that “a little wine,” as the author of 1 Timothy advises, can be good for what ails ya.

Not every tippler will be happy with the study’s results, though: “Beer and/or liquor consumption did not show a benefit,” the report soberly concludes.

It’s just the vino, folks.

According to the article, wine has certain anti-oxidants that tend to retard tumor growth. This is consistent with some earlier studies that show wine (especially red wine) has a mild positive effect on heart health. An occasional glass of Chianti or Lambrusco is part of the highly-touted “Mediterranean diet.” Now, it appears the fruit of the vine does a little something for lymphoma prevention as well.

The oncologists aren’t exactly advocating pub crawls. Far from it: “This conclusion is controversial, because excessive drinking has a negative social and health impact, and it is difficult to define what is moderate and what is excessive,” says one of the lead researchers, by way of a disclaimer.

(Nota bene: 1 Timothy does specify “a little wine.” All things in moderation.)

I’ve always thought an occasional glass of red wine to be one of life’s little pleasures. It’s nice when something that tastes so good turns out to be good for you, as well.

Wine has even found its way into religious poetry on occasion. I close with these lines from the medieval Persian poet, Rumi:

“The grapes of my body can only become wine
After the winemaker tramples me.
I surrender my spirit like grapes to his trampling
So my inmost heart can blaze and dance with joy.
Although the grapes go on weeping blood and sobbing
‘I cannot bear any more anguish, any more cruelty’
The trampler stuffs cotton in his ears: ‘I am not working in ignorance
You can deny me if you want, you have every excuse,
But it is I who am the Master of this Work.
And when through my Passion you reach Perfection,
You will never be done praising my name.’”

– Mevlana Jelaluddin Rumi (1207 - 1273)

Salut!

February 19, 2009 - Wisdom to Survive

Today I’m reading an article from Newsweek, written by Chesley B. “Sully” Sullenberger III, Captain of U.S. Airways Flight 1549, who piloted his plane to a successful emergency landing in the Hudson River. Captain Sullenberger is a national hero, of course. His story of coolheaded competence and courage has spoken in some remarkable ways to a nation grown weary, and wary, of its leaders.

His tale of survivorship says a few things to those of us surviving a different sort of crisis.

First, although I used the word “hero” to describe him, it’s a word he shies away from:

“As my wife, Lorrie, pointed out on 60 Minutes, a hero is someone who decides to run into a burning building. This was different – this was a situation that was thrust upon us. I didn’t choose to do what I did.”

Cancer, too, is thrust upon us. We don’t choose it. Although some are quick to describe us with words like “courage” – maybe even “hero” – it’s not a mantle most of us wear comfortably. We didn’t run into this particular burning building. We woke up smelling smoke, and now we’re trying our best to find a way out of the place. Just because we’re not running around yelling and screaming doesn’t make us especially courageous, or heroic.

Second, Captain Sullenberger has something to say about what it takes to get through a crisis:

“During every minute of the flight, I was confident I could solve the next problem. My first officer, Jeff Skiles, and I did what airline pilots do: we followed our training, and our philosophy of life. We valued every life on that airplane and knew it was our responsibility to try to save each one, in spite of the sudden and complete failure of our aircraft. We never gave up. Having a plan enabled us to keep our hope alive. Perhaps in a similar fashion, people who are in their own personal crises – a pink slip, a foreclosure – can be reminded that no matter how dire the circumstance, or how little time you have to deal with it, further action is always possible. There's always a way out of even the tightest spot. You can survive.”

Indeed. We can survive. When bad news comes, when frightful challenges arise, we may feel for a time like we’re headed for disaster. There are things we’ve learned, though – or can learn – about survivorship. Such wisdom we can fall back on, when the engines flame out and we feel ourselves suddenly descending. Just follow our training, and our philosophy of life. These things will see us through.

“Those who are wise shall shine like the brightness of the sky, and those who lead many to righteousness, like the stars forever and ever.”
– Daniel 12:3

July 25, 2008 - Farewell to Randy Pausch

Sad news, but news we expected eventually. Professor Randy Pausch of Carnegie-Mellon University has died of pancreatic cancer:



See my October 24, 2007 blog entry for more on this remarkable man, and his "Last Lecture" delivered at Carnegie-Mellon. It's become one of the most popular downloads on YouTube. Oprah also had him on her show, to give a Reader's Digest condensed version of the lecture.

Here's a link to a news article about his death.

Many of us are grateful to Randy for modeling what successful survivorship is all about.

Carl

July 13, 2008 - Mind-Body Medicine Stories

Late this afternoon, Claire and I are sitting on the screened-in porch of our little house in the woods. It’s been raining softly most of the day. We have neither energy nor desire to do anything other than just sit here. After all the frenetic days of getting ready for the trip, a long day of driving and another day of settling in, we’ve finally hit rock bottom. We’ve arrived. We’re officially... on vacation.

The first book I picked up to read, out of the pile I brought with me, was one I’ve been hoping to get to for some time: The Cure Within: A History of Mind-Body Medicine, by Anne Harrington (Norton, 2008). I found it so lively and fascinating, I plowed right through it.

Harrington heads the History of Science Department at Harvard. In this wide-ranging survey, she traces the history of a very old idea that’s continued to bob to the surface, despite periodic attempts by some medical scientists to push it back down: the idea that our state of mind influences our bodily health.

The movement called “mind-body medicine” – if it can indeed be called a movement – is fairly amorphous. It contains within it everything from serious scientific studies to absolute quackery. Rather than trying to portray it as a coherent system, Harrington wisely chooses to tell stories. She identifies six signature “narratives” that come up again and again, across the generations:

1. The Power of Suggestion – Beginning with roots in religious exorcism rituals and continuing through the rise of mesmerism (later known as hypnotism) in the 18th and 19th centuries, this narrative culminates in the more recent understanding of placebos as something that may have real therapeutic value. Even skeptical, post-modern folk continue to respond to what has been called “the power of suggestion,” especially when mediated by a doctor or other authority-figure we trust.

2. The Body that Speaks – Beginning with the work of Freud, Harrington traces the efforts of various pioneers of psychology to listen to what their patients’ bodies are saying: not just the quantifiable messages of blood counts and body temperature, but also more subjective messages related to state of mind. From primitive Freudian notions of “hysteria” in women, through studies of “shell shock” (later, post-traumatic stress syndrome) in soldiers, through now-discarded truisms like stress as the cause of stomach ulcers, this narrative has evolved through many incarnations. The saga continues to be told by modern practitioners like cancer-treatment guru Bernie Siegel, who – rightly or wrongly – traces the roots of many cancers to emotional unease.

3. The Power of Positive Thinking – From “faith-healing” miracles at Lourdes, through Mary Baker Eddy’s Christian Science, through Norman Vincent Peale’s “power of positive thinking,” through Norman Cousins’ laughter therapy of the 1970s, to AIDS activists’ embrace of the self-healing concept in the 1990s, Harrington describes the persistent idea that we can think our way to better health.

4. Broken by Modern Life – Before the mid-20th century, the concept of “stress” was nothing more than an engineering term. But then, beginning with the pioneering work of psychologist Walter B. Cannon at Harvard (who identified the “fight or flight” response), and continuing through Hans Selye, who popularized the idea of stress as the signature problem of the modern era, stress is now on everybody’s mind. We’ve heard of the “Type A” personality that’s said to be at greater risk of heart attacks, and we’ve heard how stress-management techniques have helped AIDS patients maintain a healthy immune system. Can anyone doubt that psychological stress is real, and has an impact on physical health?

5. Healing Ties – “If two lie together, they keep warm,” observes the book of Ecclesiastes, “but how can one keep warm alone?” To that ancient wisdom, Harrington might add, “how can one stay healthy alone?” From stories of close-knit, ethnic communities whose members are inexplicably spared the worst of certain diseases, to tales of isolated, sickly children in orphanages who were rarely picked up and cuddled, to support groups that keep cancer survivors healthy, there’s ample evidence that social relationships play a big role in our health.

6. Eastward Journeys – The more disenchanted we in the industrialized West come to feel about our mechanistic, often soulless society, the more some of us are turning eastward, borrowing insights from ancient spiritual practices of India, China and Tibet. Harrington tells the tale of Harvard physician Herbert Benson’s interest in Transcendental Meditation – which he later secularized as “the relaxation response” – and of the east-west migration of practices such as acupuncture and qigong into complementary treatments for cancer.

Reflecting on Harrington’s rich depiction of mind-body medicine, I have to say there’s something troubling about it. If the mind can influence the body in the direction of either health or illness, then what does that say about those who become sick? Are we who have cancer somehow deficient in our thinking? Should we, the victims, be blamed?

Harrington is alert to this problem, mentioning it on several occasions throughout her book. One of the most memorable is connected with her quotation of a “darkly comic” 1940 poem of W.H. Auden, called “Miss Gee.” It’s about an elderly spinster who gets cancer, which her doctor attributes to her tightly-buttoned emotional life.

Here’s an excerpt:







“She bicycled down to the doctor,
And rang the surgery bell;
‘O doctor, I’ve a pain inside me,
And I don’t feel very well.’

Doctor Thomas looked her over,
And then he looked some more;
Walked over to his wash-basin,
Said, ‘Why didn’t you come before?’

Doctor Thomas sat over his dinner,
Though his wife was waiting to ring,
Rolling his bread into pellets:
Said, “Cancer’s a funny thing.

‘Nobody knows what the cause is,
Though some pretend they do;
It’s like some hidden assassin
Waiting to strike at you.

‘Childless women get it,
And men when they retire;
It’s as if there had to be some outlet
For their foiled creative fire.’” (p. 90)

(The “rolling his bread into pellets” is, I expect, a reference to the fact that some early placebo pills were made of bread.)

Ought cancer survivors to be blamed, somehow, for some “foiled creative fire” that has rendered us susceptible to disease? Harrington urges caution. She’s well aware that the insights of mind-body medicine can be a double-edged sword. For that reason, she concludes her book by urging that these healing narratives be used with discretion. Such stories must be used descriptively, not prescriptively. They help us “bridge the lacunae in our thinking.” Even though the use of such narratives may seem, to some, unscientific, medicine still ought “to embrace them as part of its map and part of its territory alike” (p. 255).

The Cure Within is a satisfying read. Check it out.