Saturday, January 16, 2010

Your Mood Does Not Matter: Be as Crabby as you Want

Editor's note: one of the most accomplished  breast cancer blogs I have ever come across is by Hester Hill Schnipper. This oncology social worker's hospital is connected to Harvard University and she has many academic accomplishments. So we are very excited to welcome her to Loop.  Her topic will ring true for anyone who has ever felt pushed to "stay positive".

For years, in my daily practice as an oncology social worker, I have been trying to convince women that normal sadness and anxiety about cancer and cancer treatment does not impact their prognosis. Mood has zero to do with it. This frequent fear of cancer patients, that negative thinking harms recovery or worsens prognosis, has been a Damocles Sword hanging over far too many heads. It also, of course, is circular; it is easy to think along the lines of: " Being distressed will make my cancer worse, and the worse it gets, the more distressed I will be, and then it will be my own fault that the cancer comes back."

These worries are often exacerbated by the remarks of well-meaning friends who remind us: “You have to have positive thoughts” or “Think about good things; I know you are going to be fine.” Not only are these directives annoying, but, after a time, even the most resilient among us can begin to wonder if they are actually true. As in, you hear something enough and it takes on a life of its own.

James Coyne, PhD and his colleagues at the University of Pennsylvania Medical School have done us all an enormous service with the publication of their article: "Emotional Well-Being Does Not Predict Survival in Head and Neck Cancer Patients: A Radiation Therapy Oncology Group Study." (Cancer, Volume 112, Issue 10, 2008, pp 2327-2330) This strong study concludes that emotional status (meaning mood, level of positive or negative thinking, general outlook) neither affects progression of the cancer nor length of survival.

There has never been a well-designed study that indicates anything different. Although there is much written in the popular press about mood or personality type and cancer, it is basically hogwash. My own instinct is that such comments are one way that people who have not had cancer try to convince themselves that they will not ever have the disease. If you can believe that  your health is guaranteed by positive thinking and a sunny outlook, you can feel safe in the world.

Having spent thirty years working with cancer patients, mostly with breast cancer patients, I have never believed this for a minute. Each week, I sit with women of every possible flavor and style. The only common denominator is being female.

Of course, your mood impacts the quality of your life and the enjoyment of your hours. If you spend your days sad and anxious, the quality of your life will suffer. Your cancer, however, will not be impacted at all. The chemotherapy or radiation or hormone therapy will work just as well whether you are crabby and pessimistic or annoyingly cheerful. However, next time you are having a bad day, remember Dr. Coyne and thank him and his colleagues for the reassurance that your negative thoughts or general gloom are not worsening your cancer health. Allow yourself, without guilt, to feel as sad or anxious or frustrated or angry as you need to feel.--and then move on towards a better day.

After Breast Cancer: A Common-Sense Guide to Life After TreatmentHester Hill Schnipper, LICSW
Chief, Oncology Social Work
Beth Israel Deaconess Medical Center, Boston
survivor of two breast cancers

Want to read more from Hester? She has a very valuable and informative blog. She is also the author of "After Breast Cancer" which you can pick up in our Amazon store just a few inches away.


  1. Wonderful article!!

    So many times I've heard "a positive attitude is so important" from friends, strangers, medical professionals, you name it. We're all burdened with the "what if's" (i.e., if I ate better, didn't fall down on the side that got cancer, wasn't depressed for that whole year...). That's bad enough! Then you have to feel upbeat and cheerful, or else?!?

    As far as I'm concerned, any emotion you're feeling at the moment is the right emotion. If you're feeling giddy with hope or really fed up with everyone and everything, it's OK. It's what you feel and no one should negate its validity. Now, if someone tells me to feel positive, I say "shut up and pass the cake."

  2. It's funny, people tell me all the time I have such a positive attitude I will be fine.
    A. It's usually based on a pretty superficial observation.
    B. They are really just trying to make themselves feel better and say something comforting.

    I do think a positive attitude can help with say...housework. (I love taking out trash I tell myself!)

  3. Having just been diagnosed with my second breast cancer two weeks ago, and being about 48 hours out from a bilateral mastectomy.... I may be a little crabbier than usual and I'm celebrating this article. I think if I had a dollar for every variation on 'think positive' or 'you can beat it again -- you're so strong' I could fund a whole lot of worthwhile research.

  4. Excellent posting!! The last think a breast cancer patient wants to hear is, "Think positively," which is what I heard from others during my treatment. I also heard that "breast cancer is the best cancer to get."

    People are in denial when they say these things. I really loved your article, and thank you for doing us such a great service in writing it.

  5. Debbie, hope you are feeling better soon. You have amazing genuine positive energy, and have earned the right to be crabby when you want.
    I really want to find a pink Oscar the Grouch.

  6. That only thing I hate more than "You have such a good attitude" and "With your sense of humor" is when someone says, "I have a pink shirt for you!"

  7. As a spouse of someone who has had active cancer for 5 years, with all the chemo and surgeries that come with that, I agree that it is very theraputic to let your feelings out and if you are feeling down or crabby and irritable it is totally understandable. However, in the family unit, letting your feelings out and being as crabby as you want to be, actually can be harmful to other family members who live with you, such as your children, especially young children. How is crabby OK in that situation?