The burden of positive thinking

By Ellen Anderson, Ph.D
March 5th, 2023

February was “Red Dress Month,” a campaign from the American Heart Association to promote awareness of heart disease in women. Much like the “pink ribbon” campaign for breast cancer awareness, there are multiple walks, runs, and celebrations for survivors of cardiac illness. Such events are intended to honor those who have been affected by the disease.

I attended a recent event for cancer survivors with a video presenter presenting a high energy, upbeat, motivational talk replete with phrases such as “booyah!” and extolling the audience to “find your joie d’vivre”!

The audience included multiple women with stage IV cancer and it was hard to ignore the incongruence between the speaker’s intention and the effect on the audience. While the message appeared to resonate with some, others reacted with facial expressions of anger, skepticism, and sadness.

It is a nuanced line between promoting mindful awareness of the positive aspects of life and insensitive positivity. Working with people who have medical problems is my passion and life’s work.

Life threatening illness, even when curable, provokes thoughts of mortality in most people. This existential awareness can be a catalyst for profound change and self-awareness. However, the road to such self-awareness can feel lonely, angry, hopeless, and beset with uncertainty.

Oncology patients who are in active treatment often fear that their treatment will stop working, or that cancer will recur or progress. Life is put on hold in the context of serious medical illness for both the individual affected, as well as their family.

One of the more common frustrations voiced by clients is that friends and family encourage them to “stay positive.”

The late Barbara Ehrenreich, activist for social justice and author of the book “Bright Sided: How the Relentless Promotion of Positive Thinking Has Undermined America,” has written about the wave of “mandatory optimism” that has permeated medicine and psychology.

She writes that “Americans need to recover from the mass delusion that is positive thinking.” Though well meaning, efforts to buoy a loved one with optimistic thoughts can feel invalidating. Life threatening illness is frightening and evokes a wide range of emotions. Clients report feeling guilty that they are angry and sad, even though these are expected reactions to becoming ill.

The transition from apparent health to sickness involves complex feelings of loss and grief. Social psychologist Ronnie Janoff-Bulman, professor emerita at University of Massachusetts Amherst, theorizes that people hold implicit assumptions that allow them to feel relatively invulnerable to trauma such as life-threatening illness. People state, “I never thought this would happen to me” in the face of trauma or crisis and search for a reason or meaning. Thoughts about the person they might have been if illness had not developed are common. Anticipatory grief occurs when there is an expectation of potentially shortened life span or loss of bodily integrity.

Yet another type of loss involves disenfranchised grief, that which is not acknowledged or validated by others. Treatment for early-stage cancers can be debilitating and result in tremendous losses such as inducing menopause in women with breast cancer, chronic incontinence as a side effect of prostate cancer, or loss of bodily integrity in cases of mastectomy. Family and even health care professionals may inadvertently invalidate a person’s sense of loss by focusing on the notion that they should be happy that they are cancer free and indeed, that cancer can be a “gift” that promotes growth.

It is difficult enough for therapists to sit with clients trying to metabolize grief, sadness, and worry. Thus, it is not surprising that by engaging in well-meaning efforts to try to raise a person’s spirits, we may do just the opposite.

Life threatening illness can serve as a catalyst for the development of emotional resilience. Teresa Desheilds, psychologist and researcher at Rush Medical College, has described resilience as both an outcome and a dynamic process of recalibration. Allowing ourselves to let go of the pressure to provide reassurance or promote positive mood in another person and instead, mindfully staying focused on the present moment without judgment accomplishes a great deal. It acknowledges grief, provides social support and in so doing, may help to foster emotional resilience and hope.

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