The Mind-Body Cure. Bal Pawa
reacted in a state of panic before I could give her all the information. She had lost an aunt to breast cancer many years earlier and watched her die. No amount of reassurance and education about new treatments would convince Jane that she would not necessarily have the same outcome as her aunt. It took a lot of time to calm her down so I could explain the next steps.
Shortly after the initial visit, both Carol and Jane required the same surgery, which the same surgeon performed. The same oncologist at the same hospital prescribed the same chemotherapy and radiation protocol. Since the pathology report was the same, they received the same course of medical treatment.
Due to her anxious mood, I referred Jane for counseling and a cancer support group. Counselors reported that Jane lived with the fear of pain and death and had little faith in herself or the medical system. Her anxiety became so severe, I also had to prescribe sleeping pills and anxiety medication. Occasionally, the anxiety escalated to debilitating panic attacks. She rarely left her house except to attend medical appointments. Jane cut herself off from friends and stopped going to church.
It’s important to recognize that having anxiety isn’t “wrong” or “bad.” Anxiety is energy, and it is up to us how we channel that energy. In Jane’s case, anxiety was a maladaptive emotion that made her body sick. Carol chose to channel her “anxious” energy into constructive behavior to keep herself motivated toward her goals of traveling and spending time with her grandchildren.
The oncologist and I had discussions about Jane’s lack of response to cancer treatment, the severe side effects, and the poor prognosis she faced. Carol also had side effects of chemo and many rough days, but her follow-up reports were excellent. The staggering difference perplexed me. Why were these two women responding so differently to the same treatment when surgery had confirmed identical pathology? Had I missed something? I second-guessed myself and reviewed both files after work one day, trying to find a reason why one patient was declining day by day and the other patient was improving.
Sadly, Jane continued to get sicker. Her cancer spread to other organs including her brain, and she lost her battle with cancer after eighteen months of treatment. For Jane, it had truly been a “battle.” She was angry and scared and saw her cancer as the enemy.
Carol had a fairly good recovery despite the awful side effects. When she lost all her hair, she went out and bought several wigs and called them funny names. Marilyn Monroe was her blond wig. A dark brown wig with a whitish streak she called “Roadkill.” Carol kept up a good front of humor and she remained grateful for each day; she saw her cancer as a “gift” to remind her to live each day to the fullest. Today, Carol is still alive and cancer-free, and I receive occasional cards and messages from her. She went on a cruise and has made countless memories with her grandchildren.
These two patient interactions forced me to consider the stark difference in their attitude and mindset. Jane had accepted defeat before she began the fight. She feared death far more than she trusted herself and the medical system. Jane truly believed the cancer would kill her, and it did. She had fixed beliefs of an illness mindset and no one had the power to change her beliefs. That is the profound power of the “nocebo” effect.
While the benefits of cultivating a health mindset are desirable, just thinking about it and “espousing” it are not enough. “Think healthy thoughts and you will be healthy,” many self-help books profess. It may be a step in the right direction, but positive thinking backed by a health mindset and applied ability—effort and practice—guarantee better outcomes. The positive knowledge and dialogue have to become a part of the subconscious narrative; we must have faith that we are a part of our healing and that healing begins inside. And we must act on that belief.
HOW TO CULTIVATE A HEALTH MINDSET
As a physician, I have learned to recognize the qualities that are a common denominator for health when assessing patients. Individuals with a health mindset see health obstacles as challenges and learn how to navigate them by asking questions and staying open, curious, and informed. They are compassionate and kind toward themselves. They work harder and smarter than other patients because they know they are worth it and are confident about being in charge of their health.
They show their vulnerability and ask for help when needed. They display a can-do attitude. They step outside their comfort zone to get the health outcomes they need and want. They see a future for themselves and have cultivated family or friend support systems. They have purpose and want to live better. Those with a health mindset are more likely to see diagnosis of an illness as a challenge to overcome and seek opportunities to improve their coping skills and enhance their knowledge. They often reframe their adverse experience as a “gift” rather than a curse. It helps if they are lighthearted and possess humor. The ability to laugh at themselves or at life and realize being healthy doesn’t have to be a serious business goes a long way.
In my practice, I recall a patient who had a terrible car accident, an athletic student who suffered multiple injuries including damage to the spinal cord. Doctors said he would never walk again. He took this as a challenge and proved them wrong. He was walking in less than a year; through sheer grit and determination, he achieved what doctors considered medically impossible. There are hundreds of cases where patients have gone against the odds to prove the medical establishment wrong for boxing them in. If we examined their pre-sickness personality, we would find they had a health mindset before they became ill. They had a permanent belief, an inner wisdom, an ability to trust that they had options, and their ability to respond was “unlimited” even if their circumstances were limited. To cultivate healing, I urge my patients to be active participants in their healing and hold on to their power by being responsible and accountable for their choices. It’s a lesson I had to learn firsthand.
➤ My Story
After my accident, I remained in a holding pattern of physical and emotional pain for quite some time, for several reasons. I had developed an inner dialogue of being a “victim.” I blamed the driver: “He should have been watching.” I blamed myself: “I could have taken a different route home.” Sometimes I pitied myself because I felt it was unfair the accident happened to me. Losing my baby made me upset, sad, and frustrated—I knew I was in no shape to have more children in my condition and I wasn’t getting any younger, but I wanted a bigger family. I developed terrible insomnia, mostly because of chronic physical pain and nightmares of the accident. This left me with severe fatigue, which was often debilitating.
I was led to conclude the only answer to my situation was more drugs and more surgeries, yet neither appealed to me. By that time, I had tried many different medications, received several injections, done a variety of physical therapies, and even undergone multiple surgeries. Nothing had provided sustained relief for the chronic pain. Looking back, I now see that I was in an illness mindset because I felt hopeless: nothing had worked, and as a result, I believed there was no end in sight. I also believed I didn’t have the power to change my outcome, that I was a victim of my circumstances and pain and loss, that I just had to put up with it. And being a physician compounded the problem, because I often felt that if I couldn’t heal myself, how could I expect to help others.
My first step to healing was starting to become aware of my “self,” especially the thoughts that were not serving me well. I began to notice the repeated patterns of negative thoughts and make a conscious effort to think more positively. For example, instead of mourning the loss of my unborn child, I began to focus on the two beautiful children already in my life. Instead of seeing the loss of my career delivering babies as a failure, I began to focus on what possibilities were going to come from this situation someday. Instead of resenting the physical pain in my body, I began to see it as telling me to pay more attention to self-care and be more kind and compassionate to myself. Reframing my thoughts and making that change to a new mindset for healing took awareness, insight, energy, and time, but it was the best prescription I have ever filled.
Upgrade Your Inner Dialogue
Look within and take an honest inventory of your