Positive thinking is for bullies

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We would all agree that coping with cancer is enough for anyone. Now I've written about cancer and metaphors before. I can't get enough of the topic, although I should never have written that first blog without having read and re-read (and, as is the case here, re-re-read) the most important book on the subject, Susan Sontag's illuminating Illness as Metaphor.

Sontag notes the incessant comparisons to cancer:

- During Watergate, Deep Throat was a cancer within the White House
- DH Lawrence called masturbation a cancer on civilization
- Sontag herself compared the White Race to cancer during the Vietnam War
- Leon Trotsky said that Stalinism was the cancer of Marxism

Then she strikes the bell:

  • "The people who have [cancer] are hardly helped by hearing their disease's name constantly being dropped as the epitome of evil."


Sontag wrote the book when she herself was undergoing treatment for breast cancer. In the book she makes a shocking claim—that in the 1960s and 70s in the US and elsewhere it was common for doctors to omit something important when talking to their patients—namely, cancer patients weren't told they had cancer.


The doctor would inform the family, not the patient.

I talked to my aunt, who worked as the head of social services for one of the largest hospitals and cancer centers in the US, and she confirmed it. "Patients were only told they had a tumor. They were never told the 'C' word." This was the case, she said, because everyone feared a patient hearing 'you have cancer' would roll into a ball and begin the process of dying on the spot.

Our conception of cancer remains, such that people hear they have cancer and want to roll into a ball anyway. This often recedes as they learn more about their disease, a process that takes cancer out from an elevated spot peering darkly over our shoulder at us, and into the street, under the emboldened light of day.

Sontag concludes,

  • "As long as a particular disease is treated as an evil, invincible predator, not just a disease, most people with cancer will indeed be demoralized by learning what disease they have. The solution is hardly to stop telling cancer patients the truth, but to rectify the conception of the disease, to de-mystifiy it."



It would seem that Sontag's vision is coming true—too true, for some—according to Barbara Ehrenreich's book on her experience with a breast cancer dx, Bright-Sided: How the Relentless Promotion of Positive Thinking has Undermined America , published in extracts by the Guardian as Surprise! You've Got Cancer. She writes:

  • "The first thing I discovered … is that not everyone views the disease with horror and dread. Instead, the appropriate attitude is upbeat and even eagerly acquisitive. There is, I found, a significant market for all things breast cancer-related. You can dress in pink-beribboned sweatshirts, denim shirts, pyjamas, lingerie, aprons, shoelaces and socks; accessorise with pink rhinestone brooches, scarves, caps, earrings and bracelets; and brighten up your home with breast cancer candles, coffee mugs, wind chimes and night-lights."

This outlook goes overboard for Ehrenreich, leaving her feeling isolated:

  • "No one among the bloggers and book writers seemed to share my sense of outrage over the disease and the available treatments … In the mainstream of breast cancer culture, there is very little anger … In fact, the overall tone is almost universally upbeat."

She notes a 2004 study out of Australia that showed that a positive attitude did not impact cancer survival, a finding the American Cancer Society was quick to hedge by asserting that while a positive attitude has little or no bearing on actual outcome, it does contribute to quality of life (neither of which, to my mind, seems scientifically quantifiable or provable anyway).


In sum, Ehrenreich finds the so-called "tyranny of positive thinking" espoused by the likes of Oprah Winfrey and Deepak Chopra to be for the benefit of others and to the potential detriment of the patient:

  • "The sugar-coating of cancer can exact a dreadful cost … it requires the denial of understandable feelings of anger and fear, all of which must be buried under a cosmetic layer of cheer. This is a great convenience for health workers and even friends of the afflicted, who might prefer fake cheer to complaining, but it is not so easy on the afflicted."


Cancer patients have enough to carry, their burden is plenty great, they don't need to shoulder the added freight of our collective fears of this disease, either by force or metaphor.

Let's not bully people with cancer into making us feel better about their diagnosis. Rather, lend an ear and let 'em feel whatever they feel like feeling.

By Ross Bonander

- Sontag, Susan. Illness as Metaphor. Picador, New York. 1988.

- Ehrenreich, Barbara. Bright-Sided: How the Relentless Promotion of Positive Thinking has Undermined America . Metropolitan Books, New York. 2009.

- When Thumbs Up Is No Comfort, by Jan Hoffman (The New York Times, June 1, 2008)

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