Sunday, July 6, 2008

That’s It! It’s Sexism!

I’ve been doing a lot of thinking about the mind-body connection in health, starting from some interesting comments from Elizabeth about how a cancer study showed that people do just as well when they have a bad attitude, exclude themselves, etc., so I’ve done some internet digging and other reading.

In a recent article, Peggy Orenstein says that we want to believe that stress causes illness, and that she has had to deal with “intimations that stress, or some other-self inflicted wrong thinking could be the source” of her breast cancer and infertility problems, and that we believe the “corollary…that we’re also responsible for our own misfortunes.” In fact, she says, most ovarian and breast cancer survivors attribute their survival rates to positive attitude, with fewer than 5% of the breast cancer patients citing medical treatment as curative or partly responsible for survival.

Can that really be true, that positive attitude (along with complementary therapies, no doubt) cures, while medical treatment really isn’t necessary? Or do people operating in the realm of uninvestigated beliefs and biases believe that medical treatment won’t work if someone has a “bad attitude,” doesn’t pray enough, or should have feng shui-ed the house? In the cult of breast cancer, women are told that they’ve taken on too much, had too many responsibilities, had their heart chakra psychically wounded, any of which is theoretically possible. As someone who uses complementary therapies, I don’t knock these ideas entirely. But it’s unintelligent to assign most of the manifestation or recurrence of illness to personality and social factors. All kinds of factors can influence the development of breast cancer, including family history (those BRCA1, BRCA2, and ATM genes can be powerful predictors of breast cancer), environmental factors, diet, age at first menstruation, age of menopause, pregnancies, diet, and breastfeeding “status,” among a host of others.

While there’s some indication that the cancer survival rates may be the result of earlier detection rather than better therapies and surgical techniques, reducing stress alone or being “courageous” could not be the primary factor in the change in the survival rate. In fact, if this were true, then we’re back to the 1970s “blame the victim” for cancer mentality: if you die, it’s your fault, and you have cancer because you did something wrong. In addition, patients on placebo drugs or an older drug would perform much better in the clinical trials comparison to patients administered a newer therapy. And in terms of genetics, do women inherit their parents’ or grandparents’ problems?

Let’s look at breast cancer recurrences. According to a publication of MD Anderson Hospital, the 5-year survival rate for recurrences of breast cancer increased from 10% in the 1970s to 44% in the late 1990s. The 5-year survival rate for first-time breast cancers has been similarly dramatic. So according to the reasoning of the breast cancer cult, women in the 1990s and beyond are under much less stress, pray more, and have a more positive attitude than women in the 1970s. Given our 24/7 electronic culture that extends to our working and personal lives, and more overscheduled lives, and factors such as poverty and lack of access to medical care for many people, does anyone really think this is true? Could it be that breast cancer survivor patients have got their lives in order better than those who died?

The cult of breast cancer, it must be remembered, is specifically female. Many physicians have confirmatory bias in regards to gender, believing that their female patients are neurotic or stressed rather than ill, finding their beliefs “confirmed” by observations rather than questioning their assumptions. Thus women are less likely to be diagnosed with heart attacks and are sent home from the ER with an “anxiety attack” because symptoms of heart attack are different in women than men. Or the typical back pain patient is told that their back pain is from “stress” (physicians will almost never use the term “psychological”) rather than biomechanic, or that most people will have an acute episode of back pain in their lives, and that they will probably recover (and when they don't?--pull out the pop psychology). And patients themselves also exhibit confirmatory bias: they reduce their stress, go to PT, adopt yoga: ergo, they get better. Nevermind that they’d get better anyway without treatment for some conditions, or that the drugs, surgeries, changes in diet, and exercise, not a positive attitude, make the difference.

While on occasion men are blamed for inexplicable illness, as with Gulf War Syndrome, most often it is women who are told, by physicians, friends, and strangers, that we’d just get better if we were better people and lived our lives more purely. It’s primarily women who are the target audience for the “heal yourself” genre and my favorite, yoga and acupuncture. Thus we get nuts like Louise Hay telling us that people with muscular dystrophy believe “It’s not worth growing up” (nevermind that they all have different genetics from people without muscular dystrophy), people with multiple sclerosis, which affects more women than men, show “mental hardness, hard-heartedness, iron will, inflexibility. Fear” (not those that I know!) and those with a stiff neck show “unbending bullheadness” (and see, I already feel guilty, although sometimes I am not bullheaded enough, and that’s affected my life in major ways; above all else it’s important to me that the people I am around are happy). My neighbor believes that his multiple sclerosis was precipitated by a very stressful business situation in which his partner behaved unethically, and stress can have effects on the immune system. Nevertheless, stress is often unavoidable; in his case, it was unpredicted. That doesn’t mean the illness is his fault or that he can cure it by being positive, nor do many people seem to suggest that he should, in comparison to women I know with chronic illnesses.

We should learn to give credit where it is due and remove the blame from the body's malfunctioning. Early detection of illnesses and their early treatment with better pharmaceutical products, not sheer willpower, have reduced cancer mortality. Allopathic and complementary medicines have some major effects on illness and pain, and while a positive mindset might have some still undetermined effect on recovery, continuing to elevate breast cancer patients as heroes and continuing to honor the occasional person with quadriplegia who is able to walk again as someone who “didn’t let her disability stop her", as some kind of beauty pageant winner among unwilling and ugly ducklings, devalues those who do not recover fully. Confirmation bias leads us to believe that women in particular are disabled or ill or even die because of their bad attitudes rather than their health.

If positive attitude created cures, my colleague at work should not have died. She was always positive, happy, genuine. I'd say more, but I have to feng shui the house.


Haralee said...

In my experience it is people who have not experienced cancer themselves who say "you brought this on your self".
It is the poor logic that goes along on many subjects, and yes it is sexism.

FridaWrites said...

Welcome, and thanks for your input. I would love to see the day when people would demonstrate empathy without having to experience such illnesses themselves.

Elizabeth McClung said...

I am incredibly disturbed by Peggy Orenstein article. That SO MANY women believe that whether they live or die is based on a smile (I just see the Simpson's episode in my head where lisa, like all females is told, "If you just smile enough; people will like you, things will go well!"). Read Chemo World as published in Harpers of July 2007 I believe for a look at Chemo from a ward nurse who watched the head of the ward get cancer and start on the chemo track. She has little illusions about Chemo and Cancer and wrote about the side effect and tremors of chemo, "One woman said that if she couldn't knit she would rather die, and stopped treatment. She died." but then goes on to describe others, who even as they plainly lay dying, cracking jokes would keep taking the chemo and then died too, while others lived.

Actually it was when I was having my, "What did I do? moments that someone put the link to the study on my blog sometime in the past (A year ago) - helped cured my doubts - ah here it is:

"People who have a positive outlook about their cancer are just as likely to die as people who are depressed about their disease, report U.S. researchers."

So, you are free to get mad, get angry, not be a "nice girl", pout, get depressed and know that no, you aren't to blame, you aren't making it worse, you are just surviving.

They should put that paragraph about the entrance to the Women's Hospital - support groups are great, don't get me wrong but cancer sucks - has and will. Why are women supposed to be chipper about it? Get medicine.

FridaWrites said...

I'm glad someone cured your self doubts; that's a freeing gift.

Unless proven otherwise, I'm going to adopt this position for my own health issues. My guess is the guilt harms me more than any "bad outlook" about my health would. Honestly, most any part of a "bad outlook" is a result of people's reactions to me rather than the pain itself.

My response to one of the spine doctors about surgery was that I was:
1. afraid
2. felt guilty
The fear he understood; the guilt he didn't. And that's good. My guess is that many women feel guilty about what they can't do, about the cost, about the down time, about not getting better.