Martin, a 70-year-old Georgia resident, experienced two major losses within a short time. First, he lost his wife of 40 years. Then, he remarried, but his new wife of six weeks deserted him. He became very depressed. Two and a half years later Martin was diagnosed with pancreatic cancer.
Was there a hidden link between his depression and the cancer? Research shows there is such a link. So, is cancer just the last straw in an unhappy life?
Two major studies of Western Electric Company employees showed a relationship between self-reported depression symptoms and higher risk of mortality over 17-and 20-year follow-up periods. The findings led some to speculate that depression would officially become a risk factor for cancer.
Additional studies show that a large portion of women diagnosed with breast cancer are convinced their disease stems from a major life stress, such as an abortion, divorce, child’s illness, or the loss of a job they liked.
This may not have surprised early doctors. They documented the impact of mental health on physical illness in ancient times.
Ancient Greeks found the link between
depression and cancer
Two thousand years ago, the Greek physician Galen observed that depressed people were especially prone to develop illness.
In 1759 an English surgeon wrote that cancer “went with disasters in life.” Later, in 1846, British medical authorities considered “mental misery, sudden reverses in fortune, and habitual gloominess of temper… to constitute the most powerful cause of the disease.”
Dr. Walter Hayle Walshe, a prominent surgeon and cancer authority in the middle of the 19th century, added, “I have myself met with cases in which the connection appeared so clear that I have decided questioning its reality would seem a struggle against reason.”
Of course, not everyone agrees with these early findings. Some researchers point to data that suggests depression predicted cancer mortality in smokers but not in non-smokers.
What’s more, several later studies failed to find much of a correlation between depression and cancer. One meta-analytic review concluded that depression was only a very small indicator for cancer. Other studies continue to prolong these see-saw conclusions. So, while some studies imply an increased risk of cancer, others suggest that depression doesn’t necessarily indicate anything.
Why are conflicting results so common?
At first glance, it seems it should be easy to determine if cancer is linked to depression or not. However, it’s not easy to separate other emotional factors or even physical ones from depression. Behaviors like smoking and using alcohol, along with biological factors such as growing older, becoming overweight, and having a family history of cancer, are all common risk factors.
Researchers can find it difficult to control for these factors in a study group, or to separate the role of stress or depression from these factors.
Do YOU have a cancer prone personality?
Sometimes it’s called the “hit and sink” phenomenon, referring to the children’s game of Battleship…
Imagine a person who never felt fully welcome during childhood, or simply had cold, distant, or demanding parents who gave little or no encouragement. Later, this person conforms to what everyone expects of them, to avoid conflict. They safeguard their emotional security by investing heavily in their profession, marriage or children.
When that investment is threatened or lost, the childhood grief returns, and the emotional suffering is more profound than ever — leading to feelings of helplessness, despair, and abandonment.
When the second “hit” strikes, a person’s psychological and/or physical structure may collapse. The Emory University lab of Charles B. Nemeroff, M.D., PhD, published a study based on this theory. Dr. Nemeroff found that depressed adult patients with traumatic childhoods had stronger inflammatory factors — ones contributing to cancer development — and reacted far more than most people to lab-induced stress.
An animal experiment by Martin Seligman, PhD, at the University of Pennsylvania demonstrates this perfectly. Warning: I find this study distasteful, and you may, too, but we can learn something from it.
Helplessness leads to cancer in lab animals
In this research professor Seligman and his team grafted onto rats cancer cells that were known to induce a fatal tumor half of the time. In this experiment the rats were placed into one of three groups:
Control group: The animals received the cancer cell graft but were not manipulated in any way.
Group 2: Rats were given small electric shocks, which they could learn to avoid by controlling a lever in their cage.
Group 3: Rats were grafted with the cancer cells and given electric shock, but there was no escape mechanism available.
As published in the journal Science, having an escape mechanism had a very clear effect on whether the rats succumbed to cancer.
Surprisingly, group 2, which could avoid the shock by controlling a lever, rejected cancer development more effectively than the control group — 63 percent of group 2 rejected it, while 54 percent of the control group rejected it. That’s how important it is to feel you have some control, some ability to manage your own fate.
Sadly, only 23 percent of the animals subjected to electric shock without means of escape could overcome their cancer. It appears that the helplessness of their situation increased the tumor’s spread.
Does the quality of your relationships
make a difference?
Psychiatrist David Spiegel, M.D., from Stanford University, believes that to be fully human, people need authentic relationships. As a young psychiatrist in 1980 he had the opportunity to work with psychotherapist Irvin Yalom, M.D., who was testing this idea.
Together, they held weekly support groups for women seriously ill with metastatic breast cancer. Their prognosis for survival ranged from a few months to a few years. In the study, these groups of eight to ten women met weekly for a year. They talked about their fears, their loneliness, and their anger, along with their desires and ways of coping with the disease.
Something quite miraculous happened. The meetings were filled with natural laughter and camaraderie. Somehow by accepting their own wounds, they had opened the way to positive emotions, joy, the desire to live, and more.
Dr. Spiegel compared the psychological state of these participants with women (with the same diagnoses and medical treatments) who did not participate in these group meetings.
The women who had learned — thanks to the support group — to confront their fears, to express their inner feelings, and to experience more authentic relationships, were less likely to experience depression, anxiety and even physical pain.
Dr. Spiegel expected the groups to improve their entire emotional state. But he never expected to discover what he did about the course of the disease — or the chances of survival.
Support groups can double survival time
When Dr. Spiegel followed up with these women ten years later, a big surprise awaited him…
Three of the 50 support group members answered the telephone themselves. Considering how extremely grave their condition was, that was simply astounding. Not a single member of the 36-women control group had survived so long. That’s right, the women who hadn’t enjoyed the benefit of a support group had all passed away.
While questioning the families about how long the support group members had survived, he found that they’d lived on average twice as long as the members of the control group.
He even discovered a difference between regular attendees and sporadic attendees of the groups. The more regularly a woman attended, the longer she survived. It’s important to stress that all the patients had similar diagnoses at the beginning, and that the selection of those who joined the therapy group versus the control group was completely random. The study was designed to guarantee that members of the therapy group didn’t survive longer just because they had better health to start with, or because they had a different psychological disposition. The outlook for both groups was the same at the beginning.
When these results were published in the journal The Lancet, they rocked the medical establishment. Since then, other studies have tested this same hypothesis. Four had results comparable to Dr. Spiegel’s. Six observed no effect.
Today, Dr. Spiegel is associate director of the Department of Psychiatry at Stanford University, and one of the best-known academic psychiatrists.
When asked to explain his unusual findings, he said, “Feelings you can’t express become an internal obstacle. They use up resources we don’t completely understand. Expressing and accepting them stops using these resources to keep them out of awareness. How that translates in how the body fights illness is still a mystery, but I’ve come to believe it does, and we are beginning to understand the mechanisms.”
Thanks to this study, the link between mental state and the development of disease progressed from being some kind of crazy “new age” idea to a respectable scientific hypothesis.
Psychoneuroimmunology is an established
During the past 20 years, a cutting edge new medical field has begun studying the specific link between psychological factors and your immune system function. It’s called psychoneuroimmunology. It connects the dots between psychology, neurology, and immunology.
It’s a bit complex, but everything suggests that the cells of your immune system (NK cells and T and B lymphocytes) are especially sensitive to feelings of helplessness. For example, the overwhelming feeling that nothing can be done to overcome the disease — like those poor rats that were afflicted with shocks and had no way to stop them. If it goes on long enough it can result in the loss of will to live. Just like professor Seligman’s rats.
Humans, unlike the lab animals, can rediscover the will to live. We can experience a decisive turning point in the course of a disease.
Reconnecting with anything alive — the tree outside your window, children running through the hallway or down the street, your dog or cat, even the breaths you take — can prompt your immune system to rally and fight on.
In addition, I’d add that after a loss or any other major trauma if you don’t seek professional help then keep an “emotional diary.” At least once per day, write down your innermost feelings without any editing. If keeping a diary is not for you, then pray or talk openly with a trusted friend.
- Irwin, Michael R, Several Factors May Explain Cancer, Depression Link, Psychiatric News, Nov. 21, 2003, Vol. 38 Number 22, p. 27. American Psychiatric Association.
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- Moyers, B., “Healing and the Mind,” Public Broadcasting System, 1993.