Monday, December 12, 2005

An Unwanted Journey: Day 0018 - Optimism

A few days ago I wrote that hope and concern were flip sides of the same coin. Another way to imagine this is to think of a spectrum with markers demarcating more or less optimistic outcomes. As I await medical imaging results and the pathology report, it is the continuum or spectrum of outcomes that drives my anxiety and my hope.

At the pessimistic end of the spectrum is the possibility that the images will reveal a tumour which has broken through the bowel walls completely, has invaded numerous lymph nodes and possibly even metastasised to the liver or lungs. The biopsies would show clear carcinoma.

At the optimistic end of the spectrum is the possibility that the images will show a large tumour that has not broken through the bowel wall, but is long and relatively shallow. The biopsies would show a tubulovillous adenoma with low-grade dysplasia like the previous biopsy. The CT scan and MRI would show no indication of lymph node involvement and no hint of metastases to any other organs.

In between, we get middling results. Perhaps the biopsies show no carcinoma, but the images show penetration of the bowel wall. Perhaps the biopsies give evidence of cancer, but the tumour is shallow with no lymph node involvement. Perhaps there is only some evidence of enlarged lymph nodes but no marks on the liver. And so on…

As I read Paul Tillich’s The Courage To Be today, I discovered that these kind of scenario-building fantasies reflect the natural inclination to relieve anxiety by turning it into fear of a particular object. In other words, generic anxiety and dread are eased by thinking of specific situations that I fear but for which I can generate a measure of courage or fortitude. By focusing on concrete objects or situations fear and bravery becomes possible. Far, far worse is unspecified, inarticulate dread. And, I suppose, it might also be reasonable to assume that unspecified, unrealistic hope is unhelpful since it betrays denial and unwillingness to face truth.

But I’m not so sure about generic optimism. Martin Seligman’s book Learned Optimism has a chapter devoted to health and the effect of learned helplessness. In case after case, he demonstrates that a “fighting spirit”, a sense of general optimism, a sense of control and participation in one’s own treatment leads to better results. Where there is a delicate balance, optimism he says can make the difference between life and death.

One thing about all this is virtually certain. It is far better to live one’s life with hope and optimism than to wallow in despair and dread.

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