GABRIELLE GIFFORDS'S remarkable recovery from a bullet to her head has provided a heartening respite from a national calamity. Representative Giffords's husband describes her as a "fighter," and no doubt she is one. Whether her recovery has anything to do with a fighting spirit, however, is another matter entirely.
The idea that an individual has power over his health has a long history in American popular culture. The "mind cure" movements of the 1800s were based on the premise that we can control our well-being. In the middle of that century, Phineas Quimby, a philosopher and healer, popularized the view that illness was the product of mistaken beliefs, that it was possible to cure yourself by correcting your thoughts. Fifty years later, the New Thought movement, which the psychologist and philosopher William James called "the religion of the healthy minded," expressed a very similar view: by focusing on positive thoughts and avoiding negative ones, people could banish illness.
The idea that people can control their own health has persisted through Norman Vincent Peale's "Power of Positive Thinking," in 1952, to a popular book today, "The Secret," by Rhonda Byrne, which teaches that to achieve good health all we have to do is to direct our requests to the universe.
It's true that in some respects we do have control over our health. By exercising, eating nutritious foods and not smoking, we reduce our risk of heart disease and cancer. But the belief that a fighting spirit helps us to recover from injury or illness goes beyond healthful behavior. It reflects the persistent view that personality or a way of thinking can raise or reduce the likelihood of illness.
The psychosomatic hypothesis, which was popular in the mid-20th century, held that repressed emotional conflict was at the core of many physical diseases: Hypertension was the product of the inability to deal with hostile impulses. Ulcers were caused by unresolved fear and resentment. And women with breast cancer were characterized as being sexually inhibited, masochistic and unable to deal with anger.
Although modern doctors have rejected those beliefs, in the past 20 years, the medical literature has increasingly included studies examining the possibility that positive characteristics like optimism, spirituality and being a compassionate person are associated with good health. And books on the health benefits of happiness and positive outlook continue to be best sellers.
But there's no evidence to back up the idea that an upbeat attitude can prevent any illness or help someone recover from one more readily. On the contrary, a recently completed study of nearly 60,000 people in Finland and Sweden who were followed for almost 30 years found no significant association between personality traits and the likelihood of developing or surviving cancer. Cancer doesn't care if we're good or bad, virtuous or vicious, compassionate or inconsiderate. Neither does heart disease or AIDS or any other illness or injury.
And while we may be able to point anecdotally to a Gabrielle Giffords as an example of how a fighting spirit improves medical outcome, other people with a spirit just as strong die — think of Elizabeth Edwards, for example. And many patients who employ negative thinking nevertheless recover from illness every day. We want good things to happen to good people and this desire blinds us to evidence to the contrary.
But such beliefs have implications for how we regard people who are ill. If people are insufficiently upbeat after a cancer diagnosis or inadequately "spiritual" after a diagnosis of AIDS, are we to assume they have willfully placed their health at risk? And if they fail to recover, is it really their fault? The incessant pressure to be positive imposes an enormous burden on patients whose course of treatment doesn't go as planned.
Very early in my career, I participated in a study of young women who were hospitalized and awaiting the results of biopsies to determine if they had cervical cancer. While I was interviewing one of my patients, the biopsy results of the woman in the next bed came back to her — negative. The fortunate woman's father, who was there with her, said in relief: "We're good people. We deserve this." It was a perfectly understandable response, but what should my patient have said to herself when her biopsy came back positive? That she got cancer because she wasn't a good person?
It is difficult enough to be injured or gravely ill. To add to this the burden of guilt over a supposed failure to have the right attitude toward one's illness is unconscionable. Linking health to personal virtue and vice not only is bad science, it's bad medicine.