My friend’s son–somewhat of a haphazard student throughout high school–landed himself a spot in the class of 1996 at none other than Harvard University.
I had to know more about this.
“John,” I asked, “What do you think you did, maybe outside of school, maybe in extracurricular activities–I don’t know–that got you into Harvard?”
“You know how I got into Harvard, Dr. Abrahamson? Really and truly?” he parried.
It was plain dumb luck.”
Gotay did come up with something, though. In her article “Why me? Attributions and adjustment by cancer patients and their mates at two stages in the disease process,” those who didn’t cite chance, most commonly attributed it to–and I find this incredibly inspirational, as trite a thing as that is today–the chance to find positive meaning in the illness, and God’s will.When asked by researcher Carolyn Gotay, Canadian Cancer Society Chair in Cancer Primary Prevention, why they believed they had gotten cancer, a group of breast cancer patients surveyed most frequently sided with John. Gotay found that her subjects most often cited “chance” (the grown-ups’ version of ‘dumb luck’).
I was a bit amused by a study of breast cancer patients,as well, this one conducted by Shelley Taylor, professor of social psychology at the UCLA, given that when she examined a group of women, she found that slightly less than a third of the those in her study had even considered the question of what had caused their cancer important at the time of diagnosis. Taylor was actually forced to conclude that “the attribution process, however, does not seem to be important early on in the illness adjustment process.”
Thus her subjects weren’t the “dumb luck” crowd–they were the “who cares now?” group, as I call it. [I assume that these women may have considered the question important later on in the progression of their illness, but I do enjoy the amusement factor temporarily at least, envisioning Dr. Taylor approaching the women, pencil and paper at the ready, looking for a clue the meaning of life and death–and having her subjects simply respond that they really weren’t interested in her question. It might take you down a notch.]
But these two studies aside, it is part of human nature that people search for explanations for events, particularly an event as life-altering as a cancer diagnosis.
In fact, the largest support group for breast cancer calls itself “Why Me?” thus emphasizing the importance of causal attribution.
And women do, despite Taylor’s poor beginnings, attribute away in cases of breast cancer. Interestingly to me, some of their attributions for their cancer actually seem to irk those with a more scientific bent.
For example, in the article “Cancer, the Mind, and the Problem of Self-blame,” the researchers note that breast cancer survivors’ attributions for the development and progression of their cancer lack scientific soundness. They quote a 2001 survey by Stewart and colleagues of Canadian breast cancer survivors, recurrence-free for an average of nearly 9 years, where the researchers found that 42% of them believed that stress caused breast cancer.
Yet, according, at least, to Block et al, that is completely without scientific foundation. Even more shocking (to the researchers, that is; I think this has entered the current psychological understanding of cancer) was the finding that 60% of the women attributed their lack of recurrence to having a positive attitude and only 4% to use of tamoxifen, the commonly used cancer drug. [For research on the fascinating topic of the correlation between a positive attitude and health, and even cancer survival rates, see the post “‘Don’t Worry, Be Happy’–And You Just Might Live a Longer and Better Life: A Positive Outlook’s Effect on Health.”]
So if scientists have ruled out self-blame, stress, and attitude as acceptable means of causality, what should people believe causes their cancer?
Well, the scientific community would have us attribute cancer to exposure to carcinogens, hereditary, and specific risk factors–smoking or sun exposure.
But to me that doesn’t excuse the tone or Block et al’s piece. I found the following summation line of the article close to snarky, really. Apparently their subjects’ attributions were something less than acceptable to the researchers. “While there has been much publicity on lifestyle factors that can cause cancer, from excessive sun exposure to smoking, there clearly is a substantial part of the public who are predisposed to believe that emotional factors are a cause of cancer.” “Predisposed to believe,” are they? As if believing that stress might be a factor in your cancer is an error in your genetic makeup?
How dare they? the authors seem to be asking of those with these beliefs. I myself think the world of attribution should be run as more of a democracy, so let people attribute away as they will, even if Block et al aren’t impressed.
And there are many, many, who, unfortunately, attribute their cancer to themselves. In fact, I find it most concerning how common the tendency is among cancer patients–regardless of what Gotay’s ‘dumb luck’ study found–to blame themselves.
In the September 1999 article “Self-blame attributions in women with newly diagnosed breast cancer: a prospective study of psychological adjustment” in Health Psychology, Glinder and Compas find that self-blame is a common response to a cancer diagnosis–and that it comes at a high price. The researchers found that self -blame was positively associated with anxiety and depression, and Freidman et al added poor quality of life to the affective issues.
In a second study on the topic, conducted by the same team several years later, published as “Self-blame and distress among women with newly diagnosed breast cancer,” the researchers found that self-blame attributions for breast cancer didn’t just yield psychological distress shortly after the diagnosis–but that the distress continued for as long as the study did–a full year. Without any further information, I can only assume that the psychological suffering continued well beyond that, as well, barring effective psychological interventions.
I don’t have the answer to the cause of cancer–any more than any other person, really, despite what they might claim. But I firmly believe that your beliefs surrounding its origins are crucially important–even if they don’t jive with what the established scientific community wants you to subscribe to.
But there’s one critically important point to know about the blame game, and its relevance can’t be overlooked. Multiple studied have found that, when patients believed they had control over the cause of the disease, they did better emotionally. Thus those who blamed someone else, or blamed themselves, fared more poorly than those who believed the locus of control was more in their hands. If you find yourself gripped by your belief that your cancer is your own fault, it is incumbent upon you to get help to improve your quality of life and psychological state of being, and thus your overall adjustment.
I’m not sure what anyone can say about the “dumb luck” group’s emotional prognosis–but I still appreciate their honesty, lack of negativity, and courage in being willing to face the ordeal without all the answers.
Sometimes we wind up in a situation by mistake, but that situation is the making of a better us–no matter whose fault anyone would like to say it is.And of course I like how they remind me of John, who graduated, despite all prognoses to the contrary, summa cum laude from Harvard.
Bennett KK, et al. Self-blame and distress among women with newly diagnosed breast cancer. Journal of Behavioral Medicine 2005; 28(4):313-23.
Berckman KL, Austin JK. Causal attribution, perceived control, and adjustment in patients with lung cancer. Oncology Nursing Forum 1993; 20(1):23-30.
Block KI, Dafter R, Greenwald HP. Cancer, the mind, and the problem of self-blame. Integrated Cancer Therapy 2006; 5(2):122-30.
Friedman LC. Attribution of blame, self-forgiving attitude and psychological adjustment in women with breast cancer. Journal of Behavioral Medicine 2007; 30(4):351-7.
Glinder JG, Compas BE. Self-blame attributions in women with newly diagnosed breast cancer: a prospective study of psychological adjustment. Health Psychology 1999; 18(5):475-81.
Gotay Caroline. Why me? Attributions and adjustment by cancer patients and their mates at two stages in the disease process. Social Science and Medicine 1985; 20(8):825-831.
Talor SE, Lichtman RR, Wood JV. Attributions, beliefs about control, and adjustment to breast cancer. Journal of Personal and Social Psychology 1984; 46(3):489-502.