CHAPTER 12 – Learning to Change
As we have seen, while cancer can be triggered by any number
of factors, it can only develop and spread if the terrain is favourable. There
is no way to prevent cancer or slow down its growth (once it has already taken
root) without changing this terrain in depth. Basically, seeing our response to
cancer as a war or even a combat may not be the right metaphor. Rather than
fighting insurgents, we may be better off changing mentalities. Our guiding
principle, above all, should be to bring more awareness into our lives in order
to change our attitude and that of our cells. But to what extent can we really
change? One of the world's greatest cancer surgeons, William Fair, MD,
experienced this inner revolution against his will.
Dr. Fair's Transformation
A specialist in prostate and kidney cancer, Bill Fair was head of the prestigious Department of Urology at Memorial Sloan-Kettering Hospital in New York when he learned he had colon cancer at a very advanced stage. After two operations and a year of intravenous chemotherapy (which didn't prevent him from operating several times a day), his tumour returned. This time it was even more aggressive, so aggressive that his doctors, chosen from among his hospital colleagues, told him sadly that his cancer was now "incurable". In their opinion, he had only a few months to live. Bill Fair was too "emotionally shattered" to react, as he later recounted. His wife, a former nurse in the armed forces, took things in hand. She told him the time had come for him to look after his "terrain." Spurred on by his wife, this workaholic, who was on deck seven days a week and often worked thirty-six hours at a stretch, took up meditation and yoga. Instead of grabbing a bite to eat at a fast-food counter in the hospital cafeteria, he was initiated to the benefits of a vegetarian diet. As a prominent member of the Western medical elite, he had never taken an interest in what the worlds other medical traditions had to offer. Now he asked to meet researchers who had started a program investigating traditional Chinese medicine at the National Institutes of Health in Washington. This transformation was anything but easy. With his sharp mind, his biting tongue, and his characteristic surgeon's arrogance, Bill Fair had long cultivated a profound contempt for all these "alternative" approaches. His son remembered his former references to "touchy-feely West Coast nonsense." Summoning up her courage and a great deal of patient kindness, Fair's wife finally convinced him he had nothing to lose. He could approach these other ways of looking at life with the mind of a researcher. He could keep what worked for him and leave the rest. He could preserve his critical mind and at the same time listen to his explorer's instinct. Bill Fair went along with it. Very haltingly. For example, after a training program in California on relaxation, he jumped on the red-eye to New York the same night because he wanted to be back at work early the next morning. But little by little, with yoga, meditation, a careful diet, Bill Fair changed. From the overbearing surgeon, from the authoritarian researcher and self-assured author of more than three hundred articles published in international cancer journals, he calmed down. He became a gentler, friendlier man. He learned to carefully choose the people he would spend time with, and in turn he would give them all his attention. Impressed by what he found out about himself, about his new relationship with his body, his mind, and the people around him, in a few years Bill Fair became the person he basically would have always liked to be. He was asked three years later what he thought of the benefits of this approach focused on improving the "terrain." Benevolently, he answered, "I've already lived three years beyond my colleagues' prognoses. As a scientist, I know that doesn't prove anything; it may just be luck. But there is one thing I'm sure about: I don't know if I extended my life, but I certainly expanded it."
His disease had given him the opportunity to discover
approaches he had long despised. They had brought him peace and well-being.
These mattered a lot to him now. He felt as if he were unloading himself of
whole facets of his former personality. He learned, like many other patients,
to pay more attention to what really mattered to him, independently of others'
judgment. He no longer had to play the role of "brightest in the
class." Bill Fair never renounced his passion as a physician or his
scientific rigor. He continued to underscore the importance of conventional
cancer treatments. He insisted that complementary approaches had to undergo
strict evaluation. But, month after month, he became more genuine, more
patient, and gentler. More receptive to the mystery and the richness of life.
Little by little, Bill Fair became a defender of these new
approaches. He wanted them to be integrated into teaching and treatment
programs. He organized a dinner for several deans and some of the principal
oncologists of New York medical schools, so that they could meet one of the
most respected American activists, Ralph W. Moss, a science journalist and an
ardent promoter of complementary methods in oncology. In the course of the
dinner, Fair leaned over to Moss and said: "I imagine ten years ago you
would never have dreamed you would one day find yourself at dinner with these
people." The activist answered: "Ten years ago, I would never have
dreamed of finding myself at dinner with you, Bill. Bill Fair had indeed
changed a great deal.
The path Dr. Fair followed is open to whoever may decide to
take it. Hemmed in as he was in a culture that systematically denigrated that
personal quest, this change was more difficult for him than for anyone else. If
Bill Fair was able to transform his attitude toward life so radically, we must
all be able to follow his example.
Changing Personalities?
At the University of Toronto, the psychologist Alastair
Cunningham, PhD, has been looking after groups of cancer patients for thirty
years; he teaches relaxation, visualization, meditation, and yoga. He helps his
patients find the strength to become themselves, to draw as close as possible
to their deepest values. He often works with patients considered
"incurable," who have been given only a few months to live. By
following them systematically, he has identified the attitudes that help
predict which patients will have a chance of living far beyond their prognoses.
Some of the patients he has followed from this group have outlived their
prognosis by more than seven years. His studies suggest that these are people
who, perfectly calmly, have asked the fundamental questions "Who am I
really?" and "Where do I want to go?" Then they have drawn the
consequences. One of his patients put it this way:
Cancer sort of shifted the way I
was developing in life and the goals I was pursuing… I was totally focused on
building a “bigger me.”… I was sort of following what our culture says is the
approved path and then when I faced the fact that I might not live very long, I
realized that all of that would die ... and I started to question who I was
really, if all that went.... It seemed like the whole focus of my life then
shifted. [And now] I think I would be able to experience life today more fully
[and]… to accept life as it comes to me and be part of that and just enjoy.
The closer Alastair Cunningham's patients got to their true
values, the less constrained they felt to act only for the sake of propriety,
or out of obligation, or for fear of causing disappointment and losing the
affection of others.
Another patient says:
I was one to follow the rules
quite a bit and please everybody; I think I feel more comfortable with my place
in the world now than I did before I was diagnosed. Definitely.
Most of them then discovered a real pleasure in making
choices they hadn't allowed themselves up until then, and even in saying no. A
third patient whose survival was exceptionally long:
Now I even say no, but before I
would've been paranoid to say no. Now I can say, "No, not today, that
doesn't suit me." … And there was no guilt when I made the decision not to
go back to work next year… It's not what I want to do… I'm very happy with what
I do now, and it's much easier to make a decision on the spur of the moment,
and go to see a movie because you feel like going to see a movie, or sitting
down and trying to sketch even though you know you're not good at it but it's
so peaceful and pleasant. That's all.
What these patients have succeeded in doing in their lives,
Cunningham comments, is ridding themselves of their "type C personality",
of always trying to avoid making waves (see chapter 9). Rather than going
through life passive and submissive, little by little they have learned to appropriate
their freedom, their authenticity, and their autonomy. Cunningham calls that
"de-type-C'ing" themselves.
This change is also visible in the way these patients
approach their treatments, including their way of stimulating their natural defences.
I asked Dr. David Spiegel what was different about the three women in the
support groups who had survived their metastatic cancer for more than ten years
at a time when available treatments had little effectiveness. He described them
this way: They didn't stand out; they often remained calm and silent. But they
had very specific ideas about what they would or wouldn't do to help
themselves. They accepted certain treatments and refused others. They seemed
imbued with a quiet strength.
This attitude of awareness and freedom of choice applies to
natural methods too. Whether it's a question of diet, or yoga, or psychological
support. These approaches are not all equally valid for everyone or at all
times. On one day the most beneficial method will be meditation; on another,
keeping a diary; the day after that, exercise. What we recognize in these
exceptional survivors is their clear-eyed capacity to say "This is what I
need now" and, firm but flexible, to move forward in their lives.
This change often amounts to more than learning to say no
and asserting personal choices. Patients who have managed to survive for a
substantial length of time have a strength buttressed by another attitude that
is also often new to them—gratitude. They have become capable of perceiving
another dimension to life that had escaped them earlier. As if a sort of x-ray
enabled them to see the essential through the fog of the ordinary. One of them
explained, for example, that one evening at dinner his wife and children
started to quarrel. It was a familiar scene that never failed to exasperate
him. But on that particular evening, instead of feeling angry, he saw all the
love that was flowing around the table. If their feelings flared up, it was basically
because they each cared so much about what the others thought. The affection
that sustained this family suddenly seemed so palpable that tears came to his
eyes and he was overcome with gratitude.
I experienced some of this same gratitude years after my
separation from Anna. We had settled our painful divorce, after the legal
process had dragged on for three very difficult years. We were sitting, again,
at the kitchen table in the small blue wooden farmhouse we had lived in
together in Pittsburgh. The crackles of a fire in the cast iron stove filled
the silences when we could not find words or even really look at each other.
Sacha, now eleven, was playing by himself upstairs. I had loved this kitchen,
this fire, the garden outside where I planted almost all the trees with Sacha
looking on. And I had loved this woman. Then the words came. I was able to say
that if that divorce had been so difficult, it was perhaps because a big part
of me still loved her and loved what we had created together. That behind what
I may have done in anger there was mostly my pain. As I could imagine hers too.
And that now I was grateful for this love that remained between us, a love that
would help our son grow. She did not say much, only wiped a few tears that had
started to roll down her face. As I left the house —again— she put her hands on
my arms, smiled shyly, and said, "I love you too." We had parted.
You found it! If you are reading this, let me know something
in your life that you are grateful for, or that you have learned from this
chapter. Leave a comment below, or send me a message directly. - Mark T
In the end, the best protection against cancer is a change
in attitude arising from the process of growth valued by all the great
psychological and spiritual traditions. To describe the very foundation of the
life force, Aristotle speaks about "entelechy" (the need for self-fulfilment
that starts with the seed and comes to full fruition in the tree). Jung describes
a "process of individuation", transforming the person into a human
being different from all others, capable of fully expressing his or her unique
potential. Abraham Maslow, the founder of the human potential movement, refers
to "self-actualization". The spiritual traditions encourage
"awakening" by developing the unique — in other words, the Sacred —
in the self. It is very important that we define our most authentic values and
put them to work in our conduct and in our relationships with others. From that
approach springs a feeling of gratitude for life as it is—and our body, and its
biology, basks in its grace.
* Bill Fair's ideas and his transformation have
been discussed in several publications. One of the most noteworthy was a piece
in the New Yorker by Jerome Groopman, MD, a professor of medicine at Harvard
Medical School and a writer.3 1 met Bill Fair myself in Washington in October
2001, three months before he finally succumbed to cancer. He had survived four
years longer than his doctors' prognoses.Don’t forget to send me your thoughts. Mark
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