PART ONE

Paths of Hope and Ways of Healing

Chapter Two

Healing and Curing: The Starting Point for Informed Choice

Healing Goes Beyond Curing

There is a fundamental distinction between healing and curing that lies at the heart of all genuinely patient-centered approaches to cancer treatment and care. This is not some “flaky” New Age distinction, but one rooted in the greatest and oldest continuous traditions of medicine. It is a distinction yet to be fully recognized and honored in mainstream American medicine today. But while the distinction between curing and healing is widely recognized, the significance of these two complementary approaches to recovery from cancer is rarely explained to people with cancer.

As the term is generally used, a cure is a successful medical treatment. In other words, a cure is a treatment that removes all evidence of the disease and allows the person who previously had cancer to live as long as he would have lived without cancer. A cure is what the physician hopes to bring to the patient. Curing is what the doctors hope to do, the external medical process of effecting an outcome in which the disease disappears.1

Healing, in contrast, is an inner process through which a person becomes whole. Healing can take place at the physical level, as when a wound or broken bone heals. It can take place at an emotional level, as when we recover from terrible childhood traumas or from a death or a divorce. It can take place at a mental level, as when we learn to reframe or restructure destructive ideas about ourselves and the world that we carried in the past. And it can take place at what some would call a spiritual level, as when we move toward God, toward a deeper connection with nature, or toward inner peace and a sense of connectedness.

Although curing and healing are different, they are deeply entwined. For any cure to work, the physical healing power of the organism must be sufficient to enable recovery to take place. When a physician sets a bone or prescribes an antibiotic for an infection, he is doing his part for recovery by offering curative therapy. Yet when the inner healing power of the organism is insufficiently strong, the bone will not knit or the infection will not subside. Healing is thus a necessary part of curing–a fact with profound implications for medicine, since the authentically holistic physician is deeply aware of the essential role his patient’s recuperative powers play and will do everything he can to encourage the patient to enhance those recuperative powers.

Healing, however, goes beyond curing and may take place when curing is not at issue or has proved impossible. Although the capacity to heal physically is necessary to any successful cure, healing can also take place on deeper levels whether or not physical recovery occurs. I have had many friends with cancer for whom curative treatment ultimately proved impossible. Yet, even as their disease progressed, the inner healing process–emotional, mental, and spiritual–was astonishingly powerful in their own lives and in those of their families and friends.

That you can participate in the fight for life with cancer–by working to enhance your own healing and recuperative resources–is a profoundly important discovery for many people. Cancer patients often experience themselves as losing all control of their lives. They become the passive objects of all kinds of decisions and treatments by their medical teams. They feel they must do what their physicians tell them. They may feel that they can do nothing to help themselves. Often, no one has offered them the opportunity to consider the distinction between healing and curing.

It is not yet known scientifically how much difference personal efforts at healing can mean in terms of life extension. However, it is clinically known by most psychotherapists who work with cancer that a patient engaged in personal healing work can make a transformative difference in his quality of life. An ever-increasing body of scientific evidence now suggests that a strong desire to live–a willingness to engage in the struggle for life–and a continuous movement toward a healthy relationship with life, do help some people in their fight for physical recovery. Conversely, long-term chronic depression, hopelessness, cynicism, and similar characteristics tend to diminish resilience and increase physical vulnerability.

Interestingly, the successful fight for life is not necessarily waged best by the person with an excessive attachment to the outcome. As we shall see, the shamans in traditional systems of medicine around the world found that if they sought first to safeguard the soul, rather than the body, the body tended to respond better. Similarly, a boxer who is angry at his opponent is usually less skillful and more likely to lose the fight. Surgeons do not operate on their wives or children because they know that their attachment to the outcome would lessen their skills. Soldiers in desperate battlefield situations know that to be trapped in fear of death may doom them: they need clear heads, courage, and hope, against all odds, to survive.

In Europe, mountain climbing stories have been meticulously collected from climbers who survived life-threatening falls, and these stories may illustrate the complexity of the healing response. As the fall begins, the climber does not scream as falling people do in the movies. Instead, time slows down enormously–as it does for many people just before a car accident. Everything seems to be taking place in slow motion. The survival benefit of this slowing down of time is that the falling climber has every opportunity to notice lifesaving possibilities–handholds or shrubs that might be grasped to break the fall. But if the opportunities for active self-preservation disappear, the faller then enters a state not of panic but of deep peace. He may experience the often-reported process of life recall, with his life flashing back before his eyes. He may hear celestial music. Hitting the ground is usually experienced without pain–he only hears the impact. Hearing is the last sense to disappear into unconsciousness.

By analogy, the healing response that takes place as we go into the “free fall” of a cancer diagnosis seeks every opportunity to maximize the possibilities for physical life recovery. Intelligence and intuition may be brought together in choices of treatment, hospital, doctor, and of complementary therapies or the paths of self-exploration, health promotion, and self-care. The very process that maximizes the opportunities to recover also prepares us to make the best of a long life with cancer, or the best use of whatever time we have available.

Thus the starting point for informed choice in both mainstream and complementary cancer therapies is the patient’s recognition that he can play a crucial role in the fight for his life. The recognition of the unique role that each of us can play in our own healing reaches beyond choices about therapy to choices about how we intend to live each day for the rest of our lives.

Universal, Common, and Unique Conditions of Healing

How do we set about healing ourselves? One of the best analogies Rachel Naomi Remen, M.D., uses is that of becoming a gardener of ourselves. We cannot grow ourselves in our garden by simple, direct volition. But we can create the conditions of growth, or the conditions of healing, by nourishing, nurturing, and tending within us that which we value and wish to help grow.

Obviously, there are many different kinds of conditions for healing: physical conditions such as diet, exercise, relaxation, clean air, good water, and time spent in nature; social conditions for healing, such as work that is meaningful, friends that you care about, and a loving family; and emotional, mental, and spiritual conditions.

It is useful to differentiate between universal, common, and unique conditions of healing. For example, inner peace is an almost universal condition of healing. A deep experience of love is also almost universally healing. (By contrast, anger or hate is a less common condition of healing; yet there are those cases of people who have recovered physically from the most life-threatening conditions out of an intense desire for revenge or sheer negative cussedness–the “too mean to die” phenomenon.)

There are many common conditions of healing. Many of us are healed by attention and care from our friends and family, by finding work that we deeply enjoy, by laughter, by music that moves us, by great art. But some of the most important conditions of healing are the unique conditions of healing. William Blake said that any man who would help another must do so in “minute particulars.” He was talking about helping another person by assisting him in the minute particulars–the unique way–that is most meaningful to him.

One of my favorite experiences of the discovery of a unique condition of healing was with a renowned elderly pediatrician–whom I will call William Sawyer–who attended the Commonweal Cancer Help Program with advanced prostate cancer after his wife had died a very difficult death with amyotrophic lateral sclerosis (sometimes called “Lou Gehrig’s disease<%4>”<%0>). He had nursed her throughout her illness, and had developed cancer while she was ill. Rather than have the curative surgery that was available to him during his wife’s final months, which would have required that he leave his wife alone, Bill chose palliative treatment so that he could be with her. After his wife died and his cancer spread, he flew across the country to attend our Cancer Help Program.

Bill made it very clear to us that he was not at all certain why he had come to Commonweal. Others, he said, wanted to live. He was not sure he did. Although he had never believed in life after death before, since his wife had died he had an increasing sense that he would join her when he died. And he looked forward to that prospect. It was not, he said, his cancer that distressed him. It was his depression over his wife’s death.

I had no inclination to try to talk him out of his authentic experience of grief and his sober encounter with reality. So I spent the week with him listening. Listening, by the way, is one of the greatest ways we can help others heal–one of the greatest ways to create conditions of healing. Most people back away from great pain that others are suffering, or rush in with suggestions for how to “fix it.” At Commonweal, we do not back away and we do not try to fix it. We listen.

I acknowledged the truth of what Bill was telling me. But since he was alive for the time being, I wondered what gave him any kind of enjoyment. And Bill began to talk about the birds that he fed outside his home in rural Massachusetts. He loved birds deeply. He had also always loved cats–he had a special capacity to communicate with cats. I asked if he had a cat. No, he said, he did not have a cat because if he got a cat he would worry about what would happen to the cat if he went into the hospital or if he died.

So Bill and I spent the rest of the week working on whether or not he could have a cat. I said that I would help find people to take care of the cat if he went into the hospital. I said that I would be honored to take his cat if he died. Since my wife liked Siamese cats, I suggested that perhaps we should get him a Siamese that we might inherit one day. But Bill did not want a Siamese cat. He had taken care of poor, forgotten, and mistreated children all of his life. What he wanted was to go to the ASPCA and get a cat that had been abandoned–perhaps hurt–and nurse it back to health.

Bill left at the end of the week and went home. A few weeks later I got a call. Bill had found a mongrel kitten at the ASPCA that had been thrown from a moving car and had broken many bones. He was now nursing it back to health. At regular intervals until Bill’s death we received cards and letters signed “William and the Cat.”

I tell Bill’s story because it is a perfect example of a person with cancer who needed to discover for himself a unique condition of healing. We could have talked to Bill forever about diet, exercise, imagery, and other common conditions of healing that have, in fact, been relevant for many other people on the Cancer Help Program. We could have urged him to fight for his physical recovery. If we had, we would have missed completely the opportunity to help him find his true condition for healing: giving himself permission to have a cat. But note that not just any cat would do. He had to rescue a wounded and abandoned cat, as he had helped rescue wounded and abandoned children all of his life. It was a way that he could continue to express the love in his great heart, a way that he could continue to give.

One day years later Rachel Naomi Remen remarked to me that Bill’s struggle over whether or not he could have a cat might have had a deeper significance. He might have been struggling, she suggested, with whether he was permitted to love again. Here was a man who had lost a wife whom he had deeply loved for many decades. He did not seek another wife, but he did seek another companion with whom he had deep communication.

Although his struggle with cancer continued, reinforced by many other ailments of old age, Bill lived on for many years. And through the struggle, the company of a cat that he rescued and nursed back to health remained a deep source of solace.

Biomedicine and Biopsychosocial Medicine

Cancer patients should be aware that a great debate is now taking place today as to what role, if any, modern medicine should play in helping patients with their healing processes.

On one side of this debate are proponents of biomedicine, who honestly and straightforwardly believe that the physician-scientist is a technician who should offer the patient his technical skills, and stay out of psychological and spiritual issues. This is a clean and reasonable position, not to be mocked.

On the other side of the debate are proponents of what George Engle has named “biopsychosocial” medicine. Biopsychosocial medicine recognizes that disease takes place in a psychological and social context, that these psychosocial contexts influence both the cause and the course of many diseases, and that the physician interested in the most effective curative processes must also be concerned with healing in the psychosocial context.2

Professional interest in biopsychosocial medicine has grown over the past few decades as popular and professional interest has increased in “mind-body” medicine and such emerging scientific disciplines as psychoneuroimmunology. Psychoneuroimmunology is an interdisciplinary field of study that proposes that the mind, the neurological system, and the immune system are a deeply interrelated single system. In psychoneuroimmunology and allied fields of behavioral medicine and health psychology, a growing body of research has indicated that it often matters to the physical course of disease what is happening in the emotional and mental processes of the patient. Hence George Engle, Norman Cousins, and numerous others have argued that the physician truly ought to concern himself with healing as well as curing.

Further thought about the distinction between biomedicine and biopsycho- social medicine has led to distinctions that can be genuinely useful for the cancer patient. Consider the following relationships:

Biomedicine (Science) Biopsychosocial Medicine (Human Experience)

Disease Illness

Pain Suffering

Curing Healing

Biomedicine is legitimately concerned with the physical processes of disease. Biopsychosocial medicine is concerned both with the physical process of disease and with the human experience of disease, which is illness.

Biomedicine is legitimately concerned with the relief of pain. Biopsychosocial medicine is concerned with the relief of pain but also with the human experience of pain, which is suffering.

Biomedicine is legitimately concerned with the physiological process of curing. Biopsychosocial medicine is concerned with physiological process of curing but also with the human experience of whatever is physically, mentally, emotionally, and spiritually possible in the face of illness, which is healing.

It is very important–and not adequately considered in the popular cancer literature–that medicine has a language that distinguishes biomedicine from biopsychosocial medicine, disease from illness, pain from suffering, and curing from healing. Within the vast biomedical-industrial complex that modern society has created, it is worth knowing that many great physicians have thought long and hard about these issues, and recognize that our modern sophistication with biomedical technology is matched on the negative side by an often shocking lack of sophistication or interest in helping patients become aware of and participate in their own healing process.

How to Begin Your Own Healing

How can you participate in your own healing process? Many great physicians and healers through the ages have given this question a great deal of thought, and have produced many answers–answers that usually take the form of questions. Here are a few:

If you could do (or be) absolutely anything in the world that you wanted during the rest of your life,<M> what would you truly want to do (or be)?<D>

This is the question that the pioneering psychotherapist Larry LeShan asks in Cancer as a Turning Point. “What is the unique purpose of your life, the unique song that you were put on earth to sing?,” LeShan often asks. Some people know the answer instantly. Others discover it after a time of living with the question. Still others have to work long and hard for the answer. It is a great question, and a great guide on the path to healing, for if you discover the answer, LeShan’s next question is: “Under the present circumstances, what would be the first steps you need to take to begin moving toward living this life?” Embarking on this path can bring great healing.

Another such question might be:

Since you have been diagnosed with cancer, what do you find has become important to you, and what that previously seemed important do you discover you are ready to let go?

A cancer diagnosis can thus lead to a profound transformation of values. Things that used to seem important often become less salient, while other values to which you may have given little thought take priority. This sorting process can go on throughout your life–What do I want to hold on to? What do I choose to let go of? and, more painfully, What that I care about am I able to hold onto? What that I care about do I need to let go of?

You might also ask yourself:

Within the circumstances of the cancer diagnosis, what would I optimally choose in every area of my current life? What kind of mainstream and complementary therapies should I undertake? What kind of relationships? What kind of work? What forms of relaxation or meditation? What forms of exercise or recreation? What kind of diet? What rhythms of daily life? What studies or activities? What kinds of support and response do I want from family and friends? What are some of the unique things–very personal to me–that would give me special delight and pleasure each day?

This is an exercise in making yourself aware of what feels authentic to you. It is surprising how many people with cancer have never given much thought to what they would actually like. Clinicians often report the impression that many cancer patients have been “givers” for much of their lives, subordinating awareness of their own needs to awareness of the needs of others. Learning to be aware of and to articulate what you would like can sometimes be a new and even frightening prospect. But discovering the little (and big) activities that give you special pleasure is both fulfilling and healing. One way of exploring this question is to divide your life into different areas of inquiry. What are the specific physical, emotional, mental, and spiritual conditions that could support healing for you?

Healing and Psychosynthesis

For cancer patients who want a more explicit map of the human psyche, one of the most interesting schools of transpersonal psychology is psychosynthesis. Founded by an Italian psychoanalyst, Roberto Assagioli, who had studied with both Jung and Freud and who was a close student of Eastern as well as Western spiritual traditions, psychosynthesis offers some helpful perspectives on the nature of healing.

Psychosynthesis recognizes with Freud that many people struggle with impulses coming up from their lower unconscious–impulses related to basic drives and appetites. But it also recognizes with Jung that some people also struggle with repressed impulses from their upper unconscious, or superconscious, and that one can be as neurotically miserable seeking to be less than one is in order to conform as one can be seeking to be more than one is in order to conform.

Psychosynthesis convincingly organizes much of our experience of the world into various personality substructures it calls “subpersonalities.” Most people are able, if asked, to make a list of at least some of the subpersonalities that we unconsciously move in and out of all day. A typical list of subpersonality structures of a professional woman with cancer might include physician, mother, wife, daughter, friend, cancer patient, jogger, spiritual seeker, frustrated circus performer, etc.

The goals of psychosynthesis include becoming aware of the various subpersonalities, acknowledging that they are part of us, learning to identify and disidentify with them–how to step in and out of each subpersonality–and then gradually to synthesize and integrate them. The relevance of this to a cancer patient is that, if healing is a process of self-discovery, a process of becoming aware of and interested in our own process of self-actualization, then psychosynthesis provides one interesting map for coming to know ourselves.

Healing, Creativity, and Imagery

I have described healing as a process of becoming whole on many different levels through increasing awareness of the conditions of self-actualization and personal evolution.

Imagery, Rachel Naomi Remen says, is the language that the unconscious speaks in its efforts to communicate with us. Imagery is an extraordinarily powerful tool for communicating with the vast universe within ourselves that we are not aware of in ordinary states of consciousness. Imagery takes many forms: visual, tactile, olfactory, intuitive. We can see, feel, sense, touch, smell, or intuit a communication from within. We can discover imagery through meditation, prayer, hypnotherapy, guided imagery techniques, art, poetry, dreams, journal writing, music, or movement, to name only a few of the methods.

People with cancer often have very potent imagery close to the surface of consciousness. The enormous upheavals in their lives have brought this material into a range of ready access. Yet they may live for months or years without communicating with these extraordinarily powerful constellations of experience within themselves. Getting in touch with one’s inner world through imagery can be an astoundingly powerful route to healing.

Creativity is closely related to imagery. W.H. Auden wrote some famous lines about cancer, in which a country physician ruminates about how curious cancer is:

Childless women get it
And men when they retire–
It’s as though they needed some outlet
For that foiled creative fire.3

Many cancer patients resonate to these lines, and come to experience to what a degree they had shut down their own creativity and wholeness in the service of fitting into the lives they have constructed. All the questions about finding one’s unique song in life, deciding how one wants to live now, and getting in touch with powerful inner constellations of energy by imagery are processes of reconnecting with that inner creativity, that “foiled creative fire.”

We are not in the land of science here–we are in the inner imagic landscape. We should not assume that any of the things we have said in passing about some cancer patients–that they are often “giving” people, that they may have subordinated their own needs to the needs of others, that they may have lost some contact with their own creativity–are true for all or even most cancer patients. And I surely do not mean to suggest that these characteristics caused the cancer. I simply want to give the reader a few key ideas about what is involved in the journey of inner healing. (I will discuss the subject of imagery further in chapter 10.)

Healing and Spirituality

The healing process not only has a tendency to bring people closer to an appreciation of who they uniquely are and what their unique purpose is in this world. It also brings them closer to God, spirit, inner peace, connectedness, or whatever we choose to call that which is great and mysterious.

The longer I have considered this fact–the fundamental connection between healing and psychological development–the more I think it one of the most remarkable signatory details left to us by the architect of human consciousness, whoever that may be. Consider how truly elegant the design process is that created us so that in the face of the most difficult times of our lives, there is the possibility–not the certainty but the possibility–of access to states of awareness and experience that enable us to cope with these crises better than we otherwise could. And consider how remarkable it is that these states of awareness make many people say that they feel more alive and more whole with cancer than they ever felt before. Consider how curious it is that many people come to acknowledge, in the face of the pain, shock, and suffering of cancer, that there also can be gains of immense personal value.

A central tenet of all the great spiritual traditions is that pain and suffering, loss and sorrow, carry within them keys that unlock gates of spiritual experience that often had been closed before. How extraordinary that we should be designed in this way. What does it mean? What does it imply? (I will discuss spirit and healing further in chapter 9.)

Healing and Choice in Cancer

I place such emphasis on the significance of healing with cancer because I believe that awareness of the power and process of healing is the key to informed choice in all areas of cancer: choice in mainstream therapies, choice in complementary therapies, choice in life with cancer, choice in response to pain and suffering, and choice in living and dying.

There is no single right way to respond to any of the choices, large or small, that cancer brings. You will certainly experience pressures from physicians, family, and friends to choose one course over another. Physicians will offer you the best conventional medical wisdom about therapies. Family and friends may urge you to try alternative therapies, or conversely urge you not to try them. People may expect you to continue to live the way you did before, to continue to respond to them in the same ways. Or they may urge new ways of life on you.

At every turn there are bewildering arrays of choices, and often there is no adequate external guidance that you can count on. So when all the information is before you, consider turning inward to discover from as deep a source as possible what makes sense to you.

Information can help us develop maps of informed choice. But the healing process can be the inner compass by which we read these maps. Healing helps us discover “which way is up”–for us. Healing encourages us to move upward, toward higher and more integrated levels of awareness, toward courage, toward expansion–if not always toward extension–of life, and toward becoming more deeply the person we want to be.

Notes and References

1 Five-year cancer-free survival is often considered a “cure” with many cancers for statistical purposes, but this is a dubious use of the term. A truly “cured” cancer patient should live as long as he would have without cancer.

2 George L. Engel, “The Need for a New Medical Model: A Challenge for Biomedicine,” Science 196:4286 (8 April 1977).

3 W.H. Auden, Collected Shorter Poems 1927-1957 (New York: Random House, 1966), 111.