A diagnosis of cancer can be so overwhelming, and our health care system so bewildering and impersonal, that one often doesn’t know where to turn or whom to trust. Many people, sensibly, want to know all their options, only to discover that cancer and its treatment, conventional and otherwise, is a universe in itself, and a rather intimidating one at that, especially for the cancer patient who has at most a layperson’s knowledge of science and medicine. Cancer and cancer treatment has a history, a politics, a mainstream, a lunatic fringe. There are a multitude of choices and treatment decisions to be made even within the mainstream culture of medicine. Then there are other potentially valuable treatment avenues outside of the mainstream. Some people will want to at least become informed about them and consider them in their decision-making process. Some are specific to cancer, others are adjunctive or palliative. Some support generalized health and healing. Each has potential risks and benefits which need to be weighed according to the specifics of the disease, one’s life situation and personal values, the time frame involved, and of course, the latest research findings, which are usually incomplete and more suggestive than definitive. While medical and surgical oncology specialists know their own fields well and are in an excellent position to explain certain risks and benefits to their patients, they are frequently ignorant and sometimes scornful of other views or approaches, even if they are intended to be complementary or adjunctive to more mainstream approaches. So it is not unusual for the person with cancer and his or her family to wind up feeling isolated and on their own in trying to decide what to do.
How then to make sense of this universe of cancer for oneself, at least enough to make informed choices, decisions that might well affect the deepest aspects of one’s life? Where to turn? What to do? What not to do? Whom to believe? What to ask? What is known? What is not known? How to decide? What to combine? What order to do things in? What about the mind and inner well-being? What about nutritional approaches? Chinese medicine? Stress reduction? Yoga? What about my family? My fears? What about the meaning of all this in my life?
Even if you stay completely within the mainstream of conventional medical approaches, opinions and recommendations can differ considerably in critical areas such as diagnosis, prognosis, and treatment among different physicians and surgeons, different subspecialists, and in different countries. Then, if you wanted to know about alternatives of any kind, until now you had to start from scratch, research things for yourself, find the right people to see and elicit advice from, then weigh things and come to reasonable conclusions on your own, and this at a time of great stress, turmoil, and vulnerability.
With the advent of this book, a great deal of the information a person with cancer or people supporting a person with cancer might want to consider has been gathered together in one place. Choices in Healing gives people both a starting point and a method to follow in gathering information and pondering choices. It is sorely needed and will be put to immediate use by many people who presently feel adrift in their quest for a framework for understanding different approaches to the disease. Its arrival will be celebrated by many and perhaps criticized by some as well who may, wrongly, see it as advocating voodoo or quackery. In this regard, it is significant that MIT Press has published this book. Perhaps this signals an acknowledgment that such material, controversial as much of it is, merits serious scientific scrutiny and debate.
Its arrival is timely. A study recently published in the New England Journal of Medicine (Eisenberg et al., 328:246, 1993) reports that one third of Americans seek out and use nontraditional medical alternatives, frequently without informing their mainstream doctors. Alternative medical therapies now constitute a multibillion dollar industry in the United States alone. Yet there are few places that anyone can turn to which serve as knowledgeable and dispassionate clearinghouses to guide people in their decision making. This book is a major contribution in this area.
In another recent development, the National Institutes of Health recently funded an Office of Alternative Medicine to support research of alternative approaches, since ultimately, we cannot know the value of a therapy until it has been tested experimentally according to the standards of scientific scrutiny, but a scrutiny that does not ignore psychological, social, nutritional, environmental, possibly even spiritual factors which might significantly influence health and disease processes.
Choices in Healing had a vigorous life for several years even before it achieved its final form as the book you hold in your hands. In various incarnations, it was available from Commonweal in bound manuscript form. I was given a copy when I visited there for the first time in late 1992. When I got home and started reading it, I found myself moved to get ahold of additional copies right away so I could give them to the people I knew who had cancer. Here was something, I felt, that might be extremely useful as well as comforting. And indeed, the feedback I have gotten is that the book is a true gift to people trying to figure out what to do as they face cancer and its aftermath.
One young lawyer dealing with an episode of recurrence of breast cancer said that she felt caring on every page she read, to the point that she was often in tears, and that this deeply human tone made the technical material much more accessible to her and helped her develop her own framework for analyzing various treatment options, some of which she went on to pursue. It also helped her become more aware of a deep yearning she had for a “magic bullet” alternative, and to avoid the problems that such an attitude often results in when evaluating treatment options, frequently “hyped” by their proponents, and making choices.
To read this book is an education in itself. It is far more than a catalogue of resources; it is nothing less than a highly intelligent guide to the universe of cancer. In tone and perspective, it is warm and caring, personal and supportive, compassionate and wise. Michael Lerner the person does comes through on every page, as my friend observed. One feels held, cared for, acknowledged, not alone. Michael’s voice is present as a companion, an ally. People feel uplifted when they use this book. And this book is to be used, not simply read. It is food for thought. It is not meant to replace the advice of doctors and specialists. It is a complement to their recommendations, and perhaps a source for developing hard questions to ask of them to help in making hard decisions. And it provides an additional source of nourishment and strength when it comes to wrestling with those often life-wrenching decisions.
It does not have to be read from cover to cover. It can serve as something of a wise and knowledgeable friend, to be consulted, read, and reread as needed, a reference library in itself. It is encyclopedic in scope, yet totally accessible to the layperson. It offers up-to-date and hard-to-find information relevant to making decisions about conventional as well as unconventional therapies. It also encourages the interested reader to develop his or her own expanded ways of looking not only at various treatment options, but also at the whole of his or her life as it is colored by the experience of having one form or another of the disease we call cancer.
Michael gives us the science and the politics of cancer and of various cancer therapies, as well as the medicine, in a compelling narrative. He presents evidence where it is available, tells us what is known and what is not known in both conventional and complementary medicine, and frames the whole discussion in such a way that the reader feels supported in at least knowing the lay of the entire landscape and not just the part his or her oncologist, surgeon, friends, or family happens to know or approve of. He points out the pros and cons and the areas of uncertainty. By describing the state of our scientific knowledge, such as it is, by citing references to the medical literature that people might consult for further details, by recounting his own explorations and conversations with doctors and scientists, he gives readers an opportunity to grasp what is going on within the various fields of research and inquiry and draw their own conclusions.
The format blends technical detail with an appreciation for the inner life of mind and spirit, human relationship and meaning. Discussions are buttressed by literary as well as medical citations. Some chapters contain practical advice and resource listings. This structure allows for virtually limitless on-going explorations according to one’s personal inclinations and the circumstances of the disease.
The book provides a map of a certain territory, some of which is now coming to be called mind/body, or integrative, or complementary medicine. As with any map, people can do with this one what they like, including ignore it or criticize it, or use it as maps are most commonly used, to chart an itinerary that visits some places but not others. In this world, the territory is constantly changing as we learn more about cancer and effective treatments for it, and as we learn more about the mind/body connection. So the map, too, will have to change as new knowledge is acquired. But at least it is available now for those who would like to explore an expanded range of possible attitudes and approaches toward cancer and healing.
I believe this book will also be valuable to health professionals in the field of cancer. The sympathetic, hopeful, and respectful tone could serve as an example to us all in our communications with people with cancer. We might also gain some respect for at least some alternative/complementary approaches that we may have been unaware of before. Practicing oncologists frequently know surprisingly little of even the psychosocial oncology literature, where the scientific basis for a major role in adjunctive therapy is perhaps most compelling.
None of the alternatives presented here, as Lerner emphasizes, provides in any sense a definitive cure. But at the very least, the reader can gain a new vantage point from which to look at cancer and at possible ways to approach treatment decisions and the question of alternative therapies. At the same time, the reader can take comfort in Michael’s reassuring tone and the wisdom of his own deeply personal as well as professional inquiry into what is “out there” in the way of treatment approaches and what is “in here” in the way of different attitudes and disciplines one might explore for facing questions of health and illness, mind and body, diet, pain, death and dying.
This book provides a framework for the reader to contemplate, perhaps for the first time, that your own mind and body might shelter deep inner resources for healing and for coping. You might be interested to learn that how you approach your illness might make a big difference in your quality of life and in your relationships, and that even the course of the disease itself and its response to treatment might potentially be affected. Strong recent evidence suggests the possibility that sharing feelings in a group and practicing stress reduction exercises as a complement to more traditional treatments might extend periods of remission and positively influence survival (see, for example, Spiegel et al., Lancet 2:888, 1989; Fawzy et al., Arch. Gen. Psychiatry 50:681, 1993).
The informed pursuit of treatment options, including disciplines such as meditation and yoga which may help us as human beings to mobilize the full range of our resources for healing, can also influence how we encounter our own mortality. Perhaps inner peace, freedom and meaning, even health lie embedded within the very pain, fear, and uncertainty we frequently experience as we face illness and engage with it as full participants along the road we call our life.
A full professor at a prestigious university, who had struggled mightily with his doctors and insurer to develop and pay for the treatment plan he felt he needed, commented in class in our clinic one day that his leukemia and the impending bone marrow transplant he faced had brought him into what he called “this community of the afflicted” where he felt more at home, in a funny way, than with his colleagues. Pain and life-threatening illness frequently create a separate reality and the potential for a consciousness all its own. When we explore this reality, as people do in the Commonweal Cancer Help Program, in our clinic, and in many other places, remarkable new openings often occur for people. In his case, an insight came to him while riding on the subway that the people sitting on either side of him might very well be suffering every bit as deeply as he was or that the other people in the class were. He saw that the community of the afflicted potentially extends to everybody. So what started as a feeling of separation blossomed into a deeper feeling of inclusion and unity, one from which he took considerable satisfaction since it was in resonance with his deepest values.
As Michael reminds us, affliction can itself become a powerful teacher and augur a turning point in one’s life. While there may be few or no reliable cures at this time, profound healing is possible. It usually requires active participation on the part of the person with the disease. The illness may become an occasion for a deep looking into life itself, an acknowledgment of what is really important, a falling away of a certain automaticity or mindlessness, a blindness which frequently ignores or takes for granted that which is most fundamental and dearest to us. Often, the change appears as a subtle “rotation in consciousness,” a shift in perspective arising out of a careful observing of the activity of mind and body without judging or condemning what it is that one sees and is feeling. This is the inner work of on-going human development that is the domain of meditation and yoga, which are mentioned and discussed at various points throughout the book as options and vehicles for exploring healing and inner well-being.
I believe that the more options we have in dealing with distress and crisis, the healthier we will be psychologically, and the more we will feel like an important if not crucial participant in what is happening in our lives, with at least some degree of influence and control. Michael’s simile of the cancer patient in the role of policymaker rather than cancer researcher is entirely accurate. It explains why the message of the entire book is aimed just where it ought to be, namely, at making realistic, hopeful, and uniquely personal choices under time pressure and on the basis of incomplete evidence and partial understanding of an extremely complex disease, where nobody has the last word or a magic bullet, and many approaches can be complementary to one another.
Little is fixed while we are alive. As things unfold, as we see how the body responds to a chosen course of treatment, as our understanding and our experience grow and deepen, as circumstances change, we might want to change course, make new choices, pursue other options. This book makes the journey that much richer for those seeking information and alternatives as they grope, fight, and grow toward wholeness. I wish all who come to this book well, on their unique paths of healing.
Jon Kabat-Zinn, Ph.D.
Associate Professor of Medicine
Director, Stress Reduction Clinic
University of Massachusetts Medical Center
January 3, 1994