Can Psychotherapy Prolong Cancer Survival?

DUring its intellectual odyssey. psychiatry has been caught between the Scylla of mindless materialism and the Charybdis of disembodied spiritualism. By the end of the 19th century. we had conceptualized the psyche as little more than the product of our genetic heritage and then followed Freud in the opposite direction. attributing personality and psychopathology to early life experience. despite Freud's avowed goal of a biology of the psyche.' At the end of the 20th century. we have again returned to biology as the key to understanding all mental function and psychiatric illness. Thus. it is of more than passing interest to examine the literature on the opposite problem: the effects of mental events on physical processes. What evidence indicates that the mind can influence the course of disease in the body? The brain is such a complex and elegant organ system that it would be strange indeed if it did not control behavior and physical processes in a way that has survival value. Why did we evolve all this cortex if not to help us prolong life and master our environment? Evidence that Type A personality style predicts vulnerability to heart disease~ and that relaxation training is an extremely effective treatment for mild hypertension provides support for the idea of a mind-body relationship that goes in two directions. There have been tantalizing suggestions in the literature that mental events. such as the expression of anger. are nonrandomly related to cancer diagnosis and progression. In 1975. Greer and Morris~ found that women with malignancies at breast biopsy had more difficulty expressing anger than those with benign lesions. The mood assessment was performed before the patients had the results of the biopsy. so the difference in prognosis could not account for the psychological differences. In 1979. Derogatis et aI.' reported that cancer patients who were rated by the medical staff as less cooperative lived significantly longer. This finding was complicated by the fact that the long-surviving group had had significantly less radiotherapy prior to the study. Greer et al.° found that cancer patients with a fighting spirit survived longer. These earlier studies received support from Goldstein and Antoni. who found more repressive coping styles among breast cancer patients as compared with controls, and from Hislop et al.. who found that extroversion and social activity were predictive of longer survival among breast cancer patients. However. unlike earlier work. they found that low. rather than high. levels of anger predicted better outcome. Temoshok et al. found that relatively cooperative. unassertive malignant melanoma patients had more unfavorable prognosis: Temoshok also found that patients with malignant melanoma who self-reported more psychosocial distress had faster