For Serena,

Don Benjamin present an alternative view to sickness and the mind.

Cancer and the Role of the Mind

Don Benjamin

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Alternative therapists claim that the causation and control of cancer has
not only physical but psychological and spiritual factors as well. Orthodox
medicine on the other hand accepts only the physical factors. What is the
evidence that theories relating to psychological factors are valid and that
therapy based on these theories actually works?

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There are many factors which are claimed to be involved with the causation
and control of cancer.

These include

(a) physical factors such as:

a.. diet and nutrition, including salt, artificial colouring, flavouring,
food processing and preservatives
b.. the environment, including water and airborne contaminants
c.. occupational exposure such as asbestos and radiation
(b) psychological factors such as:

a.. the mind, operating at both the conscious and unconscious level
b.. personality
c.. inherited predisposition
(c) spiritual factors such as

a.. the psyche, soul or spiritual identity
Orthodox medicine accepts only physical factors such as diet and
occupational exposure, and then only as causative factors. They have several
theories about the process of cancer causation and reject any claims that
diet can have any effect on survival once malignancy is established.

They refuse to look at any theories other than the currently accepted one
that the tumour is the disease. Surgery and radiotherapy are designed to
kill or otherwise remove the tumour. When this fails and the "disease" has
"spread" chemotherapy is then used.

Not surprisingly there is no evidence that surgery or radiotherapy has any
effect on survival or mortality with any form of cancer except where the
tumour is obstructing a vital organ or pressing on the brain1. The only
evidence that orthodox methods can improve survival significantly is in a
few areas where cancer is known to be systemic in its nature such as with
some types of leukemia, and chemotherapy, a systemic therapy is used. In
view of the extremely toxic nature of chemotherapy and it effect on the
immune system it is not surprising that it is ineffective against solid
tumours2.

The more honest medical scientists are at last starting to use the term
"incurable" in relation to cancer3. This means incurable using orthodox
methods.

What about other theories and paradigms?

Most alternative therapies are based on the theory that cancer is a systemic
disease and tumours are only local expressions, symptoms or elements in this
disease. Such therapies are then designed to restore the body's metabolic
functions, respiratory, digestive and endocrine systems so that the immune
defences can work normally again.

Some therapies assume the immune defences have simply broken down because of
psychological factors. For example the Simonton Therapy4, which involves
visualisation and imagery techniques, assumes that stresses with which the
individual cannot cope lead to emotional disturbances in the limbic region
of the brain. Here the hypothalamus transfers these disturbances to the
pituitary gland which in turn controls the body's endocrine system and
thereby the body's immune defences.

Other therapies assume a breakdown of metabolic or endocrine systems which
in turn lead to the "cancer milieu"5.

What is the evidence that theories relating to psychological factors are
valid and that therapy based on these theories actually works?

We can look at both the cancer causation mechanism and the cancer control
mechanism. Just as diet is claimed to contribute to cancer causation,
nutritional therapies have been claimed to reverse cancer. So it is with
psychological factors.

Cancer causation

Let us first look at cancer causation. And this also provides some ideas for
those who wish to prevent cancer.

Several workers such as Hans Selye6 and Lawrence Le Shan7 have identified
personality factors that are claimed to be present in most cancer patients.
In recent times these have been refined somewhat and some recent trials have
described eight such characteristic factors for cancer patients:

1.. Involvement - Vacillate between extreme intimacy and extreme aloofness
2.. Feelings - Avoid the expression of feelings
3.. Rationality - Claim to be controlled by reason rather than emotions
4.. Anxiety - Deny fears or anxiety related to present or coming problems
5.. Harmonizing - Avoid arguments and confrontation and are rarely
aggressive
6.. Hopelessness - Feel pessimistic about life and expect the worst
7.. Helplessness - Feel out of control and need a lot of support but have
never accepted help from others
8.. Self-sacrificing - Work for others' benefits and ignore their own
needs
Sometimes they can be grouped into inability to become involved or express
feelings, hiding behind rationality (1-5), hopelessness/helplessness (6-7)
and self-sacrifice (8). These are sometimes described as starving themselves
of their own spiritual and human needs which humans have for giving and
receiving love.

In 1980 Michael Wirshing et al8 from the Psychosomatic Clinic at Heidelberg
University in Germany interviewed 56 women just prior to biopsy for breast
cancer. Interviews lasted 30-50 minutes and were taped. Most subjects were
from the lower social class. Using these 8 factors the interviewers
correctly predicted 83% of the women who were later diagnosed with cancer
and 71% of those who had benign lumps. Others not involved in the interviews
listened to the tapes and made separate assessments. These 'blind' raters
predicted 94% of the cancer diagnoses and 68% of the benign diagnoses.

So there is clearly a cancer personality or profile. It is not black and
white: for example between a quarter and a third of patients diagnosed with
benign lumps exhibited the psychological profile of the cancer patient.

The next question to ask is:

Once people get cancer what personality types have the best survival?

Two trials provide some answers:

1.. Sandra Levy et al9 from the Pittsburgh Cancer Institute looked at
survival figures for 36 women who had their first recurrence of breast
cancer. They found that those with a positive mental attitude best described
as "joy" had the longest survival. This included descriptions of glad,
cheerful and joyous attitudes. On the other hand negative attitudes, where
patients felt sad, hopeless, worthless, miserable or unhappy tended to have
the shortest survival, typically surviving less than 2 years after
recurrence. The same applied to those exhibiting hostility. Their report was
in 1988.
2.. Keith Pettingale et al10 from King's College on London reported in
1979 that psychological responses to cancer diagnosis taken from 57 women
with early breast cancer 3 months after their operation predicted survival 5
years later.
Best survivals were found among those with a "fighting spirit" and those who
practised "denial"; whereas worst survival was observed among those with
"stoic acceptance" and a feeling of "helplessness" or a situation of
"hopelessness". They reported again 5 years later, 10 years after original
diagnosis. 70% of those with a "fighting spirit" were still alive including
one with metastases as were 50% of those exhibiting "denial", 25% of "stoic
accepters", including one with metastases, and 20% of those who felt
"hopeless/helpless".

There were no initial biological differences observed, all four patient
groups having similar clinical stage, approximate tumour mass, histological
grade, mammographic appearance and hormonal an immunological profiles. The
difference in host resistance was apparently related to psychological
factors.

The next question to ask is, if the personality type predisposes certain
people to get cancer and certain other personal attitudes appear to affect
survival, can one's personality type and attitude be changed to enable a
building up of this host resistance?

For example can a person learn how to express feelings? Can he or she learn
how to put their interests ahead of those of other people? Can a person
change from feeling helpless to one with a strong fighting spirit? My answer
to these questions is Yes!

What evidence is there that psychotherapy can improve survival or reduce
mortality?

There are three trials offering some evidence that psychotherapeutic
intervention can affect survival:

1.. Fawzy I. Fawzy et al11 from the Neuropsychiatric Institute at the UCLA
School of Medicine analysed immunological responses in 61 cancer patients
with malignant melanoma over six months. There were 28 men and 33 women
randomised into two groups, a study group of 35 and a control group of 26.
The study group was given a structured psychiatric group intervention which
lasted about 1-1/2 hours per week for 6 weeks.
2.. Although not many changes were observable after six weeks there were
significant differences observed between the two groups after six months.
The study group which had received psychotherapy showed:
3.. a reduction in the level of psychological distress
4.. a greater use of active coping skills
5.. a significant increase in the percentage of larger granular
lymphocytes (LGLs)
6.. a significant increase in the percentage of natural killer cells (NKs)
7.. an increase in NK cytotoxic activity
So the psychotherapy not only made the patients feel they were coping better
with the disease; their immunological responses confirmed that they were.
These results were reported in 1990.

2. David Spiegel et al12 from Stanford and Berkeley Universities in
California reported on the effect of psychosocial intervention on survival
with a group of 86 patients with metastatic breast cancer. These patients
were randomised into two groups, a study group of 50 and a control group of
36. Both groups had routine oncological care, but the study group was
offered weekly supportive group therapy and self-hypnosis for pain for 1
year.

The survival figures showed a divergence beginning 8 months after the
psychosocial intervention ended, ie after 20 months. Average survival for
the study group was 36.6 months compared with 18.9 months for the control
group. The effect of the intervention was also to reduce anxiety, depression
and pain.

The researchers were initially sceptical of claims that visualisation and
imagery could improve survival so they did not use this technique. Rather
they emphasised living as fully as possible, improving communications with
family members and doctors, facing and mastering fears about death and
dying, and controlling pain and other symptoms. An important factor observed
was that the study group formed a bonding that countered the social
alienation that often divides cancer patients from their well-meaning but
anxious family and friends.

An unusual phenomenon observed was that the increased survival did not
become apparent until nearly a year after therapy had finished. The authors
attributed this to a mild cumulative effect.

The authors were not able to explain the results but speculated that
neuro-endocrine and immune systems may be a major link between emotional
processes and the course of cancer.

Two possible shortcomings of this trial were not knowing how representative
the patients were of the wider community; and the limitation of matching in
small groups by relying only on randomisation. Neither of these would have
affected the validity of the result because the effect was so large.

A third study demonstrating the efficacy of group or behavioural therapy in
the treatment of cancer is one by Hans J Eysenck and R Grossarth-Maticek
from the University of London13.

In the Eysenck and Grossarth-Maticek paper, published two years after
Spiegel's, there was improved randomisation. Patients suffering stress were
first matched into pairs based on sex, age, smoking, cholesterol level,
blood pressure and personality type. Only after both members of a matched
pair had agreed to participate in the trial were they randomised into
therapy and control groups. This guaranteed that the therapy and control
groups were accurately matched despite their small sizes. Cancer prone (Type
1 or "Type C") and coronary heart disease (CHD) prone (Type 2 or "Type A")
patients were treated separately in some of the studies.

They carried out six studies to test various hypotheses:

a.. the effect on the prevention of cancer and coronary heart disease of
b.. individual therapy
c.. group therapy
d.. bibliotherapy (learning the therapy from a text);
e.. effect of behaviour therapy on preventing absence through illness
requiring hospitalisation;
f.. the effect of behaviour therapy on survival of terminal cancer
patients; and
g.. a comparison of the effects of behaviour therapy and chemotherapy on
the survival of cancer patients.
Results were as follows:

Study 1 - Extended Individual Therapy

Patients were aged 30-69, mean age 50yrs; half were men and half were women;
matching of pairs prior to randomisation was on the basis of age, sex,
degree of stress, intensity of cigarette smoking, blood pressure, blood
sugar level and cholesterol. Six to twelve months after completing therapy
their personality types were reassessed using the same questionnaire as
before to measure any short-term changes to the personality that might
explain the effects of treatment.

Results: After 13 years of follow-up, none of the 50 treated in the cancer
prone group had died compared with 16 of the 50 in the control group. 13 had
cancer compared with 21 in the control group, 5 had died of other causes (cf
15) and 90% were still alive compare with 38% in the control group.

Personality retyping showed the therapy group's cancer proneness scores had
fallen from 9.8 to 5.7. As expected there was no change in score (9.8) for
the untreated control group.

Study 2 - Group Therapy

This was similar to Study 1 except that 245 patients received therapy in
groups of 20-25 people; the untreated control group also contained 245
people; sessions lasted several hours depending on the wishes and progress
of the participants; there were 6-15 sessions altogether.

Results: After 7 years follow-up there were 18 cancer deaths in the 239
treated group compared with 111 of the 234 in the control group (A few could
not be contacted). 75 were alive with cancer compared with 129 in the
control group.; 10 had died of CHD compared with 36 in the control group,
CHD incidence was 29 (cf 45); 20 had died of other causes (cf 33) and 80%
were still alive compare with 24% in the control group.

Study 3 - Bibliotherapy (therapy described in an article and explained in
3-5 hours of discussion)

There were 600 in the study group and 600 in the control group. (The latter
were given an article that did not include any treatment techniques for them
to use.)

Results: After 13 years follow-up there were 27 cancer deaths in the 600
treated group compared with 106 deaths in the 600 in the control group; 99
were alive with cancer compared with 162 in the control group; 47 had died
of CHD compared with 145 in the control group, CHD incidence was 132 (cf
203); 115 had died of other causes (cf 164) and 68.4% of those treated were
still alive compare with 16.3% in the control group.

Study 4 - Illness, Absence, hospitalisation

362 pairs of males suffering stress were randomised in the usual way after
matching and one group was treated. During the following 13 years the number
of days spent in hospital was measured for the two groups.

A total of 6194 days were spent in hospital by the treated group averaging
19 days each.

This compares with 10,136 days in hospital by the control group, averaging
28 days each.

Study 5 - Therapy on Terminal Cancer Patients.

This study involved 24 pairs of cancer patients with six different types of
inoperable cancer, including scrotal (1), stomach (2), bronchiolar (7),
corpus uteri (4), cervical (5) and colorectal (5).

Survival times of the treated group averaged 5.07 years (ranging from 1.7
yrs for bronchiolar to 9.5 yrs for colorectal). For the control group
survival averaged 3.09 years (ranging from 1.0 yrs for bronchiolar to 4.9
yrs for colorectal)

Study 6 - Behaviour therapy vs Chemotherapy

129 women metastasised breast cancer for whom chemotherapy had been proposed
were asked to participate. 17 refused psychotherapy and 56 refused
chemotherapy. 50 of those who accepted chemotherapy were divided into pairs
matched for age, social background, extent of cancer and medical treatment.
One of each pair was then randomised to receive psychotherapy. Similarly 50
of those who refused chemotherapy were matched then one of each pair was
randomised to receive psychotherapy.

This study therefore involved 100 women with metastasised breast cancer, in
four similar groups of 25 who received chemotherapy + psychotherapy,
chemotherapy alone, psychotherapy alone and no therapy. Of the 50 who
received psychotherapy 24 received creative novation behaviour therapy (as
in studies 1 and 2), 12 received depth psychotherapy and 14 received
orthodox behaviour therapy (relaxation training and desensitisation). 30 hrs
of psychotherapy was given.

Results: Mean survival times for the 100 patients was 15.7 months, ranging
from 11.28 for those who received no therapy (having refused chemotherapy),
to 14.08 for chemotherapy alone, to 14.9 for psychotherapy alone to 22.4
months for chemotherapy + psychotherapy.

The authors state that chemotherapy alone increased mean survival by 2.80
(14.08-11.28) and psychotherapy alone increased it by 3.64 (14.9-11.28).
Theoretically by adding these two effects chemotherapy + psychotherapy
should have increased survival by only 6.44 months to 17.72 months. In fact
it increased it to 22.4 months exceeding the additive value by 4.68 months,
suggesting a synergistic interaction between these two therapies.

It was also observed that the lymphocyte count of those receiving
psychotherapy continued to rise over time whereas those not receiving
psychotherapy fell, suggesting that the psychotherapeutic intervention may
have had its effect through the involvement of the immune system.

The authors recognise that the trial was not one to test the effect of
chemotherapy versus no chemotherapy, so there was no need to randomise
patients into "chemotherapy" and "no chemotherapy" groups. This was done by
self-selection: those refusing chemotherapy became the source for selecting
and matching 50 women who would receive no chemotherapy but would be
randomised to receive or not receive psychotherapy. This is in contrast to
psychotherapy where in each case there was proper randomisation into the
treatment and no treatment groups.

Comment:

The process of self-selection introduces an unknown factor into the trial.
Earlier trials of mammogram screening have shown that those who refuse
various therapies have such different personality profiles from those who
accept them that that their mortality rates are quite different. This means
that while comparison of survivals between psychotherapy and no
psychotherapy groups remain valid, similar comparison between chemotherapy
and no chemotherapy are less reliable statistically.

In all of the above evidence the number of participants in the trials has
been small. However, providing:

a.. the results are based on comparing two groups that have been
randomised;
b.. the groups after randomisation are found to be very similar in their
makeup in relation to the age and socioeconomic level of patients and the
stage of disease;
c.. the difference in survival or mortality between the study and control
groups is quite large; and
d.. the only factor varied was the addition of the particular therapy;
the results of such comparative trials are quite valid.

SUMMARY

It is therefore clear from the available evidence that:

a.. psychological factors play an important part in determining
1.. a person's susceptibility to getting cancer;
2.. survival once cancer has been diagnosed with cancer.
b.. therapies based on changing these psychological factors can have a
significant impact on the course of the disease.
It is therefore important that all cancer control programs incorporate some
form of psychotherapy as an integral part.

REFERENCES

1.. Benjamin, D. Efficacy of surgical treatment of cancer. Medical
Hypotheses 1993; 40:129-138,.
2.. Langlands, A. Battling breast cancer with dollars and sense, MJA 18
July 1994:161.
3.. Ulrich Abel Abel, U. Chemotherapy of advanced epithelial cancer: a
critical review. Biomedicine & Pharmacotherapy 1992; 46: 439-452.
4.. Simonton, S. & C. Getting Well Again, Bantam, New York 1978.
5.. Issels, J. Cancer A Second Opinion, Hodder & Stoughton, London 1975.
6.. Selye, H. The Stress of Life, McGraw-Hill, New York, 1956.
7.. Le Shan, L. Psychological states as factors in the development of
malignant disease: a critical review, J. Nat. Cancer Inst 1959; 22: 1-18.
8.. Wirshing, M. et al. Psychological identification of breast cancer
patients before biopsy. J. of Psychosomatic Research 1982; 26: 1-10.
9.. Levy, S. et al. Survival hazards analysis in first recurrent breast
cancer patients: Seven-year follow-up, Psychosomatic Medicine 1988; 50:
520-528.
10.. Pettingale, K. et al. Mental attitudes to cancer: an additional
prognostic factor. The Lancet, March 30, 1985.
11.. Fawzy, Fawzy I. et al. A structured psychiatric intervention for
cancer patients. Arch Gen Psychiatry August 1990; 47: 729-735.
12.. Spiegel, D. et al. Effect of psychosocial treatment on survival of
patients with metastatic breast cancer, The Lancet, October 14, 1989.
13.. Eysenck, H and Gross-Maticek, R. Behaviour Research and Therapy 1991;
29(1): 17-31.
-oOo-

Ask anyone: they'll tell you that all the most influential medical
cabals and pharmaceutical conspiracies follow Serena's every whim...

He does appear to have views ON disease and personality.

I wonder what sort of psychotherapies he has in mind... Perhaps
http://www.ciss.org.au could give some clues.

Curious you did not make any comments on Don's approach????
Just wondering???

Cheers

Don is the Convenor of CISS an educational Cancer support group located in
Sydney.
"Serena Nordstrup" <s_nor...@my-deja.com> wrote in message
news:c6f4cb21-b075-4121...@12g2000pri.googlegroups.com...

I see you two are still dueling it out.

Hi Thomas,
Good to hear from you.

Since measurement is Serena's bag , I just thought I would tease her just to
see what see made out from Don Benjamin's article.

Best of luck to you

Cheers Bruno

> I was wondering whether his different approach to Cancer may have some

I don't follow your "since" there Bruno.

Educational, eh?

Do you have any ideas, Bruno, on why he would use coded phrases like
"orthodox medecine" yet omit to mention the concept of placebo ?

Slimily
Serena

Hi Tom.

Bruno just ~got~ back.

Simpatice
Serena

You do realize, Bruno, that we can ~blame~ Captain Jimbo for
emphasizing the emphasis that the so-called ~werner erhard~ allegedly
placed on measurement and ~statistics~... ?

Well you must be in league with Captain Jimbo, as you have requested the
"measurement "
line on many occasions.
Can we now call you Madame Jimbo?????

Why don't you try a little harder???

Educational, eh?

Yes Educational such as developing knowledge, instructing in trying to
understand one of the many the scourges of the twentieth century.

No I don't.
DO you and why do you bring that up????
What is it about the article that displeases you???????

Slimily
Serena

Two can play the teasing game, Bruno.

Almost as good as "slippery and slimy"...

OK. Will you help?

...sounds more like research than education ...

... sounds like indoctrination rather than education ...

The twentieth century seems so long ago now... But it did have support
groups for education, I recall. As distinct from support groups for
cancer-~victims~...

I thought we might put it down to spin, and I brought it up as a means
of testing/evaluating for spin.

Did something about the article provoke some emotional response from
me, Bruno?

> Slimily
> Serena

OK. Will you help?

Since when is having a different approach in viewing a problem
indoctrination????
Seems like you only accept my way or the highway!!!!!

Spin???
He is not a public Relations man but a mere citizen trying to get across
a different viewpoint.

May not be to your liking and if so say so.

No but your tone of voice conveys displeasure .

Cheers

> Slimily
> Serena

Did you ask anyone, Bruno?

Any progress on tracking down the most effective psychotherapies
against cancerous growths, Bruno? you could benefit the world's
potential cancer-~victims~ and make a buck or two while doing so ...

> > > Perhapshttp://www.ciss.org.aucould give some clues.

I'll take your lack of response as a "yes".

Since Bruno Tonon characterized it as "instructing in trying to
understand".

> Seems like you only accept my way or the highway!!!!!

What makes "it" "seem" like that, Bruno?

... by using spin.

What I may like or not like has nothing to do with our discussion of
the the impact of Don Benjamin's efforts.

I wrote some words. Which word or words conveyed displeasure, Bruno?

Slimily
Serena

Yes they had never heard of you.

Could their be any other motivators part from monies for you Serena.
I have never thought Don Benjamin was in it for the monies!!!!!!

If that brings you some pleasure thats fine with me.

Is that so. What has Bruno Tonon got to do with the content of the article.

Don Benjamin made the effort and research to write the article, I am a mere
bystander
that thinks the article has some merit in addressing the mind or the placebo
as an important part of the healing process.

Never mind.

... by using spin.

So explain to me piecemeal how Don Benjamin uses spin, not just a few mere
words but using your esteemed logic. The one you claim to have.

Well it has in this discussion. You have a point of view about what Don has
said or you don't.

All of them my fair Serena. All of them.

Never mind , I made a mistake once again .

I humbly retreat from your presence.

Slimily
Serena

Right. And what does that imply about ignoring things on the grounds
of our alleged inability to measure whatever Serena may wish to
tabulate?

Of course, but that has no relevance here.

Perhaps not, but that has no relevance here.

against cancerous growths, Bruno? You could benefit the world's
potential cancer-~victims~ and ... perhaps gain other rewards.

> > > > Perhapshttp://www.ciss.org.aucouldgive some clues.

I'll hold you to helping me.

Yes.

Dunno. What has the content of Benjamin's article got to do with Bruno
Tonon's characterization of CISS as engaged in "developing knowledge,
instructing in trying to understand"?

You equate minds and placebos?

Curiosity, Bruno. Humor us with your insights once more.

Words have connotations and omitting words and concepts helps to frame
discussion.

Where have I made any such claim?

Have you confused me with your view of me?

Says who?

Perhaps so. So?

All?

I wrote (for example): "I wonder what sort of psychotherapies he has
in mind..."

How does the word "I" convey my alleged displeasure, Bruno?

How does the word "wonder" convey my alleged displeasure, Bruno? (What
a lovely word...)

How does the word "what" convey my alleged displeasure, Bruno?

How does the word "sort" convey my alleged displeasure, Bruno?

How does the word "of" convey my alleged displeasure, Bruno? (I have a
particular interest in your forthcoming explanation for the
displeasure inherent in this word.)

How does the word "psychotherapies" convey my alleged displeasure,
Bruno? (Benjamin used that word, apparently in a manner approving of
the concept of psychotherapies. Did something change when I pressed
the keys on my particular keyboard?)

How does the word "he" convey my alleged displeasure, Bruno?

How does the word "has" convey my alleged displeasure, Bruno? (Not too
hard to explain that one...)

How does the word "in" convey my alleged displeasure, Bruno?

How does the word "mind" convey my alleged displeasure, Bruno? (You
used that word yourself -- did it convey you displeasure then?

Perhaps more to the point, how does any combination of those words
convey my alleged displeasure?

Stick to your guns, Bruno -- stand up for your ~word~!

> Slimily
> Serena

I hate to be intrusive, but I did very much enjoy our previous
conversation and wanted to apologize for ducking out. It was just that
Tex was getting on my nerves and I didn't see much chance of the
conversation making much progress in that atmosphere.

Would you like to try again?

Nothing intrusive about it.

Feel welcome here at any time.

Simpatice
Serena

Perhaps you can help me out.

What might you like to talk about?

No offense to Bruno, I hope, but I haven't anything in particular to
say about Don Benjamin's views. I do hope though, that Bruno will
respond to your questions. I find the exchanges between the two of
you, shall we say... entertaining?

We could talk about credophilia. Bruno might enjoy that.

As opposed to... Skepticism of the pelicanist flavor perhaps ?

Indeed, yes.

I can sometimes find little shreds of amusement in the thought that
Bruno's compatriots provided the logicians with black swans, too.

Like a park or beach or mountain trail ?

We could lay out a blanket. Feed each other some cheese and crackers,
sip some wine... Watch the Pelicans...