a war on cancer? -- 9/6/23

 Today's selection -- from The Myth of Normal by Gabor Maté and Daniel Maté. Beyond the "war on cancer" metaphor: 

“We are used to seeing disease as a thing to get rid of or a foe to battle against -- as, for example, in the ‘war on cancer.’ (Which ‘war,’ for the record, has been far from victorious.) Someday, we tell ourselves, with enough research, we as a society will ‘beat’ cancer and wipe it out; in the meantime, we maintain a tenaciously defiant attitude, as expressed in the viral hashtag #FuckCancer. Our everyday language gives voice to our combative stance: we hear of a friend or a family member courageously ‘battling MS’ or some other illness; they will either prevail in the struggle or else ‘succumb.’ 

“It may be that these martial metaphors are so appealing because their force matches our feelings of anger and despair; that does not, however, make them helpful. In a previous work I quoted the Canadian oncologist Karen Gelman, a leading breast cancer specialist, who looks askance at the military depiction of cancer care and research. ‘What happens in the body is a matter of flow -- there is input and there is output,’ she said, ‘and you can't control every aspect of it. We need to understand that flow, know there are things you can influence and things you can't. It's not a battle, it's a push-pull phenomenon of finding balance and harmony, of kneading the conflicting forces into one dough.’ I noticed how closely her use of ‘flow’ mirrors V's language -- one woman speaking from medical expertise, the other from hard earned, subjectively sourced insight. 

“Beyond the declarations of war, there is another, even more popular class of misapprehensions that cloud our view of disease: ‘I have cancer.’ ‘She has MS.’ ‘My nephew has ADD.’ Embedded in each phrase is the unexamined assumption that there is an I (or a someone) distinct and independent from the thing called disease, which the ‘I’ has -- as in the statement ‘I have a flat-screen TV.’ Here is my life, and over there is the disease that has encroached upon it. Seen this way, disease is something external with its own nature, existing independently of the person in whom it shows up. Given where that perspective has gotten us, it is time to consider a new one. 

“We have already glimpsed the countless hormonal, immunological, neurological, molecular, intracellular, and epigenetic pathways that make our physiology inseparable from our emotional, psychological, spiritual, and social lives. V's understanding of trauma and stress as major founts of the process that ultimately came close to killing her is completely aligned with modern science. In a five-decades-long British study that followed nearly ten thousand people from birth until the age of fifty, it was found that early-life adversity -- abuse, socioeconomic disadvantage, family strife, for example -- greatly increased the risk of cancer before the mid-century mark. Women who experienced two or more such adversities had a doubled risk by midlife.

“‘These findings suggest that cancer risk may be influenced by exposure to stressful conditions and events early on in life,’ wrote the researchers, once more employing the carefully reticent language of ‘suggest’ and ‘may.’ To my clinical sensibilities, concerned as I am with how people fall ill and/or find healing, such results, mirrored over and over in multiple other studies, do not suggest: they scream for attention. The disorganizing impact of stress hormones on the immune system as a risk for cancer is far from a scientific secret. We have also seen how stress and trauma are prime drivers of inflammation, another central gear in the cancer-causing apparatus. Along parallel lines, girls who are sexually and physically abused have far greater risk in adulthood of endometriosis, a painful and often disabling condition that heightens the risk of ovarian cancer and whose origins perplex conventional medical thinking. Considered from the mind-body psychoneuroimmunological perspective, the puzzle becomes rather less puzzling.

“To restate a question essential to our theme: What if we saw illness as an imbalance in the entire organism, not just as a manifestation of molecules, cells, or organs invaded or denatured by pathology? What if we applied the findings of Western research and medical science in a systems framework, seeking all the connections and conditions that contribute to illness and health? 

“Such a reframing would revolutionize how we practice medicine. Rather than treating disease as a solid entity that imposes its ill will on the body, we would be dealing with a process, one that can't be extricated from our personal histories and the context and culture in which we live.”

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Gabor Maté and Daniel Maté


The Myth of Normal




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