Written by Jimmie C. Holland, MD, and Sheldon Lewis, this
book focuses on the "human effects" as opposed to the "physical
effects" of cancer, and is written as an imaginary conversation with the
reader: "I wish I could sit with you and talk about what’s been going on
for you and how you’ve been coping…But since that’s impossible, I’ve
tried through the chapters of this book to talk with you as I would if you were
in my office."
Dr. Holland is professor of psychiatry at Weill Medical College
of Cornell University and chair of the department of psychiatry and behavioral
sciences at Memorial Sloan-Kettering Cancer Center in New York City. Her
scientific contributions through her pioneering work on the psychological
aspects of cancer have shaped the discipline of psycho-oncology over the past
2 decades. Mr. Lewis is a journalist with a special interest in the human
side of medicine.
Through this book, Dr. Holland’s considerable talent and
expertise are made available to cancer patients, family members, and caregivers.
There is also a wealth of invaluable information for the "physical"
cancer specialist, both in the guise of the illuminating observations and
perspectives of the authors and through patients’ comments that are more
likely to be heard in the mental health professional’s office than in the
The common mythsthat emotional stress can cause cancer and a
positive attitude can cure it, and that people can bring cancer upon themselves
through some character "weakness"are examined in their unconscious
When misfortune strikes, it is a natural human tendency to
search for a reason. The ready explanation is often ‘he must have brought it
on himself.’ This reaction is similar… when someone is mugged. … ‘What
were you doing in that neighborhood, at night, anyway?’ This response is part
of a bigger psychological picture: … By blaming the victim, we get a false
sense of security that we can prevent events that are beyond our control.
The insidious consequences of such beliefs are also clearly
outlinedfor example, promoting isolation and alienation by placing on the
patient the additional burden of being expected to "be positive,"
delegitimizing the fear and sadness that are part of a normal human reaction to
the diagnosis of cancer.
Particularly detailed and insightful is the account of the
psychological events patients experience when they are in the prediagnosis,
diagnosis, treatment, and posttreatment phases. Such descriptions are followed
by practical and helpful suggestions as to how people may best handle their
emotional reactions to these distressing experiences. Useful checklists of
symptoms that usually require professional help are included. The combination of
Dr. Holland’s scientific and technical knowledge with the wealth of insights
from people who have actually had cancer brings to the reader a unique set of
tools to deal with the mundane (but inescapable) aspects of managing the
practical tasks of living with cancer as well as the deepest existential enigmas
that confront humans facing their own mortality.
The following summary of the book only begins to illustrate the
richness and complexity of this work.
In Chapter 1, the authors identify crucial times in the natural
history of cancer when the emotional burdens peak and patients often require
psychiatric support. This is followed by a description of Dr. Holland’s family
background and the development of her interest in the psychological and
behavioral aspects of cancer: "Whenever I read a book, I first want to know
something about the author so I can better judge the book’s contents and its
reliability. For this reason, I feel you have a right to know where I’m coming
In Chapter 2, entitled "The Tyranny of Positive
Thinking," and in Chapter 3, "The Mind-Body Connection and
Cancer," the authors examine common assumptions and beliefs about cancer
and affirm the uniqueness and legitimacy of each person’s coping style.
Chapter 4 is dedicated to the key issues of the emotional
barriers that prevent many people from seeking medical help when a suspicion of
cancer arises through self-observation of new and worrisome symptoms. Advice on
how to handle anxiety and avoid delay in consulting a physician is provided. The
emotionally trying period between testing and confirmation of
diagnosis/initiation of treatment is also covered in the latter part of this
Chapter 5 deals in a practical and straightforward manner with
the delicate topic of the patient-physician relationship and underlines patients’
and families’ demands that physicians communicate with their patients in a
sensitive manner: "You have the right as a patient to expect your doctor to
be competent, to be assured that he or she is knowledgeable and technically
skilled. However, you also have a right to expect caring and compassion from
The authors provide a list of helpful suggestions on how to
prepare for and handle the visit with the physician so as to ensure that the
patient’s information and emotional needs are satisfied. They also recommend
that patients introspectively assess how many details about their condition they
wish to receive and recognize how they may best succeed in assimilating the
information. "Communication is a two-way process; you can control more of
it if you present your problems, thoughts, and wishes clearly, indicating
whether you are someone who likes to have all the facts or just the facts needed
to make decisions." The chapter ends with an outline of patients’ rights
as formulated in New York State and patients’ responsibilities as presented at
Memorial Sloan-Kettering Cancer Center.
Chapter 6 deals with coping. Personality traits that tend to
facilitate or hinder coping and signs that the individual’s coping ability is
being seriously challenged and requires professional intervention are
The psychological side effects of cancer treatmentboth in
general and as related to specific cancersare covered in Chapters 7 and 8.
Chapter 9 deals with counseling (including sexual counseling):
"If you have had a sexual problem after cancer treatments, you know how
hard it is to bring up the topic with the doctor. And you also know that the
doctor rarely asks if you have any sexual concerns." Problem solving,
mind/body techniques (including meditation, deep breathing, muscle relaxation,
and creative techniques such as art therapy) are also explored. At the end of
the chapter, medications used to treat anxiety, depression, and other forms of
psychological distress are reviewed.
Chapter 10 provides a comprehensive overview of alternative and
complementary therapies, and an assessment of the benefits one can realistically
expect from those interventions.
Psychological problems related to survivorshipsuch as dealing
with uncertainty regarding the possibility of a relapse, prognostic information,
permanent disabling side effects of curative treatment, work and insurance
issues, and sex and fertility after cancerare addressed in Chapter 11.
Chapters 12 and 13 are focused on staying healthy, cancer
screening, cigarette smoking, alcohol and cancer, weight and obesity, sun
exposure, and living with cancer as a chronic illness.
Chapter 14, entitled "The Last Taboo," addresses the
physical, psychological, social, and spiritual aspects of dying. The authors
describe the crisis of meaning that the imminence of death can induce with the
help of some thought-provoking quotes from Arnold Toynbee (in our society,
"death is considered an affront to every citizen’s right to life, liberty
and the pursuit of happiness") and Daniel Callahan ("The meaning of
death is…relegated to the privacy of religious beliefs or, in their absence,
whatever personal resources people can bring to [it] on their own"). In Dr.
Holland and Mr. Lewis’ words,
We live in a culture that extols rugged individualism and a
philosophy of life that says you can accomplish anything you set your mind to.
And we infer that includes beating your own death. It is little wonder, then,
that people are unprepared when an illness, like cancer, strikes with its
potential threat of death. The result is a crisis of great proportions: one must
confront not only biological death, but squarely what it means not to be alive.
The role of the counselor is accordingly seen as that of the
helper facilitating the patients in finding their own meaning in the
"psychospiritual" crisis precipitated by their illness. The authors
clearly indicate their uncompromising expectations of the standard of care for
the dying: "end of life care...should be as aggressive at treating pain and
suffering as the treatment that was aimed at cure."
Chapter 15 addresses family and caregivers’ issues such as the
caregiver as advocate, the family and genetic risk, and the positive aspects of
being a caregiver. In Chapter 16, the grieving process is reviewed (patterns of
grieving, grief before and after loss, grieving over years, dimensions of
grief). The book also contains an extensive list of resources for people with
cancer, their relatives, friends, and caregivers, covering cancer in general,
specific cancers, and other topics such as aging, alternative and complementary
therapies, bone marrow transplants in children, pain management,
palliative/hospice care, bereavement, prevention, survivors, transportation, and
books for adults or young readers.
This book should be empowering to cancer patients, their
families, and caregivers. It is, however, a book for the sophisticated reader.
Cancer patients and families of patients who possess the linguistic expertise
needed to penetrate the lucid but at times complex prose of Dr. Holland and
Sheldon Lewis will probably relate to its content immediately and benefit from
the myriad strategies, tactics, and tips on how to handle the external and inner
realities of having one’s life touched by cancer.
The book may present a challenge for some physicians who, by
reason of training, have developed the intellectual keys to the language of the
book but also a deep-seated resistance to exploring the humbling depths of the
human experience of cancer and death. The willingness and courage to overcome
that resistance will be rewarded by an illuminating perspective on the journey
that cancer patients endure. Indeed, this book should be part of the library of
everyone who is involved in the care of cancer patients.