Exploring What Matters Now

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Living with cancer causes many people to go deep. They ask these ultimate questions about what matters. Many come to the conclusion — that love is something even non-believers can believe in. Many traditions teach that the search for meaning includes a deepening appreciation of love —

Exploring What Matters Now

What Matters Now?

Many traditions, cultures, religions and practices consider this quest for meaning—this exploration of what matters now—to be a core dimension of the awakening of the human spirit. Here we explore meaning, joy and spirituality as they relate to health and specifically cancer.

We had trouble naming this part of the website. I argued for “Finding Meaning.” Nancy and Laura argued for “Finding Meaning and Joy.” I understood their argument for including joy, since joy is such an important dimension of what you may find. But I also thought it was a heavy lift in a site devoted to the cancer experience to focus on joy. I also thought that it’s not just joy people may find—it is may be love or the beauty of life or simply an intense sense of aliveness. “What

matters now?” was a good candidate since it poses the question—it doesn’t propose the answer. You may find meaning, joy, aliveness, love, or something entirely different. We all agreed to list “Exploring What Matters Now” as our seventh healing practice.

In 33 years of co-leading the Commonweal Cancer Help Program, I’ve seen so many different responses to a cancer diagnosis. Anxiety, fear and depression on the one hand. A sense of awakening to what matters now on the other hand. And everything in between. So often, people experience cancer as a “wake-up call.” But what do they wake up to? It may be a sense of spiritual awakening. It may be a deepening of religious experience. It may be a personal sense of clarity that has no labels. It may simply be a sense of feeling acutely alive—of seeing the world with fresh eyes and experiencing everything with more awareness. Perhaps most often, it includes a sense of clarity about what matters now. It isn’t that you’ve missed the boat if you experience none of these things. But the fact that some kind of “wake-up call” is part of the experience deserves our attention because it can bring experiences of healing at the deepest personal level.

Michael Lerner

Alschuler and Gazella describe spirit as encompassing joy, hope, laughter, service and love.1 Christina M. Puchalski, MD, MS, defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose, and the way they experience their connectedness to the moment, to self, to others, to nature and to the significant or sacred.”2 Separately, she writes: “It is the part of humans that seeks healing, particularly in the midst of suffering.”3

The practice of finding meaning and joy is described in many ways:

 

  • Lawrence LeShan: singing your song4
  • Victor Frankl: the will to meaning5
  • Lise Alschuler and Karolyn Gazella: enhancing your spirit6
  • David Servan-Schreiber: reconnecting with your life force7
  • Keith Block: revitalizing your life8
  • Dwight McKee and colleagues: life force9
  • Jeremy Geffen: the nature of spirit10
  • Joseph Campbell: Follow your bliss11

 

Indeed, every one of BCCT’s integrative oncologist advisors include care of the spirit in their integrative protocols. As Keith Block writes, “Every possible factor influencing the progression of cancer should be explored when you are fighting for your survival. I have seen time after time the difference it [mind-spirit care] makes.”12

Religious, Spiritual and Secular Paths to Healing

A Sufi mystic, Ibn Arabi, once remarked that God never appears to two people in the same way, and never appears to a single person in the same way twice. The New Testament says the same: "In My Father's house are many rooms. If it were not so, would I have told you that I am going there to prepare a place for you?" (John 14:2). And the Dalai Lama: “People take different roads seeking fulfillment and happiness. Just because they’re not on your road doesn’t mean they’ve gotten lost.”

Many traditions hold this understanding: There are many paths to the truth. People seek meaning according to their natures. Some find that meaning on the paths that are called religious or spiritual, creating a pilgrimage. Some find meaning in nature, some in art, some in family and friends.

In deep healing work, many people find themselves drawn to religious or spiritual paths. Others seek meaning in other ways. We at BCCT don't privilege religious or spiritual paths over secular or other paths to meaning. Many paths can be rewarding to those seeking healing, and we believe that you must find the path that provides meaning to your life. Many references to various paths are found throughout scriptures and the arts. Just a few examples:

  • Old Testament / Tanakh: What does the Lord require of you but to do justice, and to love kindness, and to walk humbly with your God? (Micah 6:8)
  • Mahatma Gandhi: The essence of all religions is one. Only their approaches are different.
  • Rig Veda: Systems of faith may be different, but God is one.
  • Aldous Huxley: in The Perennial Philosophy he attempted to present what he called “the Highest Common Factor” of all theologies through passages from the writings of “saints and prophets who have approached a direct spiritual knowledge of the Divine.”
  • Burt Bacharach and Hal David’s song: “As sure as I believe there's a heaven above, Alfie / I know there's something much more, / Something even non-believers can believe in.”

The common theme in religious, spiritual and secular quests for meaning is the shared yearning. The yearning to be connected with what matters most to us—and to the ultimate realization of what we can experience in our lives—is a shared yearning.

 

Living with cancer causes many people to go deep. They ask these ultimate questions about what matters. Many come to the conclusion in the song Alfie—that love is something even non-believers can believe in. Many traditions teach that the search for meaning includes a deepening appreciation of love—that love has the greatest healing power of all.

Kindness, someone said, is just love with its work boots on. Kindness is almost universally endorsed in religious, spiritual and ethical traditions as the Golden Rule—treating others as one would wish to be treated (or not treating others as you would not wish to be treated). While love can seem like a tall order, we all know what it means to be kind. Love and kindness merge in compassion. Being wounded ourselves often opens us to deeper compassion for others.

In our work in BCCT, we do not presume to answer those questions for others. Rather, we honor each person's individual path.

The bottom line for us at BCCT is that these ultimate questions—spiritual, religious, philosophical, secular—can have immense healing power. The healing power of love is something we at BCCT have experienced directly in over 200 week-long retreats in the Commonweal Cancer Help Program and in hundreds of Healing Circles, as well as in our own lives.

Perhaps the purpose of life, Rachel Naomi Remen says, is to grow in wisdom and learn to love better.

If that may be life's purpose, then learning the healing power of love may be at the heart of why we are here.

There is nothing new in this. It is one of the most ancient human experiences.

 

 

Spirituality in Medical Practice

Research indicates that a significant percentage of patients are interested in including spiritual beliefs and practices in their medical and health approaches.18 This is in marked contrast to standard Western medicine. In his article, “Is there evidence for spiritual healing?” David Aldridge writes: “The natural sciences base of modern medicine that, in turn, influences the way in which modern medicine is delivered, often ignores the spiritual factors associated with health. Health invariably is defined in anatomical or physiological, psychological or social terms. Rarely do we find diagnoses that include the spiritual concerns of patients.”19

Even though a majority of medical schools are teaching topics related to spirituality and health, and hospitals are beginning to develop spirituality programs to increase the delivery of compassionate care,20 patients report that healthcare providers provide spiritual care infrequently.21 Doctors whose purpose is to maintain a patient’s healthy life often overlook the very life force—for that is what spirituality is. “For humankind to be centered, whole and fulfilled, the spiritual aspect of life must play a role.”22

Spiritual History

“A published report from a Palliative Care Consensus Conference attended by many highly regarded clinicians in the field of palliative care also recommended that a spiritual history be taken as an integral part of assessment.” The HOPE questions provide a formal tool that may be used in this process.23

An investigation of the HOPE questions concluded: “The HOPE questions provide a formal tool that may be used in this process. The HOPE concepts for discussion are as follows:”24

  • H—sources of hope, strength, comfort, meaning, peace, love and connection
  • O—the role of organized religion for the patient
  • P—personal spirituality and practices
  • E—effects on medical care and end-of-life decisions

An assessment of spiritual history-taking tools found “the 'HOPE' tool most comprehensively addressing the spirituality themes identified as important within the healthcare literature.”25

Dr. Puchalski developed another spiritual assessment tool for medical professionals taking a spiritual history: FICA© (Faith, Importance, Community, Address).

 

Spirituality and Cancer

The person with cancer often has urgent reason to reflect on ultimate questions: the meaning of life, what has true value, what happens with death, how to live from now on. “The recognition of the huge variety of spiritual paths that ultimately lead toward the same essential self-realization is important to cancer patients because it further liberates them to find a spiritual path that has vitality for them...Achieving deeper levels of self-realization can unquestionably transform the experience of cancer, deeply lessening unnecessary stress and anguish. And the psychobiological correlates of achieving inner peace, of regaining inner tranquility and joy in life, may transform the biological environment in which the cancer developed.”39

Though mind and spirit will not directly attack cancer, Block asserts that they exert potent indirect influence on the growth and spread of cancer by affecting your internal biochemistry, including molecular factors, and the state of your immune system.40

Researchers have postulated that a distinct personality type (sometimes called “type C”) is possibly at greater risk of developing certain cancers. This personality type is marked by being passive and submissive and minimizing or denying a person’s authentic spirit. These adaptive personality characteristics may favor the development or progression of disease.

Psychologist Alistair Cunningham, after working with cancer patients for years and studying what factors predict who will far outlive their prognoses, found these common themes:41

  • Have calmly asked the fundamental questions: “Who am I really?” and “Where do I want to go?”
  • Felt less strained to act only for the sake of conforming or obligation or disappointing others or losing other’s affection
  • Discovered pleasure in making choices they denied themselves previously, and even in saying no

Cunningham also found these common qualities among the survivors:

  • Authenticity, a clear understanding of what was important in one's life
  • Autonomy, the perceived freedom to shape life around what was valued
  • Acceptance, a perceived change in mental state to enhanced self-esteem, greater tolerance for and emotional closeness to others, and an affective experience described as more peaceful and joyous."

Dr. Cunningham says that these people have traded being passive and submissive for asserting their freedom, their authenticity and their autonomy.

 

Personality/Spirituality and Cancer Outcomes

If personality characteristics affect cancer development and progression, then working to address these adaptive characteristics may contribute to healing. Small studies involving people with incurable or metastasized cancer have investigated this line of thinking. Cunningham has published two small studies showing significant increases in survival with psychotherapy. The first correlated extended survival among those who scored higher on these scales:42

  1. Ability to act and change
  2. Willingness to initiate change
  3. Participating in self-help work
  4. Relationships with others
  5. Quality of experience

In the second study, longer-term survivors displayed a much higher degree of early involvement in their psychological self-help than did most of their nonsurviving peers. The authors hypothesize that “to the extent that the progression of cancer, or other chronic disease, is favored by a distorted psychological adaptation such as type C, healing may be assisted by a reversal of that adaptation—in the case of cancer, toward greater authenticity of thought and action.”43

In his book Cancer as a Turning Point, Lawrence LeShan, PhD, describes his observations and insights over several decades of psychotherapy work with cancer patients. He observed many patients in despair and over many years concluded that “the solution comes from becoming more and more the self you truly are...And it is only after this—after finding and showing your true being—that love can be accepted and believed in.”44 LeShan then goes on: “It is essential that the person first learns to sing their own song fully and then, as part of their human needs, finds a way to express their spiritual concern with others or with the human race as a whole. Only in this way do we act and live as a coherent whole and only in this way can we strengthen and mobilize our self-healing and self-repair abilities.”45

 

Spiritual Care

Other evidence shows that receiving spiritual care may strongly influence positive patient outcomes after a cancer diagnosis:46

  • Better quality of life
  • Greater satisfaction with care provided
  • Reducing stress and anxiety (promoting inner peace, improving coping ability)

These outcomes may be mediated through making more aggressive care choices to extend life, improving one’s sense of belonging, helping to find meaning and strengthening the will to live.

“Measures of spirituality and spiritual well-being correlate with quality of life in cancer patients, cancer survivors and caregivers. Spiritual needs, reflective of existential concerns in several domains, are a source of significant distress, and care for these needs has been correlated with better psychological and spiritual adjustment as well as with less aggressive care at the end of life.”47

A review of six studies concluded: “Two of four studies examining the impact of spiritual therapy on spiritual well-being in cancer patients found a significant and positive impact for the intervention group and one arguably found a trend for significance. However, there was no evidence of maintenance of the effect over time...An 8-week psycho-spiritual group programme incorporating an Islamic perspective also found the intervention significantly impacted hope immediately post-intervention.”48

Research has found that patients who do not receive adequate spiritual care—with “adequacy” being extremely subjective and based on the patient’s perspective—may become distressed, leading to poorer outcomes such as increased pain, feelings of isolation, hopelessness, and anger.”49 “A lack of spiritual well-being can be experienced as holistic suffering which impairs the patient’s ability to cope.”50

 

The Role of Joy in Healing

While joy may seem like "heavy lift" for a person struggling with cancer, finding joy—and promoting experiences, relationships and other encounters that bring joy—in life may bring focus to "what matters now" and even improve quality of life.

Joy and General Health

Joy can come from many sources and is often closely aligned with our innermost spirit. Joy and healing are connected within both faith and medical traditions, as shown in these examples:

 

  • Jacob Teitelbaum, MD, shares his personal experience with thousands of very ill patients in his book Three Steps to Happiness: Healing through Joy! He describes how the ability to be happy can be transformative.53
  • Buddhist Thich Nhat Hanh describes a “Healing with Joy” exercise in his book on healing.54
  • Jesuit Robert Sears, SJ, PhD, writes: “Joy is the indication that what we are made for is being fulfilled,” and also: “Joy is an intricate part of healing to which little attention is given.”55

 

Naturopathic oncologist Neil McKinney, ND, considers happiness a key ingredient in being well. He cites the work of psychologist Robert Holden, PhD, who suggests six principles of the psychology of happiness:56

  1. Identity: Choose to be within yourself and find joy there rather than outside of yourself. Ask Joy, "What would you like me to do with my life today?"
  2. Choice: Ask yourself what kind of day will you decide to have today. Ask "What 3 things could I do today to have a far better day than I imagined?"
  3. Abundance: Figure out what is the abundance that would really help you move from "static" to "ecstatic."
  4. Healing forgiveness: Happiness is blocked by grudges, cynicism, resentments and grievances. Forgiveness is freeing and connects us to a place where we are okay, before we felt broken.
  5. Relationship: Make love more important than anything else. Happiness is the start of a happy relationship . . . one where you love and are loved.
  6. Now: Being in the now ends the search for happiness. In this moment, be willing to choose happiness now.

Even if not reaching the level of “joy”, pleasant emotions also impact health.

 

  • As reported in Alschuler and Gazella’s book The Definitive Guide to Thriving after Cancer,57 a 2006 study found an increase in secretory immunoglobulin A and a decrease in salivary cortisol were induced by pleasant emotions.58 Both these levels are associated with improved health.
  • A study of 180 Catholic nuns found a strong association between positive emotions in their writings at a young age (average 22 years) and lower mortality during ages 75 to 95.59
  • Simple practices and habits, such as developing a practice of gratitude—consciously focusing on blessings—”may have emotional and interpersonal benefits”60 that then impact physical and psychological/spiritual well-being.

 

Joy and Cancer

Dr. Keith Block notes in his book Life Over Cancer:61

“We continually remind patients of the importance of doing what really matters—what is truly satisfying, what has value and meaning. And we emphasize that finding pleasure in life is vital to the energy and spirit of every cancer survivor.”

In his book Cancer as a Turning Point, Revised Edition, psychologist Lawrence LeShan shares story after story of people with cancer who found—or finally gave themselves permission to express—their joy and the positive outcomes that resulted. Many lived years beyond their medical prognosis, while others experienced healing of the spirit that led to full engagement with life, and then peace and contentment for themselves and others during and beyond their death.62 At the end of his book, Dr. LeShan includes several exercises to raise awareness of what brings meaning and joy to people’s lives. Consider participating in these exercises if you’d like to increase these practices but are unsure of where to begin

Hope and Cancer

Alschuler and Gazella describe hope as having two components:63

  1. The identification of the elements of the current situation that are undesirable and an idea of how these elements need to change.
  2. A willingness to engage in actions to bring about the desired changes and to constantly reevaluate the impact of those actions on the desired outcome.

Integrative navigator and BCCT advisor, Mark Renneker, MD, warns against false hopelessness in patients—being led to believe that they are incurable, often by their oncologists. He points out that within oncology practices, long-term survivors of even the most deadly cancers can be found. He asks of women with metastatic breast cancer: “Why shouldn’t a woman aim for and believe in her ability to be in that group of survivors?”64

Alschuler and Gazella also describe studies assessing the impacts of hopelessness and optimism with cancer patients:65

A study of 578 women with early-stage breast cancer were assessed using the mental adjustment to cancer (MAC) scale. The researchers found a “significantly increased risk of relapse or death at five years in women with high scores on the helplessness and hopelessness category of the MAC scale compared with those with a low score in this category.”66

Conversely, another study of 90 women with epithelial ovarian cancer found that higher levels of optimism were associated with lower levels of distress and positively associated with health-related quality of life in patients undergoing chemotherapy. Higher levels of optimism at the start of chemotherapy were also associated with a greater decline in patients' cancer antigen 125 (CA-125) levels during treatment.67

Religion or faith may be a source of hope for many patients. A study of factors influencing views of about end-of-life decisions among 108 patients with gynecologic cancer found that almost half became “more religious after their diagnosis, whereas no one became less religious. Ninety-three percent believed that the religious commitment helped sustain their hopes.”68

 

Positive Attitude vs. Genuine Hope

Those of us who have holistically cared for people with cancer for many years have seen the damaging effects of people believing they must maintain a positive attitude at all times. Sometimes well-meaning family and friends buy into this myth as well and urge the person with cancer to stay positive.

As Keith Block says:

This is a distortion of the idea that the mind can influence the cancer. While your mind can affect your recovery, reducing complex mind-body connections to the command to ‘think positive’ is misleading and injurious.” The idea that a positive attitude is the secret ingredient to getting well is not supported by any data. In fact, Dr. Block asserts that evidence suggests that accepting that your feelings and thoughts will fluctuate—including sometimes feeling sad, anxious, angry or depressed―and learning to manage them is far healthier than trying to deny them for the sake of staying “positive.” Suppressing difficult emotions is associated with greater distress in those with breast cancer.69

Hiding emotions is incredibly detrimental. As Dr. Christopher Germer says, “When we resist something, it goes to the basement and lifts weights.”70 By paying attention to and dancing with the more difficult feelings, you are practicing self-compassion, in part by not allowing the difficult feelings to grow stronger, and in part by building your own reservoir of strength. Allowing negative feelings does not mean giving yourself permission to despair, to be unpleasant, or to wallow in negativity. It means acknowledging negative feelings and working with them, learning from them, and coming through to new understandings.

Pressure to maintain a positive attitude is also setting the bar unrealistically high and can lead to self-blame if setbacks in treatment or a recurrence occur. Rather than add stress by blaming yourself for not keeping a positive attitude, acknowledge your emotions and moods, accept them and address those aspects of your life, your relationships and your wellness that you can influence. Asserting your choices in your care is likely to improve both your attitude and your well-being.

Finally, trying to follow the positive attitude myth may be damaging to your relationships with those you love and care about. Your interactions may become shallow and inauthentic as both of you avoid talking about your fears, concerns and other “negative” thoughts and feelings. At a time when you could be drawing strength and support from one another and deepening your love, you are avoiding the main issues you need to address.

Hope, realistic optimism and determination, as opposed to enforced positive thinking, however, may be healing. There is a saying, “Plan like a pessimist and live like an optimist.” Do the best that you can to deal with the realities of the cancer and treatment, optimize each moment that brings joy and meaning, and realize that for the difficult moments, “This too shall pass.”

Finally, hope changes over time. In the beginning, that hope may be that the treatment will cure the cancer. May that be the case for you. If there is a recurrence, the hope may be that treatments will bring remission or control the cancer. Or perhaps the hope is that you will have time and energy to complete some milestone, find expression of your life purpose, find joy in the midst of all the difficulty. The hope may be that your symptoms will be controlled. Hope that you will heal relationships. And eventually the hope that, as you near the end of life, whenever that might be, you will be able to find two of life’s greatest gifts that according to Rainer Maria Rilke are often left unopened: “love and death.”

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Credits

This article has been taken from Beyond Conventional Cancer Therapies.

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