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The curse of positive thinking

Una Adderley discusses the modern phenomenon of the power of positive thinking in the fight against disease

There seems to have been a lot in the press recently about the “curse” of positive thinking in relation to cancer. Barbara Ehrenreich, having experienced cancer, has recently published a book that questions the culture of positive thinking in relation to serious illness.1

She describes the pressure that she felt when diagnosed with breast cancer to maintain a positive, “upbeat” attitude, to “fight” the disease and even to see it as a “gift” that helps the individual towards self-improvement. Ehrenreich is deeply cynical about the whole movement, seeing the insistence on positive thinking as social brainwashing that pressurises cancer sufferers to repress more difficult emotions.

I think she has a point. A “brave” patient who manages to keep positive in the face of dreadful adversity is much easier to care for than one who rails against their situation. As nurses, our job is surely to try to make patients “feel better” so if the patient appears to be coping well then surely we have done our job well?

However, the downside of encouraging our patients to be positive can mean that they feel pressure to be brave, and we become another person for whom they have to present a cheery face.

Of course, the flip side of the coin is that if we encourage our patients to express the fear and anger they feel at their situation, there is the risk that we inadvertently leave patients feeling worse rather than better. Skilled nurses will be able to walk this tightrope to the emotional benefit of their patients but it remains a difficult task. We will all get it wrong sometimes.

Looking further afield, I think Ehrenreich's argument applies beyond patients with serious health conditions. I have a close friend who has been experiencing a very difficult work situation for a long time. My friend is usually a very controlled person but recently she expressed her anger and frustration at great length and with great passion.

I found this quite worrying as it was so out of character but when I suggested that maybe her situation was tipping over into one where some professional help might be useful, she became quite exasperated with me. She pointed out that all she was doing was expressing herself honestly in what she thought was a safe environment.

Upon reflection, I think she has a point. She needed a safe outlet, which I could provide, but I had mistakenly thought that it was my responsibility to help her feel better. In fact, just listening without trying to provide a solution would have made her feel better.

The friendship has survived and I go on, having learnt a lesson.

1. Ehrenreich B. Smile or Die: How Positive Thinking Fooled America and The World. London: Granta; 2010.