For nearly two thousand years, since Galen's observation in the second century that cancer accompanied melancholic personalities, observers have likened personality, or aspects of personality, to malignancy. The difficulty, in terms of the kind of hard scientific proof that is considered desirable, is the fact that most of these observations are ex post facto. Until very recently, few prospective studies have been done. Those that do exist, as well as all the many retrospective studies and observations, confirm a predisposing set of personality factors, attitudes, and beliefs.

Steven Locke and Mady Hornig-Rohan have edited a recent comprehensive annotated bibliography linking immune competence with the mind. Mind and Immunity: Behavioral Immunology contains 1304 articles and nearly 150 books, book chapters, and review articles dealing with the relationship of mind and immunity. In it, forty-nine papers on the topic of Personality and Cancer are cited. Most of these support a relationship between cancer and personality factors, with the predominant factor being depression and the helplessness/hopelessness syndrome. In many studies significant loss, in childhood or shortly predating the onset of illness or both, was also found.

One of the most interesting, and conclusive, evidences of the effect of personality on physiology comes from recent studies of people with multiple personalities. People with multiple personalities, like those made well known in books and movies such as The Three Faces of Eve and Sybil, have always created interest because of their strange switches in behavioral characteristics. The changes in behavior have included different body language, sometimes accents, speech mannerisms, handwriting, hobbies and skills, and different phobias and memories.

New interest is being generated by the fact that these people not only change behavior, but their brains and their bodies also change. Different personalities within one person have different brain wave patterns, different handedness, and different allergies. Eyeglass prescriptions and such objective measures as eye pressure and corneal curvature differ. A person may be nearsighted or farsighted in different personalities or even be colorblind in one but not another. As they change from personality to personality, these people experience dramatic physical characteristic changes as well.

Bennett Braun, a Chicago psychiatrist who has studied a number of persons with multiple personality disorder, notes that these changes in physiology are not greater than those that can be achieved through hypnosis. And this implies, in turn, at least theoretically, that there are no changes achieved through hypnosis that could not also be achieved through voluntary control. After all, the hypnotist holds no strings within the body of his subject. The person with multiple personality is controlling all the changes in physiology made, albeit unconsciously. Conscious control of the unconscious can be learned, perhaps of any system over time and surely over any system that can be affected by personality shifts or by hypnosis.

Early in their work connected with the psychological management of malignancy, Carl and Stephanie Simonton compiled an annotated bibliography. They reviewed the medical literature concerned with the etiology of cancer, and in more than two hundred articles they found a relationship between personality factors, emotional factors, and cancer. They found the most prevalent predisposing condition to be the loss of an important love object or relationship six to eighteen months prior to the diagnosis of malignancy. According to the authors, these losses create hopelessness because they recapitulate lack of closeness, loss, or rejection experienced in childhood. The most common personality characteristics they found were a tendency to hold resentments, difficulty in forgiving others, a tendency toward self-pity, poor ability to develop and maintain long-term relationships, a poor self-image, and feelings of rejection in general.

Claus Bahnson, in his overviews, "Stress and Cancer: The State of the Art," Parts 1 and 2, finds recurring themes of loneliness and hopelessness stemming from lack of a loving, protected childhood. Personality characteristics of inhibition, rigidity, repression and denial, when combined with the stress of loss and depression, seem to increase vulnerability to clinical cancer.

Lawrence LeShan, during the first five years of his research into personality and cancer, tested and interviewed over 450 patients and found that 72% of them had particular life-history events and personality characteristics that occurred in only 10% of a non-cancer control group. As he explored their case histories, he determined that these personality characteristics preceded the onset of cancer by many years and generally developed in childhood, when the patients often felt rejected and unloved and were constantly searching for ways to please others, inhibiting expression of their own feelings of anger and hostility in order to gain acceptance. They were generally thought by others to be fine, gentle, and uncomplaining people.

In discussing how personality might affect the genesis of cancer, there are two major theories. By far the most prevalent is the theory that the immunologic defenses are weakened, and hormonal and endocrine balances are upset by the biochemical changes that accompany depression, repressed hostility, and feelings of helplessness. If immunologic defenses are weakened, this leads to a sort of "double whammy." The body is more vulnerable to the various carcinogens present in the environment, and it is more likely to produce cancerous cells. Also, cancer cells, once present, have a greater chance to multiply unchallenged.

The other theory, born out in part by observations and research on types of cancer related to specific experiences or personality configurations, is that psychic energy from frustrated desires or subjective losses can appear somatically as an attempt on the part of the unconscious--the lower brain centers--to replace the lost object or object of desire biologically. In the latter, the type and location of the tumor symbolically match the psychological experience of loss.

In either case, stress can deter the elimination of tumor and cancer cells by impairing immune surveillance. Stress can facilitate an increase in the growth of tumors by neuroendocrine changes, mediated by the autonomic nervous system through the limbic-hypothalamic-pituitary axis. Corticosteroids associated with stress inhibit lymphocyte proliferation and metabolism.

In "A Biopsychosocial Approach to Immune Function and Medical Disorders," Marvin Stein suggests that as evidence is accumulating and knowledge unfolding of the various ways that psychosocial factors are related to immune functions, predisposing risk factors are being discovered which can provide a means for studying individuals prior to the onset of disease.

The common underlying factor in personality and stress seems to be a lack of coping ability in some way. Studies linking cancer and personality, and cancer and stress, are increasing all the time. In spite of this, there is no absolute evidence that stress causes cancer, but that it is a predisposing risk factor, there can be no doubt. However, cancer is not just one, but more than a hundred diseases. Factors influencing cancer and predisposing to cancer include genetics, diet and nutritional status, carcinogens present in the environment, radiation and excess sunlight, as well as factors stemming from mind and behavior. But regardless of whether or not stress causes cancer, there is general agreement that the body's ability to fight cancer is hindered by stress and that the body's immune defenses are compromised by stress.

For a cancer patient, there is a triple stress to deal with. There is the stress which predated the cancer and which seems always to have been present prior to diagnosis. There is the stress of having cancer and dealing with the threat to self-identify and personal security. And there is the stress of a treatment that can be uncomfortable, frightening, and depleting.

Learning to Choose Our Responses
Fortunately, humans are learners. We can change how we perceive stress and how our bodies respond to the stressors in our lives. We can acquire the skills and resources for dealing with stress as a challenge and as a learning opportunity. Learning self-regulation of responses to stress gradually leads the learner to meet change with a sense of energy and exhilaration rather than worry and despair, and this can have a powerful healing effect.

The idea that we can assume responsibility for the course of our illness suggests to some people that patients are being accused of causing their cancer, that guilt might be aroused by such an idea. Of course no one chooses to have cancer or causes their body to become cancerous in any conscious way. But the way our bodies unconsciously respond to stress may be, and probably is, a contributing factor in every stress-related illness. This is good news. It means there is something we can do to affect it in a positive manner.

There are other studies which look at the characteristics of survivors of cancer. There are also personal characteristics which increase the chance of survival, and these can be actively acquired.

The Simontons, together with Jeanne Achterberg, made a study of survivors, examining the characteristics of their own patients who outlived predicted life expectancies. All of the patients who choose their program are screened on the basis of a stated willingness to cooperate with their medical treatment and assume a responsibility for their own return to health. The exceptional patients refuse to give up, rate higher than average in nonconformity and ego strength, and have an inner-directed locus of control.

Kenneth Pelletier cited four significant factors present in those who survived cancer against the odds. Each of the patients had gone through some profound intrapsychic changes; their sense of self and innermost being had been changed, whether by a revelatory experience, meditation and prayer, or spiritual insight. They made important interpersonal changes, improving their relations with others. All had made major changes in their diet and nutrition and in the ways they cared for their bodies. And every one, without exception, looked upon their recovery not as a gift or a miracle, and not as a spontaneous remission, but as a long, hard struggle that they had won!

While a graduate student at New York University, Erik Peper compiled a list of so-called spontaneous remissions from cancer. A computer search of the medical literature from the Library of Congress and the medical libraries at Harvard and MIT yielded about four hundred articles which comprised his annotated bibliography. The circumstances surrounding the remissions were as varied as can be imagined; people used all their favorite methods, from religious sojourns to nutritional approaches, fasts, and lifestyle changes. The common ground among all these cases of remission lies in the assumption of self-regulation, the assumption of responsibility in some way, and a change of attitude involving hope, personal effort, determination, and other positive feelings.

Placebo or Visualization? The Case for Positive Thinking
The effect of belief and expectation has never been more clearly or dramatically illustrated than in the case of the man with cancer who believed in Krebiozen. This case is very famous in certain medical circles and is worth mentioning.

This is a true story about a man who had advanced cancer (lymphosarcoma) and was lingering very near death. Every possible medical treatment had been tried. His body was filled with huge tumor masses, the size of oranges, and his liver and spleen were enormous. He required oxygen most of the time, and every other day one or two quarts of fluid had to be removed from his chest because his thoracic duct was obstructed. He was in a terminal state, but he was filled with hope even though his doctors were not.