Exploring What Matters Now

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.

• Lawrence LeShan: singing your song⁵
• Victor Frankl: the will to meaning⁶
• Lise Alschuler and Karolyn Gazella: enhancing your spirit⁷
• David Servan-Schreiber: reconnecting with your life force⁸
• Keith Block: revitalizing your life⁹
• Dwight McKee and colleagues: life force¹⁰
• Jeremy Geffen: the nature of spirit¹¹
• Joseph Campbell: Follow your bliss¹²

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.

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.

This distinction is supported in research: a 2008 study investigated the relationships of survival with three measures in hemodialysis patients: spirituality, religious involvement, and religion as coping. Only the responses on the spirituality scale were associated with survival.¹⁷ A 2015 review investigated the contributions to quality of life of a “Meaning/Peace factor” of spirituality and a “Faith factor”:

• Meaning/Peace factor: reason for living, productive life, sense of purpose (and more)
• Faith factor: finding comfort or strength in faith or spiritual beliefs (and more)

The study found that the Meaning/Peace factor of spirituality was consistently associated with improved quality of life (overall, physical and mental), but the Faith factor was not after removing the effect of Meaning/Peace.¹⁸

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,²¹ patients report that healthcare providers provide spiritual care infrequently.²² 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.”²³

• A prospective cohort study of elderly poor forced to move from their homes showed that three psychosocial variables were significant predictors of mortality: “religiousness, happiness (as rated by the interviewers), and presence of living offspring. The first two reduced the risk of mortality primarily among the elderly who were in poor health, while the third one did not interact with health status.”³⁰
• A 2016 review of 124 articles reporting factors influencing human longevity found 14 factors that have a positive impact on longevity, including both happiness and religion.³¹
• A 2008 review and meta-analysis of 35 prospective observational studies concluded that “psychological well-being was associated with reduced mortality in both the healthy population and the disease population studies.”³²
• Another meta-analysis in 2009 of 69 studies concluded that religiosity/spirituality was associated with reduced mortality in healthy population studies, but not in diseased population studies.³³ Of note, a meta-analysis of studies that controlled for negative emotion showed that psychological well-being was not the same as positive emotions or positive mood, and patients who had psychological well-being even with negative emotions showed positive health effects. However, positive emotions, positive mood, joy, happiness, vigor, energy, and positive dispositions such as life satisfaction, hopefulness, optimism and sense of humor were also associated with reduced mortality in healthy population studies.

• A 1995 study of elderly patients undergoing elective cardiac surgery showed that two variables were consistent predictors of mortality: lack of participation in social or community groups and absence of strength and comfort from religion.³⁴
• A 2009 review found that “spirituality and religious beliefs and practices can have an impact on how people cope with serious illness and life stresses. Spirituality often gives people a sense of well-being, improves quality of life, and provides social support. Spiritual beliefs can also affect healthcare decision making.”³⁵ Increasing evidence supports “the inclusion of spiritual factors as an important component in the assessment and treatment of pain.”³⁶
• A study of HIV/AIDS patients concluded that lower spiritual well-being was related to significant depressive symptoms and that “helping to address the spiritual needs of patients in the medical or community setting may be one way to decrease depressive symptoms in patients with HIV/AIDS.”³⁷
• A review of spiritual well-being and health found “a strong positive relationship between spirituality and effective coping strategies, resulting in decreased stress and psychological distress and improved emotional coping among HIV/AIDS patients.”³⁸

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.

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

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

• 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

• As reported in Alschuler and Gazella’s book The Definitive Guide to Thriving after Cancer, a 2006 study found an increase in secretory immunoglobulin A and a decrease in salivary cortisol were induced by pleasant emotions.⁵⁷ 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 95.⁵⁸ .
• Simple practices and habits, such as developing a practice of gratitude—consciously focusing on blessings—”may have emotional and interpersonal benefits”⁵⁹ that then impact physical and psychological/spiritual well-being.

Alschuler and Gazella also describe studies assessing the impacts of hopelessness and optimism with cancer patients:⁶⁴

• 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.”⁶⁵
• 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.⁶⁶

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.”⁶⁷

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.⁶⁸

Hiding emotions is incredibly detrimental. As Dr. Christopher Germer says, “When we resist something, it goes to the basement and lifts weights.”⁶⁹ 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.”

Brian Bouch, MD, retired several years ago from an integrative medicine practice in Sonoma, California. After he received a difficult cancer diagnosis, he developed a specialty in integrative oncology. Dr. Bouch was the first medical director of Commonweal. In the following three videos, he talks with Michael Lerner about how he developed his practice, used certain therapies and how he worked with people with cancer.

Bold text indicates topics related to exploring what matters now.

1. 2:48-10:04 Dr Bouch’s experience with a cancer diagnosis:
1. malignant growth in his neck
2. primary cancer unknown, 5 years later source known
3. ENT oncologist recommended surgery and radical lymph-node dissection
4. embarked on is own program detox (Optimal Health Center)
5. diet and exercise
6. talked with Renneker, Block, Broffman, McKee
7. Contact provided with MD Anderson with latest research recommending 80 percent with his type of cancer do well with chemo and radiation
2. 11:45-12:50 How his cancer experience has changed him:
1. importance of exercise (qigong, yoga, vegan diet, Zen Buddhism)
2. respect for spirituality and how to bring it to our daily lives
3. 15:00-26:00 Michael & Brian discuss Integrative Cancer therapies:
1. importance of the 7 pillars of health promotion
2. creating a healthier person who may be living with cancer, extending their life, or improving their life
3. more information on the etiologic factors: genomes (what we are born with with) and epigenetic factors that influence our genes
4. measuring the toxic load is one part of functional medicine
4. 26:46-32:32 What is happening in our bodies: toxicity
1. functional medicine looks at microbiome, leaky gut, mercury, lead and cadmium
2. urine and stool sample can provide information on toxicity
3. Hydrocarbons
4. Biotoxins (such as from mold) can impact autoimmune system
5. 35:00-41:19 Detox before and after chemo
1. body/mind retreat
2. all raw vegan diet, paleo, ketogenic diet
3. exercise 150 min/week; heart rate for person in their 70s would be 116 bpm  
4. spiritual practice
5. tai chi
6. qigong
7. Buddhist meditation
8. sauna