Since ancient times, the onset of cancer has been linked to depression and melancholia. Hopelessness, despair, and sorrow were regularly mentioned as a trigger of cancer until modern research refuted such a connection.
In the second half of the 20th century, the idea of a cancer-prone personality became widespread in both the scientific and popular press. People who repressed their anger and emotions were said to be at higher risk of developing cancer. Behavioral therapy was proposed as a treatment and prophylaxis. Our investigation shows that some of the researchers who introduced these ideas were financially supported by the tobacco industry to turn attention away from causal links between smoking and cancer.
Another psychosomatic myth states that having a positive attitude or a “fighting spirit” leads to a better prognosis. The notion that patients could cure themselves of cancer if they had the right attitude or tried hard enough to overcome it, became popular in the 1970s and 1980s. These ideas were not supported by scientific evidence and led to stigma, guilt, and frustration.
As we will discover, the history of cancer has surprisingly many of these episodes. We will therefore divide it into three parts. Today, in part I, we look at the early history, from the ancient humors to wild psychoanalytic theories in the middle of the 20th century.
‘A passive suicide’
There are two main ideas in the psychosomatic history of cancer. The first one goes back to the humoral theory of the ancient Greeks and Romans. This theory was the dominant medical view for centuries and it remained in vogue until modern times.
The theory interpreted health and disease in terms of four ‘humors’: blood, phlegm, yellow bile, and black bile. Depression and cancer were both thought to be related to the mysterious black bile (‘melancholia’ is the word for black bile in Greek). Up until the 19th-century physicians frequently thought that there was a connection between the two conditions and that periods of sorrow or despair could trigger the onset of cancer.
The French physician Jean-Zuléma Amussat, for example, argued in a paper read before the Academy of Medicine in 1848, that “the influence of grief appears to me to be in a general way, the most common cause of cancer.” The English surgeon Herbert Snow agreed and stated that “worry and trouble seemed in numerous instances directly to originate the malady.” He never saw malignant disease develop in the breast of a woman leading a healthy, happy, well-balanced life. Another frequently cited source is the Irish pioneer in the scientific study of cancer, Walter Hayle Walshe. In his classic book on the nature and treatment of cancer, Walshe discussed “the influence of mental misery, sudden reverses of fortune, and habitual gloominess of temper” on the development of cancer. “I have myself met with cases in which the connection appeared so clear and decisive”, Walshe wrote, “that to question its reality would have seemed a struggle against reason”. *
In the 20th century, several researchers elaborated on this idea. Schmale and Iker, for example, studied patients with cervical cancer and found “a high frequency of significant life events which were reported to have led to feelings of ‘giving up’ prior to the ‘apparent’ onset of the disease.” Cutler and colleagues went one step further, noting a “self-destructive drive in the cancer patient” and claiming that in some patients, “cancer was being utilized as a form of passive suicide”.
The most prominent advocate of this view in the 20th century was the American psychologist, Lawrence LeShan. As a pioneer in the psychosomatic approach to cancer, LeShan was viewed as an extremist or charlatan by many of his peers. “The presence of cancer is usually an indication that there is something else wrong in the life of the patient” he claimed. In his view, cancer was a somatic reflection of the hopelessness and despair patients experienced. He believed cancer patients had given up on life. “They were simply waiting to die”, he wrote. “For that seemed to them the only way out. They were ready for death. In one very real sense, they had already died.”
LeShan wrote a book titled “You can fight for your life” where he offered insights on how patients could overcome their despair and cancer. His treatment advice consisted of reconciliation with painful childhood memories, investigating how patients have come to reject themselves, and learning how to express oneself emotionally. “No matter how hard the questions, the patient must be pushed’, he said. “Kindness must be put aside. If the patient is to have any possibility of overcoming the cancer that has invaded the body, the fight must begin at once.” LeShan’s book was a precursor to the toxic self-help literature that would appear later in the 20th century.
His own research was based on terminally ill patients and includes little consideration that this bleak prognosis could have caused the hopelessness and despair he identified in his patients. Scientific studies have since refuted a relationship between depression, bereavement, and other forms of social trauma and subsequent development of cancer. Nonetheless, the idea that melancholia and hopelessness are character traits that predispose people to cancer is a myth that would later reappear in the concept of the cancer-prone personality.
The Amazon complex
Before we proceed to the cancer-prone personality, however, we need to take a step back in time. In the first half of the 20th century, remarkable little psychosomatic research on cancer was taking place.** Cancer was seen as a localized disease best treated by radical surgery or radiation therapy. George Engel, the father of the biopsychosocial model, deplored this trend in his presidential address at the 1954 meeting of the American Psychosomatic Society. While researchers were exploring psychosocial factors in illnesses as diverse as heart disease, peptic ulcer, asthma, diabetes, and colitis, cancer remained unexplored territory. In Engels’ view, “a detailed psychological study of cancer patients may provide important information about conditions necessary to the development and location of a cancer.”
The first attempts at a psychosomatic study of cancer, however, were not very successful. Several studies were published in the 1950s, but all were ofexceptionally poor quality. They investigated cancer patients with unreliable methods such as the Rorschach test or failed to include a control group. Most were published in the journal ‘Psychosomatic Medicine’. There was something else that set them apart: they were extremely sexist and misogynistic.
The study focused on female patients with cancer of the breast and cervix and argued that their malignancies were related to a rejection of the feminine role. One study, for example, noted that “the cancer group expressed more negative feelings toward pregnancy and birth and evidenced specific disturbances in feminine identification.” Another group highlighted how cancer patients “reject the feminine role, showing instead strong masculine feelings.” After a projective drawing exercise, these researchers highlighted how “in most of the drawings the woman was made much stronger than the man” and that “the sexual characteristics of the figures were completely lacking.” A third group from Chicago said their cancer patients were characterized by sexual inhibition and frustration: only five out of forty women were freely capable of orgasm. They also pointed to an “inhibited motherhood” as some patients did not want children. The authors relate this to an unresolved hostile conflict between the patients and their mothers. Yet another research group looked at women with lymphoma and leukemia and noticed an “extreme masculine identification”. A subgroup of their patients, they said, “were ’little girls’ who lived off many different people in a parasitic relationship. They were chronically sad, whining women who cried for attention.”
Most of these characteristics were thought to be related to the development of cancer. One group even suggested “prophylactic psychotherapy … for those individuals who appear to be caught in the constellation of emotional forces which will eventually “pull the trigger.” Historian Patricia Jasen summarized and criticized this literature as follows:
“the message to readers remained clear enough: the rejection of the feminine role could be deadly.”
There was one other paper, published many years later in 1979, that fits directly into this tradition. It noted an ‘Amazon complex’ in women with breast cancer. The Amazons or ‘breastless ones’, the authors explain, are mythical people ruled by women who only had intercourse with men once a year and burnt out one of their daughter’s breasts so that it was no hindrance when using a bow. “The ideals of these patients are somewhat like those of the ‘Amazons’”, the paper reads, “they negate the typical female role and its consequences on the bodily, psychic and social level.” The authors added: “Our patients showed a very active, combative attitude in that they were ready to take on roles which are normally the preserve of men; this frequently developed into a self-destructive tendency.”
The tumor has meaning
In the 1950s and 1960s, psychosomatic research was by dominated by psychoanalytic thinking. In one of the more curious episodes of the psychosomatic history of cancer, some scientists speculated how the growth of a tumor had meaning and fulfilled some emotional need in patients.
Psychiatrist Gotthard Booth, for example, worked out a theory on the “excremental meaning of cancer.” In his view, the basic process of cancerogenesis becomes evident when one connects the preceding findings: a mass with fecal associations grows in the body of an anal personality after the loss of an important object relationship.” In simpler terms, Booth saw strong parallels between the emotional meaning of defecation and the development of cancer. He went on to explain:
“The guilt feelings following a loss of control can be expressed identically for the infantile accident of soiling and for the malignant tumor: expendable material is produced in an inappropriate place from which the subject himself can not remove it. Infant and cancer patient are forced to call attention to the fact that they lost control. Only a parental person can remove the excrement, only a physician the tumor. One may say that the cancer patient gives somatic expression to the scatological curse word which comes to the minds or lips of so many people when they find their efforts thwarted in some respect.”
Another example is the writing of Dr. Claus Bahne Bahnson, a Danish immigrant who worked with his wife at the Pennsylvania Psychiatric Institute in Philadelphia. In one paper, the Bahnson couple proposed to view cancer as “an alternative to psychosis”. They worked out a model where emotional problems could either be projected resulting in psychoses and neuroses or repressed and denied leading to somatic symptoms. Psychosis and cancer were seen as the two extremes for each type of outlet. They explained:
“In a manner similar to psychosis, which has often been understood as a dedifferentiation of function and as a regression to archaic psychic structures, the neoplasms here would be understood as resulting from a regression to a dedifferentiated and archaic pattern of cell behaviour…”
The Bahnsons saw cancer as a “regressed effort on the part of the psychological organism to replace a recent loss.”
Papers on the Amazon complex or the excremental meaning of cancer demonstrate clearly how disturbed the psychosomatic study of cancer once was, but, luckily, they had little impact. That cannot be said of the myth of the cancer-prone personality that we will explore in part II of this series. Stay tuned!
* Enthusiasts of a psychosomatic approach to cancer like to cite this section of Walshe’s book but usually fail to mention the sentence that comes directly after and where Walshe cautions: “But the extent to which this influence works practically, has doubtless been over-estimated. It should be recollected that cancer is a very rare affection before the thirtieth year, and that the number of persons fortunate enough to reach that age without having suffered under disappointed hopes and wasting grief, is, in all probability, comparatively small.
** The main exceptions were the writings of Wilhelm Reich and Elida Evans.