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Most of us have either known or heard reports of an apparently healthy, vigorous person who died almost immediately after being diagnosed as having cancer. Such patients are often so intimidated by the cancer diagnosis and have such a negative expectancy of their ability to survive, that they may never even leave the hospital following the diagnosis. The course of the disease goes downhill far more rapidly than the physicians anticipated. To explain such cases, doctors sometimes speak of the patients' "giving up" or losing their "will to live."

Many doctors have also experienced cases in which, after a diagnosis of cancer, the patients maintained a positive expectancy and had an unusually good recovery. In these cases, the medical treatment is often given the major credit for the patients' return to good health.

In general, people are quicker to believe in the relationship between dying and a negative expectancy than in the relationship between getting well and a positive expectancy. We believe one of the reasons that positive expectancy has not been as fully recognized in medicine as negative expectancy is that it is often difficult to tell whether a patient is talking positively merely for the sake of the people around him or her or Whether the words are a true reflection of feelings. When patients verbalize a positive expectancy, saying they are not going to die or they are going to "beat this thing," and yet crawl into bed and pull the covers over their heads, don't go to work, and exhibit other behavior incompatible with what they are saying, it is apparent to us that they do not really have a firm belief that they can get well.

It is entirely possible that patients are unaware of the negative expectancies they are expressing in their behavior, and that they are not conscious of their fear of cancer—which arises from having had friends or relatives who died of the disease and the generally pessimistic view our culture takes. We have learned to look at actions as well as words to read our patients' frames of mind, and the messages we get we take very seriously. We think that patients' beliefs about the effectiveness of treatment and about the potency of the body's natural defenses—that is, their positive or negative expectancy—are powerful determinants in the outcome of illness.



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