The Intriguing ‘Link’ Between Depression and Cancer
Those of you who read my ground-breaking round up of successful (and some not-so-successful) cancer alternative therapies called “Cancer Confidential” will know that I lay great emphasis on the psychological aspect of cancer containment.
My friend Lee Euler, who is an internationally-acclaimed copy writer, also happens to be a good author and recently wrote a good, well-referenced piece on this very topic and Lee has agreed I can print it here, in full. I have also copied it on the www.alternative-doctor.com website
Martin, a 70-year old Georgia resident, experienced two major losses within a short time. First he lost his wife of 40 years. Then he remarried, but his new wife of 6 weeks jilted and deserted him. He became very depressed. Two and a half years later Martin was diagnosed with pancreatic cancer.1
Was there a hidden link between his depression and the cancer?
A study published in the September/October 2003 Psychosomatic Medicine suggests there IS such a link. In the jargon of science, the findings are “statistically significant”.
So is cancer just the last straw in an unhappy life?
It’s not as simple as saying depression causes cancer. Perfectly happy, well-adjusted people get cancer, too.
So if you have a problem with depression, don’t start kicking yourself for causing your own cancer. That’s the last thing you should do. Later in this article I’ve got some ideas that could brighten — and extend — your life. I’ll give you a hint: Joining a support group can double your survival time.
But meanwhile it IS true that sadness can shorten your life. . .
Two major studies of Western Electric Company employees showed a relationship between self-reported depression symptoms and risk of mortality over 17- and 20-year follow-up periods2,3 — leading some to speculate that depression would officially become a risk factor for cancer.
Additional studies show that a large proportion of women diagnosed with breast cancer are convinced their disease stems from a major life stress — like an abortion, divorce, child’s illness, or the loss of a job they liked.
We’ve known all this since ancient times…
Two thousand years ago, the Greek physician Galen observed that depressed people were especially prone to develop illness.
In 1759 an English surgeon wrote that cancer “went with disasters in life”.4
Later, in 1846, British medical authorities considered “mental misery, sudden reverses in fortune, and habitual gloominess of temper… to constitute the most powerful cause of the disease.”
Dr. Walter Hyle Walshe, a prominent surgeon and cancer authority in the middle of the 19th century, added, “I have myself met with cases in which the connection appeared so clear that I have decided questioning its reality would seem a struggle against reason.”5
Not everyone agrees. . .
Still, this idea remains fiercely contested, and the evidence can be murky. Researchers Linkins and Comstock suggested that depression predicted cancer mortality in smokers but not in non-smokers.6
A number of later studies failed to find much of a correlation between depression and cancer7,8. One meta-analytic review concluded that depression was only a very small indicator for cancer.
Other studies continue to prolong these see-saw conclusions. So while some studies imply an increased risk of cancer, others suggest that depression doesn’t necessarily indicate anything.
Why conflicting results are so common…
At first glance, it seems it should be easy to determine if cancer is linked to depression — or not.
However, it’s not easy to separate other emotional factors or even physical ones from depression.
Behaviors like smoking and using alcohol, along with biological ones like growing older, becoming overweight, and having a family history of cancer, are common risk factors for cancer.
Researchers can find it difficult to control for these factors in a study group, or separate the role of stress or depression from these factors.
Are you giving the cancer “seed” fertile soil to grow in?
David Servan-Schreiber, MD, PhD, author of the international best-selling book Anti Cancer: A New Way of Life, describes how it takes from 5 to 40 years for a cellular anomaly to become a detectable tumor. A healthy gene can become abnormal via radiation, environmental toxins, and other carcinogens, such as the benzopyrene from cigarette smoke.
He states that no psychological factor by itself has ever been identified as being capable of creating the cancer seed.
But he goes on to conclude that certain reactions to psychological stress can profoundly influence the soil in which the seed develops.
So, is it my fault?
Many patients recall a period of particular stress in the months or years just before a cancer diagnosis. It may create a terrible sense of helplessness or an overwhelming feeling of suffocation.
These feelings don’t spark cancer per se… But a published article in Nature Reviews Cancer (2006) states that psychological stress can provide the optimal “soil” conditions cancer cells need to grow faster.9
Honestly, though… the various contributing factors can be so broad and confounding that you should never blame yourself or feel guilty for developing this disease. For one thing, that really doesn’t help your cause.
Secondly, knowing the “soil concept” can give you an opportunity to learn to live differently and handle your stresses better… and likely aid in your recovery if you’ve already been diagnosed with cancer.
Do YOU have a cancer prone personality?
Sometimes it’s called the “hit and sink” phenomenon, referring to the children’s game of Battleship…
Imagine a person who never felt fully welcome during childhood, or simply had cold, distant, or demanding parents who gave little or no encouragement. Later, this person conforms to what everyone expects of them, to avoid conflict. They safeguard their emotional security by investing heavily in their profession, marriage or children.
When that investment is threatened or lost, the childhood grief returns, and the emotional suffering is more profound than ever — leading to feelings of helplessness, despair, and abandonment.
When the second “hit” strikes, a person’s psychological and/or physical structure may collapse.
The Emory University lab of Charles B. Nemeroff, MD, PhD, published a study based on this theory… finding that depressed adult patients with traumatic childhoods had stronger inflammatory factors — ones contributing to cancer development — and reacted far more than most people to lab-induced stress.10
An animal experiment by Martin Seligman, PhD, at the University of Pennsylvania demonstrates this perfectly. Warning: I find this study distasteful, and you may, too, but we can learn something from it:
Rats were grafted with cancer cells that were known to induce a fatal tumor 50% of the time.
In this experiment the rats were placed into one of three groups:
Control group: The animals received the graft but were not manipulated in any way.
Group 2: Rats were given small electric shocks, which they could learn to avoid by controlling a lever in their cage.
Group 3: Rats were grafted, and given electric shocks — but there was no escape mechanism available.
As published in Science, having an escape mechanism had a very clear effect on whether they succumbed to cancer.
Surprisingly, Group 2, which could avoid the shock by controlling a lever, rejected cancer development more effectively than the control group — 63% of Group 2 rejected it, while 54% of the control group rejected it. That’s how important it is to feel you have some control, some ability to manage your own fate.
Sadly, only 23% of the animals subjected to electric shock without means of escape could overcome their cancer. It appears that the helplessness of their situation speeded up the tumor’s spread.11
Apparently, it’s the persistent feeling of helplessness or hopelessness that affects your body’s reaction to the disease.
Does the quality of your relationships make a difference?
Psychiatrist David Spiegel, MD, from Stanford University, believes that to be fully human, people need authentic relationships. As a young psychiatrist he had the opportunity to work with psychotherapist Irvin Yalom, MD, who was testing this idea.
Together they held weekly support groups for seriously ill women, all of whom had metastatic breast cancer; survival expectations ranged from a few months to a few years.
In the study, these groups of 8 to 10 women met weekly. They talked about their fears, their loneliness, and their anger… along with their desires and ways of coping with the disease.
They soon learned a fundamental lesson of life… Everyone is wounded to one degree or another, and is ashamed of it.
But at this point in their lives, there was nothing left to hide. So they shared their innermost thoughts and fears with one another. For some, it was their first time experiencing such a high level of trust.
Something quite miraculous happened then. The meetings were filled with natural laughter and camaraderie. Somehow by accepting their own wounds, they had opened the way to positive emotions, joy, the desire to live, and more.
For a year these women met regularly before going their own ways.
Spiegel compared the psychological state of these participants with women (with the same diagnoses and medical treatments) who did not participate in these group meetings.
The women who had learned — thanks to the support group — to confront their fears, to express their inner feelings, and to experience more authentic relationships, were less likely to experience depression, anxiety and even physical pain. 12,13
Support groups can double survival time
Spiegel expected the groups to improve their entire emotional state.
But he never expected to discover what he did about the course of the disease — or the chances of survival.
He was totally convinced there was no link between a patient’s mental state and the development of cancer… In fact, he was outright enraged by those who attributed cancer to psychological effects.
To finally prove that this hypothesis was false, he intended to show that the women in the support group did not live any longer than those in the control group.
But when he followed up with these women, a big surprise awaited him.
Ten years later, three of the 50 support group members answered the telephone themselves. Considering how extremely grave their condition was, that was simply astounding. Not a single member of the 36-women control group had survived so long. The women who hadn’t enjoyed the benefit of a support group had all passed away.
While questioning the families about how long the support group members had survived, he found that they’d lived on average twice as long as the members of the control group.
He even discovered a difference between regular attendees and sporadic attendees of the groups. The more regularly a woman attended, the longer she had survived.
It’s important to stress that all the patients had similar diagnoses at the beginning, and that the selection of those who joined the therapy group versus the control group was completely random. The study was designed to guarantee that members of the therapy group didn’t survive longer just because they had better health to start with, or because they had a different psychological disposition. The outlook for both groups was the same at the beginning.
When these results were published in The Lancet, they rocked the medical establishment.
Thanks to this study, the link between mental state and the development of disease progressed from being some kind of crazy “new age” idea to a respectable scientific hypothesis.
Today David Spiegel is associate director of the Department of Psychiatry at Stanford University, and one of the best known academic psychiatrists.
When asked to explain his unusual findings, he said:
“Feelings you can’t express become an internal obstacle. They use up resources we don’t completely understand. Expressing and accepting them stops using these resources to keep them out of awareness. How that translates in how the body fights illness is still a mystery but I’ve come to believe it does, and we are beginning to understand the mechanisms.”14
Since then, other studies have tested this same hypothesis. Four had results comparable to Stanford’s. Six observed no effect.
Why happiness impacts more than ‘just’ your mental health…
We now know that stress causes hormones to be released to activate your body’s “emergency” response (such as the inflammatory response), which can facilitate the growth and spread of tumors.
What’s more… at the same time, stress slows down any functions that can possibly be “put on hold” — like digestion, tissue repair, and immune system maintenance. Stress causes the body to put aside all those needs while it deals with the “crisis.” And that’s what chronic stress is: a feeling of continually being in crisis, under attack, pushed to the wall.
During the past 20 years, a cutting edge new medical field has begun studying the specific link between psychological factors and your immune system function. It’s called psychoneuroimmunology. It connects the dots between psychology, neurology, and immunology.
It’s a bit complex, but everything suggests that the cells of your immune system (NK cells and T and B lymphocytes) are especially sensitive to feelings of helplessness… such as the overwhelming feeling that nothing can be done to overcome the disease — like those poor rats that were afflicted with shocks and had no way to stop them. If it goes on long enough in can result in the loss of will to live. Just like Seligman’s rats.
Humans, unlike the lab animals, can rediscover the will to live. We can experience a decisive turning point in the course of a disease.
Reconnecting with anything alive — the tree outside your window, children running through the hallway or down the street, your dog or cat, even the breaths you take — can prompt your immune system to rally and fight on.
Shut down depression before it shuts down your immune system.
1. Irwin, Michael R, Several Factors May Explain Cancer, Depression Link, Psychiatric News, Nov. 21, 2003, Vol. 38 Number 22, p. 27. American Psychiatric Association.
2. Persky W, Kempthorne-Rawson J, Shekelle RB: Personality and risk of cancer: 20-year follow-up of the Western Electric Study. Psychosom Med 49:435-449, 1987
3. Shekelle RB, Raynor WJ, Ostfeld AM, et al: Psychological depression and 17-year risk of death from cancer. Psychosom Med 43:117-125, 1981
4. Lerner, M., Choices in Healing: Integrating the Best of the Conventional and Complementary Approaches to Cancer (Boston: MIT Press, 1994
5. Simonton, C.O., S. Matthews-Simonton, and J. Creighton, Getting Well Again (New York: Bantam Books, 1992)
6. Linkins RW, Comstock GW: Depressed mood and development of cancer. Am J Epidemiol 132:962-972, 1990
7. Zonderman A, Costa P, McCrae R: Depression as a risk for cancer morbidity and mortality in a nationally representative sample. JAMA 262: 1191-1195, 1989
8. McGee R, Williams S, Elwood M: Depression and the development of cancer: A meta-analysis. Soc Sci Med 38:187-192, 1994
9. Antoni, M.H., S.K. Lutgendorf, S.W. Cole, et al., “The Influence of Bio-Behavioral Factors on Tumur Biology: Pathways and Mechanisms,” Nature Reviews Cancer 6, no. 3 (2006): 240-48.
10. Pace, T.T., T. Mletzko, O. Alagbe, et al., “Increased Stress-Induced Inflammatory Responses in Male Patients with Major Depression and Increased Early Life Stress,” American Journal of Psychiatry 163, no. 9 (2006): 1630-33.
11. Visintainer, M.A., J.R. Volpicelli, and M.E.P. Seligman. “Tumor Rejection in Rats After Inescapable or Escapable Shock,” Science 216 (1982): 437-39.
12. Spiegel, D., and J.R. Bloom. “Group Therapy and Hypnosis Reduce Metastatic Breast Carcinoma Pain,” Psychosomatic Medicine 45, no. 4 (1983): 333-39.
13. Speigel, D., J.R. Bloom, and I Yalom, “Group Support for Patients with Metastatic Cancer, a Randomized Outcome Study,” Archives of General Psychiatry 38, no. 5 (1981): 527-33.
14. Moyers, B., “Healing and the Mind,” Public Broadcasting System, 1993.