When the Body Says No: The Cost of Hidden Stress (17 page)

Gilda found it impossible to speak her emotional truth to her mother, Henrietta, or to say no to her directly. When already a star and a closet bulimic, she would attempt to allay her mother’s anxieties about what she ate by concocting detailed fabrications of imaginary meals. Henrietta did not learn about her daughter’s bulimia while Gilda was alive.

Using comedy, Gilda could control her environment. Comedy filled a crucial childhood need. It was a way of endearing herself to her father and her sole means of reaching her mother, “a way of getting to her when nothing worked.” She became a “natural” comic. The price was the obliteration of her own feelings.

Gilda was a self-confessed workaholic who, she would write, “let stress and pressure run my precious life.” On a youthful trip to Paris, she threw herself in front of traffic in a dramatic suicidal gesture that could easily have killed her. “At least someone cares about me,” she said to the friend who pulled her to safety.

Even after her symptoms of ovarian cancer began to cause physical distress, including bowel blockage, Radner was more concerned with satisfying others than with her own needs. She sought and received advice from sundry sources. Her dilemma? “Suddenly I began to wonder how to please so many people. Do I take magnesium citrate? What about the coffee enema? Do I do both? Do I do the abdominal massage or the colonic? Do I tell the doctors about each other? East meets West in Gilda’s body: Western medicine down my throat, Eastern medicine up my butt.”

When it seemed she had been successfully treated, Gilda became a poster girl for ovarian cancer, featured on the cover of
Life
magazine. She was an inspiration to many, but the recovery was short-lived. Still attached to roles she had developed as a child, she berated herself for having “let down” others by developing terminal illness. “I had become a spokeswoman for The Wellness Community, and a symbol of getting well. I had been a model cancer patient completely active in my own therapy. Now I felt like a living example that didn’t work.
I’m just a fraud,
^*
I thought.”

Only close to her death did Gilda finally learn that she could not be mother to the world. “I couldn’t do everything I wanted to do. I couldn’t keep calling all the cancer patients I knew, and I couldn’t try to help heal all the women with ovarian cancer, and I couldn’t read every letter I received because it was ripping me apart…. I couldn’t cry all those tears for everybody else, I had to take care of myself…. It is important to realize that you have to take care of yourself because you can’t take care of anybody else until you do.”

  E
D WAS DIAGNOSED AFTER
his general practicioner found a small nodule during a routine rectal exam. “I went for a biopsy,” he reports, “and they did six hits on the prostate. They found an irregularity in one hit. Prostate cancer. Since then I’ve looked at all the options, and it was all either slash, burn or poison. I’ve spoken with a lot of men who have had their prostate removed, and some who have had radiation. It’s been pretty lousy for most of them.”

“You haven’t had any medical treatment?” I ask Ed.

“I’ve been to a naturopath, and I am doing hypnotherapy, and I’ve been doing a lot of looking at myself and how I’ve lived my life.”

Ed’s colourful phrase, “slash, burn or poison” refers to the three major types of treatment currently offered for prostate cancer: surgery, radiation and chemotherapy. Although some patients come through such treatments without harm, others suffer unpleasant consequences such as urinary incontinence and impotence. A review of over a hundred thousand prostatectomy cases published in 1999 concluded that “complications and re-admission after prostatectomy are substantially more common than previously recognized.”
¹

Those risks might be acceptable if the treatments available cured disease or saved lives, but the evidence is ambivalent at best. The loud public campaigns urging men to undergo screening tests for prostate cancer by means of the rectal digital exam or the prostate
specific antigen (PSA) blood tests have no proven scientific basis. “I think it’s important for people to realize that once we find their prostate cancer, we still have no evidence that treatment works,” Timothy Wilt, associate professor of medicine at the Minneapolis Veterans Affairs Medical Center, told
The New York Times.
²
“And that’s really the whole crux of the screening issue: If treatment doesn’t work, why are we using the PSA to look for tumors?”

Supporters of aggressive medical approaches ought to be disheartened by statistics gathered by Dr. Otis Brawley, a medical oncologist and epidemiologist at the U.S. National Cancer Institute. In places where screening is widely practiced, the incidence of diagnosed prostate cancer goes up, and the number of men being treated increases, but the death rate from prostatic malignancy remains unchanged.
³
If anything, prostate cancer mortality rates were slightly higher in the intensely screened areas. Also disturbing are findings published in
The Journal of the National Cancer Institute
, that men aggressively treated for prostate cancer had a higher chance of dying of other cancers than men who did not receive any medical intervention.
⁴

Although some prostate cancer probably should receive treatment, at this point it is not known exactly who would benefit from intervention. Most prostate cancers are very slow to develop, so much so that the man is likely to die before the malignancy triggers any health problems, if it ever would. In others cases, the cancer is so aggressive that by the time of diagnosis, treatment makes no difference. Since there is no reliable way of deciding when treatment works, what are people who “survive” their prostate cancer really surviving—their treatment or their disease? In the case of prostate malignancy, medicine as it is commonly practised simply does not apply the usual scientific standards.

Public opinion is based on the common-sense view that the sooner a condition is discovered, the more likely doctors will be able to cure it. Convinced that medical intervention saved their lives, celebrities like Gen. Norman Schwarzkopf, the golfer Arnold Palmer or the Canadian federal cabinet minister Allan Rock—all diagnosed with prostate cancer after screening tests—act as persuasive advocates of early diagnosis. Men need to let science, not the latest public figure endorsing PSA testing, help them make a decision about prostate cancer screening and treatment, Dr. Otis Brawley told
The Journal of the American Medical Association.
⁵

Despite scientific confusion, bias toward treatment is powerful. Few doctors are willing to let nature take its course in the face of potential disease, even if the value of intervention is questionable. And men, even if well informed, may choose to “do something” rather than tolerate the anxiety of inaction. But patients always deserve to be told what is known about prostate cancer—and, just as important, all that remains unknown.

Prostate cancer was the first human malignancy to be linked with hormonal influences. Just as cancer of the breast may improve in women who have their ovaries removed, so castration leads to a shrinking of prostate tumours, due to diminished levels of androgens, or male hormones. Orchidectomy, the surgical removal of the testicles, remains part of the treatment arsenal, as does the adminstration of powerful medications blocking the effects of the male hormones. Such “chemical castration” is the first-line treatment now offered men with metastatic prostate cancer.

Given the strong connection between hormone levels and emotions, it is striking how completely medical research and medical practice have ignored psychological influences on the causation of prostate cancer and have eschewed more holistic approaches to its treatment. There has been virtually no investigation of personality or stress factors in prostate malignancy. Textbooks ignore the subject.

The neglect of potential links between stress, emotions and prostate cancer is all the less justifiable given what is already known. By their thirties, many men will have some cancerous cells in their prostate, and by their eighties, the majority are found to have them. By the age of fifty, a man has a 42 per cent chance of developing prostate cancer. Yet relatively few men at any age will progress to the point of overt clinical disease. In other words, the presence of cancerous prostate cells is not unusual even in younger men, and it becomes the norm as men get older. Only in a minority does it progress to the formation of a tumour that causes symptoms or threatens life. It is worth asking how stress may promote the development of malignant disease. What personality patterns or life circumstances may interfere with the body’s defence mechanisms, allowing the already-present cancer cells to proliferate?

As I arrived to interview Ed, a wiry man with a body and face of someone years younger than his age of forty-four, he turned to his wife, Jean,
who was just leaving to go shopping. “It’s a pain in the ass,” he said, “but I have to go and look at so-and-so’s truck for him. It’s not starting.”

“Let me ask you something right away,” I begin.

“Sure.”

“You’re saying that looking at this guy’s truck is a pain in the ass. Now that’s an interesting metaphor, anatomically, when used by somebody who has cancer of the prostate. How easy has it been in your life to say no to things that were actually more of a pain in the ass than a benefit to you?”

“I really don’t say no. I try to help people all the time.”

“Even if it’s a pain?”

“Yeah. Even if it’s not the greatest time for me, or I should be doing other things that are more important for me. I like to help people out.”

“What happens if you don’t?”

“I feel bad about it. Guilty.”

Ed, leader of a country music band, used to do cocaine, mescaline and marijuana, “two or three joints a day, my whole youth. A problem for me ever since my childhood has been alcohol.” Ed tells me about his first adult relationship, which lasted ten years. He lived with an older woman whose two children he helped to bring up, drinking daily to suppress his unhappiness. That relationship came to an end when his partner had an affair.

“I threw in the towel. I said, I don’t want to put up with this. I never screwed around, even though I felt like it. From that day on, I quit drinking for a year and a half, started jogging and doing what I wanted to do. I had this free feeling, like this huge weight was off my chest. I could do anything I wanted to and I felt so good about myself.”

“How much are you drinking these days?”

“Maybe about four beer a day. Every day.”

“What does it do for you?”

“Jean and I got hooked up, and her problems become my problems, and it just gets heavier and heavier and heavier, and then I start with alcohol again.”

“So in some ways you are not happy in this marriage.”

“I guess the biggest thing is the control factor. I’ve allowed Jean to take control of this marriage, because of her multiple sclerosis and because she came from such an abusive marriage.
^*
She was dictated to, told
what clothes to wear and all that kind of stuff. What in turn it’s done is made me cower in this marriage.”

“So you see yourself as being controlled. How do you feel about that?”

“I’m resentful.”

“And how do you deal with it?”

“I hide it.”

“You don’t tell her that you don’t like it?”

“No. I don’t.”

“What does that remind you of?”

“My childhood? Exactly.”

Although Ed had told me previously that he had had a “very great upbringing,” it soon became evident that he had felt controlled by his parents and full of guilt if he failed to meet their expectations. He recalled he had received what he called “deserved spankings,” which, on further inquiry, turned out to have been beatings with a belt administered by his father, from about age eight on. “He believed that that was the best way of doing things.”

“What do you believe?”

“Well, now, I don’t think that was the best thing he could do, but you really don’t have much choice when you’re a young child. I wanted to be a good person. When you’re a child looking at your father, you don’t know what he’s supposed to be, because you want your dad to be perfect, and you want to be a perfect child.”

One of the puzzling features of prostate malignancy is that while testosterone—the hormone people have been led to believe is responsible for male aggression—seems to promote its growth, this cancer is most typically a disease of older men. Yet the body’s production of testosterone declines with aging. Nor have men with prostate cancer been shown to have higher than average blood levels of testosterone. As with estrogen receptors in breast cancer, it appears the sensitivity of tumour cells to normal concentrations of testosterone must have been altered.

Like hormone secretion by the adrenal glands and the ovaries, the synthesis of testosterone by the testicles is under the complex feedback control of the hypothalamic-pituitary system in the brain. That network, highly reactive to stress and emotions, sends a cascade of
biological substances into circulation. Emotional factors can directly influence male sex-hormone functioning for good or ill—just as the female hormone estrogen from the ovaries, or adrenalin, cortisol and other hormones from the adrenal glands, are affected by psychic events. It so happens that in a small series of patients, surgical removal of the brain’s pituitary gland did show positive results in the treatment of prostate cancer.
⁶

Testosterone gets a bad rap. If one wishes to compliment a woman’s self-confidence or assertiveness, one will assert that she “has balls.” A Canadian columnist wrote in praise of Margaret Thatcher, the iron-willed—or merciless, depending on one’s vantage point—former British prime minister, that she had “10 times more testosterone than the men.” Meanwhile, male destructiveness and hostile aggression are frequently blamed on testosterone. In actual fact, high levels of the hormone are more an effect than a cause.