Cunningham Alastair J, Watson Kimberly
Ontario Cancer Institute, Toronto, Ontario, Canada.
Integr Cancer Ther. 2004 Sep;3(3):214-29. doi: 10.1177/1534735404267553.
This article presents new data and attempts to draw together converging lines of evidence on the mental attributes that may favor prolonged survival in the face of metastatic cancer. The authors interviewed 10 individuals with medically incurable cancers who had outlived their prognoses by from 2.2 to 12.5 years (and have all survived, a further 2 more years in most cases, between interview and publication). The authors derived, by qualitative analysis, a number of themes common to most or all of them. Three major qualities emerged: "authenticity," or a clear understanding of what was important in one's life; "autonomy," the perceived freedom to shape life around what was valued; and "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. Previous descriptions of "remarkable survivors" have suffered from a serious limitation: the research to date has not clarified to what extent they differed psychologically from their many peers who did not survive. The authors attempted to address this question in 2 ways. Six of the subjects were part of a protocol (the Healing Journey study) in which patients belonged to a larger group, all of whom were medically assessed prospectively, by an expert panel. A prediction of the likely duration of survival was made for each of the patients in this study, and it could be shown that those who subsequently survived were not a random sample of the whole but displayed a much higher degree of early involvement in their psychological self-help than did most of their nonsurviving peers. They also compared long survivors with 2 other groups: 6 individuals with similar diseases who had not yet received psychological help and 6 individuals from the Healing Journey study whose survival duration was at the lower end of the whole group. The patients in these comparison groups also lacked many of the most salient qualities identified among the long survivors. Many of the attributes found in the long survivors were, however, also noted in the earlier reports of remarkable survivors in the literature, which suggests that the observations may be generalizable. Putting these joint findings together with the early work of Temoshok on "type C" adaptation as a risk factor for cancer, one can see that there is a mirrored symmetry between the psychological patterns possibly promoting disease and the changed adaptations that may lead to longer survival in some cases. The authors arrive at a commonsense hypothesis: 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.
本文呈现了新的数据，并试图整合一系列越来越多的证据，这些证据涉及在面对转移性癌症时可能有利于延长生存期的心理特质。作者采访了10名患有医学上无法治愈癌症的患者，他们的存活时间超过了预期，从2.2年到12.5年不等（并且在采访和发表之间，大多数情况下又存活了2年多）。作者通过定性分析得出了大多数或所有患者共有的一些主题。出现了三个主要特质：“本真性”，即对生活中重要事物的清晰理解；“自主性”，即围绕所珍视事物塑造生活的感知自由；以及“接纳”，即心理状态的一种感知变化，表现为自尊增强、对他人的容忍度和情感亲近度提高，以及一种被描述为更平和、愉悦的情感体验。以往对“非凡幸存者”的描述存在一个严重局限：迄今为止的研究尚未阐明他们在心理上与众多未能存活的同龄人有多大差异。作者试图通过两种方式解决这个问题。其中6名受试者是一项方案（“治愈之旅”研究）的一部分，在该方案中，患者属于一个更大的群体，所有患者都由一个专家小组进行前瞻性医学评估。对该研究中的每位患者都进行了存活可能时长的预测，结果表明，那些随后存活下来的患者并非整个群体的随机样本，而是比大多数未存活的同龄人在心理自助方面更早且程度更高地参与其中。他们还将长期存活者与另外两组进行了比较：6名患有类似疾病但尚未接受心理帮助的患者，以及6名来自“治愈之旅”研究、存活时长处于整个群体较低水平的患者。这些比较组中的患者也缺乏许多在长期存活者中所确定的最显著特质。然而，在长期存活者身上发现的许多特质，在文献中早期关于非凡幸存者的报道中也有提及，这表明这些观察结果可能具有普遍性。将这些联合发现与特莫肖克早期关于“C型”适应作为癌症风险因素的研究成果放在一起，可以看出，在可能促进疾病的心理模式与在某些情况下可能导致更长存活期的适应性变化之间存在一种镜像对称。作者得出了一个常识性假设：就癌症或其他慢性病的进展受到诸如C型这种扭曲心理适应的促进而言，这种适应的逆转可能有助于康复——就癌症而言，朝着思想和行动的更高本真性转变。
