Dear Annie,

I read what you wrote about this and I think it is a very important topic.

we want to think that we have more control over what is happening to us, then we really do, and believe that our thought process can control the world around us or at least keep us healthy.

in a way this is good, because it does give us some sense of control, but the flip side of it, is exactly what you say- guilt when it fails to work.

I had a patient with acute leukemia, who had an amazingly positive approach. when she had rigors due to the blood products she recieved, she would smile and tell everyone that this is going to drive her illness away, she would come for follow up visits between her chemo. and hospitalization, dressed like she was going to work. when she had anemia that would make most people fall, she would look like the picture of health, with proper make-up. she only complained once, when an arrogant consultant did not believe what she told him, but other then that, she was always smiling, supporting others, and talking about her future plans, when she will recover from this illness.

she went on trips and lead a completely normal life, the moment she was discharged from the hospital.

when she died, I was devastated. it didn't make sense that such a person would eventually succumb to her illness.
I had quite a few patients, who had a much less positive approach and fully recovered from this illness.

through out my years of practice I have realized that a person's approach to life, is very important in their quality of life. it has very little to do with the severity of an illness, nor the recovery from it.

I have seen patients that die with a peaceful smile on their face, surrounded by their loved ones, and not losing their dignity until the very end.

and I have seen patients with a very minor disease making their lives and the lives of those around them very misserable for years.

and I think it is quite normal to have times when you are more positive in your approach and times when you are less, and although it may affect your mood and way you feel in general, I doubt that it has a significant effect on the course of your illness.

that being said, severe depression, that is not just a transient and reactive response to an illness, can lead to a worse outcome. and I have seen patients that did much better after this was correctly diagnosed and treated accordingly.

so the bottom line in my oppinion is that one's approach to life, is not the cause of an illness or lack of response to treatment, but can affect the way in which the illness influences your life. and how much you are ready to fight for your life, and its quality.

alice