More than 500 people a week in Ireland are faced with the diagnosis of a serious and possibly life-threatening illness. As they brace themselves to receive the difficult news of heart disease, cancer or another chronic illness such as multiple sclerosis, their consultants usually inform them of the worst case scenario and the average longevity of those facing similar diagnoses. What consultants rarely do, according to psychotherapist and pioneer of behavioural medicine in Ireland, Sean Collins, is tell them the best-case scenario.
"For fear of giving their patients false hope, what many medical professionals do is give them what we call false despair," says Collins who, together with his colleague, psychotherapist Rhoda Draper, runs courses for people who wish to face serious illness positively.
One participant on their behavioural medicine programme said that following his diagnosis of a brain tumour, he asked his consultant what changes he could make to his diet and lifestyle to improve his health. "You can do anything you want to do," his doctor replied. "But there is one question you have not asked me which is how long you have to live?" To which, he replied, "I don't want to know." Five years later, the same man has undergone brain surgery and is now planning a trip for a long stay abroad. "Never live from day to day, always plan," he advises.
While Sean Collins stresses that he has no axe to grind against the medical profession (he had a successful heart bypass himself two years ago), he does believe that patients can be imbued with positive messages, rather than filled with hopelessness. "I always say that Rene Descartes did the world a disservice when he separated the mind and the body, leaving the spirit to the realms of the church and the body to the realm of the medics," says Collins.
"The problem nowadays is that doctors only have the time to look at symptoms in isolation from the person. But really, when someone is diagnosed with a life-threatening illness, they should be able to look at every aspect of their lives to see what can be changed so that they can prioritise what is meaningful," says Collins.
"Laboratory research suggests that, at cellular level, we renew all of our soft tissue approximately every 90 days; our skin every 30 days; our mouth lining every four to five days and our liver every six weeks. In other words, you are not the person you were three months ago."
Collins postulates that if such changes take place at cellular level, we all have the potential to influence our physiological make-up through our behaviour. He points to a growing number of studies which suggest a strong link between mind and body.
"Research in the emerging field of psycho-neuro-immunology (which explores the links between one's psychological makeup and the nervous and immune systems) has revealed that depression and hopelessness can lower immune function and actually adversely affect the prospects for recovery," writes Collins in Tipping the Scales - how to react creatively to a health crisis (a facilitator's manual for those interested in organising and participating in a behavioural medicine programme. This can be downloaded from the Ardagh Clinic's website address).
"It is also estimated that we all produce at least 300 cancer cells daily, yet our immune system knows how to identify a cell that is not `correct' and eliminate it. When we are depressed or ill, our immune function is often compromised, leaving space for opportunistic cancer cells to establish themselves," writes Collins.
In the medical journal, The Lancet, J.K. Kiecolt-Glaser and his colleagues described evidence that wound-healing was much slower in psychologically distressed patients. Prof David Spiegal of Stanford University also reported in the journal that women with "stage four" metastatic breast cancer had doubled their life expectancy by engaging in weekly group support psychotherapy.
Collins is also particularly interested in the percentage of people who outlive all medical expectations. "As Norman Cousins, American author of Anatomy of an Illness [Norton, New York] says: no single fatal illness has ever killed 100 per cent of people who are diagnosed with it." Collins gives the example of pancreatic cancer, which often develops very rapidly, yet four per cent of those diagnosed with it are still alive five years later.
Prof Fergus Shanahan is an immunologist and gastroenterologist based in Cork University Hospital. "There is a lot of circumstantial evidence to support behavioural medicine and acute psychological stress has been found to adversely affect inflammatory bowel disease in animals [human studies have not been carried out for ethical reasons].
"I believe that, if negative emotions can have an adverse effect, then positive emotions can have a restoring effect. What is not known is how important all this is and what patients such programmes would best suit," adds Prof Shanahan.
The theme of positive thinking by cancer patients is developed in a new book by Eddie Fitzgerald. Himself a sufferer of cancer of the colon, Fitzgerald has written this self-help book to encourage sufferers to face their illness in a truly holistic fashion, embracing their spiritual and emotional sides alongside their physical and intellectual.
The behavioural medicine programme developed by Collins and Draper involves participants attending full-day modules over 12 weeks. The programme includes group therapy, art/expressive therapy, laughter/ play therapy, meditation and stress management. "We're not saying we can save lives but participants can certainly alter the quality of their lives," says Collins.
Confronting death and the sickness role are issues that participants are actively encouraged to pursue in the group setting. "I think about death every day, but I choose life," said the man with the brain tumour (who prefers to remain anonymous). "You are the one who has the prognosis in your own hands. But with today's medicine I do know, that when I die, it will be pain-free.
"I also practise self-hypnosis and breathing exercises and I find journalling very good. Yes, I believe participating in the behavioural medicine programme has changed my health.
"If you have a life-threatening illness and you don't think about death, you're masking it and it can completely infiltrate you. Talking about death for me was like taking a pair of handcuffs off my brain. It was a freedom," he added. "I believe the work we are doing will create a bridge to mainstream medicine."
Collins also contends that incorporating such programmes into the mainstream approach to illness would reduce public spending on health-care because people would better manage their illnesses and therefore require less medical intervention.
Sean Collins and Rhoda Draper can be contacted at the Ardagh Clinic, 118 Stillorgan Road, Dublin 4. Tel: 01 2600118. The 12-week programme, based on one full day per week, costs £400.
Website address: www.iol.ie therapy
Cancer Busters - Paths to Health, Healing and Inner Peace by Eddie Fitzgerald is published by SDB Media, £8.95.