The Myth of Normal 78

seeking all the connections and conditions that contribute to illness and health? Such a reframing would revolutionize how we practice medicine. Rather than treating disease as a solid entity that imposes its ill will on the body, we would be dealing with a process, one that can’t be extricated from our personal histories and the context and culture in which we live. This change in approach has much to recommend it, and not only because it takes interpersonal biology into account. When we cease to view illness as a concrete, autonomous thing with a predetermined trajectory—and when we have the proper help and a willingness to look both within and without—we can start to exercise agency in the matter. After all, if disease is a manifestation of something in our lives rather than merely their cruel disruptor, we have options: we can pursue new understandings, ask new questions, perhaps make new choices. We can take our rightful place as active participants in the process, rather than remain its victims, helpless but for our reliance on medical miracle workers. Disease itself is both a culmination of what came before and a pointer to how things might unfold in the future. Our emotional dynamics, including our relationship to ourselves, can be among the powerful determinants of that future. An attitude of helplessness and hopelessness at the time of diagnosis, for example, has been shown to exert a marked adverse effect on survival in women with breast cancer even ten years later.[5] Conversely, a decrease in depressive symptoms is associated with longer survival.[6] Even in a study of women requiring biopsies for cervical abnormalities identified on routine Pap smears, those with a dejected view of life before diagnosis were much more likely to find that they received a diagnosis of cancer.[7] In men, the immune system’s capacity to react to prostate cancer was diminished in those with a tendency to suppress anger.[8] Another prostate study found that social support reduced the risk.[9] Dr. Steven Cole[*] is a prolific researcher whose work has cast bright light on the disease process. “We now know that disease is a long-term process,” he told me, “a physiological process taking place in our bodies, and how we live influences how quickly that’s going to get us at a clinical level . . . The