Physical and Mental Wellbeing in Fighting Cancer

Lucy and I, Staying Mentally Well Together

In general, I’ve stayed away from cancer literature. There seem to be so many different approaches and opinions that you can find evidence for any approach that you want to take. Want to eat bacon for every other meal? Find a website that promotes The Atkinson Diet and mentions a random study on decreasing cancer cell growth – success! A reader of the blog reached out to me on Twitter and recommended a book called Anticancer: A New Way of Life by David Servan-Schreiber. After Googling it and reading about the author, I was certainly interested. He managed to survive for almost 20 years after being diagnosed with a brain tumour, something which is absolutely amazing and shocking. Dealing with such a diagnosis for that amount of time is astounding, it must have been extremely draining both physically and mentally. He was treated for a brain tumour twice during this time, before unfortunately succumbing to brain cancer in 2011.

Some of the accolades awarded to him in his lifetime are quite astonishing. He was one of the founding members of the US arm of Médecins Sans Frontières, a medical humanitarian organisation best known for its work in conflict zones. The organisation received the Nobel Peace Prize in 1999. Looking through his work, he seemed to dedicate himself as a physician, assisting sick people in conflict zones for years. Places he spent time include Iraq, India and Kosovo, among other places. The accumulation of his work resulted in him being awarded the Pennsylvania Psychiatric Society Presidential Award for Outstanding Career in Psychiatry in 2002. What all of this information said to me is that this is a person who really does want to help people; he dedicated his life to doing so, and likely put himself in a lot of danger in the process. Couple that passion for helping others with a scientifically trained mind and a personal vendetta against cancer, and you have an incredibly powerful set of circumstances. It made me want to read the book. I ordered it off Amazon (I’m afraid to say), and it arrived the next day.

I’ve had it for a few days but only started reading it properly around two days ago. Some of it has been difficult to read, which is slowing me down. I’ll come back to that, though. The version I got is a second edition. Before the chapters started, there is a preface where the author discusses the changes between editions. Part of those changes was to add more evidence to chapter 9 – “The Anticancer Mind”. I haven’t read it yet, but he states that the chapter focuses on how keeping yourself mentally well can help your body fight cancer. The author states that people speak much more highly of the chapters on diet and foods that promote the healthy processes in the body which fight back against cancerous cells. These chapters seem to be Chapter 8 – ‘Anticancer Foods’, and Chapter 8(a) – ‘Anticancer Foods in Daily Practice’. Again, I haven’t read any of these chapters yet, but it seems fairly obvious what they are about; what foods can help promote the body’s natural defences against tumours and how to apply them in your day to day life. I may be proven wrong of course but if I am, that is because the author hasn’t described the chapters well enough. I, Dan Godley, can do no wrong! Although there is that phrase that to assume makes an ass of you and me. I’m only making an ass out of myself here if I am wrong. The author hoped by adding more case studies into Chapter 9 that people will take the anticancer mind more seriously and recognise its value.

I started thinking more about why people are less complimentary about a chapter on mental wellbeing as opposed to dietary changes. It is clear that diet is something physical. We generally know what foods are considered healthy. It would be more than a faux pas if we sat telling our work colleagues that we were on a diet over lunch, to help explain why we were digging into an entire cake and washing it down with squirty cream. There are some whacky diets around, but this would constitute a total failure of the educational system.

Things like pulses, fruit, brown bread etc, are considered to be healthy (or healthier) foods. Foods that are processed or contain a lot of saturated fat are generally thought to be less healthy. Of course, there are healthy fats, like those you get in nuts, but I believe that it is still better for you to consume these things in moderation. Similarly, you will benefit from an amount of things like butter in your diet, but they probably aren’t good in large quantities. If you regularly eat out at restaurants and wonder how they make the food taste so nice, the answer is probably butter and/or oil; lots of it. If you are trying to do some sort of diet, it is much better to make your own food. At least you know for certain what has been put into it and can control the ingredients. For example, Ottolenghi, a favourite chef of mine who makes incredible cookbooks, frequently uses large quantities of olive oil in his recipes. I will frequently tone this element of the dish down unless it is being used to create a flavoured oil, which I can save to use on other things I make.

When we have been eating healthier foods, we typically will have tangible evidence that it is benefitting us. Our weight may go down, we may feel more energised or, if we are also exercising, we may notice a change in the way we feel whilst we’re pushing our bodies. If I eat a takeaway and run the next day, I sometimes feel as if my body is having to work harder to produce the same levels of performance; it may be in my head, but I doubt it. Takeaway food will typically be much higher in things like fat and salt, which will likely impact your performance. I also generally eat a lot more when I get a takeaway, partially because the food is there and I want to eat it, but also probably because of things like MSG being added to the food.

We may feel more hungry if we are changing our eating habits, but we accept that there are sacrifices to be made in the pursuit of a healthier lifestyle. If our own standard of eating was to order a pizza every night, changing to a salad will feel difficult for a while. We know that but consider it worth the payoff, if we are in pursuit of a healthier lifestyle. If we don’t consider it worth the payoff, we don’t stick to the diet. I’ve seen adverts on Youtube for people claiming to eat whatever they want and never doing any cardiovascular exercise, yet having Hurcules-esque bodies. It is usually promoting a brand new trend of the ‘make no changes, look amazing’ school of diet and exercise. I don’t buy it personally, but perhaps they truly do know more than me and I’m an idiot for eating well and exercising. I think they’re preying on this instinct that we have, though – to look good but eat what we want; to be both ‘healthy’ but not have to change any behaviours to get that way. Life doesn’t tend to work like that. We make certain sacrifices to gain benefits elsewhere. The more we dedicate ourselves to those sacrifices, the more they become behaviours that we stand by. I used to never enjoy eating salads when I was younger as they just seemed boring. These days, I love finding a nice salad recipe for a Saturday afternoon. I made a lentil salad a few days ago that was delicious, and since discovering za’atar, I’ve really enjoyed making salad dressings which use the herb mix.

Improving your mental state is far more difficult to measure, though, which may make it more difficult to justify. We may feel happier if we begin to practice yoga but it does not guarantee that we will feel vastly better all of the time; how much of the time is considered a success? And how do we know that we wouldn’t haven’t felt that happy anyway – is it easy to attribute feeling happier to the yoga specifically? What if it is that new cake diet you’ve embarked on?

The two things, physical and mental health, may also be at odds with each other. Your mental health may suffer if you are obsessing over the right foods to eat, and how anything outside of them will promote cancer in your body. The book states that a quarter of us will die of cancer – that leaves three quarters who won’t. Do those people avoid it because they never smoked a cigarette, ate a beef burger or had ten drinks with their friends? I highly doubt it. Were they all masters of zen, facing any adversity with a level head and a wise proverb to teach? I still doubt it. My grandad smoked most of his life, was a little overweight and, to my knowledge, never burnt a single calorie with the primary intention to exercise. Did he die of cancer? He did not. Did he make it to his late 70s? You bet he did. If I had asked him what ‘mindfulness’ meant, he’d have told me to get a dictionary and check. It wasn’t a concept he knew anything about. I remember he was a big fan of Star Trek. Perhaps that’s the secret.

My grandad seemed to be an extremely happy, positive and carefree individual, though. He didn’t need to work extensively on mindfulness to be content, or he was extremely successful in hiding it if he did. My brother in law Keiran is very similar in that respect. Keiran’s intentions in the world seem fairly simple – to make people laugh. I lived with him and my sister for three years when I first moved to London and he managed to be in that headspace 99% of the time. He’s very successful at it too and is one of the funniest people I know. If he fails to make someone laugh the first time, he’ll try again and again and again. Eventually, he gets somewhere. The other 1% of his headspace seemed to be dedicated to shouting at Fifa, a computer game that has the capacity to turn the nicest human into a bitter, angry individual. It can make you feel like the world is plotting against you, and there is nothing you can do about it but sit there and watch. No one is perfect.

My point is this: some people never have issues with their mental health, some people may have but never identify or understand it and some people are in a constant war with it. Individuals arent restricted to these categories and probably float between them depending on what is going on in their lives, and it can probably vary depending on the particular issue at hand. It is more of a scale than a restrictive list of categories. I feel like I am good at reflecting on why I behaved a certain way, but not so good at identifying it at the time. As a result, I can respond to something quite irrationally, only identifying that I had done so after the fact when it is sitting on my mind, bothering me. Over the years I have been much better at not doing this as I’ve matured and learnt more about myself, and the world around me, but it still happens from time to time.

Diet affects everyone in some way, whereas improving ones mental health may be less applicable depending on the individual. I know that the same case can be made for diet too, with some people having better metabolisms etc, but I still believe the intangible nature of mental health makes it far more difficult to define and measure improvements in, making it more difficult to convince every individual that it is helpful. Someone can be skinny whilst eating pizza every night, but it doesn’t mean that they are actually healthy. They probably have high blood pressure and a heart which is crying out for a more complex range of nutrients.

It is especially true in the face of a cancer diagnosis. Everyone accepts that in the face of such news, especially where the diagnosis is more damning, an individual will experience a range of volatile emotions. The emotions will come and go, and we expect them to last for months, even years in some cases. People may never get over them until the day they die. That makes it permissible for an individual’s mental health to deteriorate during this period. Of course, some breakdown of mental stability is sometimes necessary. I’ve cried uncontrollably at times, I’ve woke up scared and not remembered why, and I’ve felt incredibly angry at perceived injustices I’ve experienced; my employer not making it easy for me to return to work, or the original diagnosis at the hospital not being specific enough and carrying a lot of negative energy. It can be necessary to feel these things to help you process them. That is how I reflect on them, and it provides them with a lesson that you can apply in the future. You hope that next time, that lesson will stop you going to those same places mentally. When I speak to people about these things, they tell me that I’m right to feel that way. Sometimes, though, they remind me that there are much bigger things at play here and that keeping myself in a positive mindset is essential. I’ve felt the power of it and it has certainly changed me as a person.

Feeling scared, sad and angry over a period of time really takes its toll on you. In my experience, it makes me far more irrational, seeking narratives which support those negative feelings and using them to intensify the emotions even further. You get locked in that mindset and it keeps you prisoner. It has never benefitted me more to respond to events in this volatile manner. I can’t converse with my family in a positive way, I don’t allow myself to enjoy the things in my life that are special and I find myself moping about, not actually trying to sort out the issues which have made me feel that way in the first place.

I’m not sure what the science is behind it yet and I hope the relevant chapters in the book will shed some light on it, but I can see how allowing yourself to remain in this state could promote the growth of cancer cells in the body. The feelings are debilitating – they can actually stop you from getting out of bed in the morning. If that is how they manifest physically in your behaviours, why wouldn’t they do something similar to the processes going on within your body? If our bodies are constantly creating ‘bad’ cells, as I read in the introduction of the book, but also has processes for dealing with them and stopping them from getting out of control, why wouldn’t those processes also be affected by these intensely negative emotions? All of it makes logical sense to me. I’ve experienced the difference in mindset between a good day and bad day of dealing with cancer; I’ll take the good days every time if I have a choice, and I do have a choice.

Nurturing behaviours that promote both physical and mental wellbeing are essential to me. My key techniques for keeping myself physically well are very similar to the mental ones really. Physical exercise, such as running and yoga, help improve both my physical and mental health. When I am in the zone with exercise, I feel a state of both intense contemplation, yet complete calm. It’s strange. I feel like my brain is ordering and dealing with things that are bothering me, but I can rarely recall any of it specifically afterwards. It is especially true of running. During yoga, I try to bat away thoughts and focus on the position and how it feels, which offers a different wealth of benefits.

Eating well is another technique for improving both my mental and physical health. The physical benefits are quite obvious and I spoke about them earlier, but the mental ones are more abstract. Eating well can make you feel better for the plain fact that you know you’re doing something that is good for you. The process of cooking is also great for me mentally. Sometimes during chemotherapy, cooking an evening meal was the only thing that got me out of bed or off the sofa. I found the energy to do it despite not finding the energy to do anything else all day. It is such a satisfying process, creating something from scratch that you then get to consume. Even when it is not the healthiest dish, you still feel a level of satisfaction that you do not get if you did not make it yourself. It is yours, and you can give it to the people around you that you love.

Finally, I want to talk a bit about the first two chapters, and why it was difficult for me to get through. The author discusses how he discovered he had a brain tumour. He was running a laboratory on functional brain imaging with his good friend and colleague, Jonathan Cohen. They had access to a new type of MRI scanner which was far more accurate than the ones widely available in hospitals at the time, which allowed them to create studies to investigate the prefrontal cortex of the brain. He states that this is a particularly difficult part of the brain to observe, so little research had been done up to this point. With access to this new type of MRI scanner and a devised technique for getting this part of the brain to show up on the scans, they had the perfect formula to start their research. Subjects would come into the lab and be put into the MRI scanner to be observed. Firstly, a scan would be taken of their brain before undergoing the task, then the subject would complete the task whilst another scan was taken. The task required them to use the prefrontal cortex as it required them to remember something and answer a question based on it, a feature which requires the use of this part of the brain.

One day, a subject didn’t show up. David was the least technical out of the people running the scans – he had come up with the method for testing subjects, but did not specialise in operating the equipment. They suggested that they scan him so the time slot is not wasted. After doing the initial brain scan, they told him that something was wrong with the equipment. They did another test, before entering the room and breaking the news to him… The equipment wasn’t broken, there was something the size of a walnut on his brain. They sent the scans over to the relevant department for investigation but David states that he knew what it meant. He had seen plenty of brain scans and could recognise when there was something abnormal going on. This was certainly abnormal. He speaks about going home that night and laying next to his girlfriend whilst she slept, smoking a cigarette and staring at the ceiling, thinking about how he was going to die at 31. I had to stop reading and take a minute to compose myself.

I’d been in that exact place. Reading it was so strange. When you read things, you experience them in a very different way to other mediums, such as film. That person’s thoughts are temporarily placed in your brain, with you still present but temporarily allowing yourself to experience the world through their thoughts. You get a feel for what they are like, what drives them and how they respond to things. A narrative is created in your head and that character sits there throughout the book. I had hardly read any of this book, and here was a man describing a situation and mindset that I had experienced. Not only had I experienced it, but it was the lowest point of my life. Laying in the hospital bed the night of my diagnosis, I stared at the ceiling whilst Anna slept beside me. All I could think was ‘how has this happened? I’m 28; I keep myself healthy. What have I done to deserve this?’ I was incredibly scared. David’s girlfriend is also called Anna which made it feel even closer to home. It was eerie.

After taking a few minutes, I continued to read. The next part really shocked me. I’ve taken a cut of it below, not wanting to paraphrase or misinterpret his words.

“Just as I was repeating, ‘It can’t be happening to me; it’s impossible,’ the other voice said, ‘You know what, David? It’s perfectly possible, and it’s all OK.’ Something happened then that was both astonishing and incomprehensible. From that second onwards I was no longer paralyzed. It was obvious; yes, it was possible. It was part of the human experience. Many others had experienced it before me and I wasn’t special. There was nothing wrong with being simply, completely human.” – Dr David Servan-Schreiber, Anticancer, Page 21

Sometimes you read something so apt that you are certain that you’ve thought it before. It is a sort of deja vu but for thoughts. It perfectly summarises the power your mind has over your emotions, and how they can define your response to a situation. David turned over those thoughts of fear and anguish in a few minutes using nothing but his own brain – a particularly powerful brain, of course. It demonstrates the power of mental wellbeing and how it can define how you deal (or do not deal) with a situation.

He says himself that the techniques in the book will not create miracles and that people should adopt the parts of it which work for them. I’m interested to see which parts really resonate with me, and to challenge myself to take more accountability in my fight against cancer. Up to now, I have mostly accepted that the oncology team provides the techniques and acumen to beat this cancer. Ultimately, they will always hold the keys to getting cured, especially where surgery is a requirement, such as with my cancer and diagnosis.

The author is not claiming that making these changes will miraculously get rid of your cancer, or replace the role that chemotherapy, radiotherapy, and other medical techniques hold in the process. The changes may provide that little edge that you need, though. Whether that edge helps get you another week, month, year, or all the way to being cured, it’s worth using them and seeing (in my opinion). Feeling in control of your life is difficult when dealing with cancer; even if these techniques only give you a new means of feeling in control of the situation, I think that is a strong argument that they have value. It is like every behaviour in life – so long as they do not dominate, delude and control your thinking, they can be used at your discretion where you find them useful.