What exactly is positive thinking and does it work? We look at this and alternative approaches to living or being ill – such as ‘vigilant realism’ and choiceless awareness.
In ‘To Fight or to Flow’ we looked at three different attitudes we might take on receiving the diagnosis of a serious illness or learning that it is terminal: to fight it, to resign ourselves to it, or to accept it.
Another approach that some people adopt is ‘positive thinking.’
What is positive thinking exactly? Charlene Proctor, Ph.D., who describes herself as ‘the official guide to positive thinking,’ defines it as, ‘a discipline that trains the human mind to change a perceived reality by repeatedly making positive mental statements.’ 
Yet, whether we want to acknowledge life’s valleys or not, they do exist. And they are not against the mountains; in fact, don’t they only enhance our appreciation of the mountains? Making our way through the down-times of the valleys can be as significant as the highs of mountain-climbing. So-called negative situations can make us stronger in ways that ‘good times’ cannot. [See The Dance of Dualities.]
While it’s not uncommon to hear cancer survivors say, “I wouldn’t have missed the experience for anything; it’s made me take a good look at how I was living and how I want to live now”, this is quite a different matter to having to pretend that we are feeling positive when we are anything but.
If, in the name of ‘positive thinking,’ we repress our doubts they are bound to continue as an undercurrent, niggling at us and eroding our energy. Not only that, but trying to keeping doubts at bay is stressful and creates conflict inside – not what is needed when your body is trying to combat the stress of illness. [See ‘Finding Calm on a Roller Coaster’]
As one cancer patient put it: ‘Friends and relatives only want to know that you are being positive, so there’s no space for voicing the insecurities that I have, or the doubt, or the fear and anger that surface from time to time.’ Others agreed with her: ‘I feel like I’m living with two faces,’ said another. ‘There’s the optimistic one I present to others, and then the other, who I really am, feeling what I really feel.’ One of the pluses of seeing a counselor said a third was that ‘She is someone I can talk freely to about how I am really feeling, knowing I won’t be judged.’
Writing for the London Telegraph recently, reporter Sinclair McKay reviews Barbara Ehrenreich’s book Smile or Die: How Positive Thinking Fooled America and the World. Ehrenreich was diagnosed with breast cancer and “from the mammogram on, she found that she had entered a world of pink ribbons, Ralph Lauren pink ponies and balloons, of ‘fun runs’, of books featuring personal testimonies with statements such as ‘cancer is your ticket to real life’ and ‘cancer will lead you to the divine.’
“Ehrenreich found that any expression of dissent,“ continues McKay, “any suggestion that one found the illness frightening and the treatment and insurance arrangements disgraceful – led to her being howled down online by fellow sufferers for having a ‘bad attitude’ and ‘anger and bitterness.’” She then took a look at the rest of American society and found “it has been taken over by the same fixed-smile, thinking-on-the-bright-side fever.”
McKay concludes his review: “All she is ultimately asking for in a sane world is not gloominess or pessimism but simply ‘vigilant realism’. Fat chance,” opines McKay, “because it is all really about fear in the end: fear of death, of illness, of poverty”. 
Barbara Ehrenreich, who holds a PhD in cellular immunology, has this to say:
‘Rather than providing emotional sustenance, the sugar-coating of cancer can exact a dreadful cost. First it requires the denial of understandable feelings of fear and anger, all of which must be buried under a cosmetic layer of cheer. This is a great convenience for health workers and even friends of the afflicted, who might prefer the fake cheer to complaining, but it is not so easy on the afflicted.’ 
One of the consequences of a belief in positive thinking is that patients may even start believing that feeling sad or angry will cause their condition to worsen or that, through some underlying attitude, they caused their own disease in the first place.
Ehrenreich proposes what she calls a radical alternative to either positive thinking or negative thinking, both of which can be equally delusional.
‘The radical alternative I want to propose to either positive or negative thinking is just realism, trying to be realistic, which is to try to understand those things that threaten…and figure out together the best way to make change, to do something about it. 
Smile or die: Barbara Ehrenreich TED Talk
Being realistic: laying the cards on the table
Doctors notoriously avoid having ‘the conversation’ with their terminally ill patients – that is, the conversation in which they must tell their patient that perhaps it is the time to consider how and where they would like to enjoy the time that remains.
Of course, a proportion of patients, and their families, also want to avoid that conversation. However, palliative care physician, Yang Chiuminj of Kings Hospital, London, says that when she ‘lays the cards on the table’ in front of seriously ill patients who are unable to talk about their fears and doubts, they are usually relieved. (She agrees that many of her colleagues are reluctant to initiate this dialogue and that it does take sensitive handling).
Typically, Dr. Yang starts such a conversation with something like, ‘…And tell me: what is your worst fear about what’s happening?’ They are able to relax when there is an opening to voice their concerns,’ she says.
Realism: Not really good for you?
Other folk reckon that realism isn’t good for us. According to the Annals of Behavioral Medicine (Volume 39, page 4) ‘Realism can be bad for your health. Optimists recover better from medical procedures, have healthier immune systems and live longer, both in general and when suffering from conditions such as cancer, heart disease and kidney failure.’
Positive beliefs – such as feeling safe and secure or believing things will turn out fine – seem to help the body maintain and repair itself (Psychosomatic Medicine, Volume 70, P 741).
We are surely all aware of how attitude affects our lives on a daily basis, although when we are stuck in a negative frame of mind this may be the last thing we want to hear. So what is going on here?
Colleague Dr. John Andrews suggests that the life-positive forces express themselves most easily with relaxation, not tension and – unlike the stress-creating attitude of ‘I’m going to beat this disease’ – both relaxation and life-positive energy will best support healing.
Positive thinking operates on the superficial, mental level, and it is possible to keep the mind so busy with thought, either positive or negative, that we never give ourselves the opportunity to go deeper. This may explain why, no matter how hard they try, for some people positive thinking is simply not enough and may only add to their burden.
See also The Biology of Belief
In ‘To Fight or To Flow’ we featured the story of a person with a terminal illness having to make an emergency dash to the hospital, where he underwent a literally life-changing experience.
There had been a lead-up to that incident Chintan recounted that re-enforces the difference between ‘positive thinking’ and connecting to ‘pure positive energy.’
At the time, Chintan was very weak from intensive chemotherapy sessions, but ‘also because I had the feeling that I didn’t have much life energy left. One day I was walking in the country side, just outside Geneva, along a jeep trail used by farmers to get to their fields. Because of the sensation of physical weakness, generally in my life I was aware of limited physical resources, so I was moving slowly, doing things slowly….
‘On that trail I walked under three, huge oak trees – the only trees around. They were around 250-300 years old and, as I passed under the middle one, suddenly I found myself filled with a huge wave of Life. With it was the feeling that I wasn’t that weak; that actually I was fully alive and why was I walking so slowly anyway! With that came a sensation of waking up.
‘The feeling came from inside. It was not a thought, not “positive thinking” but a felt experience and one that actually puzzled my mind! So I started walking fast, as I used to pre-cancer, and I felt so elated. It was delightful to feel this life force running through my body. I walked much more than planned and came back home feeling so alive… expanded.’
He felt that this incident was pivotal in his being so accepting and full of trust when, sometime later, he was admitted to the emergency department in the nearby hospital….
By your choice, nothing is changed. By your choice, you only get into a kind of ignorance. That which you choose is part, and that which you are not choosing is also part of reality. The unchosen part of reality will remain hanging around you, waiting to be accepted. It cannot disappear; there is no way for it to disappear. If you love life too much and you don’t want to see the fact of death…death is there hanging around like a shadow. 
Unlike acceptance, positive thinking is the determination to affect a particular outcome. The downside here is that if, despite your best efforts, you don’t find things going your way, you may feel devastated and even ashamed (‘I wasn’t positive enough’) and guilty that you’ve failed – failed yourself and all those who believed in you.
The following attitude is one that some readers might feel a certain resonance with: I believe thinking positively can play a part in getting better. So I have the attitude that I am not dying of cancer but living with cancer. If I think about the chance of my dying it feels that it is like inviting death. It feels healthier to concentrate right now on living.
‘Choiceless awareness’ is about taking no attitude but being open to what is, whatever that is – the ultimate in acceptance. Osho points out that ‘equilibrium is when you don’t choose, when you see the fact as it is. Life is not an either/or question, there is nothing to choose. It is all together.’ 
What we want and what we don’t want are two ends of the same stick. Often choosing means fighting what we don’t want instead of focusing on what we do want. To focus on the awareness of our emotions rather than outcomes allows us to move away from being stuck on what we don’t want in our lives, to relax and allow our state of being to be the determining factor.
2. Sydney Morning Herald(Feb 27-28, 2101
3. & 4. Smile or die: Video recording TED Ehrenreich, B
5. Zen: The Path of Paradox, Volume 3 Osho (Rebel]