Dr. O. Carl Simonton doesn’t look like much of a revolutionary, but his work with cancer patients — focusing on their ability to help themselves get well — has sent widening ripples through the medical community.
Trained as a radiation cancer specialist, Dr. Simonton is so relaxed and warm in person that I was surprised last month — at a conference in Tampa, Florida, on the healing potential of the human brain — at his obvious authority on the podium.
The increasing professional attention and respect for his work — in identifying and modifying lifestyles that are associated with cancer and other major diseases, and using meditation and imagery exercises to combat illness — is obvious, too. During the next year, he will be involved in two major research studies — with the Kaiser Research Foundation and the National Cancer Institute — to document his approach.
Dr. Simonton is the medical director of the Cancer Counseling and Research Center in Fort Worth, Texas. With his wife and co-worker, Stephanie Matthews-Simonton (interviewed in THE SUN, Issue 61), he has co-authored Stress, Psychological Factors and Cancer and Getting Well Again. A third book, Gently Changing, is in progress. Cassette tapes outlining the Simonton method are also available.
A profound change in his work came about through his treatment of his father, who died of cancer last August. Two and a half weeks later, Dr. Simonton addressed the Tampa conference, describing the application of his techniques to ease his father’s death. The personal immediacy of Dr. Simonton’s presentation shows the courage and truthfulness basic to his work.
I’m grateful to Ms. Teresa Keener and the Institute for the Advancement of Human Behavior, which sponsored the conference, for permission to use excerpts from Simonton’s address, and to Carl Simonton for his cooperation in the interview which begins below.
The Cancer Counseling and Research Center is located at 1300 Summit St., Suite 710, Fort Worth, Texas 76102.
— Lightning Brown
SUN: Your method of cancer therapy puts patients to some extent in charge of their own healing. How do you do this?
SIMONTON: I think your point is that I have a very deep regard for the person’s ability to influence his own health, much more so than I was trained, or than is now being taught. I believe very strongly that what an individual does and how an individual thinks has a significant influence on his health.
SUN: People create their own illnesses?
SIMONTON: We develop our illnesses for reasons. The words that we use to communicate these concepts make it seem as if this happens consciously, when quite the opposite is true. We don’t know how this very complicated process happens. We aren’t aware of the stresses, of the things that don’t fit, which play a role in our bodies breaking down. And then we are not aware of the secondary gains, the good things that happen to us as a result of getting sick.
The more we look at this, the more it appears that illness is a coping strategy, a way of dealing with difficult issues in life. Illness winds up being one of the acceptable ways of dealing with incongruities, with things that don’t fit.
SUN: How do you help patients to identify the causes of an illness?
SIMONTON: What we have our patients do is to take the symptoms of cancer as the illness, and to look for the five biggest changes that they can identify in their lives in the 18 months prior to the diagnosis being made. If they have had subsequent flareups, they look at the six months prior to each flareup. Then, they look at their emotional reactions to those changes. Finally, with each episode, they look at five good things that happened to them as a result of the diagnosis or of each flareup — what they get out of being sick.
SUN: Cancer brings fringe benefits?
SIMONTON: We tend not to be aware of what our needs are. We block out our needs because we learn early that we have to go to school in order to achieve, so that we will eventually one day be successful, and then automatically will follow happiness. This is a common thing, though we may not all buy into it equally. In order to become successful, we have to numb ourselves to what we want.
It is important for us to appreciate that secondary gains are very good for us. What we get through illness is very important to us, and the statement that illness makes is that the illness is the best way that we can see to meet those needs right now. The objective is to see what we are getting, and to continue to get it through the illness until we can find more effective ways of getting needs met.
Information about stresses and secondary gains is for lifelong use. If indeed I believe that my health is related to my reaction to the events of my life, and that a lot of why I get ill is to get things which I don’t have internal or external permission to give myself, then, for the rest of my life, I will look at my health differently. My health is now a feedback device for helping me take a temperature of what is going on in my life, how I am reacting to it, and how well I am getting the important things I need so it changes the whole dynamic of my life.
SUN: How does this lead to cures?
SIMONTON: In general, I believe that our health is a reflection of the way we live our lives. As we begin to look at improving our health, we take stock of the healthy practices that we have used up to this point, to try to strengthen those, and gradually to incorporate possibilities that we have not been using. If we have been very conscious about food, then diet is the central focus; if we are a creative thinker, then we will emphasize meditation. Meditation tends to be a strange word for some people, but a lot of people like to sit around and think, and for me, that’s meditation, too. If we like to talk things over with someone else, then we are using counseling.
If we change too quickly, it creates anxiety. This is something that I did not appreciate until just a few years ago. It may be very unhealthy for a person to meditate on cancer in the way I just described, because the change may be too much, too fast. . . . You can take a person who is functioning pretty well, and with a little well-intentioned help leave them where they are not functioning worth a damn.
SUN: Is there a scheme of healthy behaviors which you encourage in your patients?
SIMONTON: I divide relevant practices into six areas: exercise, diet, meditation, play, counseling, and purpose in life. I find it important to acknowledge that none of these are inherently healthy. Any of these practices can be used in healthy ways or unhealthy ways.
SUN: Two years ago, when we spoke with your co-worker, Stephanie Matthews-Simonton, your emphasis seemed to be on relaxation and visualization, on the practice of meditation. Have you now expanded from this?
SIMONTON: In the beginning, meditation was the only tool that we were using, at least the only tool I was labeling. I believe it is a very important tool. With time, I have appreciated other aspects of health. But, as with so many things, what we tend to do first tends to catch the eye, and it’s kind of flashy. Whereas diet is relatively new for me. I have really only involved myself in the nutritional aspects of cancer treatment within the last three years. I consider all of the practices to be very important.
SUN: What does meditation do to promote healthy living?
SIMONTON: The way that I view imagery and meditation is that meditation is a central way, and a relatively direct way, of changing our beliefs. As such, we can use meditation to change the way we live our lives, because if we change our beliefs, we automatically change our lives. If I think I am a certain sort of person, then I will live my life accordingly. If I want to change the way I live my life, one way of doing that is to change my beliefs about myself and my universe.
If we look at the specifics of what we are trying to do with cancer patients’ beliefs, then we should look first at basic societal beliefs — that cancer is a very powerful and devastating disease that eats me up from the inside out, that comes upon me for no good reason, the treatment of which is very hazardous and against which my body has very little potency.
I ask my patients to focus on the aspects of cancer that we understand to be true, and which counter those strong societal beliefs. We focus on the cancer being weak and confused, composed of weak, confused, deformed cells, focus on the treatment as being helpful to my body in regaining health, and on my body’s strength and ability to destroy the cancer cells. What I am attempting to do is to help the person dramatically change his beliefs about the situation by focusing on the aspects that we want to change.
SUN: Can this sort of meditation be dangerous?
SIMONTON: All of this is a lot to ask a person to do. It can be devastating to the individual to do this, because we are doing a lot more than talking about just the nature of cancer. We are talking about the nature of the individual, about the nature of health and illness, about life and death.
If we change too quickly, it creates anxiety. This is something I did not appreciate until just a few years ago. It may be very unhealthy for a person to meditate on cancer in the way I just described, because the change may be too much, too fast, and result in much anxiety. And as a result, when the person sits down to meditate, what they come away with is a sense of fear and depression. If a person comes to meditate and leaves feeling this way, the conclusion is not good for their health. We must honor the way we feel.
SUN: Does the same apply to diet, or counseling?
SIMONTON: You can’t talk about good diet in the abstract any more than you can talk about any of the other aspects of health in the abstract. If we take, for instance, the Texas pig farmer, who is eating chicken-fried steak, meat and potatoes, and pork chops — a salty, high-fat diet — and you take that person and put them on a “healthy” diet, low fat, high vegetable and fruit, low salt, that person is going to die much faster because they will not be getting the nourishment from their food. It’s too big a change. I didn’t appreciate that before. You cannot divorce the program from the lifetime habits of the individual.
As a society we are taught to put ourselves into someone else’s hands when we are sick, to become infantile and to turn over our own potency. In my counseling, I ask a patient to own their own potency and to ask for help at the same time. This goes against a large societal form, and that creates lots of difficulties. We are not necessarily doing anybody a favor when we approach this, and that is why our work must be couched in terms which do not create more problems than they solve for the individual. That is a real possible hazard in doing counseling, that you can take a person who is functioning pretty well, and with a little well-intentioned help leave them where they are not functioning worth a damn. It’s important to realize that this is a hazard.
SUN: You summarize these awarenesses and developments in your method as “gently changing.”
SIMONTON: I think that we make consistent changes if they are gentle. If we don’t, if we make changes that are not compatible with the long-term living of life, the changes stop.
SUN: Is that a definition of wholistic?
SIMONTON: Definitions of wholistic are hard to come by, but that is not one. Many times, the wholistic movement tends to be militant in its dicta, and some of the processes which have developed out of the wholistic movement have been detrimental along exactly those lines, in trying to get people to make radical changes. That has been a problem.
SUN: Yet, in common with the wholistic movement, you reject therapies which are invasive or foreign to the individual’s life. Do you place yourself somewhere between wholistic medicine and traditional practice?
SIMONTON: Certainly, I place myself between those two camps. In certain instances, the wholistic movement has been in reaction against traditional medicine. I don’t like that. I like to try to use what comes out of traditional medicine, and to realize that, for certain types of people, traditional approaches are best. If that’s what they expect, if that’s what their whole lives have been oriented around, then for those individuals that’s the best approach.
Illness is a coping strategy, a way of dealing with difficult issues in life. Illness winds up being one of the acceptable ways of dealing with incongruities, with things that don’t fit.
SUN: How many patients have you treated through your program?
SIMONTON: I began treating patients in 1971. Counting all the patients I have treated with my method, you are talking about several thousand, about three thousand.
SUN: You are now in the midst of major transition, personally and professionally.
SIMONTON: A little over two months ago, my father was diagnosed with advanced malignancy. He died two weeks and two days ago. The family called me in to take charge of the situation. I know that, in all likelihood, he died much more quickly as a result of the counseling than he would have without it. He commented to the family that the experience would test my beliefs and abilities.
I feel solid with who I am and what my work is about, but I am in a state of transition with regard to how I am going to move about in the world. There are certain transformative changes in my method that were precipitated by my father’s death. But at the same time, my experience underscored the validity of what I had been doing and of the direction in which I am going.
SUN: Your father was your first patient to ask you to help him die. How has your experience in working with him created new directions for your work?
SIMONTON: The direction I would like to see things go would be to help people clarify whether they wanted to live or die. If people wanted to die, we would help them die more quickly, comfortably, and under the circumstances where they want to die. If they want to die in the hospital, then in the hospital; if they want to die at home, then at home.
I didn’t know whether Dad would want to die in the hospital or at home. My guess was that he would want to die in the hospital, but the opposite was true. I was very glad for that, but I didn’t expect it. So many things happened that were unexpected for me. Not the least of these was how fast he clarified that he wanted to die, and die in a hurry. That was unexpected. I expected him to die fighting, to die a fairly miserable death. I didn’t know about the length of it — it had the potential for that — but certainly one of poor quality where he would be struggling and putting up the superficial appearance of fighting as he was dying.
It wasn’t my job to change the way he died. That was clear to me. My job was to try to help him and to help the family, and to take care of myself.
SUN: But you did succeed in changing that for him.
SIMONTON: No. I think that’s the way he wanted to die. I think I helped him to clarify a lot more than he might have if I hadn’t been helping. I think I helped him to clarify the issues. He could have avoided it; he faced them. I helped. I think I made it easier for him and for the family.
SUN: What reasons are given in medical schools against doctors treating their own families?
SIMONTON: The rationale is that you lose objectivity. I said this to the family. I wanted to maintain objectivity, and for that reason I would not anticipate staying there more than two or three days at a time. I said that if I stayed there longer I would get caught up in the prevailing emotions of the situation, and I would lose my effectiveness. I needed to leave and do other things so that when I came in I would have some perspective.
These are difficult issues. I can’t say that this is the way to do it with any other person, but I knew I had 12 years of experience to bring to bear on the situation I was coming into. What I attempted to do was my best, and to know that I could only do so much and then I had to expect help. I did a lot of praying, and I got a lot of help.
SUN: Carl, you are extremely brave. Not least, as a physician, you are brave to face death on such personal terms, and not to objectify or deny it.
SIMONTON: Someone pointed out to me the other day that 50% of medical bills are spent in the last 30 days of life. I had no idea it was this much. But it is obvious that we are doing more and more to try to keep people alive. We as a society are doing this; medicine is a product of the society. And this fear of death, and this tendency to do anything that we can to keep someone alive, is an incredible economic burden, saying nothing of the emotional burden of our inability to look at death as part of life.
We in medicine and the other helping professions have put ourselves into the position of having to stop a very natural flow of events. And from that standpoint, we are always going to have difficulty, by looking at stressful events as things we can’t integrate, seeing every death as a failure.
SUN: Are there medical models for these new directions in your work?
SIMONTON: There are very few therapists involved in the treatment of cancer patients who openly talk about death as an option. That’s appropriate, since, in our society, there are very few places where death is talked about. So it is not good all of a sudden to be taking people who have been diagnosed with malignancy and telling them that they have the choice to die. How often do we as individuals hear that we have the option of dying? It’s just as true for us as it is for the patient with malignancy — it’s just that they are faced with a situation that makes it a lot more pertinent.
It is important to appreciate that making a lot of drastic changes which might theoretically sound good can be terrible if we don’t sensitize ourselves to the ramifications of such changes and the devastation that they can bring upon patients.
I think that it is important that doctors function where they are comfortable functioning, and not to ask doctors to do a lot of changing. What I’m looking at is to find my best way of functioning as an individual, and for us to look as a society at how we want to function.
It is not necessary to have doctors administering what we are talking about. These are things that families can involve themselves in. I wouldn’t want a large percentage of other physicians to try to start practicing medicine the way I practice medicine. I don’t think it would be good for them, or for society. What I would like to do is to give voice and acceptance to the large numbers of people who have similar beliefs to mine, and a method for operating so that they can be more involved with their own processes.
SUN: Last words?
SIMONTON: I would hope that as we are trying to move away from a mechanistic and depersonalized mode in medicine, that we would also be moving away from a depersonalized way of living life. I hope that we will move toward a more harmonious-blending with nature, medically and societally.
I would like for us to beware against believing that we are in control. I think that this is a dangerous and inaccurate leap. We are not in control. We did not create ourselves. But being open and trusting to the forces that did create us and our universe, and attempting to operate in harmony with them — this is the struggle for me. We must move toward love and harmony with Earth. More and more, this is becoming meaningful for me.
The final thing is that, when we talk about these things, about change and directions for change, and ways in which we want to change ourselves, it is very easy to put things into words. It sounds so nice and simple. We begin to assume that what sounds simple will be easy. It is important for us to appreciate that many of these changes tend to be difficult. When the changes don’t come easily, we must avoid becoming overcritical and self-deprecating. We must be gentle with ourselves.
A Father’s Death
These are excerpts from Dr. Simonton’s talk in Tampa, Florida.
My father did not become ill by accident. I had watched his health deteriorate over the last several years. Three years ago, in the summer of 1979, after having multiple illnesses, heart attacks, end-stage liver disease and encephalitis, and after not being expected to live, he was one of the most exciting medical case histories I had ever known.
I had always referred to him as my favorite patient. This became particularly true after he began using results of my work to improve his own health. At age 67, in 1979, he qualified in the senior men’s timed events in the national finals of the National Rodeo Association. For almost anyone, he was at that point in excellent health, particularly for a 67-year-old man who had been near death.
After that summer, he stopped riding. There were several big events which precipitated this. The largest was the suicide of a grandson in February of 1981, almost to the day 18 months before he died. We always look for special events 6 to 18 months before a diagnosis of cancer. He held himself responsible for his grandson’s suicide, who was only 14 years old.
When we were together that Fourth of July, it was clear to me Pop was dying. I had not seen him between February and July, and it was very clear to me that he was moving toward death. I started including him in my schedule, one weekend a month. He lived 220 miles from me, and I wanted to spend time with him. There was a lot I wanted to get to know prior to his death, and I knew that might not be far off.
Then, in November of 1981, just before Thanksgiving, a great-granddaughter died of crib-death. That was very hard on him. She was about a month old.
I hated to go home that Christmas. There were three major crises going on in the family, and I didn’t want to be spending my Christmas in that turmoil. But I went, and I was ill. I had awakened at four in the morning ill, and by six I was throwing up. I knew that it wasn’t going to keep me from going, that I was just going to be sick, and that I was going to show them how to use illness. The family asked me why I was sick; I knew they would ask me because they are all familiar with my work. My oldest niece said, “Obviously, you’re sick because you don’t want to be here.” “Right,” I said.
It was a very difficult and a very rich Christmas. We held the first of a series of family meetings to discuss Pop’s dying. My older sister said that Pop was having a rough time, but that, after all these many illnesses, he would come out the other side of it. She was the oldest, and she knew best. I liked hearing that. Mom and Dad’s fiftieth wedding anniversary was coming up the following November, and none of us thought he would have the guts to die before then. We were wrong.
His 70th birthday in February was a very big event. He talked about being 70 as being as long as a person ought to live. He continued to go downhill, mostly stayed in the house and continued his retreat from life. He didn’t want any serious discussions — after one major attempt to bring up a serious topic, a terrible experience for me, I decided that I would spend time with him on his terms.
He was worse in June. In July, he was hospitalized with fever of unknown origin. On the 24th, the four of us kids and some of the in-laws met again. No diagnosis had been made. We said that the problem was not what he was dying of, because he had been dying for a long time. The problem was that he was dying. Only a week after that, he was diagnosed with advanced malignancy. We knew that was a distinct possibility.
I didn’t know if Dad would want me to be involved with his care. I was prepared for him not to want me around as he died. But his reaction to the diagnosis was that he wanted to fight to get well, and that he wanted me to help him. Over and over he commented to the family that this would really test me, and my beliefs, and my abilities.
I proceeded to think through all I had learned over the past 12 years, and how it might apply to his treatment. I was pleased with what my work had developed, and excited about going ahead. And I was scared. I knew that it would be a sonofabitch of a job.
He was diagnosed on a Saturday with advanced widespread cancer extensively involving his liver. No treatment was appropriate. On Tuesday we had another family meeting. I saw that it was going to be a difficult time whether he got well or died. He hadn’t gotten sick by accident. I had dealt with many people who had regained health from such a situation, and I knew that it was hell, that it involved real transformations of life stances, that it involved the whole family. I outlined what I wanted the family stance to be. I wanted us to believe that he could get well, though I knew we all had our own beliefs. Having dealt with the recoveries of a lot of people a lot sicker than Dad, it was easy enough for me to believe that he could get well. That was not central, though. What was central was that it was okay with us that he might die, even though we wanted him to get well.
Because I knew him so well, I took the liberty of setting the goals and plans for his program. Meditation was the first thing, because he had used it over and over, and had confidence in his ability to use it. He had incorporated meditation as a health practice and had taught it to patients in hospitals and nursing homes where he was a Baptist chaplain. His physical activities were simple: he was just to get dressed three times every week. We set some goals for his diet, and discussed the important element of purpose in life. Dad was to journal what he was doing.
Six days later he had only gotten dressed once. He had gotten cranky and cantankerous, and hated to have anyone remind him of what he was supposed to be doing. We got together again and had a family meeting. We all agreed that he was making only a token effort at regaining his health. We agreed to confront him with it, and to see whether he wanted to continue. So we did. We presented it to him straight: he wasn’t doing nearly enough to get well. He agreed that he wanted to give it another shot, that he wanted to try to get well. And so he did for another four days.
He had been a boxer in his youth. He began to use a phrase I never heard him use. He said he was going to throw in the towel. And from that time on, he didn’t show the ambivalence I have seen in so many patients. Dad became peaceful, no pain. He was really loving and expressed a lot of love. When I got home the next time, he asked me if it was okay with me for him to die. I said that wasn’t what I wanted for him, and reassured him that I was willing to work with him to die, just as I was willing to work to help him to try to live. He said that he wanted to get it over in a hurry.
It made sense to me that, if he were going to die, he should die quickly, painlessly, and comfortably. He said he didn’t know how to do that. I told him that I thought that one can use the same tools in dying as in living.
Most persons I have dealt with don’t want to ask the questions, don’t want to actively involve themselves in dying. He kept asking me how. I told him that one can meditate on dying just as one can meditate on living. I was amazed that he was asking such important and clear questions. No patient had asked me this; families had, but I had never been forced to formulate a response to a patient. Dad was a preacher. I told him to relax himself, to think about turning loose of life and going to be with God. It seemed to make sense to him.
He proceeded to die comfortably and quietly. He was dead five days later.
