SUN: You said that preventive medicine will come about when we teach parents to raise their children differently. Could you elaborate on that?

SIMONTON: Most of the personality patterns associated with cancer are formulated during the first five or six years of life. That’s when children experience the lack of enough unconditional acceptance from one or both parents, feel responsible for that, feel there must be something wrong and bad about themselves. They learn maladapted ways of getting their needs met: for instance, to put other peoples’ needs first, never to be angry, to be the good little girl. When someone is forty or fifty, we have to intervene and change processes that began way back when. If we were to prevent disease, I think what we would need to do is first, provide more professional parenting. Teach people what children need emotionally to grow into healthy children. Secondly, encourage the expression of feelings in appropriate ways, rather than encourage the inhibition of feelings. Unfortunately, in the past, many parents taught children to be seen and not heard, not to be angry, to be polite at all costs, to always achieve, be successful. Now that means we have to intervene in some way with the parent, because people usually can’t teach skills they don’t have themselves. It means increased awareness on the part of the parents of their own psychological make-up, because children learn coping strategies and mimic their parents. If Daddy bottles up his feelings, guess what all the little boys in the family are like? If the mother is self-sacrificing and a martyr, guess what all the little girls in the family are likely to do?

SUN: But how do you start making that kind of change in the society?

SIMONTON: I think the first step is in education, helping people become increasingly aware of how psychological factors play a role in the disease process and what are healthy and what are maladaptive coping strategies. Then we can begin to talk about parenting and children. We have to address the culture we have now if we hope that that culture will raise children in a different way. More data, more education of the public at large. I think that’s a possibility. With the media coverage that we have, we can change public attitudes and public awareness about factors in a very short period of time. So I think we have the capabilities and the technology to do that kind of massive education. But it’ll take some time.

To consider a disease like cancer as an act of fate over which you have no influence . . . puts a human being in a very helpless condition. The data doesn’t support this.

SUN: You said earlier that looking at cancer the way you do means attacking some beliefs that underlie the culture, but we need “to temper evangelical zeal in doing this.”

SIMONTON: We have to realize how upsetting these ideas are to the beliefs underlying our culture. If we call cancer a psychosomatic disease, then it’s very hard to decide that any disease is not psychosomatic, meaning the result of a combination of psychological and biological factors. Well, that creates a great change and uproar. There have been physical diseases and there have been emotional diseases. Now we are saying they’re all the same. Also, we live in a culture where suicide, which is the only word we have for self participation in death, is immoral and illegal. Yet if we say that peoples’ emotions, attitudes and psychological factors play a role in the outcome of their disease, what we’re saying, very simply, is that people may play a role in how and when and of what they die. In our work we encourage patients to be aware when they feel that death is coming, or is the next choice for them, and give them permission to make that choice and communicate that directly. That causes an enormous shift in the patient’s family system, because the family members may not be able to tolerate the patient deciding to die and accepting death. People can be kept alive in a lingering state of health that most of us would not wish for them, because members of their family are not ready to turn loose. We see that all the time in a hospital where family members will insist that more and more treatment be given in an effort to keep Mama alive, until Mama is in so much pain. Then they say, enough.

What would happen if that family system permitted Mama to say, “Death is coming and I don’t want this extensive treatment. I feel good about the life I’ve lived, and I want to be able to go home and do what I need to do to get my affairs in order.”? How much might her life be shortened, how much more comfortable might she be at the end of her life? That’s not the way we’ve approached disease.

I think the other thing that we need to take into account is that disease fills important psychological needs. We don’t have psychological coping skills, and don’t allow people good emotional outlets. When one’s sick, one’s permitted to be angry, to be cranky, to act out, to say no, to put oneself first, not to accomplish and not to succeed. If we’re really going to eradicate disease as we know it in this culture, we have to find a replacement, a different code of living — one in which the major value and priority in life can’t be success, accomplishment, and bottling up your feelings and presenting a front. We have to provide alternative models of living that are healthier, broader, and more supportive to human nature. Without that, we just pressure people into a more difficult experience.

SUN: What do you do to stay healthy?

SIMONTON: I meditate regularly, I exercise regularly, I see a psychotherapist regularly, I have a fairly extensive support system of close, intimate friends. I take a lot of time off from work, much more than I ever used to. I say no. I limit the number of hours I work, I limit the number of days in the week I work, I put my vacations on the calendar first. I have learned to put the quality of my life first, and to stop postponing gratification. I’ve been fortunate. I’ve learned a lot and gained a lot personally from my experience with cancer patients. When you watch people die as a result of lifestyle and psychological factors you learn about what’s unhealthy in your own life.

I’d say there are a couple of things I could do to be healthier. One would be to say “no” more. I think my work is important, both for our patients and for the evolution of our culture. I could expend myself very rapidly by not setting some limits. Secondly, I tend to forget that I have limits, I am human, I have needs, and I’ll go too far and get too tired before I recognize that. Usually my greatest difficulty is in controlling the amount of time and energy I put into my work and then investing in other relationships and activities, so that I’m not just pulling back from work and experiencing a loss, but investing in other meaningful things. I’ve had to pull back and invest more in relationships, play, hobbies, and other kinds of things, playful activities that balance out the high intensity rewards that I get from my work.

SUN: There’s been a lot of talk here about nutrition, but you haven’t mentioned food specifically.

SIMONTON: You’re right, I didn’t. My biggest problem with food is usually eating too much. My own belief in nutrition and clinical experience with it leads me to believe that nutrition is important in maintaining health, and in boosting the body’s overall health. I personally don’t feel it’s a major curative agent for me, and that may be just because of my own belief system about it. My diet has changed over the course of the last few years because I became a runner. I found that I ate differently, naturally: higher fiber, less refined sugar, fewer foods with a lot of additives, more fresh fruits and vegetables, decreasing my overall caloric intake.

Some of the finest work that’s come out indicates that the closer organisms are to their ideal body weight, if not just under that, the better their defense mechanisms function. Again, we recognize that cancer and heart disease are a result of industrialized society, but the more overweight your are, and the less physically active, the greater your risk of heart disease and cancer. Longshoremen in this country have a much lower incidence of heart disease and cancer. Anyone who sweats everyday has a much lower incidence of cancer and heart disease. So, physical activity is important, but so is not being overweight.

SUN: Do you think you might ever get cancer?

SIMONTON: I suspect I’m probably more disposed to heart disease. That runs in my family. My grandmother had cancer when she was 72, survived until 90, and had no further evidence of disease, and as far as I know, she’s the only one in my family.

SUN: If you had just a few words to say to people who have either just found out that they have cancer, or families of those people, what would they be?

SIMONTON: I would say to the person, you are not a helpless victim, there are things you can do to affect the outcome of your disease process. And, as much as possible, find meaning in what seems like a disastrous situation. To consider a disease like cancer as an act of fate over which you have no influence either in the origin or the outcome puts a human being in a very helpless condition. The data doesn’t support this view. You can affect the situation, and you can play a role. There’s a meaning and a reason for what’s happening in your life. I think when one’s life is threatened it’s a very effective coping mechanism to ask: What’s worthwhile about my life? What do I think my individual purpose is on this planet? Then stay as close to that purpose as possible, staying invested and connected to a sense of purpose.

Look at the “why’s.” I think, “Why me?” is a very appropriate question. I think people can assign meaning by asking the question, “Why me?” — not, “Why did fate get me?” as if it shouldn’t have happened, but, “Why is this happening now in my life?”