INSANITY AND CANCER

                                                                                       A Psychosomatic Contrast - L. R. TWENTYMAN,

                                                                                                            (BHJ. Vol. LXIII, 1/1974)

         As a general physician I do not claim any special experience in the field of Cancer research.  I have for forty years been continuously interested, perplexed and stimulated by the problems grouped loosely under the psychosomatic banner, ever since as a Cambridge undergraduate I read and fell under the spell of Georg GRODDECK, that most intuitive of pioneers in this field.  But during the last twenty years I have seen and cared for medically a large number of Cancer patients, though of course a tiny number compared with anyone working in an exclusively oncological department.  On many occasions I have found myself having to accompany some human person through this illness and I feel that any insight I have gained has come through these privileged meetings.

         During these years I have also allowed myself to be influenced by the body of psychosomatic experience and ideas within the homœopathic school of medicine, and by the theoretical and practical work developing in the school of medicine attempting to further the impulses of R.STEINER.  Owing to various cultural forces, unnecessary barriers still exist between these bodies of thought and it is by no means easy to speak across frontiers.

         What I hope to bring forward then, is based on clinical experience and on an interest in these labyrinthine problems, an interest stretching throughout my professional life.  I hope that it may be of some use in our common attempt to find Ariadne’s thread to lead us out of the labyrinth.

         I find that quite a number of attempts have been made to relate the paths leading to Cancer with those leading to Psychosis; that of the Bahnsons comes particularly to mind.  From these we gain an idea of alternative reactions, so that regression may manifest more in one path or the other.  I am reminded of an old saying I heard long ago, to the effect that if you want to cure Cancer you must first convert it into insanity and then you have only to cure the insanity.  I wish to contrast these two modes of illness perhaps more intensively, more radically.

         From the homœopathic point of view there is, I think, a particular interest in the views of AHNSON who draws attention to a spectrum of disease from Cancer to Schizophrenia, with intervening series of psychosomatic and psychoneurotic conditions comprising really the whole range of human illness.  HAHNEMANN in the Organon drew attention to what he called “one-sided” diseases.  After characterizing most diseases as manifesting in both local, or somatic, and mental, or psychic, symptoms, he points to the two extreme poles.  On the one hand the conditions manifesting in purely local symptoms with practically no discernible mental or general involvement, and on the other those disorders which display a purely mental symptomatology in which it is extremely difficult to find a local or somatic basis.  I do not think it is going too far to point to Cancer and Schizophrenia as the most typical examples of what he is indicating.  In 1920 Rudolf STEINER, in lectures given to an audience of doctors, characterized explicitly the polarity of Cancer and Mania, and this constituted one of the most important of the many ideas he put forward in connection with the grasping of the Cancer problem in a new and potentially fruitful manner.

         Under our present medical administration it is seldom that the same physician can have close experience of both Cancer and psychotic patients.  I do not think that this is due only to the administrative pressures arising out of the need to group together patients requiring similar facilities for treatment – surgery and radiation on the one hand, or the wide range of occupational facilities and care on the other for those “sore thumbs” which society can no longer tolerate.  I think it is also because most of us are temperamentally and in other ways better equipped to adapt to one or the other set of human problems.  I know from experience how appallingly difficult it can be for a Psychiatrist, used to dealing equanimously with all manner of mental patients, to face and come to terms with the slow bodily disintegration of the Cancer patient.  It is also of course even better known how totally disrupting the presence of a mental patient can be in an ordinary medical or surgical ward.  Not only are the other patients upset, but so are the nurses and physicians.  I have been led to see these two forms of illness not only as alternatives, but really as polar opposites to each other.

         Let us look a little closer at some basic phenomena.  After the obscure precancerous phase is over, the malignant tumours originate locally, usually in a single centre, but sometimes multicentrically.  From this centre or centres, there intrude into the body, developments, I hesitate to use the word growths, which bear no, or only minor, allegiance to the order, the form, of the original organism.  This chaos tends to proceed by steps and stages until the body disintegrates, the form of many of its essential organs is destroyed, and even the bones, those citadels of inner structure, are broken and replaced by chaotic tumour tissue.

         It is characteristic of these formations that when palpated they feel hard – stony hard is the phrase taught to medical students to describe the feeling when a typical cancerous tumour is examined by the fingers.  It is strange that our first impression of such a lump, when we feel it, is its resemblance to something inorganic, not really organic.

         Now about the differences  between living and non-living substances we could go on endlessly, but for my purpose now I wish simply to draw attention to the almost self-evident differences in relation to what we may call Form.  A non-living, inorganic object is in a certain obvious sense indifferent to size; even so formed an object as a crystal can be equally conceived as large or small, and its structure is uniform, not inwardly differentiated within a definitive space.  There is for any living creature a reasonably narrow limit to its variation in size; it carves out a definite space, and also a characteristic and definite life span in time.  The inorganic is as indifferent to its duration in time as to its extension in space.

         It would seem that malignant tumours in many ways fall under the sway of laws more characteristic of the inorganic than the organic worlds.  They feel stony hard, they grow indefinitely, and have no inherent life span.  We might almost say that they behave like inorganic structure of which the units are not atoms or molecules, but cells.  The cells are living, but the relationship between them is tending more towards the realm of the inorganic.  We do then get the impression of invasion of the organism by forces really belonging to the outer world, a situation resembling that which occurs normally only in the sense organs.

         Now what to me is so striking in patients with progressive Cancer is that whilst their bodies almost visibly disintegrate, and may seem at the end to be little more than skin and bones, the personality remains intact.  I do not wish to give any special meaning to the word personality, but simply to describe the fact that it is usual to be able to maintain normal human contact with these patients who for the most part retain an interest in life, and often keep and maintain the hope and wish to get better, even to the very last days.  And in our concern for these tragically fated individuals I think that we may often help them most if we put aside our medical fatalism and join them in the battle to get better.  It is, I think, true that we can often perceive something of the fatal impasse in the life destiny of these human beings which underlies the illness, but at the same time we should try and divine the growth in personality, the metamorphosis of soul, that is potentially present in this crisis.  We can then honestly accompany them in the battle for restoration of wholeness and for the new birth which they seek.  How far this can be achieved in this world is really not for us to decide.

         In stressing a certain “normalness” in the personality of the Cancer patient I am for the moment remaining within the normal scale of human observation that which can be observed in everyday life.  We do not, as a rule with these patients, hear their relatives say “he is not himself”, or “he is quite changed”, or similar utterances.  They may say “he is sick”, or “I am afraid he has got some disease”.  He remains essentially himself, and in himself, not “beside himself” as we may say of the insane.  And it is further a strange fact to me, and not sufficiently often stressed, that these patients seldom commit suicide, in spite of the easy availability of drugs.  Does not this distinguish them sharply from the depressives?  We hear much today of demands for euthanasia and often the appeal is in reference to Cancer patients with intractable pain.  It is my experience that even these patients seldom want to die, but remain interested in fighting their disease and getting better.  They feel their disease as something foreign to themselves and do not seem to me to be weighed down with the burden of guilt so typical of depression.

         In saying this I am of course aware that unconscious motives of suicide can be discerned.  But this is near to the point I am seeking to indicate, the polarity of Cancer and Psychosis.  In Cancer patients it is only on deeper psychological exploration that the disturbance of personality can be brought to light.  For the most part they present well adjusted, normal faces to the world.  Perhaps this is not surprising when we recall how Booth has characterized in similar terms the Cancer Personality and the ruling values of society in the twentieth century.

         Up to now I have presented a one-sided picture of Cancer as invading and attacking a normal, well adapted personality who is cut short in the midst of a successful life and often fulfilling valuable tasks in social and family life.  How comes it about that such a personality is open to attack?  How comes it that our modern society which has achieved so much materially in the over-coming of poverty, epidemic illness and the manifold inefficiencies of earlier times, is in danger of disintegration?

         It is at this point that we have to extend our vision to include the pre-cancerous phases and I find it helpful to make use of an extended concept of metamorphosis.  During embryonic existence and early childhood there are obviously at work enormously powerful constructive forces of growth and organization, bringing into existence our well-formed organisms.  Later on, what becomes of these forces?  They are no longer needed in forming the organs and organism.  A comparatively small residue of them will be needed to maintain the functions and repair damage.  How small a part can be guessed from observing primitive organisms in which the capacity for repair and regeneration remains so incomparably greater than in our differentiated organisms.  We can no longer, as primitive forms can, re-grow a lost limb.  I think it is not unreasonable to consider the view that these forces which in early life are almost wholly involved in organic growth and  development and in the multiple metamorphoses of form that proceed during embryological existence, become progressively freed from the organic depths to become available for conscious soul life.  In a phrase, we think with the same forces that in an earlier phase we grew with.  We find it difficult today, after centuries of the rigid dualism underlying modern science, to envisage a metamorphosis of forces from the organic realm (conceived of course today as mechanism) into mental, imaginative forces of the soul.  Edward von HARTMANN did, however, in his Philosophy of the Unconscious, point to such development and emancipation of forces.

         When irregularities come about in those processes of metamorphosis, largely during the years of education, it may easily happen that some of these forces are not led over into the awakening mental and psychic life, but are left asleep, or even rejected by the awake conscious life, and sent back to sleep.  Then these rejected or discouraged forces may remain as islands within the organic depths, islands of forces which if development had been regular would jave been taken over into the conscious realm of personal life.  Nor do I think it difficult to see that these islands will then regress rather than evolve and that in the course of time they can form centres from which disturbances in the organs can grow, culminating ultimately in the destruction of the organs by tumours.

         So I am trying to visualize a precancerous phase in which forces which should have become more awake and mental, stay within the unconscious organic realms and they disturb the proper functioning.  When an actual malignant tumour develops a further step is taken, and organizing forces of the outer, subhuman world penetrate and destroy the organs.  The tumours do represent gaps thrust into our organisms from which our proper organic forces have retreated.  Is not this something similar, in a pathological, distorted way, of course, to what has developed in our sense organs?  These are inroads into our organisms into which the forces of the outer world penetrate.

         Does what I have been trying, very rapidly, to sketch throw any light on the Cancer personality?  Under our modern educational pressures, when specialization is forced early on children, and only those aptitudes leading to technical training and a career are stimulated and exploited, we do witness on every side a tragic onesidedness of personality developing.  How many talents which could have enriched our lives lie buried in each one of us.  How very little of our human personality, of all the wealth of human faculties latent in us, is ever called upon by our civilization which seems more concerned to lull us to sleep than to arouse and awaken us to active human life.

         In earlier times consciousness was more diffuse and general; a much greater realm of shade, shadow and dream existed between the light and darkness.  Today our white-hot laser beam of awareness has not transitional realm of intermediate colour between itself and darkness.  We learn to adapt to and master a small, specialized empire of our own with this narrow but brilliant light, and the rest of our humanity vanishes into the outer, or inner, darkness.  With these well adapted faculties the Cancer patient can continue to perform a normal modern life even whilst the realm of emotional relatedness, of our hopes and aspirations, of dreams and creative fantasy, lies in relative ruin.

         Before leaving these particular considerations, one further aspect seems to me important.  We are all of us today tied to the material side of life.  The spiritual origins of our existence have become a shadow world for us to which even faith can scarcely rise.  Yet we all yearn for a new experience and path to the spiritual.  It seems to me, if I can hazard a guess, that the very individually differentiated ways, in which each one of us develops our talents in order to master our particular little empire, are the main bonds imprisoning us in our limited horizons.  The organ in which Cancer develops may be the one through which the personality became hopelessly caught in the net of materialistic interest.

         To illustrate what I am trying to say, let me take the case of Breast cancer, which can be so emotionally traumatic.  We know that in earlier times the whole image of the child at the breast was coloured with the highest overtones of artistic  and religious  feeling.  To judge from art and myth, something much more cosmic than our modern concepts of earthly chemical constituents, something imbued with living warmth and love, flowed with the milk through the breasts to the child.  When these thoughts and feelings really  lived in humanity, something infinitely healing must have flowed not only to the baby but to the breasts and the mother must have felt herself united with the spiritual universe from which the baby had descended.  Today unfortunately and tragically we live at the time when nourishing infants is regarded as something entirely chemical – so many grams of carbohydrates, proteins, fat, so many micro- or milligrams of minerals and vitamins, bunged together in a bottle for the babe to get on with?  And why?  So that the mother can continue to regard her breasts as main ornaments in the sex war, for her entirely egotistical search for  excitement and security through seduction and conquest.  It is today even given as a reason for not breast-feeding that the mother can then get back on the pill.  The breast therefore becomes the means, not of healing and of restoring the link between heaven and earth, but the means whereby imprisonment in egotistical despair is brought about.

         To what extent can we see the tumour as a nemesis, a punishment for these terrible crimes we commit, and to what extent as a healing, arising from inscrutable depths?  I hesitate to voice these thoughts, but must we not as physicians try to reach, however tentatively, meaning or sense in these dire straits, which for the patient are felt as the extremity of meaninglessness and despair.  Must we not make every effort to lift from patients the added burden of the medical profession’s own meaningless concepts of disease in general and Cancer in particular.          

         There does seem to be a relative freedom from Cancer in the Schizophrenic and insane.  There is even, it is reported from Greece (Rassidakis et al., 1971, 1972, 1973), a diminished incidence of Cancer in the families of schizophrenics.  Psychiatrists working in mental hospitals assure me that their patients as a group are remarkably resistant to organic disease.  The manifestations of mental disease are as different as possible from what we have been considering.  The capacity for normal behaviour, for relating “objectively” to situations, breaks down.  Normal communication with others is impossible, thoughts become emotionally coloured to extreme degree, everything we associate with the ordinary use of the term “personality” breaks down.  The individuality is overwhelmed by archetypal forces which are as much outside the normal as are the invading organizing forces in the tumour.  In spite of the severe, almost total, derangement of behaviour and consciousness, the bodily health can remain remarkably intact.  It is not easy to discover the organic basis of insanity.  We certainly know that metabolic disorders can manifest in psychosis and today the increasing range of drugs capable of disturbing consciousness to the point of psychosis is known to all of us.  We also know that structural damage in various parts of the brain can cause severe mental incapacity.  But broadly speaking, and again keeping to the ordinary human scale of observation, mental diseases, psychoses, are not local diseases, do not manifest in organic changes.  We know also that the whole range of concepts of disease and diagnosis which has become customary in internal medicine is singularly inappropriate in this field.

         We expect today that the thoughts that someone has, should not be so strong as to compel him to fanatical belief, but that he should be able to move freely, without compulsion, in the midst of differing, even opposed, ideas.  We expect that in his actions he should be able to adapt objectively to the demands of the institutions and people with whom he works.  And we expect in his emotions that he can live in interplay of sympathy and antipathy with others, neither aggressing exaggeratedly, nor being too submissive.  Something I suppose of this sort is our idea of normality.  And then, in ourselves, in families, friends, all around us, even on to the world stage of politics, we find degrees of abnormality which in the insane have gone over the top.

         From the point of view which I am trying to bring forward today, how can we characterize the phenomenon of mental disease?

         It seems to me that when we observe as open-mindedly as possible these phenomena, we can perceive that organic forces are here pushing up into the psyche and this is what gives to the symptoms their compelling quality.  If we can see a part of the Cancer problem in the continued existence within the organic unconscious of elements, forces, which should have been awakened into consciousness; then we can see a part of the problem of insanity in the appearance in consciousness of forces which should have been withheld in the realm of the unconscious physiological processes.  They have shed up and out beyond the normal limits, so that the person is beside himself, outside himself.

         Again the terrible irony of disease seems to me to make itself apparent.  I think that one can characterize those prone to psychosis as being tempted to scale the heights of heaven without achieving the meaning of this world, without accepting the drudgery and toil of this world.  Those also who take to drugs tend to despise the painstaking efforts that work in this world involves.  They want the heavenly vision by short cuts.  They want and prefer to be carried away.  And then the nemesis of insanity comes and their consciousness is drenched by the organic, bodily, forces from the realm they really so despise.

         I am aware that I have only inadequately sketched the polarity of Insanity and Cancer, both highly complex and varied realms on their own accounts.  But with your good will I hope that you can fill in and fill out the deficiencies in this presentation of a polarity which I think is very rewarding to ponder upon.

         I have still to add a word on the meaning or meaninglessness of these diseases, which belong more to adult life and the ageing pole of life.  To do so I must bring in another range of diseases.  In childhood it is the infectious, inflammatory diseases which are typical.  These diseases tend to run a short acute course, culminating in self cure.  It is very difficult to distinguish in them between the disease and healing processes.  The disease is also the healing.  The presence of pain and fever calls attention to the dangers, and we are easily seduced into teleological concepts of the meaning and purpose of the phenomena.  Vast epidemics do indeed face us with enormous riddles of human destiny, but the individual phenomena in inflammatory disease tend of themselves to lead to cure.  They are therefore not the terrible enigmas, torturing us with the vision of an utterly chance-ruled meaningless cosmos, that Cancer and Insanity do seem to be.  I hope that by placing these together in polar relationship to each other, and thinking them together and with the inflammatory diseases, we can begin to restore our human state.

         In the midst of the natural scientific assault upon man we have lost our sense of proportion, our human scale.  The one-sided exaggeration of matter and motion, concepts derived exclusively from our senses of touch and movement, at the expense of the other senses and concepts based on them, has led to a disorientation.  It has led through the influence of the microscope to the modern concept of disease as molecular and genetic morphological disorder.  The patient on the human scale, with his life history and subjectively experienced symptoms, is lost.  On the other hand, through psychology of the unconscious, man has found himself determined by unconscious forces equally beyond his experience.  If on the one hand man has been reduced to the product, epiphenomenon, of material, deterministic forces, on the other he has been exposed as the plaything of divine or demonic archetypes.  Where between these two micro- or macrocosmic worlds is the human world to be established?

         If the only reality was the reality of this world, or if the scientists’ vision of the inevitability of the heat death of the universe were the ultimate truth, then indeed the despair LeShan has revealed lying in the depths of the Cancer patient’s psyche would be justified.  I remember a man dying a painful death with his skeleton riddled with metastases.  He was an Englishman who had lived in the East and become a Buddhist of some eminence,  a writer of Buddhist tracts and a man of refined intelligence and spirituality.  It was possible to arrange for him to have small single room in hospital rather than to be in a general ward.  After he died his friends wrote to me and expressed their thanks for this small privilege which had made it possible for him during the last days of his life to, as they said, meditate uninterruptedly on his corpse before his death.

         The relationship between soul and body cannot be grasped in an abstract formula.  Two extreme phases force themselves on our attention in the course of these diseases.  I think it is possible to see how through the experience of Cancer the soul fights its way to freedom and learns, not merely through pain, its essential independence and reality.  And in this vast multitude who today experience death through Cancer, should we not try to see something being striven for which is necessary and invaluable not only for the individual but for our whole human world.  It seems to me that we must learn how to observe the enormous forces being created through the unprecedented number of persons undergoing the experience of dying with Cancer.  Something real lies concealed in the mere figures of Cancer mortality.  And I have the growing sense that these forces have to do, not only with the patient  as a single soul, but are won for all of us and that they are forces needed for the healing of our world disaster.

         Perhaps we can now bring all this to a temporary resting place, with certain insights.  In  inflammatory diseases it is really the body that is healed and by means of the soul.  The soul engages more organically with the body.  Consciousness is dimmed.  Some degree of softening, dissolving, takes place, and then reconstruction under the guidance of soul and ego.  It is a regression towards the embryological phase of existence, to help remodel the body more in accord with the soul’s needs.  Hereditary influences also can be lessened through this.

         Psychosomatically I believe we must say that in inflammation the soul is acting and transforming the bodily constitution.  It belongs to the life phase of the soul’s incarnation.  In mental diseases, from which incidentally we do not die, the soul is overwhelmed by organic, metabolic forces.  These prevent the soul in its one-sided escapist flight from the world, and involve it again, albeit abnormally, in organic forces.  How right therefore are the efforts to restore these patients to life activity, through workshops, fruitful occupation of all sorts, and social involvement, and to help them regain balance through these activities.  In Cancer, regressed soul forces are now acting destructively in the organism and the soul itself needs to find its way again to real experience of spiritual reality.  These problems belong to the phase of the soul’s excarnation.  The buried talents of the soul lying hidden in the tumours need to be awoken and integrated into a renewed and widened consciousness.  It is probable that artistic activities could be the best means of bringing this about.

         Cancer is indeed a trial of the sould and to meet it requires of all of us more than the usual efforts customary in our times.

         I have tried to find a way to understand the more distressing features of this terrible disease, so that we can be a little more able in ourselves to accompany our patients along what must still be for many the path to death.  I have tried to find ways of seeing Cancer in relation to Inflammation and Insanity, so that the particular features of it may stand out.  I have become convinced that with each of these modes of illness we must take a line different from the trends still dominant in medical science, and follow a psychomatic approach.

         It is perhaps through Cancer that we can begin to be aware again of the reality of the soul in the midst of the disintegration of the body.  Sometimes indeed it is easy to see the soul grow in strength and innerness whilst the body falls away and the old Greek image of the soul as butterfly escaping from the chrysalis becomes almost visible to physical eyes.

         Finally, I can only say that again and again with these patients I feel overwhelmed at the prospect of the enormous task of reconstruction of our culture that is called for and will be required in order to render Cancer unnecessary.

BIBLIOGRAPHY

BAHNSON, C.B.,  and BAHNSON, M.B. (1964) Cancer as an Alternative to Psychosis: A Theoretical Model of Somatic and Psychologic Regression.  Psychosomatic Aspects of             Neoplastic Disease, ed. KISSEN AND LeSHAN.  London: Pitman Medical Publishing Co., Ltd.

BOOTH, G. (1964) Cancer and Humanism                   (Psychosomatic Aspects of Evolution),          Psychosomatic Aspects of Neoplastic Disease,                   ed. KISSEN AND LeSHAN. London: Pitman                   Medical Publishing Co., Ltd.

FERENCZI, SANDOR (1938) Thalassa.  A theory        of  genitality (Translation of Versuch einer Genitaltheorie).  New York: Psychoanalytical Quarterly Inc.

LeSHAN, L., (1966) An Emotional Life-History           Pattern Associated with Neoplastic Disease,                Annals of the New York Academy of Sciences,           125, Art. 3, p.780.

RASSIDAKIS, N.C.. et al. (1971) Malignant                    Neoplasms as a cause of Death among          Psychiatric Patients.  International Mental    Health Research Newsletter, 13.  No.2.

RASSIDAKIS, N.C.. et al. (1972) Malignant                    Neoplasms as a cause of Death among          Psychiatric Patients II.  International Mental    Health Research Newsletter, 14. No.2.

RASSIDAKIS, N.C.. et al. (1973) Malignant                    Neoplasms as a cause of Death among          Psychiatric Patients III.  International Mental    Health Research Newsletter, 14. No.3.

STEINER, R.  Lecture of 8 October 1920, in                   German.  Published in Gesamtausgabe,        Bibliogr. Nr. 314.  Dornach; Rudolph Steiner   Verlag.

TWENTYMAN, L.R. (1957) Approach to the Pre-      Cancerous State.  The British Homœopathic                  Journal, 46, 64. [p. 529 of Hahnemannian Gleanings, 1959.]

TWENTYMAN, L.R. (1957) The Psychosomatic          Problem in Relation to Cancer.  The British                   Homœopathic Journal, 46, 144.

TWENTYMAN, L.R. (1970)  Cancer and the   Twentieth Century.  The British  Homœopathic Journal, 59, 58.