On “Positive Attitude”

XKCD.com posted a comic strip called “Positive Attitude.” In just three frames, the faceless, nameless stick figures capture a common American experience: the mandate for positive thinking in the face of illness.

1. After telling a service provider that s/he is sick and scared, the provider explains to the patient that having a good attitude is vitally important: “Think positively and you’ll get better.”

2. When the patient starts to inquire about occasionally feeling sad, afraid, or “like crap” the provider interjects that, “If you don’t recover, it will be your fault.”

3. After the patient admits to the provider that this statement makes him or her feel worse, the provider questions the patient and demands that s/he stop making such statements: “See? You’re doing this to yourself…Stop it!”

The demand for optimism not only prevails in American culture (as Barbara Ehrenreich also points out in Bright-Sided), it saturates pink ribbon culture. Ads, images, TV shows, and personal stories perpetuate the demand for inspiring optimism and provide positive reinforcement whenever it is attained. Normalization, hope, transcendence, and the omission of negativity or even realism positions optimism to be the cornerstone of survivorship. Optimism takes perfect form in the she-roic breast cancer survivor, an idealized caricature who smiles through the tears, maintains hope, is transformed for the better, and ultimately wins her battle against breast cancer.

Most of the diagnosed women I have met do not fit the description of the she-ro, but some of them aspire to it to varying degrees. The desire to beat the illness is the ultimate aim, but optimism resonates too. Illnesses present the diagnosed with opportunities for reflection and change that may have positive effects on their lives. They might assess their priorities or relationships, spend time differently, and appreciate aspects of their lives that were less visible prior to the illness. They might also feel compassion and understanding in ways that promote the types of solidarity that are so visible in voluntarism and public gatherings. Yes, illness can result in positive outcomes. At the same time, illness itself is not usually joyful and celebratory. It is discomfiting at best, painful and deadly at worst.

Facing medical uncertainty, deciphering scientific information, making decisions in the face of conflicting data, adapting to a changed body, experiencing lingering side effects, being forced to change or relinquish careers, adjusting to new family roles and dynamics to accommodate the illness, confronting one’s mortality…these are just a few of the aspects of diagnosis that might lead to feelings and expressions that are anything but upbeat. Yet, I have heard numerous accounts of diagnosed women being “kicked out” of support groups, chat rooms, and conversations when trying to articulate their concerns about this side of illness; feeling that others do not want to know how they are doing unless their responses are positive; Or of doctors (similar to the practitioner in the comic strip) reprimanding them for having a negative attitude.

The focus on individual optimism obfuscates the unsettling realities of illness, but it also diverts attention from the social determinants of health—such as treatment modalities, access to care, support networks, and other factors known to influence healing processes. When the overemphasis on positive thinking places the burden of healing on the sick, the diagnosed might “try to be happy” when they feel differently, and then blame themselves if they cannot maintain constant cheer. In this scenario, optimism itself can be an added stressor that may contribute to other aspects of poor health. Ultimately, the optimism dictum in pink ribbon culture creates a controlling image: the she-ro is a triumphant survivor. By definition she lives on, suggesting that the women who do not survive, simply, were not optimistic enough.

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