Attitude, Illness and death

June 2, 2008

I know Christmas isn’t here yet, but I want to give you lots of notice of what I think will be a challenging and fascinating series of talks in the Royal Institution Christmas science lecture series by Dr Hugh Montgomery. He is an intensive care doctor, genetics researcher and Director of the Institute for Human Health and Performance at University College London and I think a brief ‘trailer’ is in order as I think what he has to say is so important about a topic that is often avoided, certainly by many doctors.

His lecture series will address what it is about certain people that enables them to survive starvation, extreme cold, extreme heat or lack of oxygen. He suggests that genes, environment and luck all play a part but what he was not able to tackle in the lectures is the question of the will to live in medical situations because it is a controversial topic. So I would like to flag it up here for your consideration.

Personally, I have given three talks this week; on procrastination, stress management and alternative health. The common theme in all of them was how important your attitude is to your success in life, your health and your happiness. The British Medical Journal has previously reported on the fact that a positive attitude prolongs lifespan and that positive thinkers recover faster from everyday illnesses and do not suffer from them as much as do those who have a more negative orpessimistic outlook.

Belief is a powerful thing. Ask anyone working in an intensive care ward or a hospice and they will tell you about people who have survived terminal illnesses altogether, or for longer than anyone could have predicted, and also have let go and died when given seeming ‘permission’ from family or their Doctor to do so. This is something that has long been privately acknowledged, but not publicly discussed, in the medical profession; that the ‘will to live’ or desire to die can influence a patient’s survival.

Dr Montgomery has raised the issue, based on his own experience. “What I have found again and again is that dying patients hold on for a loved one to arrive – say for a son to get the visa to fly to London and see mother in hospital for one last time. My father, who was unconscious in hospital for the last couple of days of his life, died at the rare moment when we – my mother, sisters and me – were in the room at the same time.” I have heard, and experienced myself, this phenomenon and been told of many similar stories of people ‘waiting’ to go for a specificevent or person to be present – and sometimes, absent.

As I said, this is a privately acknowledged fact by many doctors but it is also a controversial one. Dr Montgomery is not suggesting that some people who succumb to fatal illnesses may just lack the will to survive because it is important not to generalise. He is also looking at this from a behavioural psychology rather than a medical viewpoint. What he is saying is that one’s mental attitude or emotional state can cause fatal illnesses or help one survive and there is plenty of data to help support that view.

Certainly, we know that stress, often emotionally related, can cause coronary disease. St John Ambulance can confirm this in terms of the number of people who have heart attacks at football matches or majorsporting events. Dr Montgomery acknowledges that more work is needed on the notion of the will to live. “But when you come across, as I often do,two patients who seem to be in a similar condition and have the same strengths and weaknesses, but one dies and one lives, I’m convinced there is a will to live and that it’s important in deciding who survives. “As I am for ever pointing out to people, if you look at life with a half-full glass attitude then your ‘bonus gift’ is to have the potential to live an extra 7.5 years longer than your half-empty glass neighbour.

Worth thinking about isn’t it?


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