Healing and the Mind; 103; Healing From Within

Healing and the Mind; 103; Healing From Within

Date: 1993-02-23

Healing From Within

BILL MOYERS: Most of us brought up in the tradition of western medical science tend to regard illness as a kind of mechanical breakdown that afflicts our bodies and requires a technical repair. The physician becomes the mechanic under the hood and a cure is something done to and for us. Well, the two people we'll meet in this program take a different approach. They administer no drugs and perform no surgery. Together they represent a growing field of medicine which holds that the way we think and feel can have a significant effect, not only on our physical health, but on our capacity to cope with illness and disease. One draws on the 2,500 year old tradition of Buddhism which holds that a calm mind is the key to health. He works right in the heart of a modern hospital with patients referred to him because their own doctors can do nothing more for them. The second works from the perspective of western psychology. He found with a group of women suffering from breast cancer that the simple act of sharing experiences and emotions actually help them live longer. In the belief that the physician is only nature's assistant, both of these men help their patients learn how to reach deep into their own resources for healing from within.

MOYERS: The University of Massachusetts Medical Center is located in the New England town of Worcester. Like most busy hospitals in America, it will serve twice as many patients this year as it did ten years ago. Despite all the powerful weapons of modern medicine, many patients can't be helped. Frustrated doctors are beginning to turn to an ancient alternative.

JON KABAT-ZINN: [yoga session] Head and neck balanced on the shoulders, allowing the eyes to close and just tuning into the breath. And a sense of your body as a whole, just sitting here.

MOYERS: Jon Kabat-Zinn gave up a promising career in molecular biology to establish this stress reduction clinic right in the middle of the hospital. Since then he has seen over 5,000 patients. We spent eight weeks with Jon as he taught a new group of patients a very old form of Buddhist meditation. How do your patients, your new patients react when you mention to them the word and the idea of meditation?

KABAT-ZINN: Well this is the problem, would this be so weird that nobody would be interested in doing this at all? "Give me a break. What are you talking about, meditation, yoga, to make it even worse?" And so we had no idea and this had never been tried before in a medical center, whether people, mainstream Americans -this is not Berkeley -would ... would go for a clinic, the foundation of which was intensive training in meditative disciplines. They're being sent by their doctors for all sorts of very real problems. And they're not at all interested in yoga or swamis or gurus or Zen masters or enlightenment, they're suffering. And they are coming because they want some relief from their suffering. These are just regular folks, truck drivers, businessmen, teachers. In some cases the stress of their lives contributed directly to their illnesses and in others, the stress of their illness that sent their lives spinning out of control.

Jo Driskell has such a serious heart condition that her doctors say that she could die from a heart attack at any moment with no warming. Erma Jones injured her back at work a couple of years ago. She lives in constant pain. The same thing happened to Dan Kelleher. He'll never be able to work as a carpenter again because he's in a lot of pain and he can't lift or bend anymore. Judy Fine had most of her bowel removed four years ago and she's been living with chronic pain. Jackie Soto recently learned that both she and her little baby are HIV -positive.

None of these people have any particular experience with meditation. And none of them see how coming here once a week for the next two months is likely to help. It's very special for us to be here. This is something that 15 years ago you couldn't find it anywhere in any hospital, anywhere. You'd have to go to some monastery in Asia in order to find what we're going to be learning.

Our first meditation will be an eating meditation. I'm going to pass around some raisins. And the instructions are basically to take them in your hand and look at them as if you'd never seen them before. Basically as if you dropped in from Mars and you just had never seen these things before.

People will carry a lot of baggage about what meditation is and we want to dispel those notions right away. So we'll say, look the first meditation exercise that we'll do isn't breathing. It isn't sitting in the full lotus posture, or doing ... standing on your head or some weird thing. We're going to just eat one raisin and we're going to do it mindfully, with awareness. Notice how the body knows where to position it and how to position it and then start chewing and don't swallow. Just very slowly, very slowly, chewing and experiencing the effect of the chewing, which we tend to call tasting.

You begin to taste this thing that automatically we eat like this usually you know. And we don't taste them. And you're on to the next hands full before you start finishing chewing this one. And people have the realization, my goodness, I never taste raisins. I'm so busy eating them that I don't actually taste them. Now most of us when we eat, we're doing a lot of different things. There's eating and reading the newspaper. There's eating and having a conversation. There's eating and watching television. But very often ... and there's eating so fast that you're just like you know, out of touch with it completely. Slowing it down and really tasting helps bring you into the present moment. If you've ever been starving or been out camping where you know, after four or five days, I mean it was just a nut or a raisin left, you know how you can stretch that out. I mean you know, take a half an hour to eat your raisin or your nut. It's special to eat. Why should eating the raisin or eating your dinner be any less of a viable, vital moment than when you're driving in your car, or when you're making love, or when you're talking with your children, or anything else? I mean if this is really it, why not own the whole thing? And when you're eating, really eat and when you're walking, really walk and be in your body and when you're driving, really drive.

Once we do the raisin exercise and people begin to realize, wow, there's nothing magical about meditation, about mindfulness. It's simply, when you're eating, just eat. Be completely with the eating and the tasting. Then we transfer from there to the breath and we say, now taste your breath in the same way. Moving in past the nostrils, moving out past the nostrils. Being in touch with the breath. Feeling of the breath moving into your body and out of your body. The same thing comes up, wow, I didn't realize a breath is such a rich experIence.

Let's take a deep breath in, down into this region of the body, feeling the belly expand a little bit more.

When I focus on my breathing, I feel the breath moving into my body and out of my body. It's a feeling. It's not thinking about breathing or what breathing is doing. It's just feeling the breath. Then I ask myself to stay on the breath, to ride the waves much as if I was lying on a rubber raft on the ocean and the waves would pick me up and the waves would take me down. And I'm just feeling the lifting and the falling away. The lifting and the falling away.

Relaxing. Feeling the body sinking into the mat.

It helps stabilize and calm the thinking process itself, so that you just give the mind one thing to do, like just ride the waves with the in breath, ride the waves with the out breath. There's nothing magical about that, is there? And being in touch with your breathing literally through your belly and actually feeling that movement.

MOYERS: Does this make any sense to you, you know, lying on the floor and concentrating on your toes?

DAN KELLEHER: Well, yeah, I think it does make a little bit of sense, because actually it's putting my mind in touch with me in ways that I never was before.

MOYERS: What was the problem?

DAN: I have a ... a herniated disk in my back.

MOYERS: When did that happen? DAN: Three and a half years ago.

MOYERS: It's been ... you've been in pain ever since?

DAN: Oh yeah, 24 hours a day, seven days a week.

DEBBIE ORZACK: When I had surgery last year and the neurosurgeon said, whatever problems you have you should just deal with them. And I felt terrible. I felt like he was just leaving me in the middle and I felt really guilty and frustrated and angry. And then....

MOYERS: Last year, Debbie Orzack underwent surgery to remove bone growth, which was compressing her spinal cord.

DEBBIE: I mean I ... I fight it all the it ... I fight the pain. You spend a great deal of energy fighting it. That's energy that you can use for other things.

MOYERS: Were you skeptical when you came to class? Did you ... did you have ... were you optimistic about coming here? Did you think, oh my God, just another....

DEBBIE: I was skeptical. I mean the idea of meditation, it's always been "Oh, it works for everybody else, it's not going to work for me." After talking to Jon, he said something to me that was really meaningful. He said, ''You want to go from just existing to living." And he said, "I ... this program could help you do that."

KABAT-ZINN: As you relax and sink even deeper into ... into the mat, into the floor. And as you breath in just imagining that the breath is moving right down through the lungs and through the belly. Down the left leg, all the way to your toes. And as you breathe out that the breath is just moving back, up from your toes and ultimately out your nose. All of your muscles in a deep state of relaxation and the mind simply aware of this flow of energy, of this flow of breath. Experiencing your entire body breathing. And sinking deeper and deeper into a state of well-being as we come in touch with feeling complete, feeling whole, a realm in which your limitations are not confining, a realm of oneness, a realm of silence, of stillness, of peace. After each class they're required to go home and practice for 45 minutes every day. It's always interesting to hear what comes up for them in this first week.

MARY: I can't be aware of my breath.

KABAT-ZINN: You can't be aware of your breath?

WOMAN: No.

MAN: I found it difficult to keep my thoughts just on my breath.

KABAT-ZINN: The mind is full of thoughts.

MAN: My mind was alive, right. Absolutely.

MOYERS: I'm with him, wherever you were ... wherever you were I was with you. My mind was a monkey, it was leaping from tree to tree. I even think it leaped into his tree while we were meditating.

KABAT-ZINN: Let me ask you both a question, is this news to you or were you aware of it before?

DAN: I was never aware of how much I think while I'm not talking or driving or walking or ....

KABAT-ZINN: This is an important observation because very often we go through life on a kind of automatic pilot basis. And we kind of aren't even aware that there are all sorts of thoughts going on. They're not subliminal, they're just there, slightly beneath the surface of awareness, but they actually drive many of our actions and behaviors. Did anybody notice that this week?

ERMA: It was difficult but I sort of like ... I didn't want to do it. But then I said, "Well if I don't do it, what's the use of going to the class?" But yeah, I found it very hard the first three ... three days. I couldn't ... I... I fell asleep. I just actually fell asleep. JO: I was crying, sobbing and I have no idea why. And I thought, God if anybody was around here and saw this, because I was just ... I mean deeply sobbing, suddenly.

KABAT-ZINN: Do you have any sense now of what that was about? Isn't it interesting that you can lie down on the floor and move your mind through your body for 45 minutes and it will unlock something.

JO: Yes. And afterwards I felt like, "Well, I wonder what we're

going to find out," you know?

KABAT-ZINN: I like your attitude.

MARJORIE: And I was with my children in the car and they're yak yak-yak-yak yak-yak-yak-yakking and I'm thinking, "Oh God, I'm not a mother, I'm a car, I'm a chauffeur." And then I thought, "Wait a second, lighten up, you're with your children, enjoy them."

MOYERS: Had you ever tried meditation before?

MARJORIE: No. And I was feeling guilty as everyone was going around saying, "Oh ... " How they were experiencing emotional ... very different experiences. I'm feeling guilty because it was very successful and positive for me.

KABAT-ZINN: Everybody's experience of this is going to be different. Because everybody has a different body and a different mind. So the point is to realize that all of these mind and body states are accessible to all of us. But the best way to get into them is to not try. We're cultivating something that is not passive and not active. It's non-doing.

MOYERS: It is 2,500 years old and it's un-American, it's Buddhist, eastern and that's what makes it so difficult to share with people. And they're going to look and say, ''Well, that's just like lying on a couch, or all that mumbo-jumbo about tuning and mindfulness, I mean what in the world is going on?"

KABAT-ZINN: When you're lying down on the couch, taking it easy, relaxing or whatever, if you watch what's actually going on in your mind and your body, you may discover that it's far from relax ing. That there's an awful lot of thinking going on in the mind and you may be daydreaming or you may be worrying or you may be fantasizing or whatever.

MOYERS: Well, my mind constantly chatters. It doesn't stop, even when I'm ....

KABAT-ZINN: Well, this is ... this is what meditation is really about, is the learning how to recognize that the mind is continually chattering. Most people don't even know that. And yet, that chatter winds up being the force that drives us much of the day. What meditation is really about is looking deeply into the chatter of the mind and becoming more aware of its patterns. Let's say your mind goes off. Where was one place it went this morning that you could share with us?

WOMAN: When is this going to be over?

KABAT-ZINN: Okay, so the ... the thought comes up, I'm sitting here, oh my God, you know, and sort of you look up or look at the clock or just look at other ... other people seem to be doing great. It's just like torture, you know, when is this going to be over? Right? Something like that. Okay, so now you notice, for that moment with the -My God, when is this going to be over? -Your mind is actually not feeling your breath. Is that true?

WOMAN: Right. .

KABAT-ZINN: Okay. The idea is to just notice, "Oh, when is this going to be over?" is actually just a thought. So you look at it and then you gently just bring the mind back to the belly, back to the breath. And then the next thought will come, ''Well I don't want to be

here, I mean to hell with this breath. I ... you know, aaaggggh." Right?

WOMAN: Right.

KABAT-ZINN: Okay. And you just notice, "Oh, that's one too" and come back to the breath. And it takes a certain amount of work to develop that: And the work is, goes off, bring it back. A little bit like a fishing rod. You just reel it in.

MOYERS: You have to lasso it.

KABAT-ZINN: It's the willingness to lasso it gently, kindly, escorting it back to your belly or to wherever you're feeling the breath moving and just coming back. So if the mind wanders a million times, you just bring it back a million times. ‘

DEBBIE: I tried to do it after I was doing my stretches for rehab, thinking that that's when I needed to relax. And all I felt was a real heightened awareness of all the pain. I felt really angry at all the pain and all the trouble that it's caused.

KABAT-ZINN: So there's a ... a lot of anger there.

DEBBIE: Yeah.

KABAT-ZINN: Do you feel at all friendly towards your body?

DEBBIE: I feel like ... I've always used my mind to overcome it. And now I can't do that anymore.

KABAT-ZINN: Well, this is an experiment in learning how to do the whole thing differently. And the first thing is that if pain is there, you're not going to sort of wall it off and deny that it's present. Okay? It ... it's ... it's going to be here and we have to in some way, learn how to work around the corners of it, work with it and still not have it erode the quality of our life.

MOYERS: The treatment of pain costs this country $63 billion a year. Dr. John Zawacki, a gastroenterologist at U. Mass, has referred over a hundred patients to Jon's stress reduction clinic.

Dr. JOHN ZAWACKI: There are people with pain problems. Just pain that they can't control and no one knows the cause for the particular type of pain. I see that quite often. And so that type of person, where everything has been done, pain medication has been given, it's not been successful, we have sent patients to the stress clinic to learn how to adapt, learn how to live with their pain.

MOYERS: When you tell your patients you're going to prescribe meditation for them, how do they react?

DR. ZAWACKI: Some would just say, "Not for me. Um, it'll be-I'm crazy then."

MOYERS: You don't quite use the word meditation. How would you like to ....

DR. ZAWACKI: That's correct, sometimes I use the word meditation and sometimes I use stress reduction. I don't have a ... a planned approach any time. I never quite do it the same way, but I eventually get in and say that there is this course, meditation, stress reduction, it's been very effective for many of my patients. I've tried it myself. I haven't been able to do it. I tell them that I haven't been able to do it, but I try and I use some of the things that helps me. I say I think it might offer you a lot of benefit and what have you got to lose?

MOYERS: So Jon's just not dealing with the kind of ... sort of flaky issues we think of when we think about emotions. He's dealing with ... with serious, physical illness.

DR. ZAWACKI: That's correct.

MOYERS: Not easy ones.

DR. ZAWACKI: He deals with the toughest ones. That's why ... that's why I admire him so. And I think most of the physicians do because ... he takes the people we can't help. Those are the ones who get to Jon.

KABAT-ZINN: Can you bend your knees? Can they go flat? That's better. Now let's see. Beautiful, you got it. Take your hand away then. You don't need the hand in there and just back and forth. By the third week I like to get them down on the floor practicing yoga. Especially the people who feel their bodies don't work very well anymore, because often what comes up to them is quite painful.

And you feel it. Then you just see ... let me see if I can ride the waves of this sensation? And you watch the sensations come and go and very often they will change.

Noticing that you can uncouple the sensations from your thoughts about them. Like, this is killing me, it's going to last forever, there's nothing I'll be able to do about it. And you .., you learn to free yourself from those thoughts and realize those are just thoughts.

And then it turns out there's inner stillness and peace right within some of the most difficult life situations.

If you can learn to be comfortable within the pain or within the anxiety, it's going to change it completely. And you're ... you see, you're not trying to make it go away. This is a fundamental point. And people think, "Well, I'll come here and they'll make all my stress go away." We're not say ... make your stress go away at all. What we're doing is saying, actually move into the stress and begin to look at it, look at the pain, look at what the mind's reactions are. And you're, "Is this killing me right now, in this moment, is this killing me?" The answer is very often, "No, it's not, but my God, if I have to live with this for 30 years.... " And then you say, "But wait a minute, the idea is to just be in the present moment, let's just flow with this." And over a period of time people learn to actually relate differently to their pain.

MOYERS: A friend of my who read your book said, "You know, he says that we should relax into ... into physical discomfort." I don't want to relax into physical discomfort. I don't want any discomfort.

KABAT-ZINN: Uh, well, lots of luck because uh, maybe medicine has some magic pill which will make his discomfort go away completely and he can just continue to live his life. But the people that we see in the clinic have been that route and they haven't gotten satisfaction.

And on each out breath, just letting go. Letting your body become heavy as it sinks a little bit deeper into the floor or into your mat. Just full attention in each moment to your breathing. The in breath, and the out breath, following rhythmically one on the other, as you let go.

MOYERS: Fifteen years ago Dan Kelleher was the starting right wing on his high school hockey team. Three state championships won him an athletic scholarship to college.

DAN: Back then you didn't think anything could happen to you, you know, you had everything, you know.

MOYERS: The day before he was to leave for school, Dan fell while water-skiing and fractured his back. Two years later, an automobile collision left his back broken in a second place. Nine months in a body cast ended his collegiate sports career. Dan started life over again, on Cape Cod as a commercial fisherman and carpenter. But when he was 30, a deck he was repairing collapsed. Dan fell 12 feet, rupturing his spine in a third place and pinning the main nerve to his leg.

DAN: My pain every day feels like someone pulled my leg out of my body. And it ... it's just constantly ... shoots down my leg to my toes.

MOYERS: The bony mass left behind by the two previous spinal fusions prevented doctors from operating a third time. All they could offer Dan for his pain were drugs.

DAN: And I says, ''Well, I don't want narcotics, cause I know what they're going to do to me, cause I'm just going to want more and more and more." And I don't really want to get addicted to anything.

KABAT-ZINN: Breathing in, tilting the other way, arms back, head up. And when you're ready, slowly coming back up, noticing what the out breath does.

DAN: And then I met Jon Kabat-Zinn. Well, I was a little leery about it, you know. I ... I didn't ... I had no idea what it involved.

KABAT-ZINN: Breathing in and you raise the left leg and the right arm, okay. And you just stretch out, gazing beyond the extended fingers. And this is a little bit of a balancing and strengthening

.

DAN: We talked about how I felt that my life was a little out of control and I wanted to try to get my life in more control. And he seemed to think that it would help to come and take this stress and relaxation.

DAN: [with KABAT-ZINNJ I just couldn't work anymore. I couldn't do the physical job of being a carpenter. My leg is numb, my toes are numb. It's just waking up every single day, knowing that ... actually sometimes I don't even wake up, I stay up all night because I'm in pain all ... you know. My wife Mary Beth had to go back to work to support me and our three and a half year old son, Terry.

MARY BETH KELLEHER: There are times where I get frustrated with his pain. I would have to say that sometimes I forget, so I'll say to him, "Oh honey, can you go take the kid out of the tub or something," and ... and he'll ... he'll just kind of look at me. "Oh yes, sorry, I forgot," you know? Or, you know there are other times when he'll drop something and he'll get frustrated.

DAN: I mean if I have to, I force myself to get down there and pick him up.

[with Terry J

But to pick him up puts a lot of pressure and more pain shooting

down my legs. Lifting is just like out of the question. Bending. You know, like, all of the pans in my kitchen are up in the top cupboard, you know, and you go to ... to the store and something's heavy and you ask someone to carry it to the car for you and they look at you like what the heck's the matter with you? And you're always constantly worrying about what's going to happen. What's going to hap pen, now you know in ... you know, two months from now or a year from now, what am I going to do?

KABAT-ZINN: Back up a little bit more, Phil. Come at me, Phil. I could be real afraid of him but I'm moving in close. That's what the meditation practice is about. Whether it's fear that comes up or ... or pain or whatever, remember I've been telling you over and over and again, move into close to it, okay, even though it scares you. You come at me, okay. And ... and then I'm going to just sort of meet you. See, that's what you're starting to do. You're starting to say, "I'm your pain," okay. And you're.... Aha, right. He's got some feelings.... And what do you want to tell me? Now be careful because .., what do you want to tell me, though?

DAN: I don't want you anymore.

KABAT-ZINN: Yeah, that's right. But I'm here, here I am. See. So there's this sense of, like, well, just stop. Right? So ... so what can be done? And in fact what you're doing is you're starting to say, if I'm pushing against you, you're taking my hand.... Take one of my hands and move it away. Yeah, see? You're starting to work at getting yourself unstuck. I'm still here, right? I'm not going away.

DAN: No.

KABAT-ZINN: But you're beginning to assert the possibility that you can actually dance with me; that you can work with me. You can live around the corner of me and develop your life in some way around me. And you don't know what's going to happen to me, cause you can't control everything and you don't know everything. But maybe you're beginning to actually get comfortable with not knowing where the future's going, but putting your energy into the present. The only time that any of us have to grow or to change or feel anything or learn anything is in the present moment. And if we're continually missing our present moments, almost willfully by not paying attention, what I'm suggesting is maybe it's time for regular people to just stop and tune in to what we have.

MOYERS: Is it possible this becomes just a Band-Aid? Something I do when I start to feel bad?

KABAT-ZINN: Meditation is definitely not a Band-Aid. Actually, meditation is best described as a way of being and what's most important about it is it's like weaving a parachute. You don't want to start weaving the parachute when you're about to jump out of the plane. You want to have been weaving the parachute morning, noon and night, day in, day out. And then when you need it, it might actually hold you. So the way we practice meditation is to do it every day. To carve out sometime every day that's just your time for being. Focus on sound. And just hearing the sounds near and far in the room and beyond, without trying to name them or think about them, but simply be aware of hearing sound.

MARLE: This is un-American really, but it's wonderful.

KABAT-ZINN: Why do you say it's un-American?

MARJORIE: Well, because you watch the world you know, just buzz, buzz, buzz, pace, pace, pace. And I think most people are not thinking. So we're doing something different.

JO: My mind you know absolutely, it really hasn't improved that much. It still flits off all the time. But I've stopped saying no and that's the good thing that's happened with me.

KABAT-ZINN: No, to what?

JO: To the mind.

KABAT-ZINN: So you stopped struggling.

JO: I ... I now say, "Okay, go where you want, but I'm staying here." And it's like ... it's like, I don't know, I think maybe I've always said no to everything. And it's saying, you know, "I don't want to hear that no."

MARJORIE: Every week you seem softer, gentler, more relaxed more whole.

JO: I feel like ... like maybe I'm okay after all.

JUDY: I'm not very happy with this body and I haven't been for a long time. It doesn't work, it's fat. It's just not the old body I used to know. But I was walking the other day, which has been ... I've been doing a lot of walking. And the sun sent out a shadow of me and it was just totally different than my energy ... my image of myself. It was this big woman, but she just looked so strong and she didn't look fat. And I just sort of kept walking with my shadow and it was just a wonderful experience. So that was just something I wanted to share. It's just really nice. Me and my shadow.

KABAT-ZINN: If you hope to really grow in strength and wisdom and bring healing into your life, you have to at some point come to the realization that this moment is precious. And not only precious, but it's wonderful, even if you're in pain, in this moment. Now that takes a certain amount of courage to do. And it involves seeing what comes up as a challenge. And continuing to breath and when you're ready on an in breath, coming back up. And you're not in bed, you're here. That's enormously important. And then raising it up when you're ... when you're {inaudible}. Gently. And it's a statement of taking control in your life, being assertive in yourself rather than being passive and saying, well I guess if there's no surgeon to cut it out of me, I better just curl up and feel hopeless. See these little things aren't so little. That's one of the points that I really want you to ... to ... to sort of ponder, is that the little things and the little moments, they aren't little. They are life.

MOYERS: I returned to the U. Mass Medical Center to attend Jon's eighth and last class.

SHIRLEY: One of the reasons I came here was muscle spasms. And I haven't had ... hadn't one until the other day. All of a sudden I had to stand up suddenly and I suddenly thought of my breathing. And I put my hands down on the coffee table and I concentrated on my breathing and all the anxiety that I was feeling just ... just went. And as soon as that went, the muscle spasm let up. It was ... like a miracle.

MARJORIE: Moment to moment living, being in the present has made me more aware of the joy in my life.

MOYERS: Now you ... this is the eighth week, this is the last session, you ... you literally feel better?

MARJORIE: Yes. I just hoped to get out of it something that would help me. I had no idea it would go in this direction at all. And chew ing that raisin, you almost saw somebody catapult out of this room.

KABAT-ZINN: Why, because it was so weird?

MARJORIE: So stupid. Uh, what I thought to myself is it took me an hour and fifteen minutes to get here. I had to hire somebody to come drive my youngest child to school and I'm sitting here chewing a raisin?

DAN: Two people this week asked my wife, "Hey, what's with Danny?"

KABAT-ZINN: Your friends are starting to ask your wife?

DAN: Yeah, they didn't say it to me. Well, no, it wasn't my friend, it was my mother-in-law.

KABAT-ZINN: Oh.

DAN: "Boy, he's ... he's awful nice and talkative all of a sudden now." And I ... I started laughing, I thought it was pretty good. I didn't notice that. I says, "Oh, there's nothing with me."

KABAT-ZINN: Now there are very few people that I know on the planet that couldn't benefit more from greater ... from a greater dose of awareness. And almost everything that we do would become more vivid and more alive and we would probably be a lot happier if we were more in touch with the present moment. And it seems like in America there's only one day that you're really supposed to stop and be thankful for what it is that you actually have. And the other 364 days you run around desperately trying to get more of what you don't have and push away what you don't want. What I'm suggesting is that we reverse that and start to really tune into the miraculous qualities of being alive. And instead of being sort of on automatic pilot, see what's possible if you start to kindle the flame of being fully alive. Fully present with the breath, with the body.

DAN: I find that it's easier for me to sit and meditate now than it was at the beginning.

KABAT-ZINN: In the spirit of what we've been practicing these past seven weeks.

DAN: And I can stay with the pain.

KABAT-ZINN: Just tuning into your body.

DAN: There are sometimes, moments in my day where I ... I'll notice that I'm not in pain. That's a big turning point for me.

MOYERS: Research at the U. Mass Medical Center shows that three-fourths of Jon's patients report moderate to great improvement in their conditions. And four years after taking the class, over 90 percent are still practicing some form of meditation.

MOYERS: Across the country on the West Coast there's an experiment with healing from within that could affect the lives of millions of women.

JUDY: When you have to think as you're laying there in bed, I've got to get up and go to the bathroom, but you don't have the energy to do it, I mean that's getting pretty basic.

SHEILA: I mean they tell me that if I so much as have somebody come up to me and give me a hard ... bear hug I could crack my ribs.

MARY ANN: I just see things getting stripped away from all of us a lot of times, one thing after the other stripped away. Stripped away, stripped away. And then who is left?

MOYERS: These women all have metastatic breast cancer. Cancer that has spread throughout their bodies. Nearly 50,000 American women will die of the disease every year. A woman with this disease has approximately two years to live. JUDY: We used to go for a walk even. Now he doesn't go for a walk, cause I don't go for a walk. It affects every little tiny phase of your life. You know, there's a big empty hole. Mr.

MOYERS: But these women have discovered a measure of hope in a therapy that involves no new drug or experimental surgery. What's going on seems very simple. They're just talking.

SANDY: Can I do it? You know, what if I say yes ... what if they say yes and I say yes and a month or two down the line I ... I can't handle it or ... or I die, you know? I want to keep it ... that's really going to disappoint them.

MOYERS: But medical researchers are fascinated at what happens as they talk.

WOMAN: Oh I'm so busy and accomplishing so much.

MOYERS: They're all part of a remarkable study at the Stanford Medical Center in Palo Alto, California.

Dr. DAVID SPIEGAL: Make a list of maybe three or four ways of describing who you are. Take the least important of that three or four and imagine that you have to give that up.

MOYERS: -led by psychiatrist, Dr. David Spiegal.

SPIEGAL: Just as a thought exercise, imagine that you can't be that anymore. And then the question is "Who am I if I can't do that?" And then maybe we could talk about that a little, what that feels like.

MOYERS: In 1977, Dr. Spiegal and his colleagues took 86 women with metastatic breast cancer and randomly divided them into two groups. One group, the control group received standard chemotherapy and radiation. The second group received the same, with one important addition, they were asked to attend a psychotherapy support group like this one every week for one year. What Dr. Spiegal discovered quite unexpectedly was that the women in the support group not only felt better, they lived almost two years longer than the women who did not attend the group.

The women who received the special treatment lived an average of 18 months longer than those who did not?

DR.] SPIEGAL: That's correct. It was a doubling of survival time from the point when the women entered the study.

MOYERS: That ... that's rather remarkable isn't it?

DR.] SPIEGAL: Well, the magnitude of it was shocking to me. I even sent the paper to all of my enemies to see if they could tell me some ... some flaw in the methodology that could account for it.

MOYERS: But what had you expected to find when you set out?

DR.] SPIEGAL: What I expected was that the disease itself determines what happens. And you can help people ... you can com fort people with a disease, which is a noble thing to do, but I didn't expect that it would have major effect on how long they lived with the cancer.

MOYERS: Why are you repeating this study now with this new group ofwomen?

DR.] SPIEGAL: I ... I really felt that the issue was so important that I wanted to be absolutely sure that it was right, that there wasn't some other way to explain it, because I knew that many people, many physicians and many people in the public would say there must be some mistake, this just can't be true.

MOYERS: What ifyou don't replicate your first findings?

DR.] SPIEGAL: If I don't, I'll be disappointed, but I'll publish it. I mean the ... the truth is the only thing that can really guide what we're doing. And so I just want to know whether or not I can do it again and whatever we find, we'll publish.

MOYERS: When will you know?

DR.] SPIEGAL: I think it's going to be another four years.

MOYERS: In the meantime most of these women in the group will probably die.

DR.] SPIEGAL: Yes. Many of them will, yes.

SANDY: I was at the height of my career. And ... I had gone back to college to get my degree.

MOYERS: We began filming at the very first session of Dr. Spiegal's new experiment in hopes of learning how coming here once a week and just talking might influence how long these women live.

SANDY: It was about the time that they figure that the cancer was just getting started. So ....

DR.] SPIEGAL: The main task in the first meeting is to make a group. And part of how we did that was having each person tell their story.

SANDY: The day after my ... my 46th birthday, on September 20th, I'll never forget it, uh, it just ... the pain got so severe that my husband rushed me to the emergency room and....

DR.] SPIEGAL: Sandy, a 47-year-old woman spoke movingly about how difficult it has been for her husband and two daughters to accept her diagnosis.

SANDY: Wait a minute. How ... this isn't supposed to happen.

DR.] SPIEGAL: This was a first meeting and there was a certain amount of inhibition that one might expect.

MOYERS: Throughout the year Dr. Spiegal will record meticulous notes after every session in order to keep track of each woman's progress. RAMONA: My name is Ramona. I had a mastectomy in 1984. So I thought I was home free.

DR.] SPIEGAL: Ramona seemed reluctant to talk in the group. She said she was taught as a child that talking about feelings was a sign of weakness.

RAMONA: But I'm older than most of you, so ... I've had a lot of life.

DEBBIE: I'm a little different than the rest of you, I'm going through a real blue period. I had been a real happy person up until about six months ago or ....

DR.] SPIEGAL: Debbie is a somewhat depressed woman, who has difficulty mobilizing herself each day.

DEBBIE: I look in the mirror and I think, ''Who is this person, she's never smiling, she's never happy." And that's where I'm at today. keep saying to myself, "There's got to be something you can do to retrigger the old Debbie, but I can't find it."

DR.] SPIEGAL: Well, I hope we can be of help to you and there is no one right way of being when you've got breast cancer. And I hope that we can be of some help to you.

MARTHA: Well, you see I have a philosophy that works sort of against being in a group like this. Because I feel that it helps more to reinforce negative feelings than positive feelings about your future.

DR.] SPIEGAL: Martha, who is a Christian Scientist, was something of a skeptic about the group and what it could do for her.

MARTHA: There are all these symptoms around, there are all these people around, that doesn't reassure me one little bit to know somebody else is in my boat with the old oar out just rowing away like crazy against time. And against medicine. It's not reassuring.

DR.] SPIEGAL: It is difficult to come to a group and talk about things that are often painful and depressing. Martha never returned. She said she just couldn't see how it would be helpful to her.

This is the meeting of September 11th. Six weeks have gone by since we began the new study. The women are beginning to grow closer, but I still have to actively encourage them to express their feelings more directly to one another.

JUDY: No matter how much you want to forget or not be in the reality of cancer, it comes back at you. It really does.

DEBBIE: No, I'm overweight from all the therapies and stuff I've had and it's been a real battle. I'm not that young where it'll come off. And it's been just a ... a fight.

DR.] SPIEGAL: You want to kind of go back to life before it all happened and live it normally. And you keep bumping up against the fact that you can't. And that is upsetting.

DEBBIE: It is ... it's making ... it just makes me very angry, like punch a pillow kind of angry, which I think is healthy for me. It's about time I started.

DR.] SPIEGAL: I was glad to see that Debbie's mood was considerably brighter and that she appeared less depressed. After only six weeks, it's clear how much the other group members care about her.

DEBBIE: You know I could accept having cancer if I could control it. IfI could ... but I can't control ... control it. It controls me.

DR.] SPIEGAL: In general the group seems to be in a transition point. The members are wondering about how much to open up to one another and I think how much to admit to themselves that they're suffering with the illness and its consequences.

LORNA: I think I feel a little hesitant about coming every week and talking about my feelings, about stuff, because I'm ... I'm just aware we have different styles and that they don't necessarily want to sup port me. And ... and ... and it ... it's ... it's ... it's not through anything that's directly said, it's through what's not said.

DR.] SPIEGAL: Could you give us an example?

LORNA: Ummm.

DR.] SPIEGAL: Lorna is having a hard time feeling accepted by the other women. I was pleased that she jumped right in and was honest about her frustrations with the group.

LORNA: It was hard for me a couple of groups ago, Ramona, when you made a comment to me about ... I don't remember exactly how you put it, but that it ... it's fine with me if she wants to talk about feelings every time, but that's ... that's not something that I want to do.

RAMONA: I don't remember saying that.

DEBBIE: I think that when you open up and say your feelings and people don't respond back right away, you think that everyone's thinking, we didn't want to hear that. But I don't think that's true. I think it just takes longer for ... some of us in the group to open up.

MOYERS: Why should expressing feelings be good for your health?

DR.] SPIEGAL: We don't understand that very well, but urn, it seems to me that when you have feelings that you can't express, urn, they become a kind of an internal obstacle. There's something that is so terrible that you can't move beyond it. And there's something about expressing them that acknowledges they're real, but doesn't let them take control over you and you don't have to devote emotional resources to keeping those feelings out of awareness. Now how that translates itself into some effect on the way their bodies fight the illness we don't know for sure, but I now believe that it does have some effect on that process as well.

MOYERS: I mean it can't be an easy thing to try to ... to get them to open up and express their feelings to ... to strangers.

DR.] SPIEGAL: Well, it ... it can be hard and at first of course there's the usual reticence to talk about something that you haven't talked about with anyone else in a room with people you don't know well. What I'm trying to do is create an atmosphere in which we talk about the hard stuff and not the easy stuff.

You look to me like you're feeling sad right now.

I'm looking for signs of emotion.

RAMONA: No I don't think I feel sad.

DR.] SPIEGAL: For someone who is feeling worried but not quite able yet to talk about it.

But you're not used to having someone to really comfort you when you are feeling sad.

RAMONA: No. I don't know. I've always felt that one doesn't have to look very far to see someone far worse off than they are. And that's what keeps people from getting depressed I think.

DR.] SPIEGAL: After six weeks, Ramona is still struggling with the idea that she is somehow weak if she expresses her feelings. Yeah, but we all struggle with feelings of sadness and with wanting some help for ourselves and yet it's hard to ask for it.

DEBBIE: I still get on myself for this. I'll see people who are worse off and I'll think, how dare you? How dare you even once feel sorry for yourself? And it's taken me a long time to realize my feelings are important.

DR.] SPIEGAL: Did you feel that Ramona was feeling sorry for herself for trying to get sympathy?

DEBBIE: Not at all. I don't think that your feelings are really that much different. I just think that they're more infrequent and you were raised to deal with them just a little bit differently.

DR.] SPIEGAL: They gain not only by what they receive, but by what they give. You know getting cancer is a meaningless tragedy really, but if you can use your experience as a cancer patient to give something to someone else, to help them cope with it, you feel better about yourself as well. That's what we call the helper therapy principle. So I think in many ways, groups provide a sense of being part of the human race, being connected in a mutual giving and receiving that is a very powerful form of therapy. I'm wondering ... we've got a few minutes left, if we could each take a minute to think about, what would I want to get from the group before it's over today? Test the waters a little more and say ''Well, what do I ... what do I want?" Be cause if it's hard in here I can imagine it's really hard outside.

SHEILA: My main objective was to come in and help someone else regain hope, because you can get through it.

JUDY: I'd like to make sure that what I do, what I decide to do with treatment and things for cancer is the best thing to do.

DEBBIE: Darrel called me after I didn't show up last week. thought, somebody cares that I wasn't feeling well.

DR.] SPIEGAL: And when she called, you felt cared about.

DEBBIE: Yeah. And I think that's what I want from this group, is to find people who are supportive and caring about me.

DR.] SPIEGAL: And what do you want? What do you want from the group?

RAMONA: Well, I didn't really come wanting anything. I just volunteered for the study and here I am.

DR.] SPIEGAL: Our October 2nd meeting was sweet and sad. The members were dealing in a more palpable way than they had previously with fears of dying. Debbie talked about planning her trip to Hawaii and how much she was looking forward to it. And at the same time she knew that this would likely be her very last trip.

This is October 30th, 1991. It was a pivotal meeting for the group, because it was the first meeting after Debbie had died. Um, clearly the group was challenged to face what they most feared and emerge either feeling closer and more supported or demoralized.

LORNA: I mean do ... do we know anything?

WOMAN: That's what I was going to say. What happened to Debbie?

LORNA: What happened?

WOMAN: I'd like to know what happened to her.

LORNA: I mean what do we know.

DR.] SPIEGAL: My understanding is that she got some fluid in her lungs and that a decision was made not to be extremely aggressive in trying to ... to treat that. That they felt that it ... you know, the prognosis was good.

LORNA: I'm angry that I don't have a chance to say good-bye. mean it just feels so abrupt.

RAMONA: And we weren't able to do anything, not knowing.

DR.] SPIEGAL: Yes. How does that ... you would have wanted to be able to ....

RAMONA: Well, at least....

WOMAN: I would have been ....

RAMONA: ...certainly messenger flowers.

WOMAN: Something.

DR.] SPIEGAL: Yeah. The issue that I hear everyone talking about is the lack of predictability, the sense that here was Debbie talking about her trip to Hawaii and now she's not with us.

JUDY: There was a big bubble there of ... of euphoria for her and it ... and it was gone and it wasn't a bubble, it was a big deep hole.

SANDY: I wish I'd known her better. I wish I'd known her before cancer. I kept thinking, what was she like before? You know, because we never really knew the real Debbie, because she said that that wasn't the real Debbie.

SHEILA: I invested in her. I had feelings for her.

DR.] SPIEGAL: Can you tell us about them Sheila?

SHEILA: I just wish I could talk to her.

DR.] SPIEGAL: Yeah.

WOMAN: I would have liked to say good-bye.

WOMAN: Yeah, something.

DR.] SPIEGAL: Well, what would you say to her?

SHEILA: Not to worry. And not to fear. And to have somebody there to tell you that. And ... just share with her that it's okay and ... urn, it's ... that her family will be okay. They will ... they will be all right. And not for her to feel that ... guilty for being sick and guilty for dying on them and ... they'll ... they ... they will continue.

MOYERS: What you're doing in that group is marching death right there in the center of that circle and forcing those women to look at it.

DR.] SPIEGAL: That's right.

MOYERS: They can't turn their eyes away from it. You're rub bing their nose in it. DR.] SPIEGAL: In a sense.

MOYERS: And can that be good for you?

DR.] SPIEGAL: Well, if it ... if it is a necessary part of your life, then ... and if it's handled appropriately with ... with respect for ... people's limits, urn, I ... I ... I believe that it is indeed, good for you. The way one woman in our groups put it is she said, the way I feel about death is the way I feel about looking into the Grand Canyon because I'm afraid of heights. She said you know if you fell down it would be the end, it would be a disaster, but you feel better about yourself because you're able to look. The sort of counter-culture approach to dealing with cancer has taken a very different tact than what we do in our groups.

MOYERS: What is that?

DR.] SPIEGAL: Cause that approach has been cancer's a problem in your mind, fix it in your mind and it'll get fixed in your body. So have the right attitude. You're not going to let this thing get to you. Our patients call that, the prison of positive thinking. You know you're trapped in it because if you have a negative or depressing thought, you're yielding to the disease. And our approach is the opposite. We're saying, you have a serious illness that's likely to shorten your life. Take that into account and decide how you want to live your life in the face of it. That's very different. So we're not saying, fix it in your mind and it'll get fixed in your body. What we're saying is face it with all of your resources, don't let it isolate you from family and friends. And then somehow perhaps your body will find better ways of coping with the disease. I hear in the questions that are being raised, you know, will we be blind sided? Will we be hit suddenly by something we're not prepared for and I'm wondering what that feels like.

WOMAN: That scares me to death.

WOMAN: Yeah.

JUDY: You know every time anything happens, all week, that's what comes up, is Debbie's gone and it could happen to me.

RAMONA: She was the youngest. I felt it should be me.

DR.] SPIEGAL: Why do you wish it had been you, Ramona?

RAMONA: Well, because I've lived.

DR.] SPIEGAL: Yes.

RAMONA: And she hasn't.

DR.] SPIEGAL: Ramona cried openly for the first time, saying how unfair it was that someone so young as Debbie had died. And we reminded her that it had been Debbie who had said to Ramona, urn, your days are every bit as important as mine.

WOMAN: Yeah, she said that your days are...

RAMONA: I know.

WOMAN: ... each individual day is just as important for you as it is for her.

DR.] SPIEGAL: She meant a great deal to you.

They were frightened. You know there's no doubt that one part of what they were feeling was you know, there but for the grace of God, go 1. We have the same illness. She died, I'm going to die. And I think it forced them to really reorder some priorities in their own lives. To say, you know you never know when it can happen and boy if I'm going to do something that I want to do, I'd better do it now while I can.

SHEILA: Dh, I just felt like I had more time. I felt like I could have more time to ... to nurture that relationship instead of get ... instead of you know, just not having a chance.

WOMAN: Wait for Wednesday.

WOMAN: Yeah, wait for Wednesday.

JUDY: I was talking to my brother last night. He was saying how well I was doing and .... and all of this. And I said ... I said to him, "Well, you know the average life of a person who has recurrent breast cancer is only two years." And he was very shocked to hear that. But it was shocking to me to hear it and I suppose I wanted him to understand that because I've done well, that everybody's kind of relaxing, including me.

DR.] SPIEGAL: She did a lot of things in this group. And just as her family missed what she can do for them, we miss what she does for us. And maybe we could spend a little time thinking about what Debbie was like for us. Lorna you pointed out that she had a kind of directness, you know, sweetness about her. You know, she didn't try to keep us out and talked very directly. And I think my feeling is that that was very helpful to all of us. She in some ways led us in the direction of being more open. I think she felt very much a part of this group. I think she did feel cared about and while on the one hand, you're right. We'll always have wished to say more and wish that we had more warning. On the other hand, just watching her and listening to her over the months, urn, I have the impression that ... that we really made a difference to her.

MOYERS: How does grieving help these women?

DR.] SPIEGAL: Well, ironically there's something reassuring about grieving losses and that is, when you spend time mourning the death of someone you knew and cared about, it's also a message to you that when your time comes you will not slip away unnoticed. That you too will be grieved and cared about and missed. And that's reassuring. I think many of us have this sort of anxious fantasy as we think about our own nonexistence, that the world will roll on just fine and some body will throw a flower on our grave and ignore us. And that makes one very frightened about the prospect of dying. But when you see that what you do is carried on, is appreciated and cherished by the people you care about, in a way it makes dying less frightening than it otherwise would be.

Close your eyes, take a deep breath. Breathe out, eyes relaxed. Body float. And just enjoy the sense of your body feeling comfortable, floating and safe. And now picture in your mind's eye an imaginary screen. It could be a movie screen or a T.V. screen or a piece of clear blue sky. And I want you to take a few moments on the left side of the screen to say good-bye to Debbie, to feel her presence in this group and how it will be missed. Remember something that she said to you or that you said to her. And on the right side of the screen I want you to picture something that Debbie has left with us, that we have even though she is gone. Her gentleness, her directness. Sense of how important it is to do things for one another, that she left with us. We've been a little more open today in communicating to one another about how much we care about one another, about how much we register with one another remembering things. And I think that one of the legacies that Debbie has left us is some of that sense of closeness with one another.

WOMAN: I vote for a group hug.

WOMAN: Really good idea.

DR.] SPIEGAL: Group hug, okay. Group hug.

WOMAN: Thanks for that.

MOYERS: What happened to the group, as a group, after Debbie died?

DR.] SPIEGAL: I think the group began to become a much more coherent unit. A sense of people with a common history. And part of the common history was that we had lost Debbie. And we had grieved her loss together. And I think the group came to feel much more like ... there was an understood commitment and caring among them than we had had before. .

LORNA: I felt today as though we were really ... partners in a way that we haven't been before. Uh, there's something about going through a death this way that means that uh, it smooths out all the differences, you know so that you really ... and ... and I ... I do feel as though we really bonded today.

WOMAN: Gardening, yoga, tai chi.

WOMAN: [inaudible] too.

WOMAN: Okay, doing which ones of these?

MARY ANN: Well, the gardening and housekeeping.

WOMAN: About two hours a day?

MARY ANN: Yeah.

WOMAN: Do you do tai chi or yoga or ....

MARY ANN: Not at this time I'm not.

WOMAN: On the average, how many hours did you sleep each night during the last five weekday nights?

DR.] SPIEGAL: Journal entry, December 15th. Several new women have completed the battery of tests required to participate in the study.

WOMAN: "Friends, acquaintances or relatives can definitely influence the course of my illness." Well, I agree with that too.

DR.] SPIEGAL: Three of these new women are randomized by the computer into the support group. I was a little surprised at how readily the original members accepted these new women into the group. And I was delighted to hear that they were beginning to make social connections with one another outside the therapy room.

How does it feel Ramona with everybody paying attention to you and what you're feeling right now?

RAMONA: I'm not used to that.

DR.] SPIEGAL: You're not used to it. Now how does it feel?

RAMONA: Fine, great.

DR.] SPIEGAL: Does it help or not?

RAMONA: Yes, it's nice to know that people are concerned.

DR.] SPIEGAL: Even Ramona, who felt she needed to be strong all the time has begun to allow herself to accept support from the group.

RAMONA: I feel like I've absorbed some energy already.

DR.] SPIEGAL: After four months the women have grown noticeably closer and more honest with one another in contrast to the small talk, which was often prevalent in early meetings, they seem much more willing now to confront their fears about death and dying.

JUDY: And I found that when it really hit me was at one o'clock in the morning when I wasn't asleep. And ... and I just fell apart.

DR.] SPIEGAL: January 8th, 1992, the group started off right away with Judy crying openly about urn, the fact that she apparently had a recurrence in her neck. And it illustrated right away what the group does. She said that at home she had to keep up a front, that her fear and frustration at the possibility of a recurrence was something she felt she had to hide.

JUDY: I think we all put on a big front for the people that are around us. And I think we get so used to doing it that I felt nothing at all, and yet I knew you know when I really looked at myself, I ... I knew that this was big trouble. And the thought of going through radiation again is ... is devastating, especially when you've been through a year of chemotherapy.

DR.] SPIEGAL: And it's interesting in reflecting back on how she presented at the first meeting with this extremely extensive and well developed support network that despite having all those people, there were things that she felt that she couldn't share with them, but started right off sharing in the group.

JUDY: You don't want them to know how bad it is. And so you kind of play the game of ... of not making it any worse than you possibly can. And you just become kind of stoic. Maybe it's part denial too, I don't know. I ... I can say all the words ....

WOMAN: You don't show the feelings is that it?

JUDY: Yeah.

SANDY: I was going to say in the middle of the night is when it all comes down on you.

JUDY: Yeah.

DR.] SPIEGAL: We're much more dependent on our social environment for how we feel than we recognize. But what happens to a person who gets a serious illness? People tend to withdraw from them. They're frightened by it, they don't know what to say, they're afraid they'll set them off by saying the wrong thing. And that makes people feel as if they're already a little bit dead. They feel cut out of the world of the living. And you talk to most cancer patients, that's how they feel. I am sure that that does bad things to your body. And I suspect that our bodies then can't devote all their resources to fighting the disease. They have to be coping with the sense of unhappiness, of isolation of withdrawal that makes it harder for the body to do what it needs to do. This sense of distance and isolation can grow up even in the closest of families. For the patient, talking about her fears somehow seems like yielding to the disease. And for the family, talking about their fears seems as though it will make the patient feel worse or more depressed. So what can happen is that they each suffer separately. Sandy's family is typical of what many families go through.

SANDY: When I was diagnosed with cancer, there was nothing to soften the blow for my family. My older daughter Jennifer, she was ... she and I are ... extremely close, because we have a lot of ... she's a lot like me. We have a lot of the same feelings. I think it's been hard on her facing the fact that I have cancer. Fortunately Dr. Spiegal has started these support groups for the families, but so far Jennifer has found reasons not to go

.

Talked with your friends much about having a mother who has cancer?

JENNIFER: No. Well,just you know my ... my close friends.

SANDY: You know she wants to be a ... a supportive daughter, but she doesn't want it to hurt her and she's kind of being an ostrich about the whole thing.

JENNIFER: Thanks Mom.

SANDY: Okay, kiddo.

JENNIFER: Next week, same time.

SANDY: I've suggested to her counseling before, at different times and she just has been very resistant and I don't think that she really wants to go to group, but I'm pulling in a few markers and she's going to go.

DR.] SPIEGAL: The fact that you care so deeply about the people you love who have cancer means that their cancer has to hurt you in a very personal way also. And you can say that that's selfish, but you know what's the alternative? You know, is the alternative not to care very much?

We have monthly family meetings at which the spouses, children, parents of the ... of the patients come in and talk about their side of it.

And I wonder John or others if you have thoughts about how you ... how you cope with it, how you cope with this kind of anxiety. Will I have a reprieve? Will I have a period of time where I don't have to worry about it every day?

JENNIFER: Well, I guess for me, I haven't quite accepted it. My mother calls it my "ostrich in the sand" syndrome. Both my sister and I. Cause ... we're not ready to accept it. I don't know, maybe it takes more time. And I think a lot of the reasons are that for me they're selfish reasons, cause my mom is the greatest believer in me and I don't know what I'd do without her and it's hard. And I know how hard it is for her. And ....

DR.] SPIEGAL: So it all feels selfish to you to ... to think that.

JENNIFER: Yeah, that I'm worrying about myself and how I feel, because you know, how it's affecting me and I know what ... pain she's in and ... all the rest.

DR.] SPIEGAL: Well, what do you think she's say if she heard what you just said?

JENNIFER: Oh she'd probably start to cry and tell me that it's perfectly normal. And then she'd probably worry about ... and I don't want her to worry about me. She worries about everybody and ... I don't want her to worry that I think that I would have trouble without her. I've had a lot of failures and my mother's always just been the ... the one who's bel ... believed in me.

DR.] SPIEGAL: But isn't that what mother's do, you know?

JENNIFER: Yeah, well ....

DR.] SPIEGAL: I mean would she ... you know I would think that it would make her feel wonderful to hear what you're saying now. You know make her feel really important to you.

JENNIFER: I don't like to talk about it.

DR.] SPIEGAL: Yeah, because you feel that it's somehow selfish.

JENNIFER: Urn hmm.

DR.] SPIEGAL: Doesn't sound selfish to me, it sounds real.

LORNA'S MOTHER: I sort of ... as a mother with a daughter, tried not to let her know how badly I was feeling, because I didn't want to give her more to handle. And then one day we were together and I ... I just ... I told her. And I said I'm ... I'm losing a daughter, but I'm losing my best friend. And we have kind of what you mentioned with your mother, a mutual belief in each other. And she turned to me with the most wonderful look on her face and said, that is the most wonderful thing you've ever said to me. I ... I said, didn't you know how I feel? And she said, yes, but it's very different for you to tell me that. And she was so grateful.

DR.] SPIEGAL: Sounds like some wonderful advice. It's very important that families come together in the face of this disease because the isolation is really bad for everyone. If You can encourage patients and their families to have an open exchange of feelings, it tends to help the terrible sense of isolation that many patients feel.

MOYERS: Is there any scientific evidence for the fact that isolation is bad for your health?

DR.] SPIEGAL: There is a strong a relationship between being socially connected and .,. and not being as likely to die as there is between cholesterol and ... and mortality, or between smoking and mortality. It's a powerful relationship.

MOYERS: We don't know quite how.

DR.] SPIEGAL: We don't know how. But we know that it's true. Married cancer patients live longer, all other things being equal, than unmarried cancer patients.

MOYERS: Married men live longer I ... I understand than ... than bachelors.

DR.] SPIEGAL: Well, it's actually ... yeah, it's true. The kind of social support that immunizes you in a sense for men is marriage, is being related to a woman. For women it's not marital status, it's relationships with other women which lead me to the unhappy conclusion that having a relationship with a man doesn't do your health much good, regardless of your own gender.

MOYERS: But it does lead you to want to work with women because they are mutually reinforcing, even in the face of death.

DR.] SPIEGAL: Well, I think so. Clearly women are very supportive to one another. And ... and social relationships with women tends to help women reduce their risks of mortality.

MOYERS: When you work with these women you know you're not going to save them.

DR.] SPIEGAL: That's right. I ... that's ... that's very clear. Urn, but what I find very rewarding is getting to know them and trying to help them live as richly as they can with the time they have. Because the issue that we deal with in the groups and I think the issue in our lives altogether is really quality, not quantity. It's how do you live your life, how fully do you use your own resources, do what you want to do in the world, make and cherish relationships that are important. And some people do that in two months and some people never do it in a lifetime. And I find it a privilege to help these women live the lives they have as fully as possible.

Events are forcing you to ... to redefine who you are and conceive of yourself in ways you wouldn't have thought of. And you know much that's been good in our lives has been feeling that we can do for other people. I mean you know that's .,. you raise families, you help people, you feel strong because you can do. But I think one thing we've seen today is that you're doing for one another in a different way from the physical ways that you're used to doing it. And I think that's the question that we need to explore further is ... how can you do for others and do for yourself in new ways that you hadn't thought of before, because some of the old ways may not be available. They don't work.

Close your eyes, take a deep breath. Breath out, eyes relaxed. Body float. And just enjoy the sense of your body feeling comfortable, floating and safe. And now picture in your mind's eye an imaginary screen, could be a movie screen or a T.V. screen or a piece of clear blue sky. And then on the left side of the screen picture one of those things that you have to give up. Could be your interest in your sexuality. Could be a job. Could be driving. And just sit with that for a moment. And on the right side of the screen, picture who is left. Who are you if you're not what you had to give up? And get to know that part of yourself as well.

MOYERS: Will spending this time together once a week help these women live longer? It will be at least another four years before Dr. Spiegal can answer that question. In the meantime, these women are fighting cancer not only with drugs, but with the human spirit. In doing so, they're testing the limits of what science understands about how the mind and the body work together to fight disease.