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John Collier's "In the Forest of Arden"ARTMAGICK.COM In his book It’s Not About the Bike, Lance Armstrong wrote, “. . .cancer was the best thing that ever happened to me.” However extreme that claim may seem, it expresses the substance of a biomedical research agenda referred to as “benefit finding” or “posttraumatic growth,” whose aim is not only to document such changes but to determine whether they have desirable psychological and medical effects. Indeed, many people report that after confronting serious illness, they discover strengths formerly unrecognized or come to appreciate aspects of their lives they previously did not relish. Whether there are measurably favorable psychological or medical effects of these changes remains to be determined. However, in addition to these explicit aims, there is considerable surplus meaning to the idea of benefit finding that has not yet been identified, let alone examined. Two candidates immediately come to mind: (1) The implication that the benefits that follow traumatic events are so valuable that they would not be exchanged for a return to the pre-adversity state even if that were possible; (2) The idea that there is something unique about the experience of adversity caused by traumatic events. Casting an illness as a special opportunity for growth trivializes the adversity. The language used by researchers Sears, Stanton, and Danoff-Burg—that early stage breast cancer can lead to the “Emerald City of posttraumatic growth”—makes the first point abundantly clear (Health Psychology, 22:487-97, 2003). Emerald City represents an interesting choice of metaphor, suggesting an idyllic location full of possibilities unrealized in one’s current life and made available only by the experience of trauma. In As You Like It, Shakespeare used a similar trope. Sweet are the uses of adversity, Which, like the toad, ugly and venomous, Wears yet a jewel in his head; And this our life exempt from public haunt, Finds tongues in trees, books in the running brooks, Sermons in stones and good in every thing. Having been exiled from a civilization characterized by duplicity, deception, and lust for power, the Duke and his followers find their way to the Forest of Arden, where they discover the virtues of living the pastoral life in harmony with nature. Unlike the visitors to the Emerald City of wisdom won through disease, however, all but one of Shakespeare’s exiled characters choose to return to the civilization they revile. Perhaps this is because they have come to realize that despite the jewel worn by the toad, he’s still a toad. Unlike Lance Armstrong, they evidently do not really think that their adversity is the best thing that ever happened to them, because they eagerly embrace the opportunity to restore themselves to their previous condition. Alas, patients with cancer and other serious illnesses do not have that luxury, but there is little doubt that if they did, most of them would happily forego the experience of disease. Second, the literature on benefit finding and posttraumatic growth suggests there is something unusual and ennobling about illness that permits, even promotes, personal development in a way that is unique. The Emerald City attained through disease connotes something special, and a journey to this place will produce an outcome different from all other experiences. But in fact, experiences of a wide variety have proven to produce profound effects. We learn from our experiences all the time and learn more from intense than trivial ones. Viewing great works of art may provoke life-altering insights. Visitors to the Grand Canyon routinely report feeling humbled in a way that changes them significantly. The birth of a child, the death of a parent, reliably touches and changes us. Casting an illness or other trauma as a special opportunity for growth trivializes the adversity, and that has two unfortunate consequences—one for us as observers and one for those who have been traumatized. For observers, it raises the risk of becoming insensitive to suffering. After all, isn’t disease an opportunity, even a gift? For patients, it imposes a tremendous pressure to capitalize on this opportunity, to be happy about it, or to feel like failures when they are not. Illness is not a special blessing. It’s not a visit to an Emerald City. It’s just a toad. Richard P. Sloan is Nathaniel Wharton Professor of Behavioral Medicine at Columbia University Medical Center. He is the author of Blind Faith: The Unholy Alliance of Religion and Medicine, published in 2006 by St. Martin's Press. In a March 2011 Perspective in The Lancet he discussed the persistent belief that individuals control their medical fates.

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Richard P. Sloan

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August 2011

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