4 Control. Control also seems to play a role in the initiation and promotion of cancer
and it has been argued that control over stressors and control over environmental
factors may be related to an increase in the onset of cancer (see Chapter 11 for a
discussion of control and the stress–illness link).
5 Coping styles. Coping styles are also important. If an individual is subjected to
stress, then the methods they use to cope with this stress may well be related to
the onset of cancer. For example, maladaptive, disengagement coping strategies, such
as smoking and alcohol, may have a relationship with an increase in cancer (see
Chapters 3 and 11 for a discussion of coping).
6 Depression. Bieliauskas (1980) highlighted a relationship between depression and
cancer and suggests that chronic mild depression, but not clinical depression may
be related to cancer.
7 Personality. Over the past few years there has been some interest in the relationship
between personality and cancer. Temoshok and Fox (1984) argued that individuals
who develop cancer have a ‘type C personality’. A type C personality is described as
passive, appeasing, helpless, other focused and unexpressive of emotion. Eysenck
(1990) described ‘a cancer-prone personality’, and suggests that this is characteristic
of individuals who react to stress with helplessness and hopelessness, and individuals
who repress emotional reactions to life events. An early study by Kissen (1966) sup-
ported this relationship between personality and cancer and reported that heavy
smokers who develop lung cancer have a poorly developed outlet for their emotions,
perhaps suggesting type C personality. In 1987, Shaffer et al. carried out a prospective
study to examine the predictive capacity of personality and its relationship to develop-
ing cancer in medical students over 30 years. At follow-up they described the type of
individual who was more likely to develop cancer as having impaired self-awareness,
being self-sacrificing, self-blaming and not being emotionally expressive. The results
from this study suggest that those individuals who had this type of personality were
16 times more likely to develop cancer than those individuals who did not. However,
the relationship between cancer and personality is not a straightforward one. It has
been argued that the different personality types predicted to relate to illness are not
distinct from each other and also that people with cancer do not consistently differ
from either healthy people or people with heart disease in the predicted direction
(Amelang and Schmidt-Rathjens 1996).
8 Hardiness. Kobasa et al. (1982) described a coping style called ‘hardiness’, which
has three components: control, commitment and challenge. Low control suggests a
tendency to show feelings of helplessness in the face of stress. Commitment is defined
as the opposite of alienation: individuals high in commitment find meaning in
their work, values and personal relationships. Individuals high in challenge regard
potentially stressful events as a challenge to be met with expected success. Hardiness
may be protective in developing cancer.
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