HEALTH / Second Opinion

'DESPAIR and die' said the ghosts of those Richard III had murdered to the king before his last battle. There is plenty of scientific evidence that despair can lead to death. A recent Lancet report described how Chinese Americans reacted according to their astrological beliefs when they were taken ill.

Among the Chinese, the year of birth is linked with one of five elements: earth, fire, water, metal and wood. Each of these birth- year categories is associated with an organ and its diseases, so that fire is linked with heart diseases and earth with tumours, including cancer. A Chinese person born in an earth year is thought to be unusually susceptible to cancer, and the study in California found that those cancer patients who knew they had been born in unfavourable years died some months and occasionally some years sooner than those born in other years. The same was true of patients with heart diseases born in fire years and those with chest diseases born in metal years. The individuals who thought the fates were against them despaired and died more quickly than did other Californians with similar illnesses but no particular beliefs about their fate.

These findings are in line with research in London on patients with breast cancer. When first told they had the disease 20 years ago, some patients reacted with hopeless resignation, accepting their fate, while others decided to fight the illness as hard as they could. All were given treatment designed to maximise the chances of cure. Follow-up has shown that the fighters have achieved rather higher survival rates than those whose response was one of helplessness.

In our agnostic society the crucial question for people with a life-threatening illness is whether a determined decision to fight is likely to improve survival chances, or whether it simply avoids the negative effects of despair. Clearly willpower alone is not enough to reverse medical predictions: experience of people dying shows that many fight their illness and still lose. But it does seem that death can be postponed, if only briefly.

Should people with fatal illnesses be encouraged, then, to fight against the fates? Doing so may extend survival, but a prolonged struggle will have emotional costs. The American psychiatrist Elizabeth Kubler Ross was the first to explain that when people learn they are going to die shortly, most of them go through a predictable series of mental reactions. The first responses are commonly denial - a refusal to accept the diagnosis - and withdrawal into isolation. Next comes anger - why me? These responses are followed by discussion of the illness and a period of depression before the final stage of acceptance that death is inevitable. Fighting the illness slows this progression, but people who are able to reach the final stage are able to die without resentment or anger, making the process easier for themselves and for their families.

Death has become unfamiliar in modern society: many people aged 50 have never seen another person die from natural causes. Research that quantifies the impact of mental attitudes on dying is useful, not only in providing information for those who want to know how best to fight their illness but also in opening up the taboo topic for discussion.