Michael E. Holtby, LCSW, BCD
Staying Positive About Being Positive
This article has been published in Colorado's award winning AIDS newsletter, Resolute!
It cannot be re-printed for publication in any other form without the permission of the author.
AIDS has long been described as a disease of casual "co-factors." We still don't have an adequate knowledge of what those factors are, specific to HIV. But we do have a body of knowledge about the psychology of wellness.
For a long time this approach was considered on the fringe of medical
respectability. Such things as massage and meditation seemed more indicative of
a Boulder cult life style than science. However, a new field,
"psychoneuroimmunology" (PNI) is adding respectability to the
ideas of holistic health advocates. PNI has shown that our brains control our
immune system, that for instance, mice can be given Pavlovian conditioning to
suppress or increase their own immune systems. Further, that at a cellular level
such things as depression can make lymphocytes move sluggishly; a "lower
lymphocite mitogen response" as they call it
Hippocrates was cognizant of the particularly fuzzy line between psyche and
soma when he said, "I would rather know what sort of person has the disease than
what sort of disease has the person." That sentiment is echoed in studies by
psychologists Marjorie and Claus Bahnson who have developed a personality
questionnaire that is 88% accurate in identifying women who turn out to have
biopsy-confirmed cancer. Breast cancer in women is not AIDS, but much of the
research on who gets sick with any illness demonstrates that they often
vary in personality, outlook, and life events from those who remain healthy. For
instance. George Valliant in a thirty-year study of two hundred Harvard
Graduates, found that those who were extremely satisfied with their lives had
one-tenth the rate of serious illness and death of those who were very
dissatisfied. Another study of industrial absenteeism reflected these results
with 12 times the number of minor respiratory illnesses among the most
dissatisfied with life.
Similar studies have isolated the following psychological factors which can
reasonably be concluded serve to suppress the immune system:
1. Chronic Stress/Anxiety
2. Major Life Changes
3. Depression/Life Dissatisfaction
5. Being Unassertive/Unexpressive
6. Social Isolation
Stress is such a commonly accepted compromiser of physical as well as mental
health it needs little discussion. From ulcers to eczema, from heart disease to
asthma, stress is recognized as a casual cofactor in disease. I was particularly
impressed by the work of Vernon Riley in Seattle who could vary the cancer rate
in mice from 7% to 92% depending upon the amount of stress he introduced into
Major life changes, as a source of stress and illness, was demonstrated by
the work of Holmes and his associates in the mid-sixties. What these researchers
found was that life events, either good or bad, made us more susceptible to
disease. 80 percent of the high scorers who by number of changes occurring over
a short period of time were, by definition, experiencing a "major life crisis"
got sick, while the lowest scorers had no significant health problems. The
Schedule of Life Events contained everything from the "death of a spouse" (100
pts.) to a vacation.
Depression, a sense of hopelessness, a lack of desire to live, a sense of
being a victim in life--at the mercy of outside forces, and a general life
dissatisfaction all produce weak immune systems, inviting diseases of all kinds.
The number of helper and suppresser cells reduce proportionately with the
severity of depression. This is most evident in cases where the cause of
depression is loss. The Albert Einstein College of Medicine found 31 of 33
children with leukemia they studied had experienced traumatic loss within two
years of diagnosis. It is commonly known that widows and widowers are much more
likely to die themselves within two years of the death of their partner.
Although largely anecdotal to date, the same has been found with AIDS. This
makes the lovers of people with AIDS, who themselves are positive, particularly
vulnerable. Bartrop and colleagues have demonstrated in their research that
mitogens, the chemicals which stimulate lyphocytes to respond to a foreign body
or infection are compromised in the bereaved.
Such a life crisis is only exacerbated by an inability to express the wide
range of feelings involved with grief. Men in our culture are renowned for their
John Wayne approach to emotions. They are supposed to be strong, self-sufficient
hide their vulnerabilities, and to be "good (stoic) little soldiers." However,
such a stiff upper lip philosophy leads to internal physical problems. As Boris
Pasternak said it in Doctor Zhivago: "Your health is bound to be affected if,
day after day, you say the opposite of what you feel. Our nervous system isn't
just a fiction, its a part of our physical body, and our soul exists in space
and is inside us. like the teeth in our mouth. It can't be forever violated with
Almost all those who developed cancer in a 30 year study of 1,300 medical
students were, throughout their lives, restricted in expressing emotions,
particularly when it came to getting their own needs met They were givers and
"nice guys." Jeff Leiphart a Bay area psychotherapist found similar
characteristics in people with AIDS. They all had a "Mr. Likeable defense
against feelings of anger and an avoidance of confrontation.
Having no one to vent those feelings to also has been shown to increase one's
vulnerability to illness. A nine year study of Alameda County residents in
California found those with the fewest social contacts had a two and-one-half
times higher incidence of disease than those with the most social contacts.
"Social supports," as defined for the purposes of research is, "information
leading the subject to believe that he is cared for and loved, esteemed, and a
member of a network of mutual obligations."
The bottom line is that the more of these qualities and circumstances are
present in conjunction with the HIV virus, the more likely you are to progress
to AIDS. This is not a proven fact mind you, but well enough established to be
foolish to ignore.
At this point I am sure I have offended some readers. It will be argued that
I am saying PWAs are responsible for their illness; that if they had just done
everything "right" they would be healthy today. I don't believe this is true. If
you take this line of reasoning further, the best way to avoid illness is to
never be close enough to one person to care deeply if they leave, and thereby
avoid the immune risk of bereavement. On the other hand, such a strategy would
put you at risk for becoming devoid of a social support network You would also
have to become a total couch potato to avoid stress. However, doing this runs
the risk of creating a depressive state which leads to more immune
On the other hand, to conclude that we are powerless, that it is hopeless,
has in itself been shown to hasten death. There are many dramatic examples of
people who die shortly after losing all hope. It was a common phenomenon in the
Nazi death camps, documented by the famous psychiatrist Victor Frankl.
Hopelessness was also shown to be a predictor of who had cancer. Aurther Schmale
was able to pick out 36 of the 51 women he tested who had a malignancy by
looking for a sense of hopelessness and a recent emotional loss.
Being HIV can be a positive growth experience by its very nature as a crisis.
It can make us pay attention to things we should have all along. The reality of
our vulnerability can motivate us to reorder our priorities so we deal more with
what is really important in life, and less with those things that are
stress-inducing. Stress, after all, is an internal response to external
stimuli. It is a response we have the power to control This sentiment is no
better expressed than by Paul Dague, a psychologist who died of AIDS in January,
Impending death is a reality for us all. But to me it has become far less
important to dwell on that fact than to address the tragedy of living life
burdened with the fears, ties or indifference in all the stunning variety of
forms that these take--like perpetuating a negative self-image, doing a job that
one hates, or making ones self hostage to the rules of the jungle at the expense
of all else in life.
Since contracting AIDS. I've been trying not to accept my unconsciousness as
I did before. In fact I'm trying to see everything I say or do in light of the
underlying truth or lie I'm creating for myself--because I can't afford the cost
of allowing anything but that reality to guide me now.
A life which involves healthy physical and emotional growth also involves
risk, which. in turn, causes stress. Everyone has to decide for themselves what
priorities one sets for their lives to be at their best What is really
important in life may be harmful to your immune system, and worth the risk.
Avoiding death is no way to live. We all die. Two hundred thousand
people died on this planet today, and every day of the year.
I believe that we have some control over our destinies, including our health.
That is common sense. No judgment needs to be put on that fact There is no
reason for guilt over being sick You haven't caused your illness. But if you are
HIV positive, I believe some of what I suggest here might help your drug
cocktail keep your viral load down. If you are diagnosed with AIDS, I believe
these things might increase the quality of your life, your risk of opportunistic
infections, and ultimately your longevity. What is suggested here might just
turn your life around, an important step whether you die in the end or not
So what can you do about these immune vulnerabilities? Some things are
obvious from the foregoing discussion, and all may involve a change in your
1. Increase Your Support Network:
Organized HIV support groups are available through the Colorado AIDS Project,
B-CAP and other agencies, and through this author. They serve as one springboard
to a personal support system of people with similar concerns. Simply making
one's friends a higher priority in your life can help; putting more time and
energy into sharing your life with those close to you, cultivating friends from
acquaintances, and overcoming the blocks to intimacy with your own family.
Having a lover also helps, although too many men I see as clients view "Mr.
Right as the total answer to all their needs for affection and intimacy.
For that matter, simply being touched by another person helps. Since the Rene
Spitz studies in WWI I, a lack of touching has been recognized as a cause of
"failure to thrive" and subsequent death in infants. Pavlov was struck by the
fact that of all the stimuli that affected the dog he taught to so famously
salivate, none was more powerful than human contact The same has been
demonstrated with humans, even when in a coma Thus, professional masage can be
an especially helpful adjunct to the touching of close relationships, especially
for the single person.
2. Learn to Express Your Feelings and Accept their
Existence Within Yourself:
Emotional release through the sharing of confidences with a close friend, or
psychotherapy, personal growth workshops, or support groups all work to bolster
the immune system. John Wayne may have lived a long and full life, but many who
followed in his footsteps died being heros in Viet Nam and now are dying from
dodging emotional bullets.
Even keeping a journal has been shown to help one's immune system in blood
tests done by James Pennebaker, especially if people reported both the facts and
the feelings involved in traumatic, problematic events.
3. Pay Attention to Your Unconscious:
Other emotional outlets can come from focusing inside. Paying attention to
what is going on with our unconscious mind can make us healthier by making more
of our life a conscious process. As surgeon Bernie Siegel says, "The light is
better in our conscious minds, but we must look for healing in the dark
The royal road to the unconscious, Freud believed, was dreams. It is
relatively easy to develop a memory for our dreams by writing them down as soon
as we wake up, and by simply giving them the attention they deserve. Any
activity which engages our right brain will serve a similar function, such as
abstract drawing and guided imagery.
4. Meditate Regularly, Visualizing Yourself as
Physically & Emotionally Strong and Healthy.
A related inner activity of similar, possibly greater significance is
meditation and the positive imaging suggested by Carl Simonton. Louis Hay uses a
similar technique in her audio tape, "A Positive Approach to AIDS," which was
quite popular among my clients in the eighties. The basic idea is to imagine
while meditating that your Helper-T Cells are, for instance, vicious white dogs
which vigorously attack invaders.
Simonton's methods increased the survival time of cancer patients by
two-and-one-half times, and one in ten remain disease free after five years.
These clinical results have been reinforced by the PNI research by Nicholas Hall
and his colleagues. They found "relaxation, and aggressive mental imagery can
cause cancer patients' lymphocytes to multiply and fight tumors more
successfully." Similar findings have been discovered by researchers with the
V.A. Hospital in La Jolla, California, and by Albert Villoldo at San Francisco
Although the Simonton positive visualization methods are particularly
helpful, it is also useful to learn the altered states of mind provided by
different types of meditation. Everyone has to find his own pathways inside. For
some it may be through TM, for others the isolation "float to relax" tanks, for
still others it will be self hypnosis. All these roads lead in the same
direction, as well as deep muscle relaxation, yoga, environmental audio tapes,
5. Develop a Sense of Mastery through a Healthy
The activities suggested here can be justified for reasons other than a
greater sense of being in charge and in control. However, they all have that
characteristic in common. It is better to do something--anything (as
long as it is not potentially harmful--than to feel at the mercy of forces
outside yourself, like a virus. Just the sense that one is not a victim can be
important for one's spirit As described before, there are many examples of
people who die soon after they give up all hope.
The activities I refer to here are any regimen for health: diet exercise,
vitamins, adequate sleep, and drug free life styles. On the last point it is
worth noting that in a study of the drug use of 87 people with AIDS, 97% had
used poppers, 93% marijuana, 65% speed, and 66% coke. More than one out of two
had used several drugs (5 or more).
6. Take Stock of Your
The reality of dying forces the issue of living. What are we really doing
here? What is the meaning and purpose of life? These questions become more
relevant and urgent to address. For many men this is a spiritual quest often
with inquiries such as the Course in Miracles, or metaphysical beliefs. For
others, it may involve a resurgence of interest in their own religious
For many of the gay men I encounter in my practice, it involves a reexamination of their own homophobia They go through the throws of self-doubt and depreciation, as if they were in the process of coming out for the first time. The previously hard-won road to self-acceptance and gay pride can be found to be full of potholes. Take some comfort in the usualness of this reaction, and talk it out with someone you trust and respect.
The initial version of this article was published in Out Front, April 10, 1987 and was originally the content of a conference presentation to the Colorado Psychological Association that same month. I believe it is significant that this material remains so relevant after so many years: even the latest triple drug combinations aren't the total answer to surviving and thriving.
Last messed with November 15, 2001
Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.