A pessimist asks you if there is milk in the pitcher; an optimist asks you to pass the cream. — FOLK SAYING

It troubles me to recall him even now, many years later--the fifty-year-old attorney who gave me my most painful lesson in the value of optimism and what happens when it fades away. He was at the peak of his career, father of three, athletic, a picture of health. His only concern was a minor stomachache that had come and gone for a couple of weeks. Even though his physical examination was normal, he insisted on an abdominal scan just to be sure nothing was wrong. Although I thought this overkill, I went along. To my surprise, the scan showed a mass in the pancreas the radiologist said was probably cancer. I discussed the situation with him and proposed a diagnostic workup, including the possibility of eventual abdominal surgery. "No surgery!" he declared emphatically. "It's worthless. Nobody survives cancer of the pancreas." I pointed out that he was mistaken. Although the statistics are not favorable, people do survive this disease. In any case, we weren't sure of the diagnosis and further tests were needed to confirm it.

He consented to be hospitalized that very day, but a light went out in him. He seemed terrified, and nothing I could say would comfort him. He began to stare straight ahead, refusing to speak to me or the nurses. When I made rounds that evening, he lay silent and rigid in bed with clenched jaws and furrowed brow. Even when I informed him that his preliminary blood tests were normal, he didn't seem to care. In his mind he was a condemned man going to the gallows. I resolved that if his behavior did not change by morning, I would ask a psychiatrist to consult on his case. I didn't get the chance. That night the nurse found him dead in bed.

His was a "hex death," widely recognized in premodern cultures, in which a previously healthy individual dies shortly after being cursed. The curse--in this case, his certainty that he had a fatal illness--removes all optimism and hope, and substitutes the inevitability of death.

Optimism is the tendency to believe, expect, or hope that things will turn out well. Debates have raged over the past few years about whether it affects our health and the course of specific diseases. I find these arguments tedious, because I believe evidence of the healing power of optimism is in plain sight. These effects are most obvious when they vary from day to day, like shifting winds. In the 1950s, Dr. Bruno Klopfer reported such an example that involved a patient he was treating for advanced lymphoma. The man had large tumors throughout his body and fluid in his chest, and was terminal. Klopfer was so convinced that he would die within two weeks that all medical therapy except oxygen had been discontinued. In a last-ditch effort he gave the man a single injection of Krebiozen, an experimental drug later said to be worthless. Klopfer describes the results:

What a surprise was in store for me! I had left him febrile, gasping for air, completely bedridden. Now, here he was, walking around the ward, chatting happily with the nurses, and spreading his message of good cheer to anyone who would listen. . . . The tumor masses had melted like snow balls on a hot stove, and in only these few days they were half their original size! This is, of course, far more rapid regression than the most radiosensitive tumor could display under heavy x-ray given every day. . . . And he had no other treatment outside of the single useless "shot."

 Within ten days the man was practically free of disease. He began to fly his private airplane again. His improvement lasted for two months, until reports cropped up denouncing Krebiozen. When he read them, the man appeared cursed, and his attitude and medical condition quickly returned to a terminal state. At this point Klopfer urged the man to ignore the negative news reports because a "new super-refined, double-strength product" was now available--a complete fabrication--and injected him with sterile water. The man's response this time was even more dramatic than initially, and he resumed his normal activities for another two months. But his improvement ended when the American Medical Association released a report stating that nationwide tests had proved Krebiozen useless in the treatment of cancer. A few days after reading this statement, he was admitted to the hospital, and two days following admission he died.

If optimism can make such dramatic differences, you'd think we physicians would do everything in our power to increase it in our patients, but sometimes we seem hell-bent on depriving them of it. Some of these instances are so outrageous they are almost funny.

Andrew Weil, MD, who is director of the program in integrative medicine at the University of Arizona in Tucson, often sees patients for a second opinion.

"You wouldn't believe what those doctors did to me," one woman related. "The head neurologist took me into his office and told me I had multiple sclerosis. He let that sink in; then he went out of the room and returned with a wheelchair. Then he told me to sit in it. I said, 'Why should I sit in your wheelchair?' He said I was to buy a wheelchair and sit in it for an hour a day to 'practice' for when I would be totally disabled. Can you imagine?"