Strengthening the Will to Live

When we consider the will to live seriously, formulae such as ‘anger is bad, love is good’ become painfully simplistic.

Rachel Naomi Remen
1 January 1999

“When we consider the will to live seriously, formulae such as ‘anger is bad, love is good’ become painfully simplistic. What mobilizes the will to live in each of us is profoundly unique.”

While many people now believe that “positive” emotions have a role in the recovery of health, I have always found this idea disturbing, and perhaps even dangerous. Many people now seem to fear harboring “negative” or “wrong” attitudes and feelings in the same way people of a previous generation feared having evil thoughts. At best, the idea of “positive” emotions implies that there is a specific way to live, a right set of attitudes, that may guarantee survival. At worst, it can degenerate into self-tyranny, causing people to sit in judgment on their emotional life.

To avoid such repressive outcomes, we may need to go deeper into our thinking on such matters. Perhaps there is a healthy way to feel all emotions, for all emotions serve a purpose and are potentially life affirming. After twenty years of working with people with cancer, I cannot honestly say that any one emotion is harmful or bad for your health. Rather it seems that the only harmful feeling is a stuck feeling, a feeling that has become a way of life.

Take for example, anger, an emotion that surely gets a lot of bad press. My clinical experience suggests that many ill people may recover by initially becoming angry about their disease. For them, anger represents an affirmation of life, a demand for change, and an unwillingness to live under any but the best circumstances. It seems to me that such anger may be the first way we can express our life force when we are confronted with serious illness. Perhaps anger only really becomes a problem when we become fixed in this way of expressing our valuing of life.

Recently I asked several clinical colleagues if they could identify positive emotions in their patients, feelings they thought were directly associated with survival. There was no question that many of these physicians and psychologists liked certain emotions better than others, but the correlation between survival and emotional attitude was not clear to any of them, including the oncologists. All had worked with loving, cheerful people who died, grieving people who lived, angry people who never became ill, and humorous people who were unable to heal themselves. And yet they shared the clinical hunch that emotions do indeed affect healing. So we have here a bit of a mystery.

Perhaps there may be factors involved in illness and recovery that are deeper and closer to the core than emotion, and we might resolve this puzzle by looking further. Norman Cousins, in Anatomy Of An Illness, correlates recovery with what he calls a “passionate involvement with life.” This sort of passion may point to an older and more vitalistic concept, traditionally spoken of as the will to live. Difficult as this may be to document scientifically, clinically it is easy to appreciate. Over the years I have even come to wonder whether emotions seem to be associated with survival only because they trigger the will to live in us.

This line of thinking raises difficult and interesting questions. Is the will to live a theoretical construct or does it actually exist? Clinicians like myself who see many people who live despite overwhelming odds and who die for no known reason have come to wonder about it. And if the will to live is real, can it be evoked and strengthened?

When we consider the will to live seriously, established emotional formulae such as “anger is bad, love is good” become painfully simplistic. What enlivens us and mobilizes the will to live in each of us is profoundly unique. If the will to live exists, it may be deeply affected by core life issues, specifically questions of aspiration, goals, purposes and personal meaning. Victor Frankl, in his study of those who survived the concentration camps, notes that a sense of individual meaning altered people’s perception of external events and their ability to survive extremely difficult circumstances. So perhaps clinicians who wish to strengthen the will to live in their patients will need to support them and share with them the search for personal and individual meaning.

It is challenging to think that health professionals might befriend the will to live in each person much in the same way a gardener befriends the will to live in every plant. To do this we would need to study each person and help them to recognize and strengthen those things that may promote their survival. We would need to find ways to support people as they explore their personal mythology, hidden guilts and fears, sense of deserving to live and be well, and beliefs about entitlement to nurture and self-nurture. It would require taking as profound an interest in a person’s strengths as in the pathology of their disease.

This might radically affect the ways in which professionals talk with patients and the sorts of questions they ask. An important first question to ask people might be, “What do you believe has kept you alive until now? What keeps you going despite your difficulties?” This may be of course an important question for health professionals to ask themselves as well.

Befriending the will to live will require new professional training that strengthens and develops the intuitive and the creative as well as the cognitive in the health practitioner, and values our emotional and spiritual intelligence as much as our IQ. New health tools, which may not have been previously thought of as therapeutic—approaches such as music, color, dance and poetry and practices such as yoga, meditation and tai chi—may become a commonplace part of the physician’s black bag of recommendations and techniques.

Ultimately, such concepts as the will to live have the power to reinstate healing as the central concern of medicine and realign the profession of medicine with its higher purpose. This will require not only new technical expertise, but also a deeper and more poetic understanding of the workings of human nature.

Rachel Naomi Remen

Rachel Naomi Remen

Rachel Naomi Remen, M.D. is Associate Clinical Professor of Family and Community Medicine at U.C.S.F. Medical School and co-founder and medical director of the Commonweal Cancer Help Program. She is author of the bestseller, Kitchen Table Wisdom: Stories That Heal.