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Why do some patients recover their health and others die, when the diagnosis is the same for both? Carl became interested in this problem while he was completing his residency as a cancer specialist at the University of Oregon Medical School. There he noticed that patients who stated they wanted to live would often act as if they did not. There were lung cancer patients who refused to stop smoking, liver cancer patients who wouldn't cut down on alcohol, and others who wouldn't show up for treatment regularly.

In many cases, these were people whose medical prognosis indicated that, with treatment, they could look forward to many more years of life. Yet while they affirmed again and again that they had countless reasons to live, these patients showed a greater apathy, depression, and attitude of giving up than did a number of others diagnosed with terminal disease.

In the latter category was a small group of patients who had been sent home after minimal treatment, with little expectation that they would live to see their first follow-up appointment. Yet several years later, they were still arriving for their annual or semiannual examinations, remaining in quite good health, and inexplicably beating the statistics.

When Carl asked them to account for their good health they would frequently give such answers as, "I can't die until my son graduates from college," or "They need me too much at work," or "I won't die until I've solved the problem with my daughter.", The common thread running through these replies was the belief that they exerted some influence over the course of their disease. The essential difference between these patients and those who would not cooperate was in their attitude toward their disease and their positive stance toward life. The patients who continued to do well, for one reason or another, had a stronger "will to live." This discovery fascinated us.

Stephanie, whose background was in motivational counseling, had an interest in unusual achievers—those people who in business seemed destined to go to the top. She had studied the behavior of exceptional performers and had taught the principles of that behavior to average achievers. It seemed reasonable to study cancer patients in the same way—to learn what those who were doing well had in common, and how they differed from those who were doing poorly.

If the difference between the patient who regains his health and the one who does not is in part a matter of attitude toward the disease and belief that he could somehow influence it, then, we wondered, how could we influence patients' beliefs in that positive direction? Might we be able to apply techniques from motivational psychology to induce and enhance a "will to live"? Beginning in 1969, we began looking at all the possibilities, exploring such diverse psychological techniques as encounter groups, group therapy, meditation, mental imagery, positive thinking, motivational techniques, "mind development" courses like Silva Mind Control and Mind Dynamics, and biofeedback.

From our study of biofeedback, we learned that certain techniques were enabling people to influence their own internal body processes, such as heart rate and blood pressure. An important aspect of biofeedback, called visual imagery, was also a principal component of other techniques we had studied. The more we learned about the process, the more intrigued we became.

Essentially, the visual imagery process involved a period of relaxation, during which the patient would mentally picture a desired goal or result. With the cancer patient, this would mean his attempting to visualize the cancer, the treatment destroying it and, most importantly, his body's natural defenses helping him recover. After discussion with two leading biofeedback researchers, Drs. Joe Kamiya and Elmer Green, of the Menninger Clinic, we decided to use visual imagery techniques with cancer patients.