Dr. Paul T. P. Wong’s autobiography, A Lifelong Search for Meaning: Lessons on Virtue, Grit, and Faith, is published in weekly installments. Stay updated here.
It is only fitting to end my autobiography with a chapter on living with cancer, suffering, and death—the greatest challenge one has to face on the journey of life. Whether we can pass the final examination well depends on the adequacy of a lifetime of training and preparation.
It is a tragic mistake for us to ignore death—the only thing certain in life. We can only live fully after becoming keenly aware of the fragility and brevity of life. At the same time, we also need to learn how to embrace death as our final destination without feeling its sting.
I became interested in the death attitudes project while doing research on successful aging (Wong, 2000). To my surprise, many seniors eagerly looked forward to death, either as an escape from the burden of living, or as a gateway to a blessed afterlife. Some simply philosophically accepted death as an inevitable part of the life cycle. This discovery later became the basis for my Death-Attitudes Profile (Wong, Reker, & Gesser 1994).
My research on death attitudes also reveals that people are less afraid of death compared to the prospect of dying a slow and painful death, as in the case of cancer. In some households, cancer is a forbidden word, as if the mere mentioning of it would bring bad luck and suck all the joy and hope of living.
The Dreaded “C” Word
We all have to die one way or another, but, to most people including myself, cancer is definitely not a preferred way to go. I did not choose cancer, but it has chosen me, as it has already claimed my two older brothers.
My oldest brother David (Chapter 6) ignored the tumor growth behind his ear for many years. He finally agreed to get medical tests. The diagnosis was very bad—terminal cancer with only three months of life. However, he defied the odds and lived for another 10 years after his death sentence. I do not know how he had the fortitude and the resources to keep on living with a malignant tumor bigger than the size of a tennis ball.
My second brother Benedict (Chapter 7) dismissed his doctor’s early warning that he had colon cancer for more than 20 years. “The doctor is stupid, just look how still strong and energetic I am,” he proudly proclaimed. When he could no longer ignore the symptoms of colon cancer, it was already not operable.
Now, it is my turn to live with cancer. I have learned the lesson to get screening tests and early treatment. As soon as my PSA score hit 13, I decided to have radical prostatectomy, knowing that it might lead to incontinence and impotency. The bad news was that I had the most aggressive kind of prostate cancer with a Gleason Score of 9. It meant that this type of prostate cancer had a 76% chance of relapse five years after a prostatectomy; it also meant a higher mortality rate compared to those with lower Gleason scores.
It has been 11 years since my radical prostatectomy. Since then, my PSA score is back to 15 again and, with it, my need of both radiation and hormone therapy. I also suffered seven years of incontinence, life-long impotency, and other health problems as described later in this article.
Thus, cancer seems like a fitting metaphor for the inevitable evil and suffering of life, because it even strikes innocent children and young people who practice a healthy lifestyle. Cancer symbolizes the inherent fragility and brevity of human life—the undeniable universal fact that no matter what we do to protect ourselves, we can all be injured physically and psychologically by evil people, broken relationships, traumatic events, pathogens, accidents, loss, aging, illness, and death. It also represents all the dangers hidden from our consciousness; they will destroy us one day if they are not detected in time.
Coping with Cancer
The first instinctual reaction to a cancer diagnosis is to use all our arsenals to battle cancer, because life is valuable and worth fighting for. One starting point is diet. One day, I visited a friend’s home. On the fridge was a list of cancer fighting foods, but not too many people, including myself, have the discipline to be a vegetarian or vegan.
Stress reduction is also recommended as another tool in the battle against cancer. Effective coping depends on cultivating and conserving our resources and using appropriate coping strategies (Wong, 1993). We also need to talk to our family members and ask for their support and understanding. In the dark days of fighting cancer, nothing is more comforting than the sacrificial care from loved ones.
In addition to coping with the stress and strain of daily living, a cancer patient also has to cope with the existential crisis of confronting a cancer diagnosis. I can still vividly remember the surreal feelings when I attended the wedding banquet of my niece while waiting for the results of CT and MRI scans. In the midst of cheering and laughter, I prepared myself mentally for the bad news that my deadly cancer had already spread. During the long evening, I felt like a lonely soul in the twilight zone between the living and the dead. I was not afraid to die but was trying to sort out all the complications of leaving this world still with so many loose ends.
Apart from all the emotional tumult, I had to cope with the aftermaths of the prostatectomy. I had the misfortune—or good fortune—depending how one looks at it, of learning the secret of mature happiness by going through hell. The following section (Wong, 2008a) contains segments of an article I wrote in 2008 describing this unforgettable journey.
To Hell and Back: The Need for Mature Happiness
“About three weeks ago, I experienced an unexpected setback in my recovery from radical prostatectomy—my body reacted very badly to a medication (Detrol-LA). This drug was prescribed by my urologist to slow down my overactive bladder after the surgery, but it shut down not only my bladder activities but also all my bowel functions, resulting in excruciating stomach pain, which was extended to my back muscles and my chest. I frequently broke out in cold sweat and my vomiting reflex took over, but nothing came out.
For several days, I was writhing in pain and could not find a single spot or position that could grant me temporary relief. My world was turned into a torture chamber, a hell hole. I was reduced to a bundle of exposed raw nerves. I clinched [sic] my teeth and tightened my muscles, bracing for the endless waves of brutal assault on my body and mind. Time crawled ever so slowly. Pain was what I breathed in and breathed out. It consumed all my energy and all my inner reserve.”
The Inadequacy of PP 1.0 for the Noxious World
During those days and nights of misery, nothing mattered anymore except for instant relief from the wrenching pain, which was killing me slowly. It was death by a thousand cuts! All my scientific knowledge about what contributes to happiness and well-being faded into the distant background. All the projects that made my life worth living also evaporated into thin air.
As I pondered on the stark contrast between the nurses and the patients, the idea of a parallel universe suddenly hit me. It was a moment of epiphany. I was awakened to the fact that on this planet earth, in the same space-time continuum, there are actually two very different worlds with very different life experiences and perspectives: the normal world and the noxious world.
In the normal world, people expect positive things to happen and dismiss the occasional negative outcomes as temporary and unfortunate setbacks. They are confident about their freedom and efficacy to exercise control over their own lives. They enjoy relatively good health and take basic biological functions for granted. The science of happiness is primarily based on studying samples from the normal world.
The “noxious world” is a world of extremely trying situations that demand costly sacrifices.
Evil has always been a part of human existence, and it continues to have a way of ruining people’s lives in all sectors of human society. Evil in all its varieties pose a challenge to positive psychologists, who need to grapple with the dark side of human nature (Baumeister, 1996; Peck, 1983).
Who can plumb the cesspool of evil? Who can fathom the depth of human miseries? Who can penetrate the heart of darkness? Who can rationalize the atrocities committed against fellow human beings? Why can’t we stop the ongoing holocaust and genocide in various parts of the world? From the bowel of the earth arises a constant stream, a scream of agony and anger. Cries of victims circle the globe and reach the highest space, but does anyone listen?
We cannot wish the noxious world away. Nor can we create a utopia through science. The noxious world will not go away as long as we are locked in our creaturely bodies, driven by insatiable desires, and threatened by the capricious nature which often unleashes its deadly destructive power. The tragic triad—human physicality, desire, and nature—has the power to make life miserable, unless we find a way to transcend and transform inescapable suffering and death.
But this is also a world of heroism and extreme self-sacrifice. Who can comprehend the paradox of Good Friday? What compelled Christ to die on that cruel cross so that multitudes might find hope and redemption? Who can understand the logic that one person should endure hell so that others may find heaven? Who can scale the pinnacles of the human spirit, when individuals, compelled by their conscience and vision, willingly sacrifice all they have, including their own lives, to fight against evil so that ordinary people can live with freedom and dignity?
The reality is that the “noxious world” may be more common than we care to admit. The First Noble Truth of Buddhism is Dukkha, which may be roughly translated as life is full of suffering and dissatisfaction. This profound truth reveals that, throughout life, people suffer from various kinds of troubles, ranging from physical pain to psychological distress, from losing what they value most to the disillusion that happiness does not last. We are all acquainted with both external and internal sources of troubles. It is sad but true that often bad is stronger than good (Baumeister, Bratslavsky, Finkenauer & Vohs, 2001).
For all human beings, the inescapable existential givens—sickness, aging, death, aloneness, meaninglessness—cast a long, dark shadow over all our activities, even when the sky is brightly shining. The challenge is how to live fully with the constant awareness of the noxious world of suffering and death.
The Need for a Different Kind of Happiness
Different as they are, the two worlds actually co-exist as day and night. They even intermingle as wheat and tares—one may enjoy a blessed married life but work in a toxic organization. Birth and death can happen in the same family on the same day. Painful and happy memories are interlocked within the same mind.
The truth is that the sufferers are all of us. We move back and forth between the two worlds at different stages of life. As the baby boomers age, many of them will eventually join the “noxious world” of suffering, life-threatening illness, and death. The noxious world is an equalizer, where all the past achievements and happy memories retreat into the background and all people can think of is how to find relief from pain and how to regain some sense of hope in the face of suffering and death.
Happiness in the noxious world is predicated on the human capacity to transcend and transform negative experiences through meaning and faith (Wong, 2008b). The greatest achievement of humanity is our ability to experience the invisible spiritual reality and discover shining stars in the darkest night of the soul (Wong, 2008c).
We become nobler, purer, kinder, and more generous, when we dig deep into our innermost being and reach out to the highest heaven, while struggling to survive unimaginable terror and torment. For suffering beings (Homo Patients), happiness has a deeper meaning than positive affect, life satisfaction, or subjective well-being.
For the sufferers, happiness primarily means: relief from suffering, tragic optimism, faith in God or Higher Power, compassion and kindness, enlightenment and wisdom, meaning and purpose.
Mature happiness is hope against all odds; it is affirming the positive in extremely negative circumstances (Frankl, 1984; Wong, 2008c). It is courage to accept and endure the seriousness of my condition, assurance that help is on the way, and the resolve to hang on to the hope that I will survive this ordeal and become a better person.
This is the feeling of being part of a fellowship of suffering bonded by compassion. It is deeper than social support. Compassionate care is an integral part of holistic medicine and hospice care (Wong, 2005; Wong, 2009a). It is appreciation of the kindness and compassion shown by others. It is gratitude to the loved ones who do everything possible to make suffering bearable.
This mature happiness is informed by both Eastern religions (Buddhism, Taoism) and Christianity. It is related to the wisdom traditions from East and West. It encompasses contentment that the situation could have been worse, the wisdom of letting go of what cannot be kept and accepting what cannot be changed, the feelings of equanimity that the worst would be death, which is inevitable anyway, the knowledge that life is transient and that all suffering will pass away, the abiding sense of meaning and purpose that makes my suffering bearable, and the confidence that I will not suffer in vain and that my message of hope and happiness to suffering people will find acceptance somewhere in the world.
I will take a defiant stance towards whatever suffering I may have to endure. I am glad that I am worthy of suffering for others—that my experience of hell can open a door to heaven for people I do not even know. The above threads of thoughts and feelings once sustained Viktor Frankl in a Nazi death camp; they also sustained me in my journey through hell.
For want of a better term, the kind of happiness I have just described may be called dark-happiness, because it can only be found in the darkest night of the soul. It is rejoicing in the midst of suffering. It is the process of becoming our best when we are in the worst possible situations. Such dark-happiness may be best described in metaphors. It is a tapestry of dark colours with a few bright threads. It is the rainbow after a storm, or the silver lining of a dark cloud. It is the rejoicing after surviving terrible trauma. It is the sweet aftertaste of eating something bitter. One has to feel bad before one can feel good, and one has to let go before one can receive blessings.
The Ultimate Test of Positive Psychology
When I was writing in pain, I definitely was not in the mood for anything jovial. I did not want to hear a cheerful song or a merry tune. I would rather listen to the good old hymns about suffering and redemption, the haunting melancholy songs of Leonard Cohen, or the Negro Spirituals drawn from those cotton fields.
I can understand why people who are flying high on the wings of success and happiness are likely to be turned off by my soulful blues of sorrow and pain. But the ultimate test of positive psychology is whether it is relevant and efficacious for the multitudes in extreme and noxious situations.
Now, my back and my neck are aching from typing. Therefore, I must stop right now. However, I am glad that I have finally told the story about what I have gone through in the past three weeks. In a sense, I am grateful for the painful journey into hell. At least, I can say that I have directly experienced dark-happiness and discovered that it is indeed a gift from suffering.”
Descending Deeper into Hell
Shortly after my return from a lecture in Taiwan during October 2013, I was in very bad physical shape. In addition to a painful swollen ankle, I also suffered from dangerously high blood pressure; and then there was the massive rectal bleeding.
One Friday evening, when I tried to take a shower, I just fell and lay on our bathroom floor, shivering in the cold. My wife called an ambulance and rushed me to the ER. They told me that I had lost 50% of my hemoglobin and needed instant blood transfusion and an IV.
The next day, after a number of medical tests, Dr. Ar, the hospital doctor in charge of my case, informed me that my kidney was very sick, because my serum creatinine was 264, twice as a high as normal. My kidney problem was primarily because it could not process all the vitamins and supplements my wife had given me over the years. My high blood pressure was due to my kidney failure and my rectal bleeding was the side effect of the high dosage of high blood pressure medication.
During that evening, Dr. Ar came back to check my condition and told me that a nurse would do a simple procedure on me before the surgery in the morning. That simple procedure turned out to be anything but simple. It took three nurses, one senior clinical nurse, and one urologist, over many hours of trial and error, to discover that they could not catheterize me because of the scar tissue from my proctectomy. They tried different tubes, but nothing worked. Final, the urologist had to insert a flexible cystoscope into my urethra and bladder to locate the contracture. Just image the intense pain such a procedure would cause! All night, I screamed so much that I lost my voice. I felt like a helpless lamb in a slaughter house—my scream was an instinctive response of having a sharp object thrust into the most sensitive part of my body.
My ordeal was not over yet. The next morning, I was wheeled into the surgery room to insert a Foley catheter under a general anesthetic. I was already in a state of physical exhaustion due to the massive loss of blood, two sleepless nights, and lack of food. For the first time in my life, I was suddenly seized by a panic attack, shaking in fear of more pain. I protested that I was not ready for surgery because it would adversely affect my recovery. But no one would listen—because there was already 800 CC in my bladder. In addition, the physicians had also carried out GI investigations.
When I came out of my general anesthesia an hour later, I could see my wife greeting me and I could hear my wife talking to a doctor nearby, but I could not move, nor could I utter a sound. I was mentally clear, but my voice would not come out and no one paid any attention.
For the first time, I experienced the devastating pain of being totally abandoned and ignored by the whole world. At that time, I felt that being trapped in a paralyzed body with a clear mind must be the second worst kind of human existence—second only to physical torture. I was stuck in a no-man’s land of overwhelming loneliness and helplessness.
The whole painful experience was an education of what hell was like. But there was also the positive side. During those hospital days, I gained a deeper understanding of suffering and became more convinced than ever that we need a positive psychology specifically for suffering people.
The Mysteries of Suffering
In 2004, I decided to tackle the mysteries of suffering, which had been one of my lifelong research interests. “Transforming Suffering, Loss, and Death Through Meaning, Hope, and Faith” was the conference theme in our 2004 Meaning Conference. We also organized a special Symposium titled “The Gift of Suffering: Spiritual Transformation, Science, and Medicine” which was funded by the Templeton Foundation. Symposium participants included Dr. Harold Koenig, the world’s leading expert on spirituality and health, and Dr. George Ellis, winner of the 2004 Temple Prize in Religion, alongside psychologist Dr. Warren Brown and neuroscientist Dr. Malcolm Jeeves.
I had some unexpected experiences in organizing this conference. Firstly, my application for a Templeton Grant was rejected, because a review said emphatically that “positive psychology has nothing to do with suffering.” I had to write a long rebuttal to successfully sway the Templeton Foundation to support this symposium.
Secondly, I received a long letter from a well-known physician, who strongly objected to the wording of our symposium: “The Gift of Suffering.” According to him,
I have seen much of suffering. To call suffering a gift is a rhetorical and poetical stretch that does violence to its reality, for some suffering is truly unendurable. Daily, throughout the world, individuals are tortured for political, religious, military, and trivial reasons. To none of the recipients of this torture, whether physical or psychological, is the suffering a good gift? Every day, in many places, another child is beaten, degraded, raped, or abused. Which of your prominent leaders featured on your speakers’ list is prepared to meet with any of these children to explain to them the gift-nature of their suffering?”
He went on to provide detailed graphic descriptions of many terrible real-life cases, including the physical and psychological sufferings of an old man. He ended his letter with this challenge, “Explain the joy, explain the gift hidden within this slow and painful decline to death.”
Now, in my old age, having personally experienced or observed many cases of seemingly unbearable suffering as I have just described, I feel even more confident than 14 years ago that suffering is indeed a blessing in disguise, a gift from God that not only deepens our understanding of the self and awakens us to all the wrong things we do in our lives, but also opens our eyes to the hidden beauty and goodness of life.
I do not think anyone can find an adequate answer to the question of why little children have to undergo surgeries, chemotherapy, and then die alone. It is always heartbreaking to see them suffer and die in the hospital or in war torn regions. This dark reality may motivate us to do whatever we can so that they do not have to go through hell even before they have an opportunity to live.
According to Kathleen Brehony’s (2001) After the Darkest Hour: How Suffering Begins the Journey to Wisdom, pain, suffering, or despair has a way of adding meaning and depth to our lives. It propels us to higher levels of self-knowledge and a deeper understanding of the true reality of human existence. When we are stripped of all our illusions and delusions, when we are confronted with the reality of death, it is only natural that we would ask ourselves the following existential questions: Who am I? What is my purpose here? What is life all about? What happens after death?
In Making Sense Out of Suffering, Peter Kreeft (1987), a Catholic philosopher, observes that billions of people have been touched by apparently pointless and random suffering. He finds the ultimate meaning of suffering in the life, death, and resurrection of Christ. How can we reconcile the suffering of little children with a belief in a good God? Does God descend into our hells? Kreeft answers in the affirmative and he quotes the unforgettable line of Corrie Ten Boom from the depths of a Nazi death camp, “No matter how deep our darkness, he is deeper still.”
For Kreeft, God’s answer to our suffering was Christ on the cross. Christ came into this world for the purpose of suffering with us and for us so that we may find redemption and eternal joy. By faith, we follow the steps of Christ and become part of God’s ongoing work of grace and redemption for the suffering masses. In a poetic way, Kreeft describes the intimate fellowship of suffering,
“When we feel the hammers of life beating on our heads or on our hearts, we can know—we must know—that he is here with us, taking our blows. Every tear we shed becomes his tear. He may not yet wipe them away, but he makes them his.”
When all our cherished worldly things are taken away from us, when the whole world fades away and the end draws near, how do we remain hopeful? We can transcend our limitations in space and time by turning inwards to spiritual values, such as faith, love, wisdom, and compassion. These values represent our best self or higher angels. The faith dimension encompasses our ultimate concerns, a sense of a mystical transcendental reality, and feeling of being connected with the Creator and all humanity. Faith unlocks the mysteries of suffering and death.
I am glad that the last Meaning Conference I organized again focuses on the existential positive psychology of facing adversity and suffering with courage, faith, and meaning.
A Case for PP 2.0
Carl Jung (1989) in his autobiography Memories, Dreams, Reflections, had a very realistic portrait of the world in which we live:
“The world into which we are born is brutal and cruel, and at the same time of divine beauty. Which element we think outweighs the other, whether meaninglessness or meaning, is a matter of temperament. If meaninglessness were absolutely preponderant, the meaningfulness of life would vanish to an increasing degree with each step in our development. But that is or seems to me not the case. Probably as in all metaphysical questions, both are true; life is or has meaning and meaninglessness. I cherish the anxious hope that meaning will be preponderate and win the battle.” (p. 429)
The challenge confronting us is how we can survive, thrive, and be happy in such a world. I proposed existential positive psychology (EPP; Wong, 2009b) and second wave positive psychology (PP 2.0; Wong, 2011) precisely because we need a positive and helpful answer to the tragedy of human existence.
The first tenet of PP 2.0 is to embrace suffering and death as integral to human existence. All our efforts to enhance well-being and achieve a good life have to be built on this undeniable foundation. It means that our research and interventions have to be predicated on the understanding that the world is full of evil and suffering, just as the natural environment is full of bacteria, viruses, and toxins.
The main limitations of positive psychology as usual (PP 1.0) is its binary approach to happiness and suffering. In contrast, PP 2.0 posits that positive and negative emotions co-exist in dynamic, dialectical interactions. Therefore, I can be simultaneously at the bottom of a dark abyss and resting in the arms of our loving Heavenly Father. My eyes can be filled with tears of sorrow, but at the same time, my heart can be full of the joy and comfort from the God of all comforts.
According to PP 2.0, all emotions, including negative ones, have adaptive value. More importantly, the best way to experience positive emotions is to accept and go through the negative ones. Thus, to develop a positive attitude towards death and suffering, one needs to confront the dark side of human existence.
For positive psychologists with the mindset of modernity, they could not comprehend how the dimension of transcendental reality can greatly enlarge our perspectives and enrich our lives, even when the world is closing in on us. Nor can they understand why I would rather suffer hardships and frustrations living with the people I love than enjoying all the creature comforts living without my loved ones.
PP 2.0 demands a reorientation from what I can get to what I can give, regardless of the cost. From this perspective, other people matter, not because they contribute to my happiness, but because my sacrificial love for them makes me fully human.
Some Helpful Hints in Living with Cancer and Suffering
Paradoxically, death holds the key to living a vital, authentic, and meaningful life. Yalom (2008) once said that the idea of death has saved many lives. That is, we cannot live fully without becoming aware of the fragility and finiteness of life.
Death acceptance is the biggest challenge of acceptance, to no longer regard death as an enemy, but as a good companion and a great gift. It is an end to all suffering and anxiety; it may open the door to something better. Our awareness that we are dying offers us the best opportunity to live fully and become our best. We need to learn how to embrace death without fear of its sting.
There is so much power in acceptance. True happiness comes from accepting the dark side of life. We need to accept our vulnerabilities, limitations, and the horrors of existence—with the courage and honesty of a warrior (Wong, 2015). When we willingly surrender to death’s presence in our lives, or accept it as a gift from God, we become open to the mystery of a transcendental reality. From this enlarged spiritual perspective, suffering becomes a stepping stone that connects us with God and with the cosmos, thus losing its all-consuming power. The pain is still there, but it becomes absorbed into our expanded consciousness. In being fully present and intimate with God, we lose ourselves and our pains.
In conclusion, here are some helpful hints in living with cancer and suffering:
Learn to give what you have in order to reduce suffering and increase happiness in others. Be willing to make the necessary sacrifices and endure the pain so that you can transcend limitations and make life better for and others. You cannot ascend to heaven without descending to the hell of suffering and sacrifice.
View life through the lens of yin-yang, the universal coexistence of the good and the bad, success and failure, rejoicing and suffering. Mature happiness results from balancing yin-yang in each situation (Wong, 2016a; Wong & Bowers, 2018). The positive psychology of death and dying can be best understood in terms of the dual-system model (Wong, 2012a). According to this model, optimal adaptation depends on our ability to confront and transform the dark side of life in service of achieving positive goals. Both avoidance and approach systems are needed to be free from the prison of death fear and to motivate us to engage actively in what matters to us. From this dual-systems perspective, death fear and death acceptance can co-exist and work together for our well-being.
Adopt a double-vision. Always keep one eye on heaven with its uplifting ideals and another eye on earth with its grim unrelenting reality. Tragic optimism will emerge when we face the daily struggle to survive and at the same time believe that a better future is awaiting if we do not give up (Wong, 2009c, 2016b).
Keep the faith that life is inherently worth living and you have intrinsic value. This worldview will empower you to face death with dignity and peace if you have assumed the personal responsibility of fighting the good fight and completing your race (Wong, 2012b, 2015).
Maintain an appreciative attitude and be thankful for being alive each day. Practice existential gratitude for being alive each day, for planet earth, and for all the people that make your life comfortable. You can always find something positive in every negative situation (Wong, 2016b).
Make each day count. This means that you not only savour each moment and value each day, but also learn how to transform your setbacks and negative emotions to positive motivation to improve your life (Wong, Wong, & Scott, 2006).
Life, even immortal life, is a curse unless we can find real meaning and purpose for our existence. We do not understand, until we discover something worth fighting and dying for. We can die happy, knowing that our suffering and sacrifice have made life better for others.
I am gratified that my lifelong research on meaning and resilience (Wong, 2017) has prepared me for my battle with cancer. It is my sincere hope that the above suggestions will offer some hope, encouragement, and wisdom to all those struggling with the horrors of life.
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