Don’t tell me to be positive… when I’ve got cancer

When Sophie Sabbage was diagnosed with an incurable illness she felt fear, despair – and overwhelming pressure all around her to stay upbeat. Here she explains how plastering on a happy face can actually do more harm than good  

‘We need to feel our emotions rather than mask them,’ says Sophie

When I was diagnosed with incurable lung cancer in 2014 aged 48, the counsel to ‘stay positive’ was only surpassed on the unhelpful scale by the equally frequent remark, ‘Oh, I know someone who died of that!’ (a contorted attempt at empathy).

I wanted to scream every time positivity was prescribed. My daughter was just four and I’d been warned I might not see her fifth birthday. I was shell-shocked and grief-stricken. Yet I found myself buffeted by a storm of imperative optimism that denied me the right to feel fear or sorrow – to be human in this most vulnerable circumstance. If I could not sit in the darkness in my darkest hour, then when? Under what circumstance was it OK to not be OK?

Even the Macmillan nurse at the hospital hurried over when I was crying in the crowded oncology waiting room, spilling her own anxiety on to my lap as she asked, ‘Are you OK? Are you OK?’ At this point I was riddled with tumours and terrifying symptoms. Crying seemed entirely congruent with my situation. I was fine with it. Consequently, as I looked at the dry eyes and stiff upper lips all around me, I calmly replied, ‘I think I might be the only person here who is.’

The ideology of positivity, birthed by our optimistic American cousins and raised into adulthood by the personal-growth industry, is now global. While I’m proud to have worked in this industry for 30 years, primarily teaching individuals and businesses how to be creative with ‘life shocks’, and believe it has contributed hugely to our evolution and wellbeing, positivity has also become a contagion for which we are paying a very high price. Like all bright lights, the personal growth industry has cast some big shadows, not least this infatuation with positivity. We have positive psychology, positive coaching, positive mantras and positivity gurus. The market is saturated with books, courses and methodologies for positive thinking and living. If you just put on your positive pants, you will feel better, be better. This is the message we receive in so many ways.

I didn’t fully grasp the harm this can do until my diagnosis. Even harder than the pressure to stay positive was an underlying implication that my failure to do so would kill me as surely as the cancer would. As a patient activist, I was soon part of a global cancer community constantly stalked by an insidious belief that the patients who slip into negative thinking are the ones who die. I’ve witnessed patients desperately trying to stay positive when they need to weep, wail and unburden themselves of the emotional ‘dis-ease’ that accompanies their physical disease.

Positivity in this situation is stressful and unsustainable. It also hinders our ability to meet what is happening consciously and creatively – including our own deaths, which I have needed to do twice. The first time was in those early months of diagnosis when I was gravely ill and felt my life force slipping away as we scrambled for treatments. Then, in 2017, when a third round of brain tumours had entered the fluid pathways and most options appeared exhausted, I once more found myself planning my funeral. I raged and wept my way towards peace.

If I can’t sit in darkness in my darkest hour, then when?

This gave me the emotional clarity to make bold requests and rational decisions with the sliver of possibility (as opposed to positivity) I had left – ultimately receiving a targeted drug called osimertinib, which my private oncologist helped me fight for despite my not technically qualifying for it. I’ve tapped all my resourcefulness to survive these past five years with cancer, but I’ve needed to reach the north and south poles of my humanity to really thrive.

This detrimental pressure on patients to be positive is a microcosm of something much bigger going on in society. Just look around. The midlife crisis is being usurped by the quarter-life crisis, which kicks in for 25- to 30-year-olds who are not yet famous or flying in their careers. Addiction – to drugs, alcohol, antidepressants – affects millions. There is even a condition called ‘smiling depression’, whereby someone appears happy but suffers silently, more prone to suicide than to taking off the mask. Suicide has become the single biggest killer of men under 45 in this country (approximately 84 men of all ages per week) and is on the rise globally. Perhaps most conclusively, an epidemic of loneliness is now being identified as the number-one health crisis in Western culture – more than obesity, cancer or heart disease. As US politician and author Ben Sasse writes, ‘We are literally dying of despair.’

Of course, there are multiple factors at play here. At a time when so much is being done to remove the stigma of mental illness, I am simply urging us to look at something that is posing as a solution to the problem it perpetuates: the imperative to be positive. Positivity, like negativity, is an attitude. We think we have to be positive for fear of being negative, to belong and be liked, to conceal our insecurities in a world of shiny smiles on Facebook and Instagram.

Where negativity paints dark clouds on blue skies, positivity paints storm clouds pink. One wallows in pain, the other denies it. Neither represents the half-dark, half-light nature of reality, the sometimes-up, sometimes-down nature of the human condition.

After working with thousands of clients over the years, I’ve realised that positivity can blind us more than negativity. Someone who sees themselves as crap can get straight to challenging that invariably false perception. But someone devoted to positivity has to peel the icing off the crap before they can see it isn’t cake.

Emotional freedom lies in authenticity, not positivity (though the latter is often mistaken for the former). By depressing ‘negative’ feelings, guess what we get? Depression. But by facing, admitting and expressing those emotions our spirits come alive again. Because the way out of fear and despair is not over, but through.

With some clinical exceptions, there is evidence that we can change our feelings by changing our thinking, but let’s not replace self-effacement with self-aggrandisement, ‘I’m worthless’ with ‘I’m awesome’, a gloomy misconception with a gleaming one. Let’s do what we can to accept our flaws and greatness in equal measure instead of making one or the other an absolute. Let’s remember that however low or high we feel, we have worth that doesn’t need to be proven with popularity, glory and pseudo-happiness. Let’s weep together in hospital waiting rooms and take hold of our fear so it doesn’t take hold of us while we’re smiling for the nurses. Because inside our fear we can find what we’re willing to fight for. Inside our rage we can find what we stand for. Inside our despair we can find what we long for. There is no flow without ebb.

Sorry. I have no happy pills to dispense here. Instead I have found a way to be fully alive (even when gravely ill) and fully ourselves: by experiencing despair and joy, fear and love, awfulness and awe-filled-ness, loneliness and belonging, grief and gratitude. As the poet Rainer Maria Rilke wrote, ‘Let everything happen to you: beauty and terror. No feeling is final. Nearby is the country they call LIFE.’ This is how we can thrive rather than merely survive.

  • Sophie’s book Lifeshocks: And How to Love Them is published by Coronet, price £9.99. To order a copy for £7.99 until 2 June, visit or call 0844 571 0640; p&p is free on orders over £15.
  • Her TEDx Talk, How Grief Can Help Us Win When We Lose, is now on YouTube