Why Us?

The other day, Cancer Couple received a comment from a mother of two young children in Australia who suffers from a difficult-to-classify brain tumor and whose husband is doing well after an autologous stem cell transplant for AML/APL leukemia. You see her beautifully written blog at http://coogeegoo.wordpress.com/.

In closing, she asked, “How do you deal with the "why us?" response that has no answer?” It is a question that I have given some thought to, so I want to share a few ideas.

Many behavioral scholars believe that humans have a built in sense of morality based on cooperation through reciprocity and punishment. It is in our nature to cooperate with others as long as there is reciprocity. I’ll help you, if you help me. However, because people sometimes cheat and do not reciprocate, we are naturally predisposed to punish violators. We have a well-developed sense of fairness that causes us to look for unfair behavior and seek punishment as a way of restoring fairness. An interesting article on the inborn morality of infants can be found here: http://www.nytimes.com/2010/05/09/magazine/09babies-t.html?_r=1&scp=1&sq=infant%20morality&st=cse

I believe our fairness detector is activated when bad events occur in our lives, and we look for reasons for those events. We want to find the meaning of the events so we can determine if someone has cheated so they can be punished. I remember my mother saying, “It’s not fair” with reference to my father’s development of malignant melanoma. He was a good man who worked hard to support his family and was always honest and fair in his dealings with others. My mother thought it was unfair that such a man should have cancer when others who in her view were not so good did not. She was searching for equity in a context in which fairness/unfairness, right/wrong did not apply. Some events have no meaning. The world is an incredibly complex place, and things we see as both good and bad happen essentially at random. That is, they are not part of some overarching, goal directed process. There may be causes for the event, but they are essentially random at the core, like winning the lottery.

I know Jana and I asked the question, “Why us?” but it is a question without an answer. It is as if a meteor had crashed through our roof and struck us down. We know what happened. We can understand the injuries caused by the mass of a meteor crushing our bodies, but to ask why the meteor hit our house instead of someone else’s is a waste of time even though asking the question is a normal response to the situation.

It is reasonable to look for the mechanistic causes of cancer, but the more we understand the biology of cancer, the more it appears that while some actions can reduce our chances of developing cancer, the initiation of any given case of cancer has a random component. A person may choose to smoke and knowingly increase his or her chances of developing lung cancer, but the actual development of the cancer lies in the interaction between the carcinogens in the smoke and the individual’s genetic makeup and lifetime exposure to cancer promoting life events. My father and his nine siblings grew up on a farm and spent a lot of time working in the fields under an intense sun, but he was the only one to develop melanoma. The development of cancer is entirely deterministic but of such a complexity that the absolute prediction of who will and who will not develop the disease is impossible to know at this time.

So that is my answer, Coogeegoo. It is natural to ask the question, “Why us?” but as you noted it has no answer. Please keep writing on your blog. You have at least one person who is not a friend or relative who is interested in monitoring your progress against this challenge that you and your family have been given at such a young age.

David