The power of Will

[The GM]

Well, for those of you who have followed my personal drama that I outlined in a thread called Faith, Miracles, and Crisis, I am home. My brother, who was badly injured in a near fatal car accident is coming back up north to a special rehab center that specializes in dissected aorta paralysis injuries. I was away from my home and family for over three months while he was hospitalized in acute care wards. I am glad to be back.
Now, some people are calling his recovery a miracle, sent from God, for whatever purpose. Maybe, maybe not. I do not have enough information to make that determination. That’s beside the point of this thread though.
We held a party for the hospital staff and the people who really helped us out while we were in Texas. For those of you who are interested, the CBS affiliate will be running a story on that and my brother’s recovery tonight (Wed. Feb. 02) on the 6 and 10 pm news. The segment is called Ask Mudd for those of you in the Lubbock area. FYI, I’m the hot blonde in the black suit.
The docs and nurses were very pleasantly surprised that we threw them a ‘victory’ party. They said that no one ever does that to thank them. I thought that was kinda sad, as what they do is important and special. People should thank them a million times over. I’ll never forget them. While I was chatting w/ the nursing staff, everyone of them said they never expected my brother to survive, let alone recover. So it made me wonder about the will to survive. Is it different in humans? If an animal suffered the same sort of injuries, would they survive given the same level of care? Is human will different, special, and dare I say, spiritual in nature allowing success stories like my brother’s to happen? I’ve begun to wonder about that of late. If you want something badly enough, can you really make the impossible happen? My brother wanted to live, and it would seem that against the odds, he made it happen by the power of his own will. (And with a fair amount of help from some great people!)

 

[RussDill]

I think the will to live is crucial, but not the only factor. There was a show recently on tsunami survivor stories, and there was one paticularly depressing one, where she had given up the will to survive, and starting purposely inhaling water. She got washed up on debree and lived.

 

[Mercutio]

"Will to survive", like "will to win", is a circularly defined concept. It is only seen after the fact. The only evidence for your brother's amazing will to survive is...that he did. Had he not, everyone would be saying that "after a brave struggle, he simply gave up the will to survive." Again, the only evidence would have been his death.

If this weekend's Super Bowl goes the way every other one has, it will be won by the team that simply showed more "will to win". They just "wanted it more". Great. Circular. We infer from their victory that they had more will to win, and then attribute the victory to that will.

I am very happy that your brother has recovered. He had the care of a lot of people; he had how many blood transfusions? 30, was it? More? He had experts, and good prior health, and, frankly, the luck of the draw. It could have easily gone the other way, and has for many other accident victims. There are enough real reasons for his recovery for me to be comfortable with "and we really don't know all the other things that might have played a part" rather than turning "I don't know" into "will to survive."

But, hey, I am cynical that way.

 

[c4ts]

You can't win if you don't try in the first place. You can't live if you don't do anything to keep yourself alive. That's where the will comes in. It's part of your reason for doing something.

 

[The GM]

Exactly. So how much of an edge does that 'will' give a person? Like Merc says, who knows? When my brother first woke up, and things were looking very poor indeed, I just kept telling him, 'all you have to do is live through the worst of it, the rest will take care of itself.' It became his mantra, and ours as we ticked off the days. All you have to do is survive the worst of it...makes it sound so simple, doesn't it?
We know people can lose the will to live. Do animals do this? What makes human will special?

 

[Mercutio]

You can't win if you don't try in the first place. You can't live if you don't do anything to keep yourself alive. That's where the will comes in. It's part of your reason for doing something.

How is this "where the will comes in"? You can't live if you don't do anything to keep yourself alive....ok, if you don't eat or drink, or any of those necessities...but where is the influence of the "will"? In every example I have ever seen, it is defined circularly, after the fact. Has anyone ever heard of someone who lost the will to live during an illness, and yet still recovered and lived to a ripe old age, never missing his lost "will to live"? Do we ever read of someone who dies, having never, even to the last moment, given up the will to live? (As for the first sentence, c4ts, didn't both teams "try" to win? Mere trying is not the same as the will to win; the latter is always confered onto the eventual winners. I predict that not one paper, next monday, will say "despite the Eagles' greater will to win, the Patriots prevailed." or vice versa. Always, the winner is dubbed the one with the greater will to win.)

Our normal use of the term makes it clear that it is an after-the-fact judgment, and not an actual cause of living or dying. It is a label inferred from our behavior, not a cause of that behavior.

Originally posted by The GM
We know people can lose the will to live. Do animals do this? What makes human will special?

Because (other) animals tend not to write lots of stuff about themselves. Because it is scary to think that sometimes, people die. If we say to ourselves "he gave up the will to survive", it puts the decision back into his hands, and presumably into our own. We can assure ourselves that we need not die, so long as we do not give up the will to survive. It gives us the illusion of control in a circumstance which is largely uncontrollable.

Your brother was extremely fortunate, and you are justifiably grateful and justifiably celebrate his life (and the help of those who helped save him). To me, that is enough. That is truth. Attributing his survival to "will to survive" may make us feel more in control, but it says nothing other than that he lived.

 

[jmercer]

So it made me wonder about the will to survive. Is it different in humans? If an animal suffered the same sort of injuries, would they survive given the same level of care? Is human will different, special, and dare I say, spiritual in nature allowing success stories like my brother’s to happen? I’ve begun to wonder about that of late. If you want something badly enough, can you really make the impossible happen? My brother wanted to live, and it would seem that against the odds, he made it happen by the power of his own will. (And with a fair amount of help from some great people!)

I'll tell you my story, and you can draw your own conclusions. I don't normally share my private history with people on the internet, but this seems like a valid reason to make an exception.

My father died 4 years ago from pancreatic cancer. This cancer is particularly insidious in that it's virtually undetectable until it's in it's advanced stages. That's when several unrelated symptoms usually appear that causes an investigation - which ultimately reveals the problem. (Jaundice is among those symptoms.)

My father suddenly became jaundiced, and - after some tests - the doctors determined that he had pancreatic cancer. The reason for the jaundice is simple - as the tumor grows, it presses against the liver ducts. This eventually causes the symptom of jaundice.

My father immediately went to Sloan-Kettering in NYC, and got a second opinion from one of the lead specialists there on this disease. They confirmed the diagnosis, as well as the below treatment and prognosis.

Once the tumor has reached this stage, it is inoperable, and the patient only has a few weeks to live unless they have a major operation that re-routes the ducts - which my father did. After a successful operation, patients with this disease live on anywhere from 3 to 9 months. In unusual cases, they may last as long as 14 months, and in rare cases, perhaps as much as 16. This is what we were told at the time; I have no idea what the statistics are these days.

My father was adamant that he would "beat this thing", even though the doctors told him that only a handful had ever gone into total remission. The thought that he would eventually lose to it and dying wasn't even an issue for him - he was convinced that he was going to survive this and become one of the incredibly few that go into remission.

This was not a religious conviction for him; it was an almost obsessive belief. Pure denial, was how we all termed it privately, behind his back. It's very difficult to convey in words the degree of determination - even fanaticism - that my father had concerning this.

Two months after his operation at Stonybrook Hospital on Long Island, he was amazingly well recovered, and resumed golfing and tending bar full time.

5 months after his operation, he seemed perfectly normal, other than the side-effects from the chemo and radiation therapy, etc.

12 months after his operation, he STILL appeared to be perfectly normal, but he had lost a lot of weight, and was actually - for the first time in over 40 years - in the range of heathy weight. We joked with him often that he looked healthier now than ever before.

The doctors were quite surprised at this point. He wasn't in remission, but the tumor had shown no further sign of growth and his quality of life was stunning to them.

To make a long story short, my father lived for 21 months after his operation. His quality of life ranged from normal to acceptable up until the last 4 weeks, when he started to deteriorate. I visited him regularly, and during the last two weeks, it was apparent that he was sinking fast, and was going to die. He was still in denial about it, still insisting that he was going to eventually beat this thing.

I last saw my father alive three days before his death - he was heavily sedated, and drifting in and out of lucidity. He knew he was dying, and finally admitted to me that he was "in a bad way" - although he followed it up by saying he believe he could still beat this thing, reverting to his adamant refusal to give in. The next day, I got a call from my mother, who told me that my father had been admitted to the hospital. I offered to come, but she insisted that I stay home - she and my two sisters were there, and there was nothing I could do. My father drifted in and out of consciousness, delerious when awake, not aware of anyone being present in the room.

I admit that this was an easy decision to make. I had no desire to actually see my father die, and I had family and business obligations to fulfill, two young children and I lived over 120 miles away - so I took the easy way out. I don't regret it after speaking with my mother and sisters afterward, although sometimes I still regret not seeing him one last time.

After being in the hospital for 48 hours, my father was still hanging on, and hadn't deteriorated any further. The doctors told my mother - and I quote - "Some people just don't let go, and others just slip away. This could go on for a few more days."

My mother - a braver person than I - went back into the room with my father, and told him to let go and to stop suffering. That it was OK, that we'd be OK, and that no-one wanted to see him in pain.

According to my mother, my father turned his head toward her as if he were listening. Within minutes his status changed and he died about a half-hour later.

For myself, I am utterly convinced that the will to live has a tremendous impact on survival. It was the last lesson he ever taught me, and I'll always remember it. I hope my story helps you answer your question one way or the other.

 

[Phil]

How is this "where the will comes in"? You can't live if you don't do anything to keep yourself alive....ok, if you don't eat or drink, or any of those necessities...but where is the influence of the "will"? In every example I have ever seen, it is defined circularly, after the fact. Has anyone ever heard of someone who lost the will to live during an illness, and yet still recovered and lived to a ripe old age, never missing his lost "will to live"? Do we ever read of someone who dies, having never, even to the last moment, given up the will to live? (As for the first sentence, c4ts, didn't both teams "try" to win? Mere trying is not the same as the will to win; the latter is always confered onto the eventual winners. I predict that not one paper, next monday, will say "despite the Eagles' greater will to win, the Patriots prevailed." or vice versa. Always, the winner is dubbed the one with the greater will to win.)

Our normal use of the term makes it clear that it is an after-the-fact judgment, and not an actual cause of living or dying. It is a label inferred from our behavior, not a cause of that behavior.
Because (other) animals tend not to write lots of stuff about themselves. Because it is scary to think that sometimes, people die. If we say to ourselves "he gave up the will to survive", it puts the decision back into his hands, and presumably into our own. We can assure ourselves that we need not die, so long as we do not give up the will to survive. It gives us the illusion of control in a circumstance which is largely uncontrollable.

Your brother was extremely fortunate, and you are justifiably grateful and justifiably celebrate his life (and the help of those who helped save him). To me, that is enough. That is truth. Attributing his survival to "will to survive" may make us feel more in control, but it says nothing other than that he lived.

Merc, sometimes you're too smart for your own good. And I'm glad we're on the same team, if for no other reason than I can quote your posts and simply say "Ditto".

 

[Gulliamo]

We know people can lose the will to live. Do animals do this? What makes human will special?

Humans are special because we are self aware. I do not believe that other animals are. I am not fully convinced that we have a "will to live" but I think it is possible, maybe even likely. I think that animals that are not "self-aware" cannot have a "will" to live. But some animals do show a greater sense of "will" than others. For example: We've all read stories of the dog that ran into the burning house to wake the owner... A cat would never do that! Does that mean the cat has less will than the dog? Or have dogs simply developed a more defined sense of ownership through evolution?

At what point does the "will to live" get overridden by the "will to get out of pain?" Compare this to Merc's "will to win" by changing the sport from football to a "see who can hold the cigarette to their skin the longest" competition. I think the "will to win" would be a BIG deciding factor.

 

[Mercutio]

At what point does the "will to live" get overridden by the "will to get out of pain?" Compare this to Merc's "will to win" by changing the sport from football to a "see who can hold the cigarette to their skin the longest" competition. I think the "will to win" would be a BIG deciding factor.

Really? Do you think we can measure "will to win" before the competition starts? How? Or would we, once again, just infer that the winner had the "will to win", based solely on having won? Can you conceive of an outcome where one person had more "will to win" than the other, but lost nonetheless? What would that mean?

Sorry for all the questions--I sound like Iacchus. I hope these questions are more to the point.

 

[Anathema]

Interesting topic. Recently, my father was diagnosed with Stage 4 lung cancer, inoperable. He'll start chemo Friday. We are all pretty freaked out by the prospects, but looking for hope in any quarter. In my search for solace amid the gloom, I ran across a beautiful article by Stephen J. Gould, about the statistical realities of the cancer that should have killed him 20 years before he actually died. I found his perspectives powerful and comforting:

Attitude clearly matters in fighting cancer. We don't know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer.

Still somewhat circular, I suppose; but anything at this point beats despair...

 

[The GM]

I should add that I make my observations about will, not based soley on my bro's recovery, but from spending two straight months watching people come through those acute care doors, most in hopeless situations, many of them died. However, there were some who made it out. Besides my brother, there was another kid who came in who was the talk of the ward. He'd been in a car accident as well. By all accounts, he's a fierce competitor, a ball player for Texas Tech, I believe. He was ejected from the vehicle and literally left parts of his brain on the highway. When his parents were called, the hospital staff told them he was brain dead. Basically they'd kept him alive long enough for his folks to come and say goodbye. His father talked to him, the nature of his message was very private, but you can imagine what dad said to his son. To the amazement of the docs and nurses there, the kid's brainwaves went from flat to a blip, from blips to activity. Within a week, he was awake. Within a month he was walking and talking. To this day, the kid still has a big chunk of his skull missing, but he's determined to return to his normal life.

I watched another case, where a lady was brought in after her b-friend pushed her out of a moving car on the interstate and left her for dead. Her injuries were massive, as you might imagine and her prospects were pretty low for survival. However, she came out of it because in her mind, if she died, the b-friend would never be punished. Her need to live was so overwhelming that it seemed she cheated death itself to have justice.

There are other anectdotes as well, but it seemed that the people who had a sole focus and who refused to give up, made it where those who didn't...well, didn't. I remember a woman who came in, pretty sick and told the docs straight out that she didn't want to go on. She didn't last long, despite their best efforts to save her.

I would all be so tidy if there was a way to gauge this stuff, but there has to be something to this will stuff. If nothing else it lays the groundwork for the kind of positive attitude that Gould said was neccesary for recovery. If that's true, then will is a very real thing that affects recovery and quality of life.

 

[Mercutio]

I do not mean, by my argument, that attitudes have nothing to do with recovery. There is good evidence about self-efficacy, locus of control, being a "bad patient" (in other words, challenging what your doctor says and not merely doing it because she or he says so), all are positively correlated with recovery. Each of these things, however, can be independently measured (however imperfectly) in advance of one's eventual recovery or failure thereof. Of course attitude makes a difference. But in my experience (and I have seen nothing yet in this thread to contradict it), "will to survive", like "will to win", is different from these other examples. We do not measure it beforehand, but confer it on the survivor or winner after the fact.

As such, I suggest that the "will to survive", as a potential cause of survival, actually is harmful to our understanding of why one person lives and another dies. It has all the trappings of an explanation, when in fact it is merely a label; it may seduce us into thinking we have found a useful predictor of survival, and make the search for real predictors less urgent. ("Ah, see, it comes down to "will to survive". If you have that, you live. Case closed.")

Let us suppose that "will to survive" is the best predictor of survival. Pray tell, how do we increase a given person's "will to survive"? Is there a switch somewhere? Of course not... Perhaps a particular set of instructions before an operation would do it--a pep talk, as it were...if this is the case, by all means let us investigate the effect of this instructional set on survival. But note...we absolutely can measure--before the fact--whether a patient receives a particular instructional set or not. We can measure whether he or she survives. We can only infer, however, that the effect was moderated by some alleged "will to survive". Occam's razor suggests we cut out this middleman, and look at the effects of instructional set on survival. (For "instructional set", you may substitute any of a number of potential influences on survival--from familial support to control over painkillers, from diet to prayer...and see, empirically, which things work.)

 

[jmercer]

Instead of "best predictor", would you settle for "significant factor in enhancing the odds?"

 

[Mercutio]

Instead of "best predictor", would you settle for "significant factor in enhancing the odds?"

I don't really care what label is given to it, so long as it can be measured in advance rather than merely inferred from the outcome. Indeed, "significant factor in enhancing the odds" implies a causal relationship, which one simply cannot conclude from the post-hoc assignation of "will to win".

My use of "predictor" (you may use "significant" instead of "best" if you wish--I think you are correct there, I do not want to limit investigation merely to one "best" thing) rather than claiming a causal relationship is simply due to my behavioral bias. In order to claim causation, we would need to demonstrate it (which has been done with some operationalizations of "control", for instance). For many factors, I don't think we are at the stage yet where we need to look at causation--we have our hands full merely trying to find things which are correlated with survival. Certainly, none have ever tried to manipulate "will to win", and so we can't really speak causally of it.

 

[Anathema]

With advances in neuroscience, it may in fact be possible to map out the brain states of "high will to live" candidates, and look for such patterns in terminal patients. For instance, if we could pin down a profile like, "patients with highest levels of activity in regions X, Y and Z demonstrate superior recovery rates." At that point, perhaps deep brain stimulation could put all patients on a level playing field with respect to "recovery attitude". Until that then, I agree: trying to measure and maximize "will to live" is a pretty squishy business.

 

[Gulliamo]

Really? Do you think we can measure "will to win" before the competition starts? How? Or would we, once again, just infer that the winner had the "will to win", based solely on having won? Can you conceive of an outcome where one person had more "will to win" than the other, but lost nonetheless? What would that mean?

Sorry for all the questions--I sound like Iacchus. I hope these questions are more to the point.

I do not think we can definitively measure "will to win" but I do think we can gauge it.

Bear with me through an extreme example:

Simplified Competition: Pain resistance=hold forearms of two people together, place lit cigarette between, first one to pull away looses.
Other Factors: Person A is told if they win they will receive a million dollars. Person B is told if they win they receive one dollar.

I'll bet dollars to dimes that Person A will win every time. The "will to win" is gauge-ably higher that the "will to avoid pain".

Sure, this is an extreme example, but I just wanted to show that "will to win" is sometime gauge-able. It may very well be that in less extreme circumstances that the higher "will to win" will not out way the other factors. But all things being equal (and they rarely are) I think it does come into play. In fact, in many events the higher will would not matter as much. Example: If you told me that I would get a million dollars if I could beat Mike Tyson in a boxing match and he would only get a half million to beat me. Mike would win, with one hand, and I would walk away with one less ear.

All of that said: I also believe that many people simply have more to live for than others. Roughly translated to a higher "will to win".

 

[davidsmith73]

Really? Do you think we can measure "will to win" before the competition starts? How? Or would we, once again, just infer that the winner had the "will to win", based solely on having won? Can you conceive of an outcome where one person had more "will to win" than the other, but lost nonetheless? What would that mean?

Sorry for all the questions--I sound like Iacchus. I hope these questions are more to the point.

Perhaps we could equate "will to win" with the feeling of desire. Of course, we can't directly measure subjective feelings but does that mean that they do not exist? I am all for debating whether such a subjective feeling can be causal, but to deny it's existence based on the impenetrableness of the third person consciousness seems like a bit of a throw-back to behavioursim. It seems to me that the only way to measure the "will to win" would be by way of traditional verbal communication.

 

[Mercutio]

Simplified Competition: Pain resistance=hold forearms of two people together, place lit cigarette between, first one to pull away looses.
Other Factors: Person A is told if they win they will receive a million dollars. Person B is told if they win they receive one dollar.

I'll bet dollars to dimes that Person A will win every time. The "will to win" is gauge-ably higher that the "will to avoid pain".

I think you have just made my point.

What has been manipulated here is not "will to win", but financial incentive! We could, as experimenters, randomly assign people to one or the other of your conditions, and infer a causal relationship between the condition and one's behavior. But--and this is crucial--the only thing we would have manipulated is the reward structure, and logically the only inference we can make is that their behavior is a function of the money involved.

The fact that you (and not just you, by any means) are so quick to say that the difference is "will to win" is testament to how attractive this circularly defined "explanation" is. Once again, though, "will to win" is assigned only after the fact; reward or incentive was manipulated beforehand.

 

[Mercutio]

Perhaps we could equate "will to win" with the feeling of desire. Of course, we can't directly measure subjective feelings but does that mean that they do not exist? I am all for debating whether such a subjective feeling can be causal, but to deny it's existence based on the impenetrableness of the third person consciousness seems like a bit of a throw-back to behavioursim. It seems to me that the only way to measure the "will to win" would be by way of traditional verbal communication.

A throwback to behaviourism? Throwing toward behaviorism, and away from prescientific explanations, is in my opinion a throw forward. But then, I am a living fossil...a behaviorist. Of course, the fact that I hold that bias does not make me necessarily wrong.

No behaviorist denies feelings, though. The question about feelings is, are they causal, or simply caused? I welcome counterexamples, of course, but so far every single instance of "will to survive" has been circularly defined from the fact of survival. (Oh, and it is Watson's behaviorism which denied the existence of feelings--Radical Behaviorism does address them as private behavior, that is, just another of the myriad behaviors we engage in, under the control of environmental influences. In this view, "feeling a desire to live" would be seen as a private behavior, and we would look at the antecedents and consequences of that behavior to see its function in our lives. The third person problem is not a barrier for Skinner; private behaviors are simply behaviors, even though they have only one observer.)

If "feeling of desire" is positively correlated with survival, our next question, practically speaking, is A) can we directly manipulate "feeling of desire"? (answer: no), and B) what factors which we can manipulate are associated with "feeling of desire"? As before (in one of my above posts), even though we start out with "manipulate this, to influence "feeling of desire", to influence survival", the very fact that we cannot directly manipulate feeling of desire reduces our equation to "manipulate this, to influence survival". In a very practical sense, the feelings involved are irrelevant (I do not suggest that they are irrelevant to the patient, nor that they do not exist, but until we can directly manipulate them, pragmatism dictates that we deal with the things we can manipulate).