Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Toxic positivity


A stage 4 cancer patient taught me how constant encouragement can be emotionally draining for someone facing their mortality. Presence, love, and understanding may be better received. 

Zack had stage 4 cancer. He said to me, “I’m not doing well doc. Not doing well at all.” 


“Tell me more,” I said gently. 


He shared how he’d had to cut down his part time working hours from 30 to 20 to 10 in the past three months. He was worried he would get so tired that he wouldn’t be able to work at all. 


“My friends keep cheering for me. No one hears me say that I’m not doing well. And I’m not doing well. Cheering isn’t working. This toxic positivity is hurting my soul.” 


I felt tenderness in my heart as I listened. He wanted and needed his deep sorrow to be heard. For permission to fail, not encouragement to succeed. 


He expressed his gratitude to me for listening. He said it felt good to say this all out loud and for his feelings to be validated. I observed that though he had social connections, there was no space for him to share the anticipatory grief of leaving his life behind. No space to review his life and reminisce about his life. He wanted and needed to feel his deep sorrow. 


He didn’t need cheering, he needed compassionate understanding. 


We came up with a plan to share his needs with his friends. 


“I’m going to tell my friends, “Don’t cheer me, it’s not helping. What I need is grace and understanding.” He smiled and seemed lighter. 


Sometimes cheering may be harmful rather than useful. Showing compassionate understanding of despair can bring some level of peace to the seriously ill and dying. Rather than cheering, receptive listening can honor their life experience. 










This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.