“Well, you certainly have a very positive attitude,” said the white-haired woman with an approving nod.

“Thanks, yes. Most of the time anyway,” I replied. The woman had asked me how I became an amputee as I mingled at a coffee hour at my parents’ church. I gave her the short version of my story—cancer, chemo, surgeries—and more details in response to questions, and I kept a smile on my face as I did so.

I wasn’t upset or irritated by her questioning. She was polite, even warm. Unless people are rude, I generally answer their questions quite pleasantly. Inevitably, this involves a smile and cheerful tone of voice.

Any cancer survivor learns quickly that cheerfulness is the mandatory emotional display  in order to be judged a good patient or a good survivor. On the one hand, medical evidence supports the belief that optimism, hope, and positivity correlate with improved health outcomes for patients. On the other hand, the pervasive cultural demand for positive attitudes from people with any significant illness, notably cancer survivors, is also widely (and often sarcastically)  acknowledged. Barbara Ehrenreich explained in “Welcome to Cancerland” that “cheerfulness is more or less mandatory.” Likewise, Samantha King describes the “tyranny of cheerfulness” in Pink Ribbons, Inc., an excellent book and documentary on the ways in which corporate breast cancer awareness advocacy often benefits corporations far more than it does cancer survivors.

I’m not the only cancer survivor who finds implicit demands to be cheerful exhausting, I know. It takes courage to resist the tyranny of cheerfulness and instead admit to strangers—and even friends, colleagues, and family—that cancer is a raw deal. And even more courage to add that not only was cancer treatment horrible, but it also left many of us with chronic late effects that seriously impact our quality of life.

This act of resistance takes courage because the reply is inevitably, “But you must be so grateful to have survived! Thank god for the amazing treatments that are available now!” This demand for gratitude and cheerfulness is almost never accompanied with any acknowledgment of our past or ongoing suffering, so it sounds a lot like, “Stop complaining! You are lucky to be alive and should be grateful no matter what you have to deal with.”

I admit I don’t want to be judged a bad survivor and shamed for speaking the truth. But there is something else at work here, at least for me. Like a moth drawn irresistibly to a flame, I desperately want to believe that sustained cheerfulness is powerful enough to make me feel better. Wouldn’t it be wonderful if having a positive attitude really did help?

I want to believe that I can eliminate my phantom limb pain by cheerfully refusing to accept that an amputated body part continues to hurt.

I want to cease having panic attacks at the dentist because I have been so positive and upbeat when working with my therapist to release traumatic memories of being immobilized on a gurney for surgeries that my brain stubbornly equates with reclined dentists’ chairs.

Maybe if I smile brightly enough, the side effects of my pain medications will stop making me miserable.

If I keep my chin up all day, the feelings of anxiety and depression will go away.

So far none of these things has proven true for me.

I know that the tyranny of cheerfulness is largely about other people’s discomfort with cancer survivors’ (or really anyone’s) suffering. But the tyranny is also seductive, in that it tempts us to believe that our suffering will abate if only we embrace the good cheer mandate with our whole hearts.

When this proves untrue, as it inevitably does, it might do survivors more good to let our chins drop, our upper lips droop, our relentless smiles dim, and our positive attitudes fail for a while. Taking a break from mandatory cheerfulness—even if only in private—can help us let go of not only the burden of other people’s expectations, but also the weight of our own.