For some women with breast cancer, the best way to cope is simply to be their cranky, scared selves.

After Maia Danziger got breast cancer, her biggest gripe was when people told her to be more upbeat. "I wanted to poke them with a pitchfork," the 49-year-old actress and life coach from Studio City, California, says with a laugh. "The appropriate response to this diagnosis is to wail, 'What do you mean I could f---ing die? What do you mean I have to get my breast cut off? What do you mean I'll throw up and go into menopause?'"

Danziger – who has been cancer-free for 10 years – is all delicate bones and pale skin. But her voice is strong and her words, earthy and often X-rated, are a sharp contrast to what has been the prevailing wisdom in the breast cancer community for the past several decades: From the websites with their inspirational advice and remembrance pages, stuffed animals with HOPE printed on them and the glitzy celebrity fund-raisers, the implicit message to women with breast cancer has been that to beat the disease you must be cheerful. Among my friends who've had it, I've witnessed firsthand a determination to put on a brave face – even when nauseated, in pain and, one can only presume, scared, angry and sad beyond measure.

Why the relentless perkiness? In part, we have needed these women – our mothers, sisters and friends – to be optimistic so we can be optimistic for them. "The problem is, this 'tyranny of positive thinking' puts a tremendous amount of pressure on women," says Jimmie Holland, M.D., attending psychiatrist at Memorial Sloan-Kettering Cancer Center in New York City.

Dr. Holland is on a crusade to debunk this way of thinking. "We make people with breast cancer think they can't have a down moment because if they do, their tumors will grow faster," she says. "Since the '70s and '80s, it's been, 'Read these self-help books and you'll be positive and beat the cancer. Visualize your immune cells as guns killing off the cancer cells and you'll live longer.' That's malarkey. There is no data to support that at all."

Susan Love, M.D., medical director of the Dr. Susan Love Research Foundation in Pacific Palisades, California, agrees. "The data linking a positive attitude with survival has never been terribly strong. A patient's outcome depends on many factors," she says. "Besides, can a pessimist with cancer become an optimist overnight? Every woman has to be true to herself."

Dr. Love's perspective (shared by brash young survivors like Danziger) may be a harbinger of a new, less dogmatic attitude toward coping with cancer: You don't have to be an optimist. You can do it your way. Rage, weep or tear your hair out – if you have any hair left to tear after chemo. Surf the web for studies about breast cancer. Or don't. Just don't let others tell you how to act.

"I don't think it's productive to ask anybody to alter a way of coping that has worked for them before," Dr. Holland says. "You don't tell someone to become a different person, to become a chatty Cathy and join a support group if it's not in her nature."

The thinking on breast cancer support groups, long considered a boon to survival, is changing. Back in 1989, a widely touted study in The Lancet found that women with metastatic breast cancer who attended support groups lived longer than those who didn't. The trouble is, several subsequent studies couldn't duplicate those results. "When it comes to the link between support groups and survival, the jury is still out," says David Spiegel, M.D., author of the original Lancet study.

For her part, Danziger steered clear of the groups and turned to alternative therapies such as yoga and Mongolian chanting. She also avoided friends proffering advice. "Some people said to me that maybe now I would slow down," Danziger recalls. "The implication was that my crazy schedule had caused the disease. That way of thinking just leads to self-flagellation. So I cut those friends out of my life."

That may have been the healthiest thing Danziger could have done. A July 2004 study by the Kaiser Permanente Center for Health Research and Oregon Health & Science University, both in Portland, suggests that unwanted advice can be damaging to breast cancer patients.

Danziger didn't only lose friends; she also lost a husband. "Our marriage ended," she says, though he stayed through the treatments. "All kinds of shit went down. I went into menopause and was bouncing off the walls; then I'd crash in front of the TV in a major depression. It wasn't pretty."

Soon, however, she marshaled her forces. "For me, breast cancer required fierceness, not optimism," she says. "You need to become a warrior. That's what I tell people." That word, warrior, sums up the new attitude among survivors, especially younger ones – women like Dikla Benzeevi, a 34-year-old executive secretary in North Hollywood, California.

Benzeevi arrives at my house with a stack of material about young women and cancer, and with three teddy bears: one with CANCER SUCKS! on its chest, the others with CANCER WARRIOR and IT'S GOING TO BE OK. She also carries two photos, of her mother and her aunt, who died from breast cancer at 54 and 42, respectively.

Benzeevi's doctor discovered her lump during a checkup two years ago; since then, she has had a lumpectomy, chemo, radiation and immunotherapy. When she talks about it, she is both forthright and fierce. "The thing that mostly kept me going was anger," she says. "There was no one to help me find doctors, no patient advocate. Plus, a week before chemo, the oncologist told me I might become infertile. I freaked – I went home and cried."

Benzeevi did find her way to two support groups, including one run by weSpark, a cancer support center in Sherman Oaks, California. "It was great for getting practical advice about how to deal with all the side effects," she says. "And on an emotional level, talking to other women with cancer made me realize my feelings were normal." Marie Ritz, associate director of weSpark, explains, "We're constantly providing permission for the women to be angry. But we also give each other permission to cry or laugh at how ludicrous it is in a lot of ways."

Yet Ritz is the first to acknowledge that support groups aren't for everyone. "Some people come for years," she says. "Others come once, then we don't see them again. Everyone has to find their own way to get through it and deal with the stress."

However they do it, reducing stress is considered a good thing for breast cancer survivors, and increasingly, experts are looking at its role in the disease. Dr. Spiegel, for instance, is currently studying whether lowering stress can help patients live longer. So far, his findings suggest that women with abnormal levels of the stress hormone cortisol may end up dying sooner, though "the literature on stress and cancer progression is divided," he cautions. "But learning to manage stress more effectively is critical. Whether or not you live longer, you ultimately live better."

Sharlene Miyagishima gets through her breast cancer ordeal by laughing. The 42-year-old schoolteacher in Woodland Hills, California, is married to a fire captain and is the mother of two boys. Miyagishima was diagnosed just shy of her 38th birthday and had, in quick succession, a lumpectomy, radiation and chemotherapy. Two years ago, there was a recurrence in her sternum, part of which the doctors cut out. When she talks about all she has been through, she is frank – about her cancer, her boys, her deepest desire to see them grow up, and about her husband, who, she says, has been wonderful through everything.

"The most helpful thing for us was to laugh," she emphasizes. "That was our way to cope. One night we were at a potluck dinner. I was reheating some food and kept opening the oven door to check on it. A friend came by and said, 'Here, let me fix your hair.' Then she said, 'Oh, God, it's hard.' The bangs of my wig had melted together. When my husband saw it, we laughed."

Miyagishima has her less-than-mirthful moments, too. It's tough, for instance, to laugh off the fact that the hormone-suppressant cocktail she is on has taken a toll on her sex drive. More and more, she and other survivors are talking about these losses, not in a knee-jerk, optimistic way, but in an angry, battle-scarred way.

Danziger is willing to go as far as to say that in some respects, breast cancer has been a good thing for her. "Do I think it can be an opportunity? Absolutely. Is my life better than before? Yeah, because I know what I'm capable of," she says. "People say to me, 'Oh, you're such an example.' And I'm happy to be. I fought tooth and nail to get through it."