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Common Emotional Responses to the Diagnosis of Cancer

January 1, 2008 - 12:27 pm email to a friend printer friendly view / write comments

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Dr. West

Today’s post comes from Leah de Roulet, a great oncology social worker I introduced in my last post. She has kindly agreed to share some of her insights about coping with cancer as well as practical issues of navigating financial and insurance issues from her decades of social work experience. One of the founding directors of the nonprofit GRACE, I hope that Leah will be able to find the time to participate regularly by providing posts and participating in forum conversations about the large part of oncology that doesn’t deal with clinical trials and hard evidence. Here is her first post, on a timely topic on New Year’s Day, when we focus on beginnings.

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Cancer is a terrifying disease. While a number of other afflictions can be more assuredly fatal, malignant disease occupies a special place in our hearts and our minds. Many of us have memories of friends or loved ones who have succumbed to cancer in ways that can often be so painful, humbling and humiliating that no other illness strikes the kind of fear into us that this disease does. Such an illness, played out over an extended period of time, affects not only the patient but everyone close to the patient.

From that first enormously overwhelming expression of fear, panic, or emotional shutdown, other feelings come and go with disconcerting regularity; so many ups-and-downs that those of us who work with cancer patients think of it as the emotional roller coaster everyone rides during the cancer experience. There may be anger, depression, anxiety, a sense of being helpless, powerless, out of control, extreme feelings of vulnerability, feelings of betrayal by their own body, or of unfairness, as in “Why me?” Above all, the overriding emotion is fear: fear of treatment, fear of loss of control, and fear of death.

Always, there is grief – grief for the loss of the sense of one’s self as a healthy person, a sense most of us carry with us and seldom acknowledge until something goes wrong with our health, and that image of ourselves is destroyed. Suddenly, we are very vulnerable! This form of grief is almost never acknowledged; we are conditioned by our culture to hang tough, be strong, and certainly, no self-pity is condoned. Still, the sadness is there, and it is hard to give voice to the feelings, rarely identified as grief, for the simple fact of having cancer. Yet, think of the loss, no longer can the patient say, “I am a healthy person”, but rather, “I am a person with cancer”. Family members and friends will find it helpful to understand the feelings, emotions, and psychological tasks of the patient recently diagnosed with breast cancer, and recognize their own feelings in these descriptions. A famous author, James Baldwin, once said, “Not everything that is faced can be changed. But nothing can be changed until it is faced.”

So, how does one manage to cope with all of these terrifying waves of fear, grief, panic, and face the challenge of meeting with physicians, discussing treatment options, worrying about family concerns, financial concerns, children’s concerns, and make the best decisions possible under the circumstances? In this first column, we will begin to explore what helps, and it is my sincere hope that this will become a true conversation between you, the reader and me!

Let’s begin at the beginning, with diagnosis. Most patients report that they never heard another word after the doctor used the dreaded “C ” word, and said, “Yes, unfortunately, this is cancer”. Common responses include statements like these: “I remember feeling fear, just fear: fear of dying, fear of pain, fear of treatment, fear of being sick, fear of dying in pain.” Or, “I was consumed with panic; I wanted to run away, but there was nowhere to run; the problem was inside me! How could I feel so well and yet have something so wrong growing inside me?” I actually had a patient once who did run away; she called me from somewhere on the Olympic Peninsula after being gone for over 24 hours, and asked me to call her husband and tell him she’d be home tomorrow; she just needed time to sort it out for herself. This was the rare someone who acted on the feeling so many patients have!

Alternately, some people feel nothing; the fear and anxiety are so great. I

Posted in: Social Work/Coping with Cancer

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Common Emotional Responses to the Diagnosis of Cancer

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