October is Breast Cancer Awareness Month. I’m putting on hold my blog post on trauma to address the emotional needs facing breast cancer patients. Granted, cancer patients often talk about their experience of cancer to be traumatic, even though many do not meet full criteria of Post-traumatic Stress Disorder.
To hear that, “You’ve got cancer” is enough to unravel any brave soul. The urgency of the news leaves little room for reflection, for contemplation. You’re scheduled with the surgeon, followed by the radiation oncologist and likely the oncologist. Some medical facilities fit all three appointments into a four-hour meeting; others schedule them one at a time. Either way, your head is full and it’s hard to digest information about the stage, tumor size and grade, if it’s hormone dependent and whatever else you’re supposed to know.
All this knowledge; all these next steps, but how are you feelin’?
Facing a loss
Being diagnosed and treated for breast cancer is to face your own mortality. Your vision for what your life would be like is called into question. You thought you would live to hike the Annapurna Circuit, see your kids graduate and hold your grandkids in your arms. All these plans are now up in the air. Even if you were told the type of cancer you have is highly treatable, you’re starting to envision a very different future.
The pendulum through the messiness of grief
Being diagnosed with cancer or other chronic illness is to grieve a loss. Sure, you’re used to your body having some aches and pains, but you’re definitely not as healthy as you had thought. Thus, it makes sense that women going through breast cancer would face different stages of grief in no linear fashion.
Also known as non-acceptance, denial happens because you’re in shock and overwhelmed by the news of cancer. “Were those really my test results? Did the doctor make a mistake?” You might weep and you might also feel numb. You might wake up in the middle of the night wondering if it was all a dream. It is common for you to feel out of touch with the rest of the world because quite frankly, you would much prefer a life without cancer, thank you very much.
Your mind races through choices that could have detoured cancer. “What if I had lived a healthier lifestyle? What if I had gotten a second opinion? What if I had reconciled that relationship rather than let it eat at me all these years?” There are no answers to these questions but it doesn’t stop you from asking them. Conscious or not, when you consider how you could’ve affected the outcome, it’s a way to take back the control you feel like you’ve lost. Similarly, you might bargain with God or a higher power to give you another chance at a life without cancer. Or, at least not now, though there really isn’t a good time.
While not all breast cancer patients meet criteria for clinical depression, sadness is very much a part of the grieving process. When you think about how your body is sick, the possible side effects of treatment and how cancer might affect your quality and quantity of life, you understandably would feel sad. Women have often talked about treatment leaving them feeling “disfigured” or “damaged.” This might lead to feelings of shame and negative self-worth and the tendency to isolate and push people away.
“Why is this happening? Why me? What have I done to deserve this?” are some of the questions that breast cancer patients might ask. Implied in these questions is a sense of unjust, that this shouldn’t be happening. Sometimes, you might feel anger towards yourself, if you think you could’ve somehow prevented cancer. Other times, you might be angry at God or a higher power from “allowing it to happen,” or at your healthcare providers for not doing more to help. Unfortunately, your loved ones might get the blunt of your anger, simply because they’re the closest to you.
If denial is synonymous with non-acceptance, then acceptance is to face the reality of what is: “You have cancer.” It’s hard to read those words and to face them head on, but to keep on denying that fact is to say, “Cancer has you.” To accept something does not mean you have to like it, or that you approve of it; it only means you’re not fighting the reality of cancer diagnosis, treatment and prognosis. You’re more willing to look it in the eye, and say, “Okay, let’s do this.”
The actual stages of grief
The five stages of grief originally coined by Elisabeth Kübler-Ross is actually in the order of denial, anger, bargaining, depression and acceptance. I mixed up the order to show that there really isn’t a right or wrong way to go through grief because mourning a loss is meant to be messy.
You could be accepting the side effects of chemo one moment and then be very angry that you missed the toilet and barfed all over the floor the next. You could have a good cry and feel at peace, and the next crying episode could make you very angry at God. You might want to cancel your MRI and be in denial about what your doctors would want to say to you and the next day, invite a friend to come along to your imaging appointment.
The Kübler-Ross model likely does not encompass the emotional complexity of your cancer journey. Nonetheless, your cancer experience is your experience. It is okay to feel the way you do; all of your feelings are valid and normal. Allow yourself to go to these places; it’s a part of the healing process.
If you need help navigating through the messiness of these feelings, I’m here.
Ada Pang, MS, LMFT is the proud owner of People Bloom Counseling, a Redmond psychotherapy practice in WA. She helps distressed couples and breast cancer patients. That could also mean couples distressed by a partner’s cancer diagnosis, or couples wishing to use their marriage as a resource during their cancer journey. When she’s not thinking about work, she loves spending time with her hubby, eating good food and more recently, watching Harry Potter.