October is breast cancer awareness month.
As a psychiatrist, I am asked about coping skills to deal with difficult diagnoses, such as cancer.
Here are a few strategies you can use or that you can pass along to a friend who needs support.
1. Know about the five stages of grief.
After being diagnosed with any potentially life threatening condition, patients may likely experience the same stages of grief that people who are dealing with death of a loved one might experience.
These stages were discussed many years ago by psychiatrist Elisabeth Kübler-Ross, M.D.:
Patients may mourn the loss of the “cancer free life” they had prior to becoming aware of the diagnosis. They may deny that the diagnosis is accurate, have anger about diagnosis, bargain with God (e.g. if I do some really good things, can you make my cancer go away?), feel depressed about the diagnosis and what it means, and ultimately accept the diagnosis and hopefully work on moving forward.
2. Build a support system.
This may consist of family, friends, church members, etc. I encourage patients to bring a support person to doctor’s appointments.
Often, it is difficult to remember what the doctor has said. Your support person can take notes and ask those important questions you may not think to ask.
Let your support person be an advocate for you when you find it difficult to assert yourself. They may think of resources you are not aware of.
3. Be an advocate for yourself.
Review on-line or community resources. When you have appointments, ask your doctor if it is okay to record these appointments, which you can do easily with your phone.
You can also ask your doctor to jot down the recommended next steps, to include the important information to remember in preparation for your next visit.
If you are not feeling well, let others know. They may not know you need more help if you do not speak up.
Sometimes patients feel they don’t want to be a burden, however, letting others know what your needs are gives them something they can do to be helpful to you. They may not know what you need and giving them a few, clear tasks (e.g. please pick up dry cleaning, pick up my child after school, stay with me for a few hours this afternoon, pray for me), can make them feel like they are doing something useful for you and can save you time and energy.
4. Join a support group.
Many patients find these to be a beneficial resource. To be surrounded by others who are having similar experiences can make a big difference. Women can discuss how they have dealt with side effects from medication or discuss the best local resources. They can also share personal thoughts that they struggle with telling their spouses or children, such as, “I am scared I will die before I see my child graduate” or “I am scared about being a burden to my family” or “I am so angry at God. Why me?”
From the support group, the person may consider individual therapy and meet regularly with a mental health professional. Both individual and group support can be very helpful.
5. Be careful about you're wording.
One of the phrases that is like fingernails on a chalkboard to me, as a psychiatrist, is “I know how you feel.” And even though this is said to be supportive, it can actually have the opposite effect.
You will never know exactly how the person dealing with breast cancer is feeling, which is affected by her stage in life (younger versus older), her resilience, her overall body image, her spirituality, her supports. There may be emotions she cannot share with you. She may be trying to appear strong, but inside is the most vulnerable she has ever been. Instead, consider, “I can’t imagine how difficult this must be for you.” Instead of “Let me know what I can do to help.”
Consider dropping off a meal or offering to pick her up and take her to an appointment or babysit her kids for a few hours. It’s the little things that mean the most, especially at difficult and challenging times.
6. Embark on a spiritual journey.
Patients may ask themselves “Why me?” which can turn into “Woe is me” and they can feel stuck, isolated and depressed.
Patients do better when they can re-connect with their spirituality and ask better questions; “What does this mean for my life?” “How can I grow stronger through this?”
These patients find comfort in giving back to others, sharing their story, raising funds for breast cancer awareness, sharing education and knowledge, advocating for others.
Coming from this place of strength, they are role models to other survivors.
With education, support, and faith, you or your loved one can work through a difficult diagnosis.
~ Dr. Mel