Cancer affects us not only physically, but also emotionally and mentally – even if you are without the disease, if you are a relative, friend, colleague or health care professional. In that way, cancer is no different to other illnesses or difficult experiences we may face in our lives.
However, the one big difference with life-changing, life-shortening and potentially (or actually) terminal illnesses is that a) the impact on how we feel emotionally and mentally can become long-term and b) it strikes at the core of our existence and of who we are. That’s why you may hear it referred to as an ‘existential crisis’.
You may experience it as anxiety, depression, stress, mood swings, irritation, frustration, anger, relationship issues, guilt, self loathing, exhaustion and much more. But at the core is fear and grief, for what we no longer have and what we may never get in the future. Because cancer changes everything, even if you are in remission or have no evidence of the disease post treatment.
We become more aware of our mortality. Treatment may have left long-lasting side effects. Regular or infrequent monitoring and routine check ups can retrigger difficult memories and fears. Sometimes we may live from one appointment to the next, without the sense of much of an active life, the way we may have had it before, in between.
You may feel “I don’t know myself anymore”. We can lose self confidence, joy of life, meaning and purpose. Perhaps we can no longer do the work we loved, or have the financial security we need. Everything can be a lot more difficult and unpredictable. It’s hard to be care-free and spontaneous.
I am probably not telling you anything new, and you probably recognise a lot of it. But I am saying it, to let you know this is “normal”. You are not feeling it, because you are doing “the wrong thing” or because something is “wrong with you”.
Sometimes, it is called “the new normal”. You (and I) may say “Take your ‘new normal’. I’d rather have the ‘old normal’ – thank you very much.” But, sadly it does not work like that.
And sadly, we don’t always get enough (or any) information about what to expect emotionally and mentally through the different stages of our cancer experience (diagnosis, treatment, living with / beyond cancer…). Rarely is it an integrative part of our treatment plan.
There is not enough sign-posting about where to go for help. Depending on where you live, the help may be rationed with long waiting times. And when you get there, you may be allocated to a counselling group, where people have a range of different problems, and it’s not cancer-specific.
I certainly did not get any advice. When I was diagnosed with breast cancer for the first time, I grabbed all the leaflets I could get in waiting and treatment rooms. I did not necessarily read them all, but I instinctively felt, that I needed more help, beyond what I was offered.
I was offered bags full of medication for physical pain, but nothing for my emotional pain. My own therapy training helped me to some extend. But real life has been the greatest teacher of all.
I, too, had to find a way of living with the “new normal”. And I find it’s a process. There is no single blue print. We have to do it for ourselves. Depending on our own circumstances of the illness, overall physical health, our past, family set up and what else is going on, we have to find a way to make it work for us.
The emotional and mental impact of cancer takes up a lot of space and energy. Which means we have to make space for it and for dealing with it. Therefore we cannot carry on with all the stress, responsibilities and commitments we may have carried before. Especially if we experience the sometimes long-lasting effects of cancer fatigue, which can be unpredictable and make the most beautiful of days look absolutely dull and grim.
People often say: “But that means giving in to the cancer. I don’t want to compromise my lifestyle and way of life.” I understand that. I am talking about putting yourself first, not over-burdening yourself. Otherwise you may implode or explode. Because it’s a lot to carry.
Cancer is also about a sense of having lost control. By making explicit choices about the areas of our lives where we can, we are reinforcing the control we have.
To help ourselves we may need to investigate and acquire coping strategies and tools. Some don’t work for everyone all of the time. In the past I was not open to some things that help me now. As I said, it is a very personal process. But whatever you opt for it needs to help you destress, gain some perspective on your life now, and how you want to live it, or what you need to do to be comfortable with what may lie ahead. Strategies that help you cope with anxiety and anger, and ultimately give you some renewed sense of purpose, meaning and identity.
Therapy and counselling can offer a space to explore all this. Mindfulness, physical activities (even gentle), being creative (writing, cooking, gardening ….), breathing exercises… things like that can really help to calm us physically and therefore emotionally and mentally. And with that calmer frame in place we can think through more clearly what we want to do. They are also techniques that can help us prepare for and go through difficult moments, like scans, consultations, conversations and the like.
When we are affected by cancer, our emotional and mental health is a key integral part of our wellbeing, well beyond the end of cancer treatment.
Karin Sieger is a London-based psychotherapist and writer. She specialises in support for people affected by cancer locally in person or globally online. She offers to feature anyone who is “creative despite cancer” on her website, and hosts the weekly online talks “Cancer and You” and “Soul Cravings” on PeaceWithinRadio.com. More information about Karin and her work visit KarinSieger.com