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By Dr. Lisa Shusterman
In her essay, Turn and Face the Sun, Julie Culwell Auton describes how she lives her life after being diagnosed with breast cancer. From a therapist’s perspective, Julie’s column is a model of mental health. She openly faces her fears, accepts them as normal and finds a way to live well in spite of them.
Julie reveals that, after her cancer diagnosis, she feels a sense of heightened vulnerability, a worry about recurrence, and a fear of death. Such concerns are to be expected. The diagnosis of breast cancer makes people feel out of control. What was the cause of the cancer? Will I be able to tolerate the treatments? Will the treatments work? Will I survive? If I do survive, will the cancer recur? Can I do anything differently to prevent a recurrence? Will I be in pain? Will I see my children grow up? As Julie indicates, a basic sense of safety in day-to-day living disappears. Sometimes women tell me in counseling sessions that the “out of control” feeling makes them wonder if they are going crazy. The answer is no—you’re not going crazy. You are learning to deal with a difficult new reality in your life—the reality that you have been diagnosed with breast cancer.
Make choices everyday that enhance your life.
A cancer diagnosis changes your life. From the time of diagnosis, almost everyone becomes hyper-vigilant to bodily sensations. Julie reveals her worries that a normal post-exercise back ache, a common headache, and everyday fatigue signal cancer. Most people find that the hyper-sensitivity decreases over time but never disappears. Deciding when to see a doctor about a physical problem and when to accept a physical problem as normal remains an ongoing dilemma. When in doubt, it is better to err on the side of over-reacting to physical problems than to ignore them. If, however, you find that the anxiety about physical sensations interferes with your ability to think clearly or sleep, you may benefit from talking with a counselor or getting medication to help with the anxiety.
Julie writes that “fear of cancer (and, ultimately, death) is now my constant — though, uninvited — companion.” When someone hears that she has cancer, even if it is caught early and the prognosis is good, she wonders whether cancer will be her cause of death. Most cancer patients, including the most optimistic and determined women, become much more aware of death when they learn they have cancer. In fact, it’s almost impossible not to think about it; it’s the elephant in the room. Cancer may be your cause of death or it may not, but you need to deal directly with your fear or it can paralyze you. Well-meaning friends and relatives may try to talk a woman out of her fear of death from cancer, but it is actually healthier, from a psychological point of view, for a patient to speak honestly about her worries. Talking about a fear puts air in it and makes it lighter.
Living well after a diagnosis of cancer can be challenging. One helpful strategy is to take control when you can. Make choices everyday that enhance your life. Make choices so that if you were to die you will have no regrets. Be prepared for death but focus on living. Write your will and your advanced directives so that you know that you are ready for the worst case scenario. Then, live well. For Julie this means choosing to travel the world, relish different cuisines and take horseback riding lessons. For others it may mean repairing a problematic relationship with a sibling, finding a less stressful job, beginning a scrapbook, or learning to knit. It could mean cleaning less and playing more or learning to take care of you instead of always taking care of others. Julie Culwell-Auton is a good example of someone who used her cancer diagnosis as a second chance to choose what she really wanted her life to be. She took her diagnosis and made it a new beginning instead of an ending point. Putting your life in perspective and choosing to live the life you want to live, will help you to regain a sense of control over your life.