“I’m wondering where the lions are.”
That was the answer I got when I asked Jack (not his real name) how he was doing, one year into a CML diagnosis.
You may think that this is a surprising answer if you knew that Jack’s journey with Chronic Myeloid Leukemia has been relatively uneventful. Achieving remission only a couple of months after starting medication, with almost no side effects, Jack was living the CML patient’s dream: life was pretty normal.
Except that it wasn’t. While Jack looked great on paper – with consistently stellar blood results – emotionally, he was ball of anxiety, uncertainty and fear. Hence, the comment about the lions.
And while it isn’t hard to understand that a cancer diagnosis, even with an excellent prognosis, could create significant emotional upheaval, anyone who works with cancer patients will tell you that some people are less “upheaved” than others. We have all met those people. You know the ones. They may face terrible pain and discomfort, even certain death and yet, they smile, remain optimistic and make the most of every moment. How do they do that?
Well, it turns out that the ability to move smoothly through crisis has a lot to do with the kind of person you were before the crisis. In fact, the way you handle crisis can be predicted with some accuracy depending on what kind of childhood you had.
“Your childhood experiences definitely make you more vulnerable to anxiety,” says Dr. Mary Vachon, co-founder of cancer support organization Wellspring. “If you had early attachment issues when you were a child, this all ties into fear and health, and can create problems when it comes to healthcare challenges.”
So does that mean I can blame my anxiety issues on my mother?
The answer is not quite that simple, says Vachon, who is also a nurse, psychotherapist and clinical consultant at Wellspring. She points out that early childhood experiences affect a whole lot more than just anxiety.
“Newer research is increasingly showing that the way we were raised as children and our early experiences not only determine how we cope, but they also can and do shape our immune systems, leaving us more or less susceptible to illness.” She adds that these early experiences also determine the relationships we may develop with our caregivers.
There’s no question that the water gets muddy when you try to pin down the true impact of childhood experiences on emotional health. But what is clear is that if you are dealing with a cancer diagnosis and can’t move though the worry and fear, you need to do more than address those feelings – you actually need to start at the beginning.
“Take a look at what you are bringing to your illness,” she says. “If you were anxious before your diagnosis, you will be anxious after a diagnosis. It is more about who you are, and less about your illness.”
Makes sense. But since changing our past or personality isn’t an option, are there steps we can take to manage who we are, and get through this?
“Well, there are the usual strategies like yoga, and meditation,” says Vachon, adding that these tools can help train the mind to take control of negative thoughts and feelings and help people to “not go to that scary place” when they are overwhelmed with fear and worry.
Vachon, who runs a private psychotherapy practice in Toronto, also stresses the importance of psycho-social support, calling therapy one of the “most important intervention techniques” for people struggling with anxiety, or as Jack put it, waiting for the lions.
But I want to go back to Vachon’s point that who we bring to our diagnosis is who we were before our diagnosis. It’s a critical observation that can’t be ignored if we are talking about treating the whole patient.
Of course the people who provide us with health care don’t know who we were before. Unless you are one of those people who are lucky enough to have the same physician that you did as a child, or perhaps their offspring have taken over their parent’s practice, your doctor has no idea what kind of childhood you have had. They don’t know what your experiences have been. They don’t know you.
But maybe they could.
I mean, really. Listen carefully to how someone responds after a cancer diagnosis, and you will know in about five seconds (or under two, if that patient is me) the level of anxiety that they are not only feeling, but are likely to carry with them throughout their treatment. It’s the same anxiety that will impact how it all goes. Because here’s the thing; we know that when we feel listened to and understood, the outcomes are better. We are more likely to follow direction, take our medication the right way and tell our doctor when we don’t. We also feel supported, less anxious and less uncertain. So isn’t it worth going that extra mile to get to this place of patient/doctor nirvana?
And sure, it may seem unrealistic to expect this level of connection in a time when many medical professionals are feeling the pressure of meeting the needs of growing patient loads. Pile on the additional role of advocating for drug access and keeping up with reams of new clinical data, and you have a framework that doesn’t leave much room for the warm and fuzzies of patient care. I get it.
But still, given the benefits of better communication between patients and doctors, can we afford to dismiss it as simply something that there’s no time for?
Perhaps the answer lies in the crazy number of patient organizations that have been formed in the last few years, as advocates seek to bridge the gap in emotional support, and provide patients and caregivers with a sense of community. Or maybe the answer lies in the countless media reports that talk about the prevalence of depression, anxiety and suicide among people who have received a cancer diagnosis.
The bottom line is that if the degree of anxiety felt in the wake of a cancer diagnosis can be closely tied to past emotional health, as Vachon says, a healthcare team not able to address these concerns can mean significant emotional implications for people like Jack.
And that is something we cannot ignore.