Dr. Larry's Couch
Coping With Cancer

Coping With the Emotional Challenges of Cancer Treatment

The Shadow Side of the Soul: Entering The Emotional Abyss and Dealing with "Delayed Grief"

Carl Jung, the founder of Analytical Psychology who once studied under Sigmund Freud, believed three things. First, that our spiritual needs are equal to if not more potent than our basic biological needs. Second, each and every one of us "actively create meaning" from our reality of daily existence. And third, that each one of us has a shadow side. Our shadow is the unconscious part of who we are which contains traits or impulses that we find unacceptable and which we try to ignore. However, after our cancer treatment has ended, and we find ourselves sinking into the swamp of the emotional abyss, we are indeed forced to confront our negative thoughts and impulses that comprise the shadow side of our soul.

Many times those of us who are cancer patients become more anxious and depressed after we have successfully completed our treatment, than before. Our friends and family can't understand why. Well, there are several very valid reasons why.

For one, our tightly organized and structured daily routine of chemotherapy and surgery is gone. We are now left with "empty space" to fill and nowhere to go. We now face the task of picking up the pieces of our lives that were left scattered about after receiving our diagnosis (remember Humpty-Dumpty?) Also, our friends and family figure "the crisis is over," that we are no longer sick and that it's time to get back to business.

When you are "sick," medical staff, family and friends help shoulder your emotional burdens. However, when your treatment ends, and they begin to withdraw back into their own daily lives, this can cause you to feel abandoned, isolated and scared. You may be left with an assortment of big and little losses to grieve. These "secondary losses" may include loss of your good health, loss of a body part, loss of normal energy, loss of activities, loss of personal relationships, loss of appetite, change in your appearance, loss of insurance or financial security, and loss of opportunities at work and at school.

Some grief experts talk about this as being "delayed grief," which is grief "put on hold," for an extended period of time, even up to ten years! For example, one of my bereavement group members is only now painfully grieving the tragic death of her husband from 10 years ago, when he was suddenly killed in an automobile accident. Similarly, after you are diagnosed with cancer, you are forced to put on hold a multitude of losses that are associated with your illness until you are done with your treatment. It is during this specific period of time, after treatment ends, that you may find yourself entering a deep emotional abyss and confronting the shadow side of your soul. For many of us with cancer, this point in our cancer journey only marks the beginning of a long and winding road of emotional and spiritual recovery.

Dr. Larry's Story
At the time of my cancer diagnosis, I was running five miles five times per week, weight training three times per week, practicing the martial art of Aikido two times per week, and was eating a vegetarian diet. I did not drink. I did not smoke. I did not use recreational drugs. When I got enough sleep, I never got sick; at least not until May 19th, 1997, when I was diagnosed with Stage II B prostate cancer.

After being diagnosed, I did not have the time to really ponder what the loss of my health meant to me. All I knew was that I had cancer and I wanted it out. And I wanted it out NOW!

I went into surgery a 39-year-old male in good condition who could run, workout and urinate normally. I came out of surgery two hours later being functionally 89, hardly able to walk, stooped over, and hooked up to a urine bag and catheter. My once tight, toned, conditioned abdominal muscles, which were retracted during surgery, were now limp and distended. Yuck!

I found that my body didn't work right. I couldn't walk right. I couldn't do the simplest of physical tasks that I would have normally take for granted: bending, running, exercising, and driving a car. What most people experience GRADUALLY through the normal process of aging, I experienced all at once over a two-hour period. I was no longer the "normal" healthy Larry that I was before surgery. The shadow side of my soul was emerging. I was someone else. I was something else. I felt like damaged goods.

My recovery from surgery took quite a long time. Even after returning home and being off the catheter, I still experienced aftereffects that included fatigue, weakness, pain, sleeplessness, problems with digestion, an inability to exercise, an inability to actively socialize, an inability to commute to work and graduate school, and a diminished income. I was now dependent on friends and neighbors to go food shopping for me and to lift heavy objects. I found myself groping around in an identity "vacuum" trying to establish a "new normal." I had fallen into the abyss and didn't know the way out!

Shadow Boxing: Adding Injury to Insult
What added to my post-treatment feelings of isolation, anger and depression was the sad fact that several people who I thought of as "friends," seemingly could not handle or cope with my having cancer. Illness and death were too scary for them. It triggered their own shadows and out of their own anxiety, they distanced themselves from me during my treatment and recovery. I was deeply hurt. This was another example of what grief expert Dr. Therese Rando calls, a "secondary loss."

The other part making up my emotional abyss was the fact that since my treatment had ended, and now that I was supposedly "cured," my family and true friends went back to their daily routines. The message I received was, "It's time to get on with your life and get over it."

But "going on with my life," was impossible. I was in the abyss. I was face to face with the shadow side of my soul. I was grieving all of the losses that I had put on hold while racing around like a chicken without a head, figuring out which doctor to see and what treatment to get, following my diagnosis. IT WAS ONLY NOW, AFTER FINISHING MY TREATMENT, that I found myself needing people more than ever. It was now that I felt the most vulnerable.

The Never Ending "What Ifs?"
In addition to my loss of relationships, I was also afraid that the surgeon did not get all of my cancer out during surgery. My mind was preoccupied with such thoughts as: "What if it had spread?" "What if it comes back?" The what ifs were playing havoc with my general sense of confidence. I was no longer certain about anything. I was "shaky" about driving, bending, lifting, traveling, socializing, playing and working. Somehow I had to find my way out of this deep and dark emotional abyss and regain my confidence in me again. I truly didn't know what direction I was going in nor where I was going to end up. I was being forced to deal with death. I reluctantly came to realize that in order to climb out of this emotional abyss I was going to have to grieve for the old me, the old Larry, and my old way of life as well as acknowledging the "unacceptable" or unattractive feelings arising from the shadow side of my soul. If I did that, then I could free up enough energy to heal and reconstruct a new life, a new way of being. In essence, the soulful Samurai had to be "reborn."

The Psychology of the Abyss
Jungian analyst Dr. Jean Shinoda-Bolen says that chronically or terminally ill patients lose their innocence, come to know vulnerability, and are no longer the same people they were prior to diagnosis. After illness, we are forced to navigate in uncharted terrain. We may feel that nothing may ever be the same again.

Since the 1970s, there have been numerous studies addressing the emotional and social repercussions of being diagnosed with cancer. Among the findings is the fact that when we cope with a life-threatening illness, we will likely experience anxiety, depression, and decreased energy. Because of this, it may take those of us with cancer a year or more after treatment to get back to our daily routine—be that work, school, recreation or relationships. Research has also shown that when we are pronounced "cured," or are in remission, we often experience a new sense of vulnerability about being on our own again. As mentioned above, the fear of recurrence, along with diminished stamina and low self-image, can cause "severe psychological and sociological difficulties" in the attempt to reenter our daily routines.

My Recommendations For Getting Out of The Emotional Abyss
There are several things you can do to climb out of your after-treatment emotional abyss. First, grieve! Even though you may have done some grieving right after your diagnosis, now is the time to do the "full-on" heavy duty, torrents-of-tears grieving, for all that you have gone through with your cancer journey. It's time to "take stock" of the multiple layers of loss that you have experienced and then "sit" with them, "embrace" them, and mourn them. This is what the shadow side of our soul needs and desires. All of the effective ways to work through grief have one thing in common: the way to "get over" the pain is by going "through it," and by being with it. As the poet Robert Frost has written, "The only way out is through."

Remember, you are not only grieving the fact that you were diagnosed with cancer, but you are also grieving a whole panoply of secondary losses that went along with the diagnosis. You can begin grieving these myriad of losses by calling upon your third team of support people made up of family, friends or professionals (including psychologists) who can lend their shoulders for you to cry on and be there whenever you need them. Tell your family and friends that you need uninterrupted listening in order for you to be able to say how you feel and to adequately cry and grieve—acknowledging the thoughts and impulses that are in the shadow side of your soul. You don't want your support people to "fix it," because they can't. What they can do instead, is set a cooking timer for 20 minutes, and without interrupting, listen intently, perhaps putting their arms around you, while you recount all of the trials and tribulations that you have had to face since the day of your cancer diagnosis to the completion of your treatment. If you seem to get lost or "stall out," your support person can be instructed to say, "tell me more," and prompt you to continue. At the end of the 20 of 30-minute period, they are to summarize and feedback to you, the main theme and feeling of what you've told them. This will help you begin to let out feelings and concerns that you have "stuffed" like a volcano, during the crisis action mode phase of your cancer journey. This will also open up lines of communication between you and your family as well as making you feel understood and "heard."

Also, seek out non-traumatic touch. Let your post-treatment support team know that you need non-painful, non-probing "touch," to de-traumatize your body from the last 6-12 months of "medical" touch. Medical touch is frequently linked to pain, nausea, burning and fear. Both you and your body need to learn to "trust" again. You can do this by asking for regular non-painful touch in the form of hugs and caresses from your family and friends. You can also go to a licensed massage therapist for a positive touch experience. For a referral, contact the National Certification Board for Therapeutic Massage and Bodywork at: (800) 296-0664, (703) 610-9015, or on the Internet at: http://www.ncbtmb.com This will go a long way in helping you emerge from the abyss as well as soulfully enhancing your over-all sense of well-being.

Recognize that you need time to heal. The greater the number of losses that you have incurred, the more time it will take to fully grieve.

Ritualize your losses through talking about the good and bad times that your pre-cancer self had had. Consider joining a cancer support group, a patient therapy group or a bereavement group (more on this in the following chapter). Consult the Internet for on-line support groups made up of people with your type of cancer and those who are at your stage of the journey.

Seek out a licensed clinical psychologist who is well versed in dealing with the unique issues which cancer patients and their families often face. The therapist in question should not only help reduce your depression, anxiety, guilt and rage, but he or she should help you discover what really "floats your boat," and then collaborate with you on how to do more of that.

One of the recurring themes that my clients express in the weekly cancer therapy group that I lead, is that the only way they were able to put up with the side effects of their treatment was because they had put into place a lifestyle that made them feel good, fulfilled and excited. What's the use of going through pain, infections, anemia, nausea, vomiting, hair loss and so on, if on the other side of that, all that exists is a dismal unsatisfied unfulfilled life. Where' s the "pay-off?"

Dr. Lawrence LeShan, a noted psychotherapist and author of Cancer As A Turning Point, who has worked with seriously ill cancer patients since 1947, says that a therapist treating people with cancer needs to depart from the traditional "disease-oriented" approach with only focusing on what's wrong, and instead, help clients emerge from the emotional abyss by using a "health-oriented approach" to therapy, emphasizing "what would be …zestful and enthusiastic."

If you seek out a therapist to assist you in getting through your grief, look for one who encourages you to seek a life-style that is uniquely yours. Look for one who recognizes that you exist on multiple levels including the physical, psychological, and spiritual, and that all these levels must be soulfully addressed in therapy. Look for one who sees you as being unique and believes that you should be a part of the decision-making team. Look for a psychologist who teaches you a variety of relaxation exercises or techniques to help you emotionally cope with your illness experience (as was outlined in detail in the previous chapter when we discussed hypnosis, progressive muscle relaxation, biofeedback, and so on). The therapist should help you accept the reality of your loss, help you work through your pain of grief, help you adjust to an environment in which your old pre-cancer self is gone, so you can continue on in a new journey with your post-cancer self as soulfully and gently as possible.

To do this, your therapist should help revive memories of your old self; the "you" that you were before getting cancer and help you talk and emote about whatever feelings come up that are connected with your "old normal," way of being. He or she should also help you acknowledge the finality of your loss (you can't go back to the time before you had cancer, so that period of life has to be remembered and grieved as you decide what kind of life you want to construct from this point on, after having cancer). By using both the SANITYMatrix™ and a technique called the Healing Narrative (which we fully describe later in this book), you will be able to discover the "new" you that you are capable of being. In the next few chapters, I explain how you can use the Healing Narrative, along with The 5 Insights For Recovery, to create a "new" normal as you finally emerge from the post-treatment emotional abyss.

Closing Thoughts
To summarize, your way out of the post-treatment abyss is to "normalize," and "validate," your feelings. Many cancer patients get "hit" with an avalanche of stored up emotions and fears that they were forced to avoid during their diagnosis and treatment. Once your treatment is complete, and you no longer have a pre-programmed routine, it is customary to feel some depression, anxiety, guilt and rage. By dealing head-on with these feelings through seeking out adequate emotional support from people who can provide uninterrupted listening and understanding, as well as using the SANITYMatrix™ described in Chapter 2, you will begin taking your first step out of the abyss of cancer.

To close, I'd like to quote author Beverly Zakarian when she writes:
Your body betrayed you by becoming ill. It's natural to feel vulnerable, to fear that you can never rely on your health again. It takes time because you've been through regimens that strained every resource you had; but it IS possible…You'll find yourself feeling better and stronger, developing a sense of health and well-being with time.

And cancer survivors Glenna Halvorson-Boyd and Lisa K. Hunter, when they write:
One of the major differences in our lives before and after cancer is that after cancer we know that we have fought for our lives and that we have probably sacrificed a part of our body to the cause. With birth, life is simply given to us; we didn't ask for it. Cancer threatens to take that life away, and it is no idle threat. Afterward, we can never take life for granted again. The effect is profound.