But Don't I Have a Good Reason???
February 25, 2010
A little bit of background: as part of my work with cancer survivors in the research environment, I administer a few different questionnaires to cancer survivors (and non-cancer control subjects) who enter our studies. A few weeks back, I asked a routine question of a young woman recently diagnosed with a particularly nasty form of cervical cancer. I received a not-so-routine answer. Here is how this chunk of our interaction went –
Me: Are you experiencing symptoms of depression? (e.g., loss of appetite, difficulty controlling sleeping patterns, overwhelming sadness, inability to concentrate, etc)
Patient: Wouldn’t it be weird if I wasn’t?
Me: So that’s a “yes”?
Patient: Am I experiencing all of those right now? At this moment? Or do you mean have I experienced a few of those today or this week?
Me: We’re really looking for what you’ve been feeling like recently…say in the last week.
Patient: Again, I’m asking - Wouldn’t it be weird if I didn’t feel like that? I guess I’m surprised you even ask such a question. I’m not mad. Just surprised. Are there people who are in my position who DON’T feel like that?
Me: You’d be surprised. Each survivor I have met, and I have met many…each survivor I have met seems to deal with their cancer in a unique way. It is a really interesting phenomenon. I never realized how diverse we are as humans until I got so involved in cancer research.
Patient: Well, now I feel like an underachiever [laugh]. Who are these people who are not depressed by cancer? [long pause] I bet they have a lot of money.
Me: [laugh] Maybe. I wish it were that simple though. Sounds weird but that would be a simple fix. Then we could just raise money to give directly to survivors to prevent depression. [laugh] Can you imagine that?
Patient: Yeah [laughing and imitating a doctor]. Sorry, you have cancer, but here’s ten bucks, so you don’t get depressed.
Me: If only it were that simple….
Patient: Yeah. it would definitely take more than ten bucks. I guess all I’m saying is that I should get a pass. I mean, can we avoid calling it “depression”? Is it really depression when you have a good reason for it? Shouldn’t just be called being sad? I mean, what’s the deal? First, I have cancer…now depression? I’m not a conspiracy theorist, but this sounds fishy. [laughs]
I love my work. It is my privilege to have conversations like this one. They energize me- not only because I am inspired by people like this patient but also because patients like this generate important questions for me. I’m only 27, and I have a lot of life left, but a big chunk of my life has already been dedicated to improving the lives of cancer survivors, and I expect that I will continue to dedicate my efforts to survivors through medical school and beyond (for those of you who don’t know, I am applying to medical school this spring). Questions like the one this patient posed to me get me thinking. Moreover, I bet this is a question that other survivors have asked themselves?
Is it really depression or anxiety if I have a good reason for it? Isn’t it just being sad or worried about what will happen to me in light of the fact that I have CANCER?
Here is my thinking on this (and I fully acknowledge that this is an outsider’s perspective because I am not a cancer survivor): I think the question is interesting, but I also think it is ultimately irrelevant. In fact, I worry that this line of thinking could be potentially very dangerous if it leads survivors to ignore the sadness, the worries, the depression, or the anxiety. This question highlights a negative stigma associated with mental health issues. How do I know this? Well, consider another side effect of cancer and treatment among breast cancer survivors – lymphedema. Lymphedema is a swelling of the lymph nodes, often under the arm (this is a very simple explanation of lymphedema used only for this illustrative purpose). Can you imagine a survivor, who is suffering from lymphedema, saying "it is not really lymphedema because in fact she had cancer and that was a 'good reason' to have swelling under her arm?" I can’t. So then my question is why did this patient (and probably many others) have such a negative reaction to the suggestion of mental health concerns? And secondly, how do we overcome that negative reaction to ensure that she (and others) seek the appropriate help to deal with these issues?
I definitely don’t have the answer that will help us overcome the stigma that mental health issues carry with them. But here is my answer if you are a cancer survivor and you are reading this right now:
You do have good reason to be sad, worried, angry, depressed, scared, confused, anxious, nervous, moody, or just plain tired. But the mere fact that you have a valid reason to feel all these feelings and more does not mean that you should ignore them or categorize them as normal. In other words, you can’t assume that they will just go away with time or treatment of the cancer. In fact, the feelings might get more intense or change as you journey through survivorship.
Mental health professionals are available to help you sort through all of these issues. The easiest way to start working with a mental health professional is to call your current treating physician and ask for a referral. Please make that call.
By Christian McEvoy
Christian@ctchallenge.org
|