Vijai P. Sharma, Ph.D
In an interview recently published in the Cleveland Daily Banner, a breast cancer survivor, after a radical mastectomy, had this to say about her emotional state: "I didn't feel like a complete woman anymore because my breast was gone, and I was losing my hair. I wanted to take down all the mirrors in my house." In the same interview, she later said, "You've got feelings during that time that you don't know what to do with them. You feel hurt, angry, and you feel like your self-esteem has been destroyed, your womanhood has been taken away…"
After the surgery, radiation or chemotherapy, the crisis of personal identity, that is, the sense of who you are as a person, is not an uncommon reaction. In almost all cases, breast cancer patients and their partners go through a challenging psycho-social and sexual adjustment.
Such a response to the loss of a major organ is quite understandable and very human. There is nothing abnormal about it. A person who experiences an emotional crisis does not have a mental disorder, she has simply received the diagnosis of cancer. Isn't that enough? But, try to tell this to reviewers of managed care companies when asking for a few sessions of psychological support for a breast cancer patient and/or her partner, and you won't get anywhere.
Managed care representatives want a specific mental disorder diagnosis. The therapist's statement that a breast cancer patient or her partner is reacting with pain, confusion, distress, and anxiety (as any human being is expected to do), is not enough. The therapist must label that person as "mentally ill" by giving a specific mental disorder diagnosis, or there won't be any authorization for treatment. Many breast cancer survivors and their partners don't get the psychological support they need because the health care industry doesn't view natural human reaction of distress to a major physical crisis/illness worthy of psychological support.
The June '99 issue of Monitor, a publication of American Psychological Association, addressed this problem in an article, "Cancer Patients Find Anxiety Not Covered Under Managed Care." The article, among other things, refers to the experience of a therapist who asked a managed care company to authorize treatment for the daughter of a breast cancer patient who feared that what was happening to her mother might also happen to her. "We don't deal with fear" was the response a care manager of the company gave the therapist.
Some cancer patients have lost their parent or parents to cancer. Someone needs to help them manage their fears when they are first diagnosed with cancer. Some are not afraid but they are still filled with the rage at the disease that robbed them of their parent and the happiness of their childhood at the same time. They have to come to terms with a whole range of emotions attached to this disease.
What about preventive care for people who have earlier experienced the loss of a loved one to cancer or suffered some other related trauma? One such preventive measure is regular self-examination for possible tumor growth. Some women who know that they are at-risk for cancer are deathly afraid of the bad news. According to a report from the UCLA clinic, almost all the patients who have a mother or sister with breast cancer are terrified even to touch their own breast during self-examination.
People who have had cancer in the family often exhibit such problem emotions as fear, denial, guilt, anger or grief. Some of them develop an exaggerated sense of how much risk they really face. So, they might try to avoid such preventive measures as mammogram, pap test and self-examination. If they don't follow up on such measures, their chances of cancer one day creeping up on them are increased. If they do get cancer, it is likely to be more expensive and tragic. So, if they want to get psychological help, it is better to give it to them, with or without a diagnosable mental illness.
In a survey of 4500 physicians, researchers found that 31 percent, if they had their druthers, would choose a different profession because they feel the work stress is too much and that they have lost control over the treatment process.
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Dr. Vijai Sharma
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