Health

Coping with your emotions

How to ride out the emotional roller coaster that comes with breast cancer

When Barbara Thompson’s husband discovered a tiny lump in her breast four years ago, the Dartmouth, N.S., mother of two wasn’t overly worried. “I was 35 and had no family history of breast cancer,” she says. When her family doctor confirmed she had the disease, Barbara couldn’t believe it. “The weird part about breast cancer is you don’t feel sick,” she says. “It’s hard to believe there’s a ticking time bomb in your body.”

Within six weeks, Barbara lost a breast. “It was devastating. Before the surgery, I stood in front of the mirror thinking, ‘This is the last time I’m going to see my body like this.’ I wondered what it was going to do to my marriage.” When the initial shock wore off, she was swept up in a wave of emotions. “I was afraid to die and leave my kids and my husband. And I felt guilty that my health was threatening the security of my wonderful little family.” While Barbara tried to be positive, she cried in private, longing to have her old life back. That sorrow was tinged with anger. Several months after being diagnosed, Barbara sank into depression. “I was the living dead—I had no emotions,” she recalls. “When I realized it, my doctor put me on antidepressants and within weeks I was feeling much better.”

With support, Barbara made it through the turmoil that comes with breast cancer. The roughly 400 women a week who are diagnosed with the disease can expect their emotions to swerve wildly—gratitude at getting through surgery one day to anger at being sick the next. “Feeling positive all the time is not healthy and it’s not what really happens,” says Linda Carlson, a clinical psychologist at the Tom Baker Cancer Centre in Calgary. “Being able to express a wide range of emotions is what’s important for your recovery. You have to move through the emotions to move beyond them.”

We talked to experts and survivors to find out how it really feels to battle breast cancer. If you’re coping with the disease—or want to help your mom, sister or friend get through it—here are the main emotions you’ll face in the coming months, how each one can help and when it can harm.

Shock

Your doctor has just delivered the bad news: you’ve got breast cancer. “When a lot of women are diagnosed, their brain takes a holiday,” says Bunty Anderson, a social worker at CancerCare Manitoba. “They know one fact—that they’ve been diagnosed with breast cancer—and it takes some time before they can really begin to make some sense of what has occurred.” But there isn’t time for the diagnosis to sink in before you have to start making decisions about treatment options.

How it helps:
When you’re in shock, you don’t absorb details as effectively. Since you’re faced with too much information to take in at once, being in shock allows it to seep into your brain more slowly, says Carlson, so you can absorb the necessary information at your own pace.

When it harms:
If you’re still feeling numb months later when the whirlwind of medical appointments settles down, you may not be dealing with other feelings that are helpful for your mental recovery from cancer.

What you should do:
Start gathering information on breast cancer, suggests Carlson, to make your diagnosis more real. Take a friend or a tape recorder to your doctor’s appointments because you might not be able to take in all the details. If that doesn’t help, tell someone on your health-care team how you’re feeling and ask for help.

Fear

Once you’re over the shock of finding out you have breast cancer, sheer terror usually follows. Your mind races with questions: Am I going to die? What will happen to my body? Will my partner still love me?

How it helps:
Fear can be empowering, says Sue Wright, a breast cancer survivor and communication and outreach co-ordinator at Willow, a national breast cancer support and resource service. “You don’t want to die so you’re going to seek out treatment and do what you need to do to survive.”

When it harms:
If you’re paralyzed by fear, for example, putting off surgery for months because you’re afraid of the consequences, it could lead your disease—and prognosis—to get worse.

What you should do:
Accept that it’s OK to be scared, says Wright. “This is a scary disease. And when people keep telling you how brave you are, you don’t feel like you can admit that you’re scared.” Find a friend who will listen to your fears without dismissing them. Writing your fears and feelings down in a journal may also help. If you’re still feeling overwhelmed, talk to your doctor for a referral to a mental health professional.

Anger

You’re battling a life-threatening disease, and anger in the face of that threat is natural, especially if you’ve tried to be healthy. You may be angry that you’ve got this disease. Or you’re mad that a friend you thought you could count on hasn’t called in weeks. Anger is a common emotion after a breast cancer diagnosis, says Toronto psychotherapist Mary Vachon, especially among young women whose physicians may take a wait-and-watch approach. That’s what incensed Carol Bond when she was diagnosed with the disease at 33. “I had a lump in my breast and my doctor told me not to worry about it,” recalls the now-60-year-old owner of New Woman Prosthetics & Apparel in Halifax. “But I had a nagging feeling about it so I went back to see him six times.” Another doctor finally diagnosed Bond a year later. “I was so angry that I’d had the cancer in my body for so long.”

How it helps:
Like fear, anger can mobilize you to seek out the treatment you need, says Vachon. It also motivates some women to become advocates for breast cancer research.

When it harms:
It’s not healthy if anger is your only emotion. If you’re constantly irritable and argumentative, and starting to alienate loved ones, you may need help to overcome it.

What you should do:
Ask your doctor if there’s a social worker or psychotherapist specializing in cancer at your hospital. If not, get a referral to one. In the meantime, try asking yourself what your anger is trying to teach you, says Vachon. If your doctor was slow to diagnose, maybe you’re upset because you don’t feel like you communicated well with her. Think about how you can use your anger in a constructive way, for example, by talking to other women so they don’t take no for an answer from their doctors when they have a health concern.

Guilt

You may think that if only you’d eaten better or exercised more, you might not have cancer. Or you feel guilty that you’re too wiped after chemo to prepare your usual Thanksgiving feast. Feelings of guilt often creep in after diagnosis. “A lot of women report guilt that their illness has created stress on their families because they can’t work or keep up with the daily household functioning,” says Wright.

How it helps: To be honest, it doesn’t really. But feeling guilty is a natural part of being diagnosed with a life-threatening disease, Wright says. The key to getting rid of guilt is confronting those feelings as soon as possible, which will help you have a healthier emotional recovery from cancer.

When it harms: If you think you caused your cancer, your guilt is becoming toxic. “You’ve probably spent your adult life reading articles with advice about how to prevent breast cancer,” says Wright. “If you didn’t follow the advice, you may wrongly blame yourself for getting breast cancer. If you feel like you’re the agent of your own destruction, you may not believe in your right to a successful outcome.”

What you should do: Recognize that you feel guilty. You might try writing a letter to yourself, where you pretend to be a supportive friend who points out the rational reasons that you shouldn’t feel guilty. Then join a support group or call a support hotline and admit your feelings to a breast cancer survivor who will understand where you’re coming from. Once someone validates your feelings of guilt, you’ll begin to move away from them, Wright says.

Sadness

“There’s often a real grieving process when a woman realizes all of the losses a cancer diagnosis entails,” says Carlson. You start to understand that your life may be cut short. And you may have to come to terms with losing your hair and a breast. When 46-year-old Bonnie Bassett-Spiers had a breast cancer recurrence seven years ago, she grieved when chemotherapy pushed her prematurely into menopause. “Even though we probably weren’t going to have any more kids, I was grieving the loss of my fertility,” she recalls.

How it helps:
Sadness is a common and healthy emotion after diagnosis and part of the normal process of grieving for what you’ve lost. “You have to acknowledge the losses, feel the impact of them and let them go before you can move on,” says Carlson.

When it harms:
Feelings of sadness or depression usually pass. But if you’re in a depressed mood for weeks or months, feeling hopeless and lacking motivation, it could be a sign of a clinical depression, which affects about 10 per cent of people diagnosed with cancer, according to Dr. Gary Rodin, head of psychosocial oncology and palliative care at Princess Margaret Hospital in Toronto. If you’re depressed, you may be less likely to stick with cancer treatment, which could hinder your recovery.

What you should do:
If you have a history of depression or think you may be clinically depressed , talk to your doctor about a referral to a mental health professional. You may need antidepressant medication. If you’re open to other options, stage a grief ceremony based on the fact that some trees never seed until the heat of a forest fire causes the seed pods to burst. Without the destruction, there’s no regrowth. With that image in mind, write down the things you’ve lost because of cancer, honour the feelings of grief at losing them, then burn the papers and choose to let go of the sadness as they burn. Then, take the ash, mix it with soil, and plant and nurture a seedling that symbolizes your own resilience.

Anxiety

It’s common to feel anxiety, especially once treatment ends. For months, you’ve had regular appointments and your health was constantly monitored. Now you have time to catch your breath and reflect on what’s actually happening and you may be worried that your cancer is going to return. “I started to cancerize everything,” says Bonnie. “If I had a headache, I’d think it was a brain tumour—and other people didn’t understand. Unless you speak to another survivor, you feel like a crazy woman.”

How it helps:
Feeling anxious is a normal response to the many threats and uncertainties you feel about having breast cancer and undergoing treatment, says Dr. Rodin. Anxiety about the cancer coming back will probably flare up throughout your life around check-ups or mammograms. For that reason, it may motivate you to undergo screening and follow-up for breast cancer.

When it harms:
When anxiety persists, it also puts a strain on your body. Symptoms of anxiety include panic attacks, which can be triggered by associations with your cancer, such as driving by the hospital where you received treatment. You may also feel easily startled, have nightmares and find it difficult to concentrate. It’s normal to experience these symptoms occasionally but if you feel anxious for much of the day and it lasts more than a few weeks, you may need help.

What you should do:
If you’re obsessed over every ache, tell yourself that everyone has minor pains occasionally. If one persists, see your doctor. And join a support group. They can be especially helpful when you finish treatment, says Dr. Rodin. “This disease is very isolating. Talking about it with other women can be very calming and prevent anxiety symptoms.”

Once Barbara Thompson survived the bumpy emotional ride that followed her diagnosis with breast cancer, she was struck by a feeling of calm. “It was a wake-up call,” she says. “I realized that I was always thinking I could put off things until tomorrow.” Her experience was not unusual. “It’s common for people to go through a period of growth after a trauma,” says Carlson. “A lot of people look at their lives and think about their values. They stop holding off on things and really live life.”Barbara had been delaying taking her dream trip to Paris until her kids were older. But four months after her surgery, she and her husband flew there for five days. “It was a whirlwind trip that I probably wouldn’t have done before I had breast cancer,” she says. “But I thought ‘why wait?’ It was a chance for us to re-evaluate our marriage after all of this. We’d been together 15 years and the brush with mortality made us realize how important we were to each other.” Cancer-free for the past four years, Barbara now gets through most days without giving the disease a second thought. “There does come a day when you wake up and it’s not the first thing you think about.”

For more help
· Read Getting Back on Track: Life After Treatment , a booklet developed by Princess Margaret Hospital in Toronto.

· Call Willow, a national breast cancer support and resource service, toll-free at 1/888/778-3100 to speak to a peer-support volunteer.
· Join a support group. Call the Cancer Information Service at 1/888/939-3333 or log on to Canadian Cancer Society’s to find a support group in your community.

Fighting back tears because you’re trying to be strong? When you feel like crying, let the tears flow. Crying can be helpful because the release of emotion boosts the feel-good hormones in your brain, just like a good laugh or exercise, explains Toronto psychotherapist Mary Vachon. “When you’re always holding back tears, they’re going to spill out eventually anyway. But they’ll come when you’re not expecting it and it doesn’t seem appropriate, like when you burn something on the stove,” she says.

How much crying is too much? If you cry every day for a few minutes but you’re still carrying on with your normal activities and relationships, your crying is not a concern. If you’re sobbing every day for long periods, you may be clinically depressed . Talk to your doctor.

Helping yourself—and others

When you have cancer, you might feel you have to put on a brave face for friends and family, says Linda Carlson, a psychologist at the Tom Baker Cancer Centre in Calgary. “But you shouldn’t feel like you have to protect them.” Here’s how to cope with the emotions of loved ones:

· Tell them what you need, whether it’s help with cooking, a shoulder to cry on or time alone. People want to help but they don’t know how.
· Be frank with your kids. Keep them informed or they’ll imagine the worst and might even think your cancer is their fault. Tell them you’re sick but not contagious. Even young children can be taken to see the machines so they know they aren’t scary.
· Don’t take it personally. If certain friends or relatives aren’t as supportive as you expected, realize that it’s not about you. Your cancer may overwhelm them or remind them of a past experience with a life-threatening illness.
· Suggest support. If a loved one is leaning on you for support, tell them you need to focus on taking care of yourself. Recommend joining a support group for caregivers or family members.