Archives for Cancer
We are the story we tell ourselves about ourselves. Traumatic events disrupt out story and assault our sense of self. They leave us asking: Who am I if I can’t be a cop, a surgeon, a provider? How can I be a bride with breast cancer? How can I be a mother who loses her child?
This weekend the Wounded Warrior Project came to our town. Many had the opportunity to run the 4-mile race next to veterans and their families. The t-shirt of the young man in front of me read “ New Year’s Eve 5K, Afghanistan. ” Many were wearing shirts that read, “ If you Like Freedom- Thank a Vet.” The father of a vet wore a shirt that read, “ We’ve got them back-Now Welcome...
Disaster and trauma studies often focus on identifying the incidence of PTSD as the sequel to traumatic events. Early interventions with those affected after a disaster or traumatic event increasingly utilize psycho-education to clarify and normalize common post-traumatic stress reactions and coping strategies. While mentioned as a possible response, the high incidence of depression after trauma is less delineated and often goes unrecognized by those suffering. Depression Occurs after Trauma: A Rand corporation study reports that nearly 20 percent of military service members who have returned from Iraq and Afghanistan - 300,000 in all - report symptoms of Post-Traumatic Stress Disorder or major depression. In the first long-term study of the health impacts of the World Trade Center (WTC) collapse on September 11, 2001, findings indicate that seven percent of police officers were diagnosed with depression, nine percent with PTSD and eight percent with panic disorder. Twenty eight percent of other rescue and recovery workers had symptoms of depression. A survey of survivors from the Oklahoma City bombing showed that 23% had depression after the bombing. Depression affects approximately 15 percent to 25 percent of cancer patients. After a myocardial infarction, the incidence of major depression is from 15 percent to 20 percent, and an additional 27 percent of patients develop minor depression. Both major depression and Post-Traumatic Stress Disorder (PTSD) occur frequently following traumatic exposure, both as separate disorders and concurrently. Depression is the most common disorder suffered in conjunction with Post-Traumatic Stress Disorder. Depression is nearly three to five times more likely in those with PTSD than those without PTSD.
Almost everyone has some experience with hope: We hope for the best. We hang on to hope. We despair when we lose hope. It would seem that hope, which is broadly defined as an emotional state that promotes the belief in a positive outcome, is in inherent in human nature. Reflections of the importance of hope are found in early mythology, religion, philosophy and literature. Pandora, although forbidden, opened the box given to her by Zeus, and in a moment, all the curses were released into the world and all the blessing escaped and were lost- except one: hope. “To have faith is to be sure of the things we hope for, to be certain of the things we cannot see.” ― The King James Version of the Bible “Hope is a waking dream.” –Aristotle “Where there is no hope, it is incumbent on us to invent it.” -Albert Camus "Hope is that thing with feathers that perches in the soul and sings the tune without the words and never stops -- at all." -Emily Dickinson Clearly we need hope, but even as we embrace it we often wonder – Does hope really make a difference? Is it myth, fiction, collective denial? There is actually increasing scientific evidence that hope changes us psychologically and physiologically - that it makes a difference.
In the preceding blog, we considered the importance of recognizing medical illness as psychological trauma. In this blog we report on an interview with Michele Rosenthal, author of the trauma recovery memoir, BEFORE THE WORLD INTRUDED, survivor, and host of ‘Your Life After Trauma'. Diagnosed with a rare disease, Stevens Johnson Syndrome, at age thirteen, Michele journeyed through two decades of undiagnosed PTSD to eventual recognition, recovery and support of many as the founder of www.healmyptsd.com. What she offers in lessons learned is of value for parents of children who have faced illness, as well as adults who wonder how they will ever reclaim their bodies, heal their sense of self and take a new self into the future. Michele, your journey from illness started when you were only thirteen. Parents suffer so much when they see their children suffer. How did your parents respond? My parents were phenomenal! They were there in a very active way. Their presence next to me, their translation of what was happening to me, their role in helping the staff understand me in a certain way were all crucial to my safety and comfort.
In this era of advanced medical detection and intervention, the medical care of patients and the reduction of mortality for life threatening illness has never been greater. Against this backdrop of success, however, what is often overlooked by professionals, family, even patients, is the experience of medical illness as psychological trauma. While some efforts like the emerging field of Psycho-oncology are starting to address the totality of the patient and the American Psychiatric Association now officially considers “ being diagnosed with a life –threatening illness” a potentially traumatic event, it is perhaps most important that patients and families understand why and how medical illness often brings with it- anxiety, anger, depression, panic and post-traumatic stress symptoms. Understanding, normalizing and validating common stress reactions can demystify and lower anxiety at a time when so much feels beyond understanding or out of control. Given that the experience of trauma is a function of many variables including age, nature of trauma, duration and personal meaning, people will differ in their psychological response to medical illness. Some may experience a few symptoms which abate within months, others will deal with a delay in the experience of depression or anxiety until well after the medical crisis, and for others the persistence of emotional distress may warrant professional help.
Do you think you have an inflated sense of self? Do you have positive illusions about the way you compare with others, make decisions, control your circumstances? While this enhanced self-perception may not, particularly in the extreme, cause you to win friends and influence people – it may actually serve you well in buffering stress and coping with adversity. A recent study by Gupta and Bonanno gathered longitudinal data to examine the relationship between self-enhancement and adjustment of college students to potentially traumatic events over their four years. It is the only study to date using on-going reactions instead of post trauma retrospective reports.
It is easy to feel happy, content and hopeful when things are going well. What about when life becomes stressful? How do we hold on to positive feelings in the face of the unexpected diagnosis, the child with special needs, the job that disappears, or the deployment of a spouse? The definition of happiness most agreed upon by neuroscientists, psychiatrists, economists, positive psychologists and Buddhist Monks is not of happiness as the state of bursting with glee but of happiness as a sense of well being, contentment, the feeling of living a meaningful life, of utilizing one’s gifts, of living with thought and purpose. Positive and Negative Feelings Can Co-Exist Research tells us and perhaps your personal experience confirms that positive and negative feelings can both occur during a stressful period of time. That’s not to say that they occur at the same time or that you should “Smile when your heart is breaking.” Rather, it means that tears and fears are not incompatible with laughter, enjoyment, love or mastery as we face life’s challenges.
“I love you but I don’t love that large Disney Sweatshirt.” “When did marriage mean you would stop shaving on the weekends?” “Everything you tried on looks great– why can’t you wear any of them?” “I think they said casual not throw-away.” For most people, there was something about the physical characteristics of the person they fell in love with that tripped their chemistry into response. Should that stop mattering when the wedding is over, the kids are in school or the retirement is planned? Not Really. This is a culture that pushes looks, youth, beauty and the icons that possess theme. For those seeking a partner, there is a considerable amount of interest in what catches the attention of men when meeting women and what women find attractive in a man.
While the movie Inception has certainly invited discussion about dreams and even an interest and analysis of viewers’ own nightmares, you may recall that in the film, the motivation for entering the dream world is the recognition of the impact of a persistent idea. As Leonardo DiCaprio (Cobb) forebodes in the opening of the film, “What’s the most resilient parasite? An idea.” In the movie’s narrative, hidden beneath the scaffolding of dreams and driven by the confusion of dream and reality is an idea that ultimately destroys Cobb's wife, his relationship with his children and possibly his ability to discern reality – depending on your take of the ending. Recognizing that media both reflects culture and is shaped by it, this film raises the question, “Can a persistent negative idea threaten a relationship?” Yes.