Raquel Serrano Madrid
Madrid
Updated Thursday, March 28, 2024-16:21
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"He has cancer". These are the two words that some 286,664 people in Spain will hear this year, according to estimates by the Spanish Society of Medical Oncology (SEOM). For them and their families it is a 'before and after'. The life you knew and lived changes radically. From that moment, until the disease is completely overcome, and even after, everything is different.
In addition to the physical problems of the tumor itself, it is accompanied by the backpack of
psychological discomfort
.
Fear, anxiety, nervousness, sadness, irritability...
are part of the repertoire of sensations among the people who are going to face the entire process.
Added to the physical and mental aspects is the social requirement: smiling in front of the gallery, nothing happens here. "Don't put yourself in the worst case", "today many people are cured", "but it is one of the easy tumors", "no one dies with this cancer anymore"... The string of empty phrases that do more harm than help is long. Why are these people often forced to act as if nothing is happening? A
'tyranny of positivism'
that, in the worst case, can harm and make
patients who are not able to hide their anguish
feel much worse , at least in the early stages of the disease.
"Excessive demands on positivity can influence and generate discomfort in patients because they may come to think that sadness or fear, normal due to the circumstances, are
related to their illness or a possible worsening or
that their positivism is related to the medical improvement", maintains
Fátima Castaño
,
psycho-oncologist at the MD Anderson Cancer Center in Madrid
, who emphasizes that the objective is
prevention
and providing patients, and their families, with the necessary tools to manage psychological discomfort in the most appropriate way. .
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Trying to always be 'happy', even if we have been given bad news, such as the diagnosis of cancer, does not seem, in principle, to be a good option or at least not for everyone. "The human thing is that we are,
to say the least, overwhelmed
. Afterwards, many positive emotions can come during this process. But, above all, emphasize that we are human," highlights the psycho-oncologist. "Positivity doesn't have to be mandatory," she insists.
In any case, it is undeniable that
a positive attitude helps to face the process with greater resources
, improve quality of life and prevent mood disorders.
In addition to the person's own character,
prevention comes into play with the help of mental health professionals
. "What is certain is that carrying out prevention is very important because the fact of suffering from depression, for example, during the oncological process, represents an added illness that will have to be treated," says
Javier García Campayo
,
professor of Psychiatry at the University of Zaragoza
.
A myth: why doesn't positivism cure?
It also highlights that there are great
myths that positivity will have an impact
on a better prognosis of the disease. For example, some patients continue to believe, and very disastrous articles in this regard continue to be found online, that there is a relationship between
low mood and the development of cancer
. "There are people who have experienced a serious life event - illness or death in a close family member, a separation, among others - and understand that they have had cancer or that their illness has worsened for this reason. Of course, there is no
science to support this association"
.
This tyranny of positivism is one of the elements that often leads patients to consult: "They explain, in many cases, that they feel that they are not doing well enough because they are transmitting sadness to their families, which generates a feeling of sadness.
" added pressure
, they feel guilty and do not allow themselves to transmit negative emotions, which
makes it difficult for them to ask for help
and can lead to greater isolation."
Although in the most initial moments the emotions are closer to
anxiety
, these are also accompanied by reactions more related to
denial
("this can't go with me", "they must have been wrong"), to later move on to more emotions. aimed at
acceptance
, at how to face this situation.
Irritability
also appears
.
"In fact, some authors have come to
propose or standardize the phases
that a person goes through when faced with the perception of grief or the experience of an important life crisis such as an oncological diagnosis: from the phase of denial, depression, the anxious, angry phase... Although not all people go through them, it is very common for them to
occur in a different order
. Irritability is very common and, on many occasions, what it hides is sadness, frustration, disappointment. ...and it usually appears in people with greater difficulties expressing or identifying the emotion," explains
Castaño
.
When these emotional disorders pose an added burden for the patient,
pharmacological therapy
would be indicated. "Without a doubt," says García Campayo. "If the depression meets diagnostic criteria (DSM or similar), the use of antidepressants is recommended. Serotonergics
are usually the first choice
, because the improvement of depression also favors a better evolution of the tumor disease as a whole. If there is anxiety and insomnia , which is common, can improve with the
antidepressant
if it is of the sedative type and, if not, a
mild benzodiazepine
can be associated . "
RESPECT THE PHASES: FROM 'SHOCK' TO ADAPTATION
García Campayo
points out that in the first moments after a cancer diagnosis, the phases classically described by
Kubler-Ross occur, although they may not all be in that order
.
A 'shock' phase
is common
in which the individual is overwhelmed by the news and does not cognitively process the information. Subsequently, a denial phase usually appears that is characterized by the idea that 'it is not possible that I have cancer', that 'there must be an error in the diagnosis' and the opinion of other professionals is sought; a second opinion.
"When the disease is confirmed, it is common for
feelings of guilt
to arise : our life is negatively reinterpreted and we can interpret that cancer is a 'punishment' for something bad we have done, which is why, in some cases, it can appear, for example, a 'negotiation' with God, even if we are agnostic, promising to 'get better' if the disease progresses well.
Over time, depression appears, sadness
over the loss of health, which implies that mourning is taking place. Also
anxiety
due to worry about what is going to happen, perhaps death, loss of an organ, quality of life or functioning. Therefore, anxiety and depression, along with
insomnia
, are usually the two
predominant symptoms in adapting to cancer.
".
The psychological discomfort that an oncological diagnosis entails usually appears in all
affected people
-men, women, children, adolescents, the elderly-, but it is true that depending on the characteristics of each person, as well as their personal circumstances , family or social, this discomfort may be greater. "What seems clear is that the
more social weight or the more issues depend on the patient
, the psychological impact will be greater," emphasizes García Campayo.