Thinking or speaking about terminal illness is not easy or straightforward. Being given a diagnosis of a terminal illness throws up a myriad of questions, and a whole host of emotions. Knowing that someone we love has been told that there is no further active treatment for an illness can be a huge blow.
Many hospices offer a wide range of counselling and psychotherapy options for both patients facing a terminal diagnosis, as well as family members supporting a loved one through the final stages of their life. In this blog (the first of two blogs), we consider some of the emotional challenges that a terminal diagnosis can bring, and how a compassionate psychotherapeutic approach can offer relief and comfort through the most otherwise desperate of times.
Speaking the Unspeakable
Doctors are trained to deliver terminal diagnoses with care and compassion. Even so, to be on the receiving end of such a diagnosis can be hugely traumatic. Many people report experiencing disbelief, shock and report feeling numb and out of touch with reality. This is a normal and natural response to such news. With support, it is possible to connect more with the reality of the diagnosis and begin to explore the implications.
That response of shock and feeling of traumatisation is not only reserved for patients themselves. When someone dares to share their diagnosis with family and friends, those loved ones may also feel dumfounded. Whether we are the person with the diagnosis, or a loved one supporting someone with a terminal illness, many of us will automatically begin to imagine or picture the future – with a whole range of horrific scenes featured.
Some of the shock and fear around a terminal diagnosis can relate to those judgements and pre-formed ideas about what a terminal diagnosis means. We do, sadly, live in a society where many of us have learnt to value success and worth based on achievement and what a person can do. It’s a common badge of honour to report how busy we are. A terminal diagnosis may mean reduced capacity to work, to achieve, to succeed in quite the same way. Added to that, we live in a culture that prizes outward appearance. Social Media reinforces judgments based on how we look: with youth and vitality lauded. And that can really challenge out outlook on life and what a life well lived means to us when we, or someone we love, are given a terminal diagnosis. Many people who seek psychotherapy when they or a loved one has a cancer diagnosis explore what vulnerability means to them, what it is they truly value in life and how they feel about meaning and purpose in life.
A terminal diagnosis, then, can open up opportunity for speaking about the things that seldom get voiced – questions about the preciousness of life, and what the meaning and purpose of life are.
Supporting a Loved One in the Face of a Terminal Diagnosis
I have worked with many clients who’ve been given or who are caring for a loved one with a cancer diagnosis: sometimes, a terminal cancer diagnosis. That word: “cancer” can leave people feeling wobbly and unsure. I’ve heard from clients who report that acquaintances they once chatted with, now cross the road or look the other way of they meet by chance. It’s as if the word cancer repels people.
Of course, it can feel difficult to know what to say or do when someone you love or even a casual acquaintance is given a diagnosis such as cancer. Perhaps you’d be willing to try this experiment just to get a better sense of how you feel about the word cancer, and the idea of a cancer diagnosis? As you think of, or say the word “cancer” to yourself, what to do notice? What do you feel? Are you aware of any tension or emotion? Many people report that when they hear the word cancer, or see an advert on TV about cancer, they have some sort of painful or difficult reaction. Perhaps you notice it in your gut: at times of stress, so often it is our gut that lets us know that we are struggling in some way. Our gut is more sensitive than perhaps you realise: it’s attuned to your thoughts and feelings, particularly when fear is present. So, as you consider the word “cancer”, notice what comes up for you, and how your gut responds.
And, it’s this difficulty, this fear, this apprehension, the feeling decidedly not-at-ease when speaking about terminal illness that means people can be left with feelings of guilt in the face of a diagnosis of a loved one, friend or acquaintance. When it comes to being there for someone you care about, feelings of guilt and regret can bubble up – especially if you have any sense that you feel you didn’t provide the support you wanted to. Perhaps as a carer for someone with a terminal illness, you’ve become frustrated or upset at times, and then feel guilt for your own feelings. So, you end up beating yourself up and questioning yourself – Why wasn’t I helpful? What did I say wrong? Such rumination can really hamper connection with your family member or friend. Which, deep down, is likely to be the last thing you want. For this reason, having a safe and compassionate space where you can freely explore your own fears and feelings about supporting someone through an illness – including a terminal illness – is essential. Caring for yourself whilst caring for your loved one can be a real act of compassion for the both of you.
The Pain of Wanting to Make Things Better
Many clients come to Psychotherapy to explore their own reactions to a loved one’s illness. Some people experience a crushing sense of helplessness, as they battle with an overwhelming desire to fix or make better that comes into direct conflict with the realisation that they cannot stop the inevitable.
It can be heart-breaking to see someone suffer that you love and care for. Recognising what you can do to support them, and what is outside of your power and control can be a really helpful step. Many clients find the Psychoeducation function of Psychotherapy to be beneficial – they are able to learn more about and grow in awareness of patterns and challenges they face. Such knowledge can help to regulate and soothe frayed feelings, and give that all important sense of having some sense of control in situation that can feel out of control. Learning that offering unconditional acceptance and support for a loved one, whilst also accepting the reality of what is happening can help to free loved ones from those chains of desperation.
Change is Inevitable
A terminal diagnosis is a prompt for change. Of course, the reality is that all life involves change. Yet, it can be hard to see or sense that when things are going smoothly for us in life. Its at those moments when our world is turned upside down that we are forced to face the fact that things are changing, and changes will be inevitable.
Change can take many forms when it comes to a terminal illness. Change in mobility. Change in activity levels, and energy reserves. Change is how others relate to us. Change in what we want to do with our time. Change in who we spend time with. And for people who are connected to a personal with a terminal diagnosis, there can be change in the relationship between you both.
So, looking at consistency can be helpful. In the face of such change, how do you feel? What can you rely on as a constant? What is it that you can hold onto and stay grounded with? Many hospices offer a regular schedule of therapeutic treatments and ways to help soothe tense nervous systems. A sense of calm relaxation can help with recognition and acceptance of what you do have as a reliable constant. And for those who seek Psychotherapy in the face of this change, the constancy of session times, and building a connected, supportive relationship with a trauma-informed therapist can be really helpful.
So, as someone who has personally faced the impact of a family member being given a terminal diagnosis, I can reassure you that I will offer a compassionate space for you to speak about your own pain around illness – whether that is your own illness, or the diagnosis of a friend or family member.
I know the power of empathy and trauma-informed care, and how difficult it can be to face terminal illness alone. It may be that some of the content of this blog has raised questions for you. If so, I’d be happy to discuss how we can work together to support you. And, I look forward to sharing more of my thoughts around compassionate approaches to the emotional impact of terminal illness in my next blog.