Cancer as an Existential Crisis, by William J. Di Scipio

A cancer patient recently presented me with a metaphor: “Doctor, you know I feel as though we are both standing on the corner waiting for a bus. The difference between you and me is that I see my bus coming. You have not yet seen yours.”

What does this tell us about the cancer experience? Reference to travel evokes the metaphor that cancer is a journey, a journey like no other. While the diagnosis is no longer considered a death sentence, serious questions about the purpose and meaning of life emerge. All journeys have a beginning and an ending — the cancer journey is not unique in this regard. We are all waiting for our bus, but the schedule is less than perfect. 

When patients are first diagnosed with cancer, the medical impact and decision-making process may seem overwhelming. What with the need to gather information, seek advice and support, and make possibly life-altering decisions, we are faced with a psychological crisis: a crisis in the form of emotional trauma. 

A young woman recently called me and said she was told she had stage two lung cancer. She was a competent, intelligent, well-adjusted young single mother and upon hearing the diagnosis responded immediately with “What do I have to do now?” She was prepared to meet the challenge directly, but then looked at her hand and saw that it was shaking uncontrollably. “I think I have a need for counseling,” she said, and she called Fighting Chance.

On the other hand, a Roman Catholic priest once announced to his congregation that he had cancer. Rather than panic, deny the situation, or seek psychological help, he found the message to be a privilege given to him by God in order to better prepare him for his journey to heaven. For many people, spiritual solutions to understanding the meaning and purpose of life are not to be underestimated.

Fighting Chance is a not-for-profit organization in Sag Harbor founded by Duncan Darrow 15 years ago. When Mr. Darrow’s mother was diagnosed with cancer he found a paucity of services available and few if any roadmaps for how to seek and secure crisis help and follow-up care. He established the organization to meet this need, which has grown steadily as the population of the East End has increased.

Most of the calls to Fighting Chance are not immediate crises after initial diagnosis. My last call was from a young mother whose brother-in-law was diagnosed with cancer. She wanted to know how to tell her three children that their uncle was very sick, and their father would be away to help take care of him. Parenting and changing roles of family members should always be explored when someone is diagnosed with cancer. Changes and coping mechanisms must be viewed as associated with all stages and types of cancer. 

Another recent call involved the wife of a cancer patient. She had been separated from her husband for several months but had returned upon hearing about his diagnosis. She sincerely wanted to assist him with practical matters as well as emotional support, but the disparity in the marriage had not been resolved, and the matter was exacerbated by her return and the challenge of cancer. 

I have come to recognize this early cancer dilemma as falling along a continuum of what has been professionally known as traumatic stress disorder. Early descriptions of what happens to someone when faced with a life-threatening event referred to “shell shock” in World War I and “battle fatigue” in World War II. More recently, we have the diagnostic nomenclature of post-traumatic stress disorder. The difference with the proposed “cancer traumatic stress disorder,” or C.T.S.D., is that the trauma is not experienced in a foxhole but usually in a doctor’s office, and it is not a single event but a repeated one. Anticipatory anxiety and depressive thoughts often follow exposure to multiple traumas when no immediate outcome is in sight. 

Mental health treatment choices often take the form of palliative medication, but a combination of psychotherapy and medication has emerged as the best, most comprehensive approach. At Fighting Chance we provide emotional and cognitive support as well as coping strategies, while removing the financial burden of health care by offering all services free of charge.

Cancer is often emotionally contagious, whereby the family, caregivers, and social network of the patient are affected in what might be called “vicarious C.T.S.D.” At Fighting Chance we have embraced a family approach to counseling and often meet with the spouse, partner, or children of the diagnosed patient in order to assist with their understanding, roles, and emotional reactions as the journey proceeds. 

William J. Di Scipio is a psychologist and the executive director of Fighting Chance. He lives in Amagansett.