September 10, 2021 • 17 mins
Anxiety, depression, sadness and anger are all common reactions. Dr. Saltz answers a newly diagnosed listener’s question, and tells how to deal with these emotions so they don’t get in the way of treatment.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. What happens when you've
been told it's cancer. Cancer is responsible for a quarter
of all deaths in the United States each year. There
are one point two million new cases of cancer diagnosed annually,
(00:49):
and about people die each day from cancer. These scary
statistics despite the fact that many people do well with
cancer treatments curing the diagnosis of cancer guil synonymous with
a death sentence and be truly traumatic for most people
that first hear the word. However, the numbers of people
(01:13):
with a cancer diagnosis who are treated and survived is
actually much much larger. It feels scary, nonetheless, which is
why today I'm answering a question I received from a
listener who received a new cancer diagnosis and is psychologically
having a difficult time. Dr Coogler Ross, who was important
(01:37):
in the development of the expertise of psycho oncology or
emotionally what happens when a person is grappling with cancer.
Wrote about the stages of feelings one goes through when dying,
and in fact it is common for a person newly
diagnosed with cancer to go through some or all of
(01:59):
these stages even if they're not dying. These stages are denial, anger, bargaining, depression,
and lastly acceptance. By denial, she means saying to yourself,
this can't be true. I don't believe this is true.
(02:21):
By anger, it's meant feeling that it's true and being furious.
Furious at the universe, may be furious at whatever God
you believe in, maybe furious at family members who somehow
didn't see this. It might be rational anger. It might
(02:42):
be irrational anger. It might even be anger at yourself.
By bargaining, it's meant having a lot of thoughts that
have to do with maybe if I do this, if
I sacrifice this, I can make myself okay. By depression,
(03:02):
of course, it might be the evolution into some ideas
that you're very, very sad or can't imagine going on.
And of course, by acceptance. It's finding some way of
dealing with the fact that you do have cancer, that
it is on some sort of course, and that you
(03:23):
will deal with what comes. You might go through all
of these stages. You might go through only one or two.
You might go through them in a different order. Sometimes
the fear of one's own sickness and possible death do
cause them or their family member to be in denial
(03:44):
of the diagnosis or be completely depressed and despondent. While
it is important to grieve about the situation in your
own way, these types of reactions can get in the
way of going after the treatments that you need to get.
The fact is that gathering all of the facts from
(04:05):
the proper doctors is absolutely key when it comes to
embarking on cancer treatment. In addition, it is important to
be as positive as possible about the outcome, to be hopeful,
and to be, as it said, a fighter, because those
(04:26):
patients are the ones who generally do tend to do
better with tolerating the treatments that have to be endured.
This is a time to use all of your resources,
your family, your friends, professional health support groups. Whether you
are the one with cancer or your family member is.
(04:50):
When cancer strikes, it affects the entire family and everyone
may need help. Sometimes it's even harder for the spouse
or partner than it is for the patient. So let's
get to our listeners questions and see how can I help?
(05:12):
How can I help? With Doctor Gale Salts will be
back after this short break. Dear doctor Saltz. About a
month ago, I found a lump in my breast. I
thought it was probably nothing, really, because I've had lumps
(05:32):
before that turned out to just be psycho related lumpiness.
But this time it didn't really change, and so I
went to my gynecologists to check it out. After a
mammogram and a biopsy, it has turned out to be cancer.
I am told it is treatable and not advanced beyond
(05:53):
the breast, But honestly, I feel really panicky and keep thinking,
but what if it doesn't respond to treatment? What if
it does spread? What if? Since no one can assure
me with a certainty that I'll be okay, I'm not
okay the end of this. What if I die? What
(06:15):
will happen to my children? I find myself panicked over
chemotherapy and how ill all feel imagining it? Will be horrible.
I feel so upset that I can't think. I'm having
trouble sleeping. I'm actually having trouble thinking about anything else,
(06:35):
and I have things I need to think about, like
work and my kids. I just don't know what to
do with myself. At this point, my emotional state feels
worse than my physical state. What can I do to
feel better and handle what's to come? Getting a cancer
(06:56):
diagnosis is shocking and often does feel a traumatic because
true or not, it feels like the potential for illness, suffering,
and even death. This is the brand of the word cancer,
the meaning to many of the word cancer. Therefore, just
(07:19):
knowing this information in the short term, especially without more information,
can act as a trigger to stimulate anxiety and fear.
The anxiety and fear may not even be attached to
specific thoughts initially, but then your mind fills in the
information to explain to your mind and body why it's
(07:44):
feeling so anxious. These thoughts can come so quickly that
it seems as though it's the thoughts themselves causing the anxiety,
and that somehow makes these anxious thoughts feel even more
you But in reality, you don't know how the course
(08:05):
of your cancer will go. If you already had a
tendency for anxiety, you may be more likely to struggle
with anxiety now, but other emotions may come into such
as anger and sadness. All of this is a normal
first reaction to the news of your diagnosis. You mentioned, though,
(08:30):
that your anxiety is so severe you can't do anything
else at all. If this is true for a week
or two, then I would call this an adjustment disorder.
You are adjusting to very upsetting news, and your symptoms
will likely recede with some support from those people around you,
(08:54):
and I would advise you to try some things to
lower your overall anxiety. Thirty minutes of aerobic exercise several
times a week, paste deep breathing in the morning and
in the evening for ten minutes. Progressive muscle relaxation practice
(09:14):
for ten minutes in the morning in the evening. But
if this last more than a few weeks, then this
may be an anxiety disorder which has been triggered by
the trauma of the diagnosis, in which case I would
advise an evaluation and treatment by a trained professional, particularly
(09:36):
one who is familiar with treating psychiatric issues in the
face of medical illness. In fact, many cancer centers have
such people already on staff who are very used to
dealing with this. Psychological issues are actually very common in
a cancer diagnosis, but they are also very treatable. Checking
(10:01):
in with somebody who can evaluate what's going on and
provide some ancillary treatment can make all the difference. So
most common in a cancer diagnosis is what I mentioned earlier,
adjustment disorder. In fact, as much of as thirty two
of people who first get a cancer diagnosis experience this
(10:25):
adjustment disorder two weeks of either incredible anxiety or profound sadness,
but again with support from others around them, talking to
other people, doing some things to cope in the moment,
this will pass. Things that might also help, besides relaxation
(10:46):
training are things like education about your diagnosis, more information
to know where you stand, using distraction, watching comedy shows
or sorbing movies that take your mind off it for
a bit, and as I said, support support from friends
(11:07):
or sometimes group support. Again, many cancer centers run group
therapies for people who are dealing with a new cancer
diagnosis and just need to talk about it. If, however,
you are in the smaller number of people who really
are feeling overwhelmed for more than two weeks, and this
(11:30):
does sound like it could be you, then I would
definitely get an evaluation, because sometimes an anti anxiety medication
or an antidepressant medication for anxiety or depression can really
be helpful and may only be used for the short
term as long as you're doing some therapy along the
(11:51):
way and then can taper off the medication. The goals
of this, the goals of how you should treat yourself
in these coming weeks, are about acknowledging and accepting many
normal emotions you're having in reaction to the diagnosis, letting
others help and support you, having some of the difficult
(12:17):
talks that you will need to have about which treatment,
why you want to choose that treatment, how you feel
about the treatment, and of course general preparations for you
and your family. It's also really helpful sometimes to talk
to other people who have been there. If you don't
know personally people in your life, you might ask your
(12:40):
practitioner if there are patients who have volunteered, which often
there are, to talk to others who have been through
similar treatments. I hope that was helpful Here are some
things to consider when you or your family member have
(13:00):
told yes, it is cancer. First, remember it's okay to
be afraid. You may think that being scared can overwhelm you,
and so you might turn to denial or anger or depression.
But these feelings can keep you from actively pursuing the
(13:20):
treatment that you need. So acknowledge that you feel scared
and that's okay. It may also cause you to push
away people that you love and need who are there
to help you. So let yourself be afraid and be
able to talk to others in your sphere because it's
a very normal response. Next, do let other people help you,
(13:46):
not just for you, but for them too. The most
difficult part of this diagnosis is feeling helpless to fix it.
Letting your loved ones do whatever they can for you,
either talking to you, going to the doctor with you
will actually help them to feel more useful and make
you feel supported, organize, and act. Many cancers do very
(14:13):
well with chemotherapy and other treatments, but the earlier the better.
Though you may be reeling, you must get going and
find the best treatment available. Usually you will get the
diagnosis from your general doctor, but now you must find
the proper cancer treatment from a specialist or even possibly
(14:35):
too to explain the facts about your cancer and what
treatment options are available to you. If you can't because
of how you feel and let others galvanize for you,
delegate to them. Waiting will only lessen the odds. Prepare
for the way you want to be out of terror
(14:59):
of dying. Is hard to think about how you would
want to die if you cannot be saved, but sometimes
in the most of dire of cancer diagnosis, it is
important to think about. Nothing is harder for family than
not knowing what you wanted and then fighting amongst themselves.
(15:20):
When you are strong and prepared for the battle, is
actually the time to make those plans. Many people don't
because they feel afraid, but really preparing has nothing to
do with the outcome. It's just preparing. Do you want
a living will? Do you want life support at some point?
(15:44):
Or do you want to choose to never be on
a respirator? Who will you give power attorney to if
you cannot act? Have you made a will if there
is no hope? Do you want to die at home?
These are really tough questions, but they actually only get
(16:04):
tougher if you get sicker and closer to the scary
idea of death. Most people prepare these thoughts and decisions
well well in advance, when it is much easier to do.
It is best to decide, prepare, and tell your family
your choices while you still feel able to hold your
(16:27):
ground for what you want and can explain to your
family it's importance to you so they can support those choices.
Talk to those you love. Many people never get to
say what they needed to to their spouse, to their children, parents,
sibling or friends. Now is the time to tell them
(16:51):
whatever you really want them to know. If you don't,
you will have to live with those regrets, So don't
let fear or embarrassment holds you back. These can be
things too that your family can have to think about
if you're sick or if the worst should happen. And
(17:11):
probably most importantly, many people do need and should get
professional mental health health. This is amongst the hardest thing
that you will ever have to go through, and many
people do struggle with depression. There is no reason not
to get extra help and possibly medication if needed. Do
(17:37):
you have a problem I can help with? If so,
email me yet, how can I help at Seneca women
dot com. All centers remain anonymous and listen every Friday too.
How can I help with me Dr Gail's Salts
These are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm Dr
Gail Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. What happens when you've
been told it's cancer. Cancer is responsible for a quarter
of all deaths in the United States each year. There
are one point two million new cases of cancer diagnosed annually,
(00:49):
and about people die each day from cancer. These scary
statistics despite the fact that many people do well with
cancer treatments curing the diagnosis of cancer guil synonymous with
a death sentence and be truly traumatic for most people
that first hear the word. However, the numbers of people
(01:13):
with a cancer diagnosis who are treated and survived is
actually much much larger. It feels scary, nonetheless, which is
why today I'm answering a question I received from a
listener who received a new cancer diagnosis and is psychologically
having a difficult time. Dr Coogler Ross, who was important
(01:37):
in the development of the expertise of psycho oncology or
emotionally what happens when a person is grappling with cancer.
Wrote about the stages of feelings one goes through when dying,
and in fact it is common for a person newly
diagnosed with cancer to go through some or all of
(01:59):
these stages even if they're not dying. These stages are denial, anger, bargaining, depression,
and lastly acceptance. By denial, she means saying to yourself,
this can't be true. I don't believe this is true.
(02:21):
By anger, it's meant feeling that it's true and being furious.
Furious at the universe, may be furious at whatever God
you believe in, maybe furious at family members who somehow
didn't see this. It might be rational anger. It might
(02:42):
be irrational anger. It might even be anger at yourself.
By bargaining, it's meant having a lot of thoughts that
have to do with maybe if I do this, if
I sacrifice this, I can make myself okay. By depression,
(03:02):
of course, it might be the evolution into some ideas
that you're very, very sad or can't imagine going on.
And of course, by acceptance. It's finding some way of
dealing with the fact that you do have cancer, that
it is on some sort of course, and that you
(03:23):
will deal with what comes. You might go through all
of these stages. You might go through only one or two.
You might go through them in a different order. Sometimes
the fear of one's own sickness and possible death do
cause them or their family member to be in denial
(03:44):
of the diagnosis or be completely depressed and despondent. While
it is important to grieve about the situation in your
own way, these types of reactions can get in the
way of going after the treatments that you need to get.
The fact is that gathering all of the facts from
(04:05):
the proper doctors is absolutely key when it comes to
embarking on cancer treatment. In addition, it is important to
be as positive as possible about the outcome, to be hopeful,
and to be, as it said, a fighter, because those
(04:26):
patients are the ones who generally do tend to do
better with tolerating the treatments that have to be endured.
This is a time to use all of your resources,
your family, your friends, professional health support groups. Whether you
are the one with cancer or your family member is.
(04:50):
When cancer strikes, it affects the entire family and everyone
may need help. Sometimes it's even harder for the spouse
or partner than it is for the patient. So let's
get to our listeners questions and see how can I help?
(05:12):
How can I help? With Doctor Gale Salts will be
back after this short break. Dear doctor Saltz. About a
month ago, I found a lump in my breast. I
thought it was probably nothing, really, because I've had lumps
(05:32):
before that turned out to just be psycho related lumpiness.
But this time it didn't really change, and so I
went to my gynecologists to check it out. After a
mammogram and a biopsy, it has turned out to be cancer.
I am told it is treatable and not advanced beyond
(05:53):
the breast, But honestly, I feel really panicky and keep thinking,
but what if it doesn't respond to treatment? What if
it does spread? What if? Since no one can assure
me with a certainty that I'll be okay, I'm not
okay the end of this. What if I die? What
(06:15):
will happen to my children? I find myself panicked over
chemotherapy and how ill all feel imagining it? Will be horrible.
I feel so upset that I can't think. I'm having
trouble sleeping. I'm actually having trouble thinking about anything else,
(06:35):
and I have things I need to think about, like
work and my kids. I just don't know what to
do with myself. At this point, my emotional state feels
worse than my physical state. What can I do to
feel better and handle what's to come? Getting a cancer
(06:56):
diagnosis is shocking and often does feel a traumatic because
true or not, it feels like the potential for illness, suffering,
and even death. This is the brand of the word cancer,
the meaning to many of the word cancer. Therefore, just
(07:19):
knowing this information in the short term, especially without more information,
can act as a trigger to stimulate anxiety and fear.
The anxiety and fear may not even be attached to
specific thoughts initially, but then your mind fills in the
information to explain to your mind and body why it's
(07:44):
feeling so anxious. These thoughts can come so quickly that
it seems as though it's the thoughts themselves causing the anxiety,
and that somehow makes these anxious thoughts feel even more
you But in reality, you don't know how the course
(08:05):
of your cancer will go. If you already had a
tendency for anxiety, you may be more likely to struggle
with anxiety now, but other emotions may come into such
as anger and sadness. All of this is a normal
first reaction to the news of your diagnosis. You mentioned, though,
(08:30):
that your anxiety is so severe you can't do anything
else at all. If this is true for a week
or two, then I would call this an adjustment disorder.
You are adjusting to very upsetting news, and your symptoms
will likely recede with some support from those people around you,
(08:54):
and I would advise you to try some things to
lower your overall anxiety. Thirty minutes of aerobic exercise several
times a week, paste deep breathing in the morning and
in the evening for ten minutes. Progressive muscle relaxation practice
(09:14):
for ten minutes in the morning in the evening. But
if this last more than a few weeks, then this
may be an anxiety disorder which has been triggered by
the trauma of the diagnosis, in which case I would
advise an evaluation and treatment by a trained professional, particularly
(09:36):
one who is familiar with treating psychiatric issues in the
face of medical illness. In fact, many cancer centers have
such people already on staff who are very used to
dealing with this. Psychological issues are actually very common in
a cancer diagnosis, but they are also very treatable. Checking
(10:01):
in with somebody who can evaluate what's going on and
provide some ancillary treatment can make all the difference. So
most common in a cancer diagnosis is what I mentioned earlier,
adjustment disorder. In fact, as much of as thirty two
of people who first get a cancer diagnosis experience this
(10:25):
adjustment disorder two weeks of either incredible anxiety or profound sadness,
but again with support from others around them, talking to
other people, doing some things to cope in the moment,
this will pass. Things that might also help, besides relaxation
(10:46):
training are things like education about your diagnosis, more information
to know where you stand, using distraction, watching comedy shows
or sorbing movies that take your mind off it for
a bit, and as I said, support support from friends
(11:07):
or sometimes group support. Again, many cancer centers run group
therapies for people who are dealing with a new cancer
diagnosis and just need to talk about it. If, however,
you are in the smaller number of people who really
are feeling overwhelmed for more than two weeks, and this
(11:30):
does sound like it could be you, then I would
definitely get an evaluation, because sometimes an anti anxiety medication
or an antidepressant medication for anxiety or depression can really
be helpful and may only be used for the short
term as long as you're doing some therapy along the
(11:51):
way and then can taper off the medication. The goals
of this, the goals of how you should treat yourself
in these coming weeks, are about acknowledging and accepting many
normal emotions you're having in reaction to the diagnosis, letting
others help and support you, having some of the difficult
(12:17):
talks that you will need to have about which treatment,
why you want to choose that treatment, how you feel
about the treatment, and of course general preparations for you
and your family. It's also really helpful sometimes to talk
to other people who have been there. If you don't
know personally people in your life, you might ask your
(12:40):
practitioner if there are patients who have volunteered, which often
there are, to talk to others who have been through
similar treatments. I hope that was helpful Here are some
things to consider when you or your family member have
(13:00):
told yes, it is cancer. First, remember it's okay to
be afraid. You may think that being scared can overwhelm you,
and so you might turn to denial or anger or depression.
But these feelings can keep you from actively pursuing the
(13:20):
treatment that you need. So acknowledge that you feel scared
and that's okay. It may also cause you to push
away people that you love and need who are there
to help you. So let yourself be afraid and be
able to talk to others in your sphere because it's
a very normal response. Next, do let other people help you,
(13:46):
not just for you, but for them too. The most
difficult part of this diagnosis is feeling helpless to fix it.
Letting your loved ones do whatever they can for you,
either talking to you, going to the doctor with you
will actually help them to feel more useful and make
you feel supported, organize, and act. Many cancers do very
(14:13):
well with chemotherapy and other treatments, but the earlier the better.
Though you may be reeling, you must get going and
find the best treatment available. Usually you will get the
diagnosis from your general doctor, but now you must find
the proper cancer treatment from a specialist or even possibly
(14:35):
too to explain the facts about your cancer and what
treatment options are available to you. If you can't because
of how you feel and let others galvanize for you,
delegate to them. Waiting will only lessen the odds. Prepare
for the way you want to be out of terror
(14:59):
of dying. Is hard to think about how you would
want to die if you cannot be saved, but sometimes
in the most of dire of cancer diagnosis, it is
important to think about. Nothing is harder for family than
not knowing what you wanted and then fighting amongst themselves.
(15:20):
When you are strong and prepared for the battle, is
actually the time to make those plans. Many people don't
because they feel afraid, but really preparing has nothing to
do with the outcome. It's just preparing. Do you want
a living will? Do you want life support at some point?
(15:44):
Or do you want to choose to never be on
a respirator? Who will you give power attorney to if
you cannot act? Have you made a will if there
is no hope? Do you want to die at home?
These are really tough questions, but they actually only get
(16:04):
tougher if you get sicker and closer to the scary
idea of death. Most people prepare these thoughts and decisions
well well in advance, when it is much easier to do.
It is best to decide, prepare, and tell your family
your choices while you still feel able to hold your
(16:27):
ground for what you want and can explain to your
family it's importance to you so they can support those choices.
Talk to those you love. Many people never get to
say what they needed to to their spouse, to their children, parents,
sibling or friends. Now is the time to tell them
(16:51):
whatever you really want them to know. If you don't,
you will have to live with those regrets, So don't
let fear or embarrassment holds you back. These can be
things too that your family can have to think about
if you're sick or if the worst should happen. And
(17:11):
probably most importantly, many people do need and should get
professional mental health health. This is amongst the hardest thing
that you will ever have to go through, and many
people do struggle with depression. There is no reason not
to get extra help and possibly medication if needed. Do
(17:37):
you have a problem I can help with? If so,
email me yet, how can I help at Seneca women
dot com. All centers remain anonymous and listen every Friday too.
How can I help with me Dr Gail's Salts
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