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Cancer diagnosis response: Being hit by an existential Mack Truck

When I meet with patients newly diagnosed with cancer, they often find it difficult articulate the forbidding experience of being told for the first time they have cancer. All they hear is ‘die’-gnosis and immediately become overwhelmed by that dreadful feeling: “Oh my God, I’m gonna die!” I often try to meet them in that intimate and vulnerable moment of existential shock and disbelief by stating, “It’s like being hit by an existential Mack truck.” Invariably, the answer that follows is “Yes! I didn’t see it coming. It slammed right into me out of nowhere.”

This becomes my point of entry, as both a psycho-oncologist and existential therapist, for patients facing cancer and their ultimate survival or mortality. Too often in existentialism and oncology, incredible emphasis is placed on facing absence: death, disease, dysfunction, disconnection. This focus on absence does not help our patients grapple with the great unknowns of their illness and existence. I’ve found it is far more beneficial to help focus patients’ toward life’s presence: that which fulfills them with meaning and purpose in the face of cancer. It is far more healing to engage in restorative self-care and marinate in meaning than dwell on death through cancer.

When meeting patients for the first time, I’ve already read their medical chart and objective case history, but I invite them to share their own subjective story of cancer. Through this intimate narrative of cancer I’m able to closely track absence (e.g., fears of mortality, physical pain, mental/emotional suffering) that keep them disconnected from life, as well as presence (e.g., who and what they love, life’s work/goals) that keep them vitally involved and connected to life. After their story is shared, I normalize the reception of a scary cancer diagnosis with some basic psycho-education including common responses and terminology. For example, we may experience an ‘existential crisis’ when our everyday existence is thrown into question. As Martin Heidegger identified in his work Being and Time: “We know our existence in its absence.”

Facing one’s potential untimely demise through the diagnosis of cancer—no matter the age or stage—suffuses the body and mind with mortal terror or what Kierkegaard would term dread. This trauma produces a ‘fight or flight response’—a primitive self-protective/preservatory mechanism for a real or perceived existential danger or threat. The body is inherently benevolent and wants to survive at any cost, but the energy, thoughts, and emotions this mechanism produces may be misdirected and difficult to control. Cancer patients must learn how to effectively harness this response and learn to self-regulate in order to mitigate stress or poor decision-making. Relaxation techniques, such as diaphragmatic breathing, in combination with self-examination reduces cortisol stress hormones. This is crucial to free up the body’s immune system to fight cancer. Patients often perk up when provided tools and a veritable roadmap to help them traverse the dark murky terrain of their initial cancer diagnosis.

Much of my initial work with cancer patients is convincing them that they are in charge of choosing their attitude: die of cancer or live in the face of it. We are inculcated to fear the great unknowns of life, that which are beyond our control. It is essential to shift patients from fear-based stances toward life and cancer, toward a care-based curiosity and interest. Viktor Frankl summed this up by suggesting that “when all else is stripped away physically, mentally, emotionally, spiritually, even existentially—we still have as our last vestige of human freedom the ability to choose at any given moment or in any circumstance how we may find meaning in our suffering .” Nietzsche underscores this message: “He who has a why to live for can bear with almost any how.”

I shepherd patients toward sourcing self-regulatory and fulfilling presence to assuage existential angst in the face of absence. As an integrative behavioral health consultant, I help patients employ a healthy lifestyle (diet, exercise, restorative self-care) to strengthen their overall body, mind, and spirit to fight cancer. Once patients start actively engaging in life and become involved in meaningful and purposeful activities, they find the inner strength and empowerment to live fully in the face of cancer—come what may.

Feature image credit: Flock of Seagulls (eschipul). Photo by Kreuzschnabel. CC BY-SA 2.0 via Wikimedia Commons.

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