This article is adapted by Dr Jane Clark from an article originally written by Jane and Dr Peter Harvey. See our introduction for a background on this series of articles.
The concept of coping is not specific to dealing with life after the treatment has finished but there are some general hints and tips that may help those of you who feel that you are not coping.
People mean very different things by this phrase and it is important to try and clarify just what you mean by it. Perhaps a good place to start is to ask yourself – what would I be like if I was coping?
Many people imagine that coping means being very stiff upper-lipped, tough and emotionless, dealing with every crisis without any difficulty. Whilst this may be a slight exaggeration, for many people coping has that sort of ‘I should be able to deal with anything life throws at me’ attitude – which is not always realistic! Note the use of the word ‘should’ in the previous sentence – this is one of those rather unhelpful words (along with ‘must’ and ‘ought’) that lead to unrealistic beliefs and the setting of unreachable targets.
Thinking like this can often lead to a sense of failure, of not doing well enough, or of not trying hard enough, all of which adds to the burden of feeling that you are simply not coping.
Another useful technique is to ask yourself the following question: ‘If I was listening to a friend of mine describing all that I have been through, would I feel as critical of their coping as I am of my own?’ Most people, when they do this, find that they are a lot more sympathetic with others that they are with themselves. If this applies to you then you really do need to ask yourself why you should treat others better than you treat yourself.
Returning to the phrase ‘not coping’, it is often used when the going is really tough, when you are feeling pressured on all sides, perhaps feeling as if you and the world around you is in complete turmoil.
Again, it’s worth taking a bit of time to ask yourself – is this an accurate reflection of my life at the moment? Is it actually in turmoil and, if so, might it not be OK to feel a bit in turmoil myself? This is what happens when you are engaged in the process of coping – it happens when you are called upon to mobilize all your resources to deal with demands and threats. You are only called on to cope when there is something to cope with and that process of coping may well feel very uncomfortable.
Coping is not a single process but a multi-stranded one, making use of a variety of strategies to deal with a variety of challenges. We select the strategy to suit the purpose – there is no one right way of coping that we can use all the time for all situations. Furthermore, coping is not an all-or-nothing event – it is a process which requires effort and energy.
The process of coping can be fatiguing, uncomfortable and very difficult. You cannot expect yourself to able to cope easily and without some cost. Too often people tick themselves off for not coping well enough when sometimes they should congratulating themselves on coping at all!
There are some general strategies that may be useful – this is not an exhaustive list and may not apply to you all of the time but may provide a helpful framework.
Let’s look at each of these in more detail.
Confronting the issues is a critical first step in the coping process. Most of the psychological research on coping has been informed by the idea that at least one of the key aspects of the coping response is an appraisal of threat.
That means that when we need to cope – that is to deal with a threat – we have to be able to try to understand the threat and what it means to our physical and psychological integrity. Only by doing that can we decide how to deal with the threat. We have to engage on a cognitive and an emotional level – with our head and with our hearts – with the threat: ‘ Know your enemy’ if you will excuse the rather militaristic phrase. Once we have some sense of what the threat is, then we can mobilize our resources to deal with it.
Clearly, cancer is a major threat both physically and psychologically. Part of the process of dealing with the physical threat is to have treatment to remove the tumour and control the physical processes that underlie the growth of cancer cells.
A complementary and equally necessary process is to mobilize our psychological resources. These resources are scarce and need to be well-chosen and well-used if we are to maximize their effectiveness – so we need to confront, plainly and honestly, what the psychological threats are.
This does not mean spending all your time ruminating on what might happen. Threats need to be kept under constant review and this is one of the most difficult aspects of dealing with cancer as the nature of the threat is ever-changing and unpredictable.
One of the things that often catches people by surprise is they still need to keep this process up once the treatment is finished. An important theme of this site is that, even when the treatment has finished, you still need to maintain a watchful coping style to deal with the challenges that life after cancer treatment brings.
Confronting the issues can be a painful, distressing business and that is one reason why it is often better to do this a bit at a time. But confronting is necessary and one of its costs is the emotional upheaval that can result.
Part of the coping response is being open to feelings – all of them, good or bad, constructive and destructive, hurtful or helpful. As noted before, coping is sometimes characterized by being stiff upper-lipped, stoical and accepting. But if you think about the threats that you confront during cancer and its treatment would that be a normal way of acting?
For many people living with cancer their feelings are often confused and in turmoil, all-or-nothing, veering from one powerful emotion to another like some horrendous roller-coaster from which there is no escape. This should come as no surprise. Cancer brings with it threats to our very existence and being – not to be upset by this is the abnormal reaction. It can be helpful to write down your experience of cancer – either what happened from diagnosis to the end of treatment and/ or the feelings that have surfaced since being in this world. The popularity of blogs and social media shows how helpful the process of writing and making sense of your experience can be for both the writer and reader.
A useful phrase to remember when you are berating yourself for being upset or for not coping is to say that you are experiencing ‘..expected reactions to extraordinary events’ (coined by Michael Stewart and Peter Hodgkinson in their work with people surviving major disasters). This encapsulates the emotional rationality of the feelings and the sheer terrifying uniqueness of the threat. So, when you are feeling despondent or tearful or frightened please do not give yourself a hard time and tell yourself you are not coping. True courage comes in the face of fear, not pretending that fear is not there. The bravest people are those manage despite fear, not those who claim fearlessness.
One of the common experiences of being diagnosed with cancer is that you become public property – everyone wants to know how you are. One of the coping strategies, therefore, is to protect your privacy. There are a number of reasons for this.
First, there is the problem of repetition. Telling the same story over and over again does not necessarily get easier – sometimes it has the opposite effect and becomes harder the more you do it, particularly if you are talking about painful or difficult issues.
Secondly, not everyone who asks how you feel really wants to know the answer. This may have happened to you during treatment. One of the cruel paradoxes of the disease is that you may look very healthy whilst feeling absolutely dreadful.
So when people pre-empt you by saying ‘You look well’ it is sometime difficult to say you feel rotten. Similarly you may feel unable to give an honest reply to ‘How do you feel’ question so you say “just fine”, a mask of social acceptability to protect the feeling of others – which is something that takes energy and eats into your psychological resources. And it hurts. This does not stop when your treatment has finished and can even get worse. You have a right to control what people know about you. It’s your body, your life – guard it well.
One of the most important changes that has occurred in the field of cancer care has been in the area of communication and information. There is now an abundance of information from an equally abundant variety of sources – although, it must be said, less so in the case of dealing with life after treatment. So, an important part of coping is about informing yourself. The wording is important here – informing yourself. This is something that can be and must be within your control and yours alone.
The key to this is selecting the amount of information you need at the time that you decide upon and which is presented in a manner that suits you. While some friends try to be helpful by giving you books or pieces from the papers with the instruction ‘You really must read this’ you can choose whether or not to read them.
You know yourself and what you need better than they do. And remember your information needs will change over time – sometimes you may need lots, other times very little so be aware of your own changing requirements.
In order to make the acronym work the word networking is used rather than social support but they are really one and the same! Finding and developing strong and constructive support networks is a powerful element in the repertoire of coping strategies. The important word here is constructive. We have already seen how an insensitive and clumsy remark can trample hob-nail boots through your carefully constructed support strategies.
There are people who catastrophise for you… “I really don’t know how you cope. If it had been me I’d have gone completely to pieces”; or those people who know someone… “My auntie/uncle had what you’ve got…they died of course”; or people who tell you… “look on the bright side.. there are many worse off than you” ; or people who tell you (or order you!) that “You must be positive” (see Moving Forward 17: Being Positive and Thinking Positively); or those who completely ignore you, saying that they thought that you probably had enough on your plate of that “I didn’t know what to say”.
The final word – grieving – perhaps needs some explanation. Giggling, grinning and gallivanting could have completed the acronym and are all perfectly good coping strategies in some circumstances, but addressing the issue of loss addressed right at the start (see Moving Forward 3: Beginning to Recover & Recuperation) is a key element of the coping process. The losses that cancer can bring – independence, physical integrity, sense of self, sense of masculinity and femininity, self-confidence – are real and to be dealt with.
This ties in with confronting the issues. You cannot grieve for a loss unless you acknowledge it first. The loss of a body part, even if diseased and damaged is still a loss of part of you. The grieving process does not have to be long and drawn out, nor does it have to be shared. But it may be an important part of your overall recovery. Plus remember how you would treat a friend who was grieving…all that kindness needs to be offered to yourself at this stage!
Dr Jane Clark, Consultant Clinical Psychologist
The information and content provided in this page is intended for information and educational purposes only and is not intended to substitute for professional medical advice.
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