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The Topic of Cancer

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Foreword

ePub

“If you could hear, at every jolt, the blood

Come gargling from the froth-corrupted lungs,

Obscene as cancer, bitter as the cud”

—Wilfred Owen, Dulce et Decorum Est
(Written between October 1917 and March 1918)

I do not generally take notes on dinner parties. But after one particularly memorable and troubling supper, more than thirty years ago, I seem to have done so.

Dr. X, a distinguished psychologist, and one of my former teachers in the mental health field, rang me with the sad news that he had developed a malignant tumour in one of his vital organs, and then explained that he would have to undergo an immediate surgical procedure. An elderly widower whose children lived overseas, Dr. X had invited me and three other former students to spend the evening with him prior to his operation. No doubt he wanted some company, but in view of the fact that he had requested that his one-time students should come for what could be a “last supper”, I suspected that he also hoped that we would be able to carry on his work and edit his papers for publication should he die on the operating table. Dr. X, a talented chef in his own right, instructed me to come for what he hoped would be a “happy meal”, and he underscored that under no circumstances must we talk about cancer. In view of his impending ordeal, he wanted this dinner party to be completely pleasant.

 

Chapter One - Freud's Cancer

ePub

Martin Schmidt

Anyone turning biographer commits himself to lies, to concealment, to hypocrisy, to flattery, and even to hiding his own lack of understanding, for biographical truth is not to be had, and even if it were it couldn't be used. Truth is unobtainable; humanity does not deserve it…

—Freud to Zweig, 31 May 1936, in Freud, E. L., 1961, p. 430.

Hardly words of encouragement. So it is with some trepidation that I attempt a biographical account of the influence of cancer on the pioneering father of psychoanalysis and his theories.

One of his closest friends and colleagues, Ernest Jones, identified two features which exemplify the last twenty years of Freud's illustrious life. The first was “the truly astonishing fresh outburst of original ideas” which “effected a revolution in both the theory and the practice of psycho-analysis”. The second was the “dauntless fortitude with which he endured the political and financial dangers that threatened to engulf both him and his work, the loss of several of those dear to him, and above all the cruel tortures of the many years of suffering from the devouring cancer that ultimately killed him” (Jones, 1957, p. 1).

 

Preface

ePub

I have always been fascinated by the senses, by instinct, and the expressions we use in everyday life to recapture our sensual or instinctual experience: “He has an eye for this”, “It feels to me”, “You could smell her fear”, “I could taste his displeasure”, “the mind's eye”. For me the most alive memory of my parents is the memory of their smell: the box of scented handkerchiefs that lay on my mother's bedside table, the smell of my father's pipe that he was always at odds to clean.

I became interested in cancer for no intellectual reason but because of a sense—a sense that I have known it all my life. It was always around, akin to the “unthought known” of which psychoanalyst Christopher Bollas speaks: I instinctively knew I was acquainted with this grim stranger.

So when three years ago the topic of cancer came up in conversation with my colleague Sally Griffin at the London Centre for Psychotherapy (now part of a new organisation: the British Psychotherapy Foundation), I immediately agreed to help “organise something”, the exact contents of which I was as yet unsure. It should be straightforward enough, or so I thought at the time. I had, after all, been involved, already, before my psychotherapy career began, in setting up and, for some seven years, running a self-help project for people living with cancer, their families and friends.

 

Introduction

ePub

Jonathan Burke

The Topic of Cancer focuses on our emotional responses to cancer, the disease that physician, researcher, and writer, Siddhartha Mukherjee, citing a nineteenth century surgeon, called “the emperor of all maladies”.

The Topic of Cancer is divided into two parts broadly titled “Bearing the Unbearable” and “Containment and Creativity”.

A subject that so many of us may want never to have to consider, the prevalence of cancer locates it never far from our conscious awareness. This book aims to open the topic up for reflection by offering a range of perspectives on cancer: psychoanalytic, medical, spiritual/religious, and literary.

Psychoanalytic publications traditionally introduce their theme by referring back to the works of Freud in much the same way as we might draw on the inspiration of our parents or the sayings of our ancestors. The Topic of Cancer being largely, albeit not entirely, a psychoanalytic publication, also begins by drawing on Freud, but from a different, deeply personal perspective: a Freud we barely know.

 

Chapter Two - Understanding the Patient with Cancer

ePub

Dorothy Judd

Iam often struck by how many basic psychoanalytic concepts describing states of mind are magnified by those facing a life-threatening illness. As human beings we may grapple with these conditions, ordinarily, but having cancer can give us a heightened awareness of them, exemplified in Freud's (1916) description: “Transience value is scarcity value in time”.

Some of the states of mind which a life-threatening illness may illuminate, or make starker, include:

Uncertainty

Nameless dread

Falling forever

Catastrophic change

A sense of “going-on-being”

Existential questions about life and death, and spirituality

Guilt

A need to make reparation, or a failure of reparation

The passing of time as a fact of life, which involves an awareness of mortality

Creativity, that is to say, the lack of, or failed, or stimulation of creative potential

Gratitude

Loneliness

Fragmentation

Emptiness and bleakness

Containment, or failures of containment

Mourning: the loss of the hoped-for future, mourning of past losses reactivated.

 

Chapter One - Freud's Cancer

ePub

Martin Schmidt

Anyone turning biographer commits himself to lies, to concealment, to hypocrisy, to flattery, and even to hiding his own lack of understanding, for biographical truth is not to be had, and even if it were it couldn't be used. Truth is unobtainable; humanity does not deserve it…

—Freud to Zweig, 31 May 1936, in Freud, E. L., 1961, p. 430.

Hardly words of encouragement. So it is with some trepidation that I attempt a biographical account of the influence of cancer on the pioneering father of psychoanalysis and his theories.

One of his closest friends and colleagues, Ernest Jones, identified two features which exemplify the last twenty years of Freud's illustrious life. The first was “the truly astonishing fresh outburst of original ideas” which “effected a revolution in both the theory and the practice of psycho-analysis”. The second was the “dauntless fortitude with which he endured the political and financial dangers that threatened to engulf both him and his work, the loss of several of those dear to him, and above all the cruel tortures of the many years of suffering from the devouring cancer that ultimately killed him” (Jones, 1957, p. 1).

 

Chapter Three - The Emotional Impact of Cancer on Children and their Families

ePub

Anthony Lee and Jane Elfer

The child and adolescent psychotherapy discipline at University College London Hospital (UCLH) is part of the Department of Child and Adolescent Psychological Medicine, which also comprises teams of clinical and systemic psychologists and child and adolescent psychiatrists. With two other child and adolescent psychotherapists and a child and adolescent psychotherapist in training, we provide a psychoanalytic psychotherapy service to children and their families and to young people referred from within the hospital. We dedicate a significant proportion of our time to work with the young people who are treated in the teenage and young adult service, as well to the many young children who are treated here for their cancer in the paediatric service. A high proportion of children with brain tumours come to UCLH for radiotherapy treatment.

In this chapter, we consider aspects of our experience of working closely with children with cancer. Through case material and with reference to the literature, we will attempt to construct a narrative around the emotional impact of cancer on children and their families. It is an account drawn from our close observations of the children and their families and from our countertransference responses from being in their company.

 

Chapter Two - Understanding the Patient with Cancer

ePub

Dorothy Judd

Iam often struck by how many basic psychoanalytic concepts describing states of mind are magnified by those facing a life-threatening illness. As human beings we may grapple with these conditions, ordinarily, but having cancer can give us a heightened awareness of them, exemplified in Freud's (1916) description: “Transience value is scarcity value in time”.

Some of the states of mind which a life-threatening illness may illuminate, or make starker, include:

Uncertainty

Nameless dread

Falling forever

Catastrophic change

A sense of “going-on-being”

Existential questions about life and death, and spirituality

Guilt

A need to make reparation, or a failure of reparation

The passing of time as a fact of life, which involves an awareness of mortality

Creativity, that is to say, the lack of, or failed, or stimulation of creative potential

Gratitude

Loneliness

Fragmentation

Emptiness and bleakness

Containment, or failures of containment

Mourning: the loss of the hoped-for future, mourning of past losses reactivated.

 

Chapter Four - What the Illness may Reveal

ePub

John Woods

Introduction

From his many years of therapeutic work with cancer patients, Lawrence Goldie likens the impact of a cancer diagnosis to that of a traumatic war experience, which may result in an overwhelming “fear of what is going to happen to me”. Drawing on Bion's ideas he shows how a predicted future can become as fixed as if it were a past event. This psychological process, he maintains, has a tremendous influence on what happens to a person's capacity to deal with their illness. Psychoanalytic psychotherapy, he shows, can help the patient change in their experience from one of persecution and helplessness, to feeling “empowered to act in the present, out of concern for others” (Goldie, 2005, p. 25). The meaning of the illness may therefore be transformed from a death sentence to one of creative opportunity. But what happens if it is the therapist who has received the diagnosis? In this account I propose to show how a therapist's experience of cancer may have influenced the work with a particular patient.

 

Chapter Five - The Ill Psychotherapist: A Wounded Healer

ePub

Judy Parkinson

In this chapter I will consider the impact of cancer on the psychotherapist and his or her clinical practice, whether the psychotherapist is working alone or with colleagues in group, couple, or family therapy. I will draw upon my own experience and that of other psychotherapists who have written or spoken about how they were personally affected by a diagnosis of cancer. These include Helen Bender and John Woods, who related their own personal and professional dilemmas and challenges in a conversation before an audience at the London Centre for Psychotherapy (now part of a new organisation: the British Psychotherapy Foundation) in November 2011.

The experience of cancer

Cancer can leave us feeling that we have been invaded, our bodies taken over. Shock, fear, disbelief, and questions such as “Why me?” and “Why now?” are common in response to this unexpected intrusion into our lives. There may be a sense of dread about what the diagnosis means in the life of the individual and for the person's sense of “who I am”, the “me” feeling vulnerable and exposed to the unknown (Parkinson, 2003). Some people with cancer will experience a sense of shame or guilt for something felt to be their fault (Burton & Watson, 1988; Parkinson, 2003).

 

Chapter Three - The Emotional Impact of Cancer on Children and their Families

ePub

Anthony Lee and Jane Elfer

The child and adolescent psychotherapy discipline at University College London Hospital (UCLH) is part of the Department of Child and Adolescent Psychological Medicine, which also comprises teams of clinical and systemic psychologists and child and adolescent psychiatrists. With two other child and adolescent psychotherapists and a child and adolescent psychotherapist in training, we provide a psychoanalytic psychotherapy service to children and their families and to young people referred from within the hospital. We dedicate a significant proportion of our time to work with the young people who are treated in the teenage and young adult service, as well to the many young children who are treated here for their cancer in the paediatric service. A high proportion of children with brain tumours come to UCLH for radiotherapy treatment.

In this chapter, we consider aspects of our experience of working closely with children with cancer. Through case material and with reference to the literature, we will attempt to construct a narrative around the emotional impact of cancer on children and their families. It is an account drawn from our close observations of the children and their families and from our countertransference responses from being in their company.

 

Chapter Four - What the Illness may Reveal

ePub

John Woods

Introduction

From his many years of therapeutic work with cancer patients, Lawrence Goldie likens the impact of a cancer diagnosis to that of a traumatic war experience, which may result in an overwhelming “fear of what is going to happen to me”. Drawing on Bion's ideas he shows how a predicted future can become as fixed as if it were a past event. This psychological process, he maintains, has a tremendous influence on what happens to a person's capacity to deal with their illness. Psychoanalytic psychotherapy, he shows, can help the patient change in their experience from one of persecution and helplessness, to feeling “empowered to act in the present, out of concern for others” (Goldie, 2005, p. 25). The meaning of the illness may therefore be transformed from a death sentence to one of creative opportunity. But what happens if it is the therapist who has received the diagnosis? In this account I propose to show how a therapist's experience of cancer may have influenced the work with a particular patient.

 

Chapter Six - The Cancer Nurse Specialists’ Caseload: “Contending with the Fretful Elements”

ePub

Anne Lanceley

This chapter describes cancer nurses’ experience of, to borrow from Shakespeare, “contending with the fretful elements” (King Lear III.i.4): the emotional storm of patients’ feelings, as well as those evoked in nurses during care. The focus of the chapter originates from my experiences caring for people with cancer in hospital, experiences which confirmed to me that by listening and talking to patients, cancer nurses may help them express their feelings and achieve a more integrated understanding of their illness and its place in their lives. This form of communication can help patients cope and can lead to an improved sense of emotional well-being. Communication of this nature takes place within the overall context of nurses’ work, including the accurate assessment of complex care needs, planning and provision of day-to-day physical care, and monitoring and evaluating patient outcomes. Though nurses may work in clinical areas that espouse a philosophy of patient-centeredness, and in teams which place a high value on supportive psychological care, nurses struggle to deal with the emotional problems of patients and relatives, people thrown off balance by demanding treatments and the trauma of cancer.

 

Chapter Five - The Ill Psychotherapist: A Wounded Healer

ePub

Judy Parkinson

In this chapter I will consider the impact of cancer on the psychotherapist and his or her clinical practice, whether the psychotherapist is working alone or with colleagues in group, couple, or family therapy. I will draw upon my own experience and that of other psychotherapists who have written or spoken about how they were personally affected by a diagnosis of cancer. These include Helen Bender and John Woods, who related their own personal and professional dilemmas and challenges in a conversation before an audience at the London Centre for Psychotherapy (now part of a new organisation: the British Psychotherapy Foundation) in November 2011.

The experience of cancer

Cancer can leave us feeling that we have been invaded, our bodies taken over. Shock, fear, disbelief, and questions such as “Why me?” and “Why now?” are common in response to this unexpected intrusion into our lives. There may be a sense of dread about what the diagnosis means in the life of the individual and for the person's sense of “who I am”, the “me” feeling vulnerable and exposed to the unknown (Parkinson, 2003). Some people with cancer will experience a sense of shame or guilt for something felt to be their fault (Burton & Watson, 1988; Parkinson, 2003).

 

Chapter Seven - On Survivorship

ePub

Adrian Tookman, Faye Gishen, and Jane Eades

Introduction: the changing nature of cancer care

Over the past twenty-five years there have been significant changes in cancer treatment and outcomes (Cancer Research UK, 2012a, 2012b; Office of National Statistics, 2003). Prolonged, more effective multimodality treatments for cancer are now commonplace, resulting in increasing numbers of “cancer survivors”: people “living with or beyond” their disease (Cancer Research UK, 2012a, 2012b; Health Statistics Quarterly, 2004; Office of National Statistics, 2003). Treatments are often arduous, and in many instances “survivors” have disabilities as a legacy of surgery, chemotherapy, radiotherapy, and the disease itself. Many are in need of physical and emotional support (Macmillan Cancer Support, 2008).

There has indeed been an increase in cancer survival figures, with more patients ultimately being cured. However there are approximately 1.6 million people in England today who are living with cancer, and this figure is estimated to rise to almost 4 million by 2030 (Macmillan Cancer Support, 2008). This number includes those who have completed their treatment as well as those having ongoing treatment for cancer. This change in the patient demographics, although acknowledged in UK national publications, has traditionally not received adequate attention, leading to poorly developed services to support the cancer survivorship population (Armes, et al., 2009; Calman & Hine, 1995; National Council for Hospice and Specialist Palliative Care (NCHSPC), 2000; Nocon & Baldwin, 1998).

 

Chapter Eight - Palliative Care: What, when, and how?

ePub

Robert Twycross

What and when?

The World Health Organization (WHO) defines palliative care as:

An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. (World Health Organization, 2002)

However, for most purposes a shorter definition is adequate, such as “end-of-life care” or “comfort care at the end of life”.

Initially palliative care evolved mainly in relation to incurable cancer. Indeed it can be viewed as a protest movement against the attitude that “There's nothing more we can do for you”, either stated or implied by the oncologist. Inevitably patients felt abandoned, and all too often suffered agonising pain and other distressing symptoms for many weeks, even months, before their death. Then, in 1967, St Christopher's Hospice opened in London, an event often used to date the inauguration of specialist palliative care. Its founder, Dr. (later Dame) Cicely Saunders, was a unique catalyst in the evolution of compassionate, scientific end-of-life care in the UK and many other countries. Her dynamism and commitment inspired thousands of health professionals and members of the general public, and set in motion a global movement for improvement in the care of people with progressive end-stage diseases.

 

Chapter Six - The Cancer Nurse Specialists’ Caseload: “Contending with the Fretful Elements”

ePub

Anne Lanceley

This chapter describes cancer nurses’ experience of, to borrow from Shakespeare, “contending with the fretful elements” (King Lear III.i.4): the emotional storm of patients’ feelings, as well as those evoked in nurses during care. The focus of the chapter originates from my experiences caring for people with cancer in hospital, experiences which confirmed to me that by listening and talking to patients, cancer nurses may help them express their feelings and achieve a more integrated understanding of their illness and its place in their lives. This form of communication can help patients cope and can lead to an improved sense of emotional well-being. Communication of this nature takes place within the overall context of nurses’ work, including the accurate assessment of complex care needs, planning and provision of day-to-day physical care, and monitoring and evaluating patient outcomes. Though nurses may work in clinical areas that espouse a philosophy of patient-centeredness, and in teams which place a high value on supportive psychological care, nurses struggle to deal with the emotional problems of patients and relatives, people thrown off balance by demanding treatments and the trauma of cancer.

 

Chapter Seven - On Survivorship

ePub

Adrian Tookman, Faye Gishen, and Jane Eades

Introduction: the changing nature of cancer care

Over the past twenty-five years there have been significant changes in cancer treatment and outcomes (Cancer Research UK, 2012a, 2012b; Office of National Statistics, 2003). Prolonged, more effective multimodality treatments for cancer are now commonplace, resulting in increasing numbers of “cancer survivors”: people “living with or beyond” their disease (Cancer Research UK, 2012a, 2012b; Health Statistics Quarterly, 2004; Office of National Statistics, 2003). Treatments are often arduous, and in many instances “survivors” have disabilities as a legacy of surgery, chemotherapy, radiotherapy, and the disease itself. Many are in need of physical and emotional support (Macmillan Cancer Support, 2008).

There has indeed been an increase in cancer survival figures, with more patients ultimately being cured. However there are approximately 1.6 million people in England today who are living with cancer, and this figure is estimated to rise to almost 4 million by 2030 (Macmillan Cancer Support, 2008). This number includes those who have completed their treatment as well as those having ongoing treatment for cancer. This change in the patient demographics, although acknowledged in UK national publications, has traditionally not received adequate attention, leading to poorly developed services to support the cancer survivorship population (Armes, et al., 2009; Calman & Hine, 1995; National Council for Hospice and Specialist Palliative Care (NCHSPC), 2000; Nocon & Baldwin, 1998).

 

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