Sunday, July 27, 2014

Breast Symbolism, Breast Cancer and Psychological Impact

In 2004 prominent psychoanalyst, Joyce McDougall, described how the mutilating breast cancer treatments women are subjected to, invariably arouse considerable psychological distress that can include the loss of the feeling of bodily integrity, disturbance in self-image and the sense of subjective identity, as well as changes in feelings of sexual identity. “With the loss of the breast, the essential symbol of femininity is felt to be destroyed,” McDougall wrote. (See McDougall, J. (2004), The Psychoanalytic Voyage of a Breast Cancer Patient in The Annals of Psychoanalysis: Psychoanalysis and Women, 32:9-28, Hillsdale, NJ, The Analytic Press.)

Due to the current lack of scientific knowledge about effective ways to both prevent and treat cancer, without putting patients through poisonous and assaulting treatments, a cancer diagnosis of any type has the potential to trigger a myriad of emotions and complex psychological trauma. Because the female breast is so symbolic and laden with conscious and unconscious meaning, it is especially important when thinking about breast cancer to consider what may be going on in patients', family members' and medical providers' minds.  Breasts universally symbolize femininity, nurture, sexual maturity and fertility. The idea of a toxic presence in the breast shakes the idea of life-giving sustenance right to its core.  In many cultures, the female breast is a defining characteristic of female attractiveness and sexual desirability, so when a woman is faced with losing a breast, she will often feel threatened and challenged in many different ways, in addition to having to cope with the idea of having a life-threatening disease.

It is particularly crucial for medical providers to be aware of not just how their patients are being physically and emotionally impacted, but also how they, themselves, are being affected. Medical providers need to be trained to be sensitive to their own emotional reactions and conflicts; they are in the unenviable position of having to offer and impose harsh and sickening treatments that permanently alter their patients physiology as well as external appearance. When physicians lack emotional self-awareness, they are at increased risk of causing unnecessary harm either to patients or to themselves. With patients, they may push for treatments that statistically only reduce the chances of cancer recurrence by a very small percentage, or they may fail to adequately inform patients about the extent of various treatment side effects, i.e. what life will likely be like, both while going through treatment and maybe for years afterward. With themselves, physicians may slide into problematic coping mechanisms such as alcohol abuse, gambling addictions, or abusive behavior directed at medical subordinates or their own family members.

Psychotherapists working with women who are being treated for breast cancer or who have undergone treatment in the past, also need to tune in to what psychological conflicts, emotions, attitudes and trauma are being activated in their own minds as they listen to their patients.  The more effectively the therapist does this, the more she will be able to help her client access her own unfelt emotional trauma, with the aim of containing it and working it through.

Tuesday, July 15, 2014

Lymphedema - An Ongoing Common Side-effect of Breast Cancer Treatment

Scotland Forest. Photo by Dr. Guerra
There is recent evidence to suggest that lymphedema, a condition that can result from having lymph nodes removed or radiated as part of breast cancer treatment, is something that many patients and their families are often told little or nothing about.  Some recovering breast cancer patients only find out about lymphedema at some point after their surgery, from a concerned nurse, blood draw technician, internist or fellow cancer survivor.

Lymphedema refers to "the build-up of fluid in soft body tissues when the lymph system is damaged or blocked". (See - National Cancer Institute). Symptoms in a breast cancer survivor include swelling and/or a heavy feeling in the arm, a tight feeling in the skin and trouble moving a joint in the arm. When a person is at increased risk for lymphedema, she always has to be thoughtful about physical activity involving that arm such as gardening, household chores and working out in a gym. Anything that will cause the build-up of lymph in the arm (e.g. cuts, scrapes, bug bites, heavy lifting, hot tubs), has to be monitored or avoided, in order to avoid the possibility of inflammation and lymphedema.  Blood pressure checks and blood labs have to be done using the other arm.

Mainstream breast cancer treatment in its current form - the gift that keeps on giving.

Sunday, July 13, 2014

Women, Cancer and Anger

Because women are less likely then men in our culture to be able to fully engage with negative feelings like anger and frustration, they may be at a psychological disadvantage in this particular way when facing a cancer diagnosis. Since a cancer diagnosis typically evokes an intense and complicated set of feelings, the ability to manage and use emotions in a constructive way is crucial.

The importance to psychological health of allowing oneself to fully feel one's anger and other negative feelings is greatly misunderstood in the United States. Women in particular, are not authorized by the mainstream culture to fully engage with these emotions, and many find it difficult to allow themselves to be aware of their anger, let along use it to maximize coping strategies. Instead they often misidentify anger as hurt or annoyance and/or will themselves to "get over" it as quickly as possible.  Anger often takes the form of passive aggressive behavior, emotional manipulation, submission or depression.

As any cancer survivor knows, there is plenty to be angry about when going through a cancer diagnosis and treatment regimen. Patients need access to their anger in order to empower them to ask medical providers for information, and to persist until they get the answers they need to make appropriate treatment decisions. Anger is also an important component of coping with the many noxious side-effects associated with most of the treatment protocols currently in use.  Finally when a woman is in good command of her darker emotions, she is more likely to respond in an appropriately self-protective way when faced with intrusive, inappropriate, lame and insensitive comments coming her way from medical providers, relatives, co-workers, friends and acquaintances.

Women need to take charge of their cancer journey.  They are much more likely to do this and do it well, when they have access to all of their feelings. In the United States, we need to continue to look at why we keep believing and thinking that anger is not compatible with womanhood, and what the reasons are for continuing to deprive females of one of the most empowering coping mechanisms there is.