Potential Loss Or Illness Near You

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Every year in Russia alone, oncological diseases are detected (for the first time) in more than half a million people. This means that several million people a year face cancer in their friends, relatives, relatives, spouses, and parents. Now the system of psychological assistance to people who have been diagnosed with cancer is far from perfect, but it exists - more and more psychologists work in oncological dispensaries and hospitals, more and more specialists receive additional training in order to become oncological psychologists. At the same time, people whose life "cancer" entered indirectly, endangering those closest to them, the most dear ones, often fall out of sight of doctors and psychologists. Even friends often do not understand what one has to face with those whose relatives or spouses are "under the gun" of an illness, surrounded by a gloomy halo of mystery, death and pain.

Today, an oncological disease or cancer (cancer) is not just one of the most common and most severe in terms of treatment and prognosis of diseases, but also a full-fledged metaphor that is actively used in modern culture, and quite a lot has been said about this - both by culturologists and philosophers and psychologists and doctors.

The detection of an oncological disease, even in the early stages and with a good prognosis, in most cases carries irreversible changes both in the patient's current picture of the world and in his lifestyle. In addition to the fact that a person is faced with the need for invasive medical procedures, he has to sacrifice many components of the usual lifestyle for the sake of a potential cure. In practice, the patient of an oncological dispensary ceases to "belong to himself", all his plans are violated by the need to spend months of life in a hospital or day hospital (which, as he constantly remembers, may be the last for him), coordinate his own affairs with the schedule of prescribed procedures, change his habits eating, giving up many pleasures and entertainment that are incompatible with treatment. As a result, a person has a feeling of complete impossibility of control over his own life, many patients complain that "the disease controls me." This feeling is closely related to an important component of the fear of death - the inability to take control of death, weakness and defenselessness in front of it. An equally unpleasant factor influencing the perception of cancer patients of their own state is the fact that, in fact, after a diagnosis is made, a person acquires “the social status of a cancer patient,” which turns out to be more important than all other roles that a person played in his life. In his monograph on oncopsychology, A. V. Gnezdilov writes: “A person can fulfill a huge number of roles in life: to be a parent, boss, lover, he can have any qualities - intelligence, charm, a sense of humor, but from that moment he becomes a“cancer patient”. All of his human essence is suddenly replaced by one - disease."

But today, quite a few are described the corresponding experiences of those people whose loved ones become cancer patients, that is, they lose their usual identity and acquire the status of a “cancer patient”. This is superimposed on the inevitable fear of the potential loss of a loved one, which works as a full-fledged experience of acute grief, combined with the anxiety of the unknown.

Only superficial observations of mental changes occurring in people whose relatives and close friends are faced with incurable diseases already reveal several topics at the same time that need to be investigated for further effective work with such people.

To begin with, people whose immediate family members are found to have oncological spectrum diseases most often suffer from depression and anxiety disorders. It has already been proven that the detection of an oncological disease becomes a mental trauma for those who have been diagnosed with the disease. But no one has yet done basic research on the traumatic effects of finding an incurable disease in people most closely related to the sick person. But we have established ideas about how a person experiences loss and acute grief. It can be assumed that when faced with an incurable disease in someone closest, a person receives all the symptoms of acute loss (from neurotic reactions to severe depression). In fact, a person loses his loved one as a significant Other, instead of an object with which there was a connection, an abstract "cancer patient" appears, with whom he has to build new relationships. In addition, an indirect encounter with a serious illness exacerbates a person's own fears, including existential fears, including fear of death, fear of meaninglessness (hence the numerous attempts to link the disease with any personality traits of the patient, with his lifestyle, and so on).

In working with the clinical manifestations of acute grief, the main strategic goal of psychotherapy is to achieve a state of "acceptance of loss" in the patient. It is important that the patient accepts the loss of an object in accordance with the reality principle, and it is this acceptance that is usually considered the first sign of recovery. But it is impossible to accept the fact of the loss of a person who is still alive and continues to be treated, it is not possible. As well as discussing the illness of a loved one in terms of loss. Often, people whose relatives are sick do not receive any support or even the opportunity to discuss their real experiences of potential loss, which increases the likelihood of depressive symptoms. Since their life henceforth proceeds against the background of a real illness, a full-fledged threat to life, which is culturally and socially perceived as something genuine, "serious", it often seems "indecent" to talk about their neurotic reactions and emotional problems, and such people often are ashamed. In accordance with our observations, most often in these cases we are dealing with masked or essential depression, which is more difficult to treat, leaves an imprint on a person's personality, and regularly becomes a source of psychosomatic diseases.

If, when working with people who have lost their loved ones, we have developed a number of techniques aimed at alleviating the experience of loss, then for working with potential, delayed in time, we have practically no ready-made "best practices." The exception is, perhaps, existential psychotherapy, in the theoretical calculations of which there is quite a lot of information on working with the fear of death and the experience of loss. Nevertheless, the techniques used in this area of psychotherapy are not suitable for everyone, and they were developed mainly for people who have faced a vital threat themselves, or for those who have already lost their loved ones. Meanwhile, a period of uncertainty associated with the expectation of the death of a loved one, filled with worries about his health, hope for healing, anger at the “meaninglessness” and “inexplicability” of the grief that has befallen the family, can be much more difficult for a person than the period of actually living a loss with symptoms. acute grief. In a sense, it is appropriate to call this state "chronic" mourning, by analogy with the already developed term "acute grief". But when "acute grief" does not find a way out and lasts for years, we usually deal with a state that Sigmund Freud called "melancholy", implying a state characterized by "deep suffering dejection, disappearance of interest in the outside world, loss of the ability to love, delay in any activity. and a decrease in well-being, expressed in reproaches and insults at one’s own address and growing to delirium of expectation of punishment”. Freud himself and his followers emphasized that the main quality that distinguishes melancholy from the state that we today call "clinical depression" can be considered the impossibility of accepting the loss of an object and a narcissistic identification with the lost, which does not allow mentalizing the loss. In addition, the obvious impossibility of openly grieving, already described by us, when it comes to potential, not yet accomplished loss, increases the likelihood that the experiences associated with loss, not being able to manifest in consciousness, will be distorted and transformed into phobias, psychosomatic reactions, essential and masked depression.

In a situation when it comes to a partner or spouse, we can see a phenomenon that can be called merging with the patient. The patient's feelings, his fears, including those of an existential nature, are introjected by the partner. Sometimes this leads to the appearance of conversion psychosomatic symptoms: the patient's spouse develops senestopathies, pains, nausea from biochemistry sessions and other sensations that are not in any way due to the state of his own health. Together with the patient, his healthy partner is independently alienated from society, draws a clear line between "friends" and "aliens". He considers himself and his partner “his own”, and everyone around him, especially those who have not encountered cancer or other incurable diseases, is “alien”. If the disease cannot be cured and the patient dies, his partner experiences his death as his own, demonstrates not only symptoms of depression, but also suicidal tendencies, or falls ill after him under the influence of the fusion mechanism. In other cases, there is alienation between the sick and the healthy partner, bordering on rejection: fears of death, dying, illness as such, distort the perception of a healthy person and make communication with the sick person impossible. Another common reaction of loved ones to the disease is pronounced denial. It seems that continuing to live as if the disease does not exist is an effective way to maintain your mental well-being, but in reality it is not. First, like other psychological defenses, denial distorts the perception of reality, does not allow a person to live in time those feelings that seem unbearable. Secondly, in this case, the patient is literally alone with his experiences, which enhances the feeling of social isolation, meaninglessness, alienation. This reduces the patient's chances of adequate help and support (including the necessary measures of care and assistance in undergoing treatment), and also increases depressive and neurotic symptoms, which ultimately reduces the likelihood of remission.

Today, it is necessary not only to study the peculiarities of people's response to a collision with cancer in their loved ones, but also to establish a system of assistance to those whose relatives, spouses, partners, children, parents, and so on, have received an appropriate diagnosis. This will help prevent probable depression, neurotic and psychosomatic disorders, and other psychogenias that arise when faced with cancer "indirectly", as well as indirectly affect the quality of life of the patients themselves and the likelihood of remission.

This is just a small part of the observations describing the most common reactions to the threat of potential loss, resulting from a person's encounter with an incurable disease from someone from close relatives or friends. However, this is enough to suggest that relatives and friends of patients need qualified help as much as the patients themselves.