Earthquakes and silver linings

 It’s mental health awareness week, and although I’m Chairman of a cancer charity, I thought I’d take the opportunity to write about the enormous mental challenges of receiving a diagnosis of cancer.

People who have had the dread diagnosis will tell you that there is ‘life before cancer’ and life after cancer’. That in a fundamental way, things are never the same again. Never again is there the same comforting feeling of a certain future underpinning life. This can be terrifying in much the same way as experiencing the normally trustworthy ground under our feet moving during an earthquake. It generates a level of fear that is existential and ongoing.

Coming to terms with this sort of fear can be one of the most attested to ‘silver linings’ of cancer, but that doesn’t make it something you’d wish on anyone. And even for those who do succeed in reaching silver lining territory, it can be a long and painful road, and one which requires a lot of support. The feelings of isolation that often accompany the fear tend to only compound the difficulties.

When in the midst of such turmoil, talk of silver linings is unlikely to provide much comfort and may even promote anger, but if this aspect of life-sized crises such as cancer were more widely appreciated, then it could hopefully lead to better support, which could in turn mean more silver linings, sooner.

Human beings are notorious for their inability to stomach too much reality at one sitting, and never more so than when it involves dismantling treasured futures. The one feature all our individual futures share is a complete absence of reality - they are products of a practically universal societal habit of living with a ‘security blanket’ that enables us to avoid lots of things in the present that we can’t or don’t want to deal with. This is so ingrained and widespread, so much the very ground on which we stand, that it goes entirely unnoticed… 

until that is, an earthquake 

like cancer comes along to wake us up to the fragile nature of our existence, to our mortality.

After a cancer diagnosis we find a new and unwelcome companion constantly by our side - uncertainty. Above all, humans like to ‘know’ in order to feel secure. But cancer has a way of stripping away our certainties and propelling us into a limbo of waiting - waiting for the next appointment, waiting for the next test result, waiting for the next scan, waiting, waiting, always craving some morsel of certainty. This limbo is purgatory to those who depend on knowing for their security.

But, of course, the truth is that life is fundamentally uncertain, the future completely unknown. Which means that to come to terms with the experience of cancer is in fact to come to terms with Life, with Reality, something few have the appetite for, unless severely pressed.

If, through providing the right kind of support, it was possible for people to move through the mental and spiritual crisis of a cancer diagnosis more quickly, the pay-off could be enormous, and on many levels. But what would appropriate support look like? Well clearly it couldn’t come from anyone still reliant on their own security blanket to feel safe enough to function in the world - this would be a clear case of the ‘blind leading the blind’. The only people qualified for the task are those who have come out the other side themselves. They are living proof of what’s possible and can authentically deliver their experience of the journey and of the benefits of making it.

Fortunately, social media has provided a platform for many - often lead by ‘extraordinary survivors’ - to contact one another, to inspire confidence, to provide support. This is an entirely unstructured process, and who knows, that may be the appropriate means to such an unusual end. But I like to think it could be more structured and thereby more visible as a resource, more accepted as a necessary part of dealing with cancer effectively. The concept of ‘expert patients’ has taken hold to some extent, so maybe it could be extended to a whole other level.

I mentioned that the pay-off for helping someone through the existential crisis of cancer could be on many levels. The reason for this is the now indisputable role of the mind in overcoming challenges to our physical health and regaining our wellbeing. On the macro level, someone drowning in hopelessness and terror - 

a ‘victim of cancer’ - is not even able to make decisions that will give them the best chances. They are likely to allow over-zealous professionals, family or friends to guide critical choices for them. By contrast, a person who finds a way to deal with the uncertainties of cancer will discover a growing autonomy and will place an increasing reliance on their intuition to navigate their best way forward.

On the micro level, science has now demonstrated clearly the effect our state of being has on the functioning of key body systems such as immunity. I often refer to what I find to be the most striking feature of the results of Dr Kelly Turner’s researches into the commonalities of what are described by doctors as ‘spontaneous remissions. In her book, Radical Remission, she dedicates a chapter to each of the nine factors that all extraordinary survivors attributed their recovery to (there were many more factors identified, but nine were listed by all those surveyed). The striking feature of these nine factors is that seven of them are in the realm of the mind and spirit, and only two in the physical. This gives some perspective on the importance of coming to terms with the reality of a diagnosis as quickly as possible.

The inseparability of our mental health from our physical wellbeing is deeply ingrained in our culture - notably in our language - but has only recently started to be accepted by science. With this growing recognition, I hope we can look forward to a time when people are supported at every level when dealing with cancer. The mental and spiritual health of someone with cancer is a major factor in the outcome of their treatment, one that has been discounted for far too long. Might it be possible to develop new streams of support that will enable more people who have had the misfortune to experience the earthquake of cancer to find those silver linings?