Let me repeat that it is vital that you give yourself time and space and permission to go slowly as you move through this transition back toward your life. Remember that the people who love you want to believe that your breast cancer is over and done with, cured. It is too frightening and painful for them to think about the fact that you are still living with breast cancer and that you will never receive a promise that you have been cured. Many other illnesses and health problems are truly over when they are over, and some people don't understand that breast cancer does not work that way. Joan told me of a major fight with her husband three months alter the end of her treatment. They were shopping for a wedding gift for a nephew and also bought a set of kitchen utensils for themselves. When they left the shop, Joan burst into tears. "I can't help wondering if I will even live to use that slotted spoon," she said. Her husband, frustrated and angry, kept repeating, "Stop worrying. I know you are fine." These comments, of course, served only to isolate her with her fear.
Difficult though this is to accept, the truth is that your family and friends are eager to be relieved of their worry about you and to return to their own busy lives. The result is that most women find that the strong support they receive at the time of their diagnosis begins to lade as treatment goes on and may be much diminished by the time it is completed. It is unfortunate but true that your diagnosis may soon become old news to even those close to you.
Other serious concerns, which will he discussed more fully in later chapters, may include noticing real changes or rifts in long-standing relationships. The chances are good that some of your friends were not as present for you as you would have hoped they would be. Now is the time to think about whether you want to talk with them about your hurt and disappointment, how you want to deal with the anger you are feeling, and even whether you want to expend the energy to try to repair those friendships. Family members, too, may not have behaved as you wished they would. You learned that a real crisis does not necessarily mend long-standing family conflicts or issues. Linda described never feeling close to her older brother and always wishing that they could find a way to be a more important part of each other's lives. When her breast cancer was diagnosed, he called regularly and even came to visit right after her surgery. However, as the months passed, he stopped reaching out to her so often, and by the time her treatment ended, their old patterns of rare communication had been reestablished.
For all of these reasons, it has been my experience that many women call me for the first time after completing their treatment. Although they may have been aware that psychological-support services were available to them at any point following their diagnosis, it is only now that the emotional issues seem impossible to manage alone. Kathleen, a forty-year-old nurse and mother of two, began to work with me six weeks following her final chemotherapy. A very competent and energetic woman, she was dismayed to find herself feeling vulnerable, frightened, and often fatigued. Beyond worries about numerous family, professional, and financial issues was her unsettling sense that "something is just wrong with me." Besides some practical advice on coping with her problems, the most helpful part of our work together, I believe, was the reassurance that all of her feelings were normal and that she would gradually come to feel more like herself.
Most women come in for a few therapy sessions and then begin to feel better. Like Kathleen, they need acknowledgment of their experience, normalization of their feelings, and a chance to express their fear and sadness to a neutral and supportive person. Calling a therapist is never a sign of weakness. To the contrary, it is often the smartest and strongest tiling you can do for yourself. Why suffer needlessly when help is at hand?
Occasionally, women have a particularly difficult time psychologically and do not naturally and gradually regain their emotional equilibrium. While their feelings may seem to be more intense versions of what others experience, on occasion their symptoms seem to fit a syndrome called post-traumatic stress disorder, or PTSD. This is a not-uncommon human reaction to a terrible life experience and can affect survivors of any major crisis or disaster. Symptoms include difficulty sleeping, mood swings, angry outbursts, and flashbacks or intense preoccupation with the crisis. Although more commonly associated with survivors of an accident, wartime battle, or a natural disaster such as an earthquake or fire, my experience is that following breast cancer some women also have feelings and behaviors that fit this model.
Women with breast cancer who have previously experienced trauma in their lives are especially vulnerable to full-blown PTSD. If you have been a victim of childhood sexual abuse or rape or another violent crime or natural calamity, be aware that this is likely to be a particularly difficult time for you. Even if you feel that you are managing well, it would be advisable to make a connection with a therapist, meet once or twice to establish a relationship, and thus know that you have someone available to help you if the feelings become acute.
A woman need not have PTSD, however, to become depressed or anxious. Again, these are frequent reactions to this crisis. There was an old advertisement that ended with the line, You can pay me now or you can pay me later. I think that this fits the experience of going through breast cancer. Sooner or later, you have to deal with the emotional trauma. Some women fall apart at diagnosis, others at some point during their treatment. I believe, however, that for the majority of women, the most difficult time comes at the end of treatment.
How can you tell if your psychological recovery is more than "normally" difficult and whether you need help from a therapist as you move toward recovery? By reading this book you are, of course, learning more about normal reactions following cancer and can begin to compare your feelings with those described here. If you find that you are having difficulty sleeping, that your appetite has changed in either direction and you are gaining or losing weight, that you have lost interest in your usual activities and friends, that you have trouble concentrating, and that you are frequently tearful or angry, and if these feelings persist for several months following treatment, you should consider talking with a therapist. As a general rule, if you wonder if this would be helpful, it will be. Chapter 17, "Getting Support," discusses more fully finding and working with the right therapist. As is always true, it is important to work with a therapist who is knowledgeable and competent and who is someone you like. The human chemistry is vital.
A few weeks after my own final chemotherapy treatment in 1993, I traveled with my fiancé and his daughter to his father's eightieth birthday party. In retrospect, I should have paid attention to my vague sense that this was a mistake and that I was not strong enough to take on this potentially emotion-filled event. The situation was even more complicated because his twenty-one-year-old daughter and I were just getting to know each other and were carefully navigating the potential land mines of an upcoming second marriage. The first problem developed almost immediately. Trying to be polite, I suggested that she ride in the front seat with her father. I realized later that I did not expect her to actually do this and I certainly did not realize that I would be furious. Huddled in the backseat, tired, vulnerable, and thin-skinned, I was lost in miserable fantasies of recurrent cancer and premature death.
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