January 22, 2019
By: Leenoor Foning PathSOS Cancer counselling lead

Cancer Counselling : Why We Need It - PathSOS

Padma Agarwal (name changed) was 30 years old when she got diagnosed with Breast Cancer. Though everyone at home was shocked and upset with her diagnosis, they were relieved that it was Stage 1 cancer and felt comforted by the statistics - life expectancy is higher with breast cancer. However, Padma’s reaction wasn’t as positive.

Everyone at home consoled her “Be positive! It’s Stage 1 cancer! And its only breast cancer! It could have been worse”, but no one understood the depression and anxiety that had crawled into Padma’s life. Her sense of identity and self-esteem were shattered and concerns about the road ahead were eating her at the core. As her treatment for cancer continued, Padma’s mind grew restless; questions about finding a life partner, marriage and a settled life ahead troubled her greatly. Additionally, she felt rather alone in this distress, for she felt that if she opened about her sadness and depression to her family, their positivity and strength would break, and make the situation worse for everybody.

This is one of the common struggles of being a cancer patient - inability to openly speak about ones illness and the fear, anxiety and depression that often accompany it. It was Padma’s personal choice to come to see me for cancer counseling, without the knowledge of her family.

The counselling space provided Padma a platform to reflect on her emotions, which enabled her to acknowledge and process her feelings of depression and anxiety. For the first time, she was able to openly express about how she was struggling to deal with her physical transformation and mental struggle. It was important to say these things aloud in words, since it enabled Padma to vent out her pent-up fears and free up some mental space to focus and talk about tools to deal with her anxiety and distress.

Padma realized that her constant pretense of being strong and brave had alienated her from her family. She found the courage to open up to her family. In being transparent about how she felt, her family understood the support she truly needed. They soon realized she didn’t need words of encouragement or positivity, Padma simply wanted to be heard.

Ayaan Kapoor (name changed) was only 11 years old when his father succumbed to pancreatic cancer. He was too busy playing on his iPad when his father walked out of the door for the last time. Ayaan thought it was just a regular hospitalization for chemotherapy.

The news of his father’s death 2 days later, left Ayaan shocked and heartbroken. Anger, guilt and sadness continued to remain part of Ayaan’s life, which resulted in difficult and challenging behaviour during his growing up years. He was caught smoking cannabis at the age of 14 and his anger outbursts became a huge cause of rift in the family. His counselling journey began with me because of such behavior.

Ayaan’s story is a classic example that highlights the struggles and troubles cancer brings into the lives of not only the patient, but also his/her loved ones. The greyness cancer brings with itself, slowly and surely creeps into the lives of everyone connected to the cancer patient.

Through his counseling sessions, Ayaan was able to unearth many emotions related to the loss he and his family had gone through. He expressed anger at not being told about his father’s critical condition. In family therapy, his mother was able to express about how she felt she was protecting Ayaan by not involving him in the process of his father’s care. Years of anger were addressed in these sessions.

Five years after Mr Kapoor’s passing, Ayaan and his mother were able to finally look beyond the anger and guilt and talk about Mr Kapoor, his cancer, their journey and their loss. They were able to empathize with how hard it must have been for Mr Kapoor and what his emotional journey might have been during his illness. They recalled Mr Kapoor’s aggression towards Ayaan in his final days and his unwillingness to meet friends and family.  “Perhaps he was depressed”, mother and son felt.

Today, mental health is acknowledged as being an important aspect of a person’s wellbeing. Depression, anxiety, stress and fear are considered to be very normal responses to a cancer diagnosis. However, despite this recognition in the medical world, little or no support is being made available for the emotional needs of cancer patients and their families, especially in India.  While countries like UK, USA and Australia have an entire wing of psycho-oncology and palliative care in their health care system, this concept is still relatively new in India.

It is time we acknowledged the importance of cancer counselling and its benefits. Counselling and the right emotional support, available at the right time, enable people to manage their distress and help them cope better with the challenges of living and dying with cancer. The taboo in talking about death and dying, stigma attached to mental illness and ignorance about emotional needs are key factors that make the journey of cancer harder.         

Professional counselling can lessen distress, from the early stages of diagnosis and treatment, right through grieving and bereavement in the case of loss of a loved one. 

According to the National Comprehensive Cancer Network (NCCN) panel, distress is “a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioural, emotional), social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatment. Distress extends along a continuum, ranging from common normal feelings of vulnerability, sadness and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation and existential and spiritual crisis”.

Leenoor Foning is a Registered Counsellor with the British Association of Counselling and Psychotherapy and a MBPsS member of the British Psychological Society. She has 9 years of experience in the field of Counselling and Mental Health in both UK and India. She devoted part of her education understanding and studying the process of death and dying. She currently runs her own counselling practice called MINDSPEAK and heads the Psyhco-Oncology department at PathSos, Aushealth, Gurgaon, India.

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