Help for cancer patients and their families. Stages of the patient's response to a terrible diagnosis. Assistance of psychotherapists and medical psychologists

Psychological support should be an integral part complex treatment cancer patients.

According to V.A. Chulkova, such assistance can be provided in several interrelated areas (Fig. 12.3).

Rice. 12.3. Psychological assistance in the treatment of cancer patients [Chuykova V.A., 2004; with changes].

Changing public opinion through all media

And this means getting rid of stereotypes, dispelling the mystery of the disease and making the discussion of the problems of patients more open. Everything is currently more people are close to the disease (relatives, friends and acquaintances, neighbors and colleagues are sick) - it is important to learn how to live with this disease.

Messages in the media should not be built in the form of intimidation of the population, which already experiences severe fear, which often prevents people from contacting an oncologist in a timely manner. This requires balanced and truthful information about the disease, about the difficulties and possibilities of treatment.

At the same time, it is necessary to rely on positive results treatment, possibly involving former patients. Only in this way can people gradually get rid of the fear of cancer and change their attitude towards sick people.

Creation of public organizations to provide social and psychological support to cancer patients

Today, former breast cancer patients are physically and emotionally healthy on this moment, undergo special selection, education and training, and then, using their personal experience and acquired knowledge, provide social and psychological support sick women.

There are also branches of this movement in Russia (Nadezhda, St. Petersburg). The creation of public organizations responds to the changed mentality of patients and is an indicator of the desire to cooperate with specialists in overcoming the consequences of treatment and improving the quality of life of cancer patients.

Thus, in the International Conference on the Treatment of Breast Cancer, regularly held since 1997 in Canada, along with professionals, former patients also participate.

Assistance of psychotherapists and medical psychologists

The purpose of psychotherapy is to help patients to accept the disease, to be able to live and be treated in the conditions of the disease and to be able to adapt to the changed life situation, using the internal resources of the individual.

For cancer patients, individual and / or group psychotherapy should be carried out throughout the entire treatment process, taking into account psychological problems arising at each stage of treatment, as well as the personal characteristics of a particular patient.

At the beginning of treatment, more time is devoted to working with the patient's condition (expressing feelings, reducing anxiety and fear, mastering relaxation skills). In the future, the emphasis is on taking responsibility for one's health and creating a qualitatively new attitude to life (increasing self-esteem, psychological processing of the situation of the disease as a qualitative increase in knowledge about oneself and one's capabilities, understanding the "personal meaning" of the disease, turning to the spiritual aspects of human life). Of all types of control, cognitive control is the most effective (rethinking one’s life values).

Behavioral control (an attempt to influence what happened with certain actions: following a diet, daily routine, etc.) also allows for improvement, although not to the same extent.

Therapy of mental disorders is carried out taking into account the stage of the disease, the consequences special treatment and outlook for the patient.

This includes:

A. Environmental therapy (nature, home, family environment, spiritual awakening),

B. Presence therapy (the principle of sharing pain and problems of the patient with the doctor).

b. Individual Therapy(rational, suggestive, group). Rational psychotherapy is usually carried out in the form of an individual conversation, necessary condition which is to create an informal, trusting environment. This is achieved by a non-directive style of managing a conversation, the absence of strict regulation, the opportunity for the patient to speak out, a variety of topics, etc.

The life-affirming nature of the conversation, fixing attention on the successes of modern oncology and the role of the patient in achieving the effect of treatment most often help to obtain a psychotherapeutic effect.

Suggestive psychotherapy, based on suggestion and self-hypnosis, should not contain any denial of the fact of the presence of the disease. The main chain of suggestion is the achievement of calming the patients, the development of confidence in the ability to cope with the disease, in the possibility of a radical cure, etc.

D. Art therapy (treatment by means of art and self-expression in art) consists in switching the patient's attention to creative (creative, constructive) methods of regulation inner world etc. This type of psychotherapy is also called distraction.

Mostly music therapy various options occupational therapy, collecting, etc. both in the form of a separate psychotherapeutic effect, and in combination with others, especially suggestion.

Therapy of psychotic variants of changes in the psyche with the presence of disorders of consciousness has a predominantly somatogenic orientation. At the same time, therapeutic measures include detoxification therapy, glucocorticoids for symptoms of cerebral edema, antipsychotics and tranquilizers (haloperidol, chlorpromazine, relanium) to relieve agitation and anxiety, antidepressants (amitriptyline) for depressive states.

In persistent cases, it is advisable to consult a psychiatrist. The effectiveness of the use of psychotherapy in the programs of analgesic drug treatment of cancer patients, especially those with phantom pain, was also revealed.

Thus, psychotherapy is necessary for most cancer patients, as it undoubtedly improves their quality of life and probably affects its duration. In this regard, the use of psychotherapy in oncology requires further development.

Development of educational programs for doctors and nurses

This contradiction gives rise to many difficulties in the practical work of a doctor and a nurse. In professions of the "subject-subject" type, the necessary requirement is the ability to communicate, establish contacts, maintain interaction, and feel the state of other people.

Therefore, the work of a doctor and a nurse consists of two interrelated species activities: actually medical and communicative. It is the skillful combination of these activities that is the key to their successful work.

In the existing training programs for doctors and nurses, there is no special section for training them as specialists involved in communicative activities. This gap is most often filled by the requirements of compliance with the norms of deontology, as well as an appeal to the life and professional experience of a doctor or nurse, but this, as practice shows, is clearly not enough for effective work especially in the oncology clinic.

Obviously, doctors and nurses need educational program on psycho-oncology, including lectures and psychological trainings.

This would contribute to a holistic approach to patient care and thereby improve the quality of their care, as well as increase the ability of doctors and nurses to cope with their own

The role of the oncopsychologist in cancer treatment

Earlier availability oncological disease really was a sentence, but medicine is in constant development, as a result of which the prognostic picture of diseases of this circle changes. At the present time, a number of oncological diseases are controllable, and subject to the recommendations of doctors, a patient with such a diagnosis can achieve stable remission and live long years with a high quality of life. However, it is important to understand that cancer is serious illness which is considered chronic and requires long-term treatment. And this means that the treatment requires a lot of patience and in any case is associated with stress - both for the patient and his family members, even with a favorable prognosis. That is why during the diagnosis, therapy and rehabilitation of oncological patients plays an important role psychological help.

How can a psychologist help cancer patients?

The development of oncological diseases occurs relatively quickly, and therefore, after the diagnosis of cancer is made, it is required to begin treatment as soon as possible. The sooner the patient starts treatment, the faster it will be possible to achieve remission and the better it will become. However, many patients experience shock and fear after diagnosis, which prevents them from addressing treatment issues in a timely manner. It is also possible that upon hearing the word "oncology", the patient thinks that death is inevitable and improvement is impossible (which is not true) - and these thoughts prevent him from fighting the disease.

Thus, when working with a patient oncopsychologist primarily prepares the patient for treatment helping him form the motivation to fight the disease, fight for own life. Even if the course of the disease is unfavorable, a person always has something to fight for. There is always something for which you should not give up and strive to live on. And in the same case, if the forecast oncological process looks much heavier in the eyes of the patient than it really is, oncopsychologist helps him to look at reality with objective optimism and not to waste time, but to start treatment right now.

In many cases, the patient cannot independently form an objective picture of his disease, because fear and anxiety interfere with this. As noted above, many tend to perceive the existence of malignant tumor with tragedy, which does not always objectively reflect the patient's condition. Along with this, it often happens that a cancer patient treats therapy too lightly, as if not noticing the symptoms of the disease, avoiding visiting a doctor or stopping necessary preventive measures after the condition improves. In this case, the person is also driven by fear and the desire to believe that he is healthy - and this leads to a violation of the treatment plan and, as a result, to a deterioration in the condition. Such a denial of the diagnosis in an oncological patient can either form immediately or appear later, after passing through the stage of shock.

Accordingly, the work of a psychologist with cancer patients is also aimed at formation of an adequate picture of the disease and assistance in the development of constructive behavior patterns and plan suitable image life.

Thus, the task of the oncopsychologist is the formation of optimistic attitudes in a cancer patient k, which will stimulate his motivation for treatment and help him recover faster.

Otherwise, the cancer patient will be unable to ignore the problems of the disease and enjoy life, and anxiety can lead to the aforementioned psychosomatic reactions that also require attention. oncopsychologist. It is important to note that a person who constantly experiences fear and sadness is also highly susceptible to developing depression– and depression is not just a mood disorder, but a disease. Depression often develops among cancer patients and is a serious disorder in itself, because it leads to a decrease in energy potential, a lack of desire to communicate and a feeling of constant melancholy, which leads to a decrease in motivation for treatment, a lack of desire to fight for one's life, the appearance of suicidal tendencies and a number of other disorders along with worsening condition.

Therefore, it is extremely important to prevent the patient's negative experiences from becoming so deep - accordingly, a psychologist can help an oncological patient in matters of preventing and combating a depressive state.

Therefore, during chemotherapy psychological support for cancer patients is especially important - thus, the tasks of an oncopsychologist include psychological support of the patient throughout all stages of treatment during which the psychologist provides him with the necessary emotional support and keeps him motivated to fight the disease.

Often the symptoms of cancer and side effects Therapies give rise to many chronic or temporary problems that cause additional discomfort for the person. physical weakness and fast fatiguability in many cases deprives a person of the ability to work and do the usual things, many often experience fatigue and drowsiness, which is why they spend most days in bed. Restriction of mobility deprives a person of the opportunity to live a full life, and also undermines his self-esteem. Often, cancer patients feel helpless and feel guilty before their relatives, who have a number of responsibilities and the need for additional care. The self-esteem of the cancer patient and his psychological state is also reflected in the change in his appearance, in particular hair loss and weight loss.

In this way, self-assessment of a cancer patient is also a target for correction by an oncopsychologist, which seeks to help a person realize the irrationality of his feelings of guilt and maintain self-esteem. Guilt and low self-esteem can also trigger the development of depression, and the oncopsychologist helps the patient not to succumb to these feelings.

Despite the fact that oncologists are now effectively coping with cancer, the development of the disease cannot always be stopped. Unfortunately, sometimes the disease is detected too late, or the body of the cancer patient is too weak to resist the disease. Therefore, cancer can really lead to death, the proximity of which undoubtedly frightens the patient and gives him a feeling of helplessness and depression.

If the inevitability of death becomes obvious, then psychological help for a cancer patient becomes an urgent need. The proximity of death is something that is extremely difficult to come to terms with. This is what causes intense fear, creates deep grief and forces the dying person to rethink his life. It is very important that in such a difficult period there is someone nearby who will help you come to terms with the circumstances, accept the situation and shift the focus of the oncological patient's attention, encouraging him not to give up medical care, communicate with relatives and devote your time to those activities that you want to have time to do. When a person experiences such deep grief, he feels both lonely and confused - and it is an oncological psychologist who can help a cancer patient look at the situation from a different angle.

Work of an oncopsychologist with relatives

When a person goes through such a difficult test as cancer, it is not only he who suffers. Often, close people suffer no less than the patient himself. After all, it is they who are afraid of losing a loved one, it is they who care for him, provide assistance and encourage him to be treated, forgetting about his own needs. And it is the loved ones who have to deal with dire consequences. emotional stress patient, such as irritability, depression and emotional instability. And therefore Relatives of a cancer patient also need psychological help.

In addition, often close people do not know how to properly behave with a cancer patient in order to help him, and not harm him. How to support a person, how to behave with him? What should he say, and what topics should be avoided? When is it important to help, and when to leave alone? An oncopsychologist also helps to answer these and many other questions, who considers the personal characteristics of the patient and people close to him, as well as the specifics of the whole situation.

Thus, if you or a person close to you had to face the diagnosis of an oncological disease, then along with treatment by oncologists, you should definitely seek help from an oncopsychologist. It is he who will help your family members not to fall under the power of fear and anxiety, but to look at the situation differently and find ways to cope. To cope, overcome, choose constructive ways to solve problems and not lose hope. Moreover, there is reason to hope for the best - remember this!

Psychological assistance to cancer patients is aimed at debunking various fears and prejudices regarding the incurability of the disease found in them, replacing negative attitudes with positive ones, which will be focused on making the patient himself a personally active person involved in restoring his health. Scientists have long established the ability of cancer cells to periodically appear in the body of any person. This is a generally accepted fact. If a person is healthy, then the threat from cancer cells is recognized immediately, and the body immediately isolates and destroys them.

In patients with oncology, the opposite happens: malignant tumors increase without receiving a rebuff from the body, thus external symptoms cancer. But doctors are convinced that the human immune system - natural defense mechanisms can be restored and the body itself can eliminate malignant tumors. This is what psychological assistance to cancer patients is aimed at, so that patients believe in this wonderful opportunity for healing and the need to continue the struggle for life and recovery. And if in further man if the immune system is maintained at the proper level, then in the future you can not be afraid of a recurrence of oncology.

The diagnosis of cancer causes superstitious and genuine horror in all people. This one is often based on some common prejudices:

- cause unknown malignant disease;

Cancer must be accompanied by pain and lead to premature painful death;

- the sick person is not able to help himself, he can only shift the responsibility for his life to his attending physician;

- All types of cancer treatment are unpleasant and mostly ineffective.

Psychological assistance to cancer patients and their relatives, first of all, is expressed in dispelling these fears and prejudices, replacing them with positive attitudes towards a cure. Psychologists should be able to convey to patients that each person is able to independently participate in the restoration of health. Diagnosing a cancer disease does not mean that it is already necessary to prepare for death. This means that you need to learn to live fully, while using the full potential of health inherent in nature.

Psychological support for cancer patients initial stage It is expressed in helping the sick person to realize that oncology is not a whim of cruel fate, it is not an absurd accident, but a long process that has reasons and its own history. Most of the causes that contributed to the occurrence of cancer, modern science are known and are determined on a case-by-case basis. Having learned the causes that caused the disease, a specific action plan should be developed with the doctor to eliminate these causes and to overcome the consequences. In order for this task to be feasible for the sick person, it is necessary to consider three aspects of a person’s life: mental, physical and spiritual.

Most seriously ill patients from time to time think about the following questions of life: “What is life? What am I living for? In what? Who am I? What was I born for? These spiritual fundamental problems for a cancer patient are often brought to the fore. Equally important are the psychological and emotional factors. Experts believe that these aspects are of great importance, since they play a significant role in the occurrence of oncology and in its therapy. This is where you need to look for the key to success in healing.

Methodology complex therapy cancer is available to everyone and implies the following: , the ability to cope with life stresses, proper nutrition, regular . All of the above is necessary in combination with the appropriate type of therapy for each specific case. With such an attitude towards the disease, patients are not only cured, but a deep, true love for life awakens in them, they learn without fear, to calmly accept the outcome of life. And although all specialists set themselves the goal of helping the patient recover, the proposed approach is of value to those who are destined to die. But even for those patients who are late with the start of treatment, there is a real prospect of victory over the disease.

Complete recovery from oncology is a complex process, but as practice shows, it is quite possible. All specialists assign a significant role in the cure for oncology to the condition immune system person. For the right choice anticancer effects, a consultation of specialists is needed, at which doctors of various profiles develop a single tactic for managing a patient.

Despite advances in medicine, many scientists believe that in the next 20 years universal remedy can't be invented for cancer. And sadly, but it should be noted that, along with complete cure, there will be cases when not all patients will get rid of the disease and they will have to come to terms with the fact that they are going to die, so the problem of providing care to palliative patients is currently relevant.

Palliative psychological care for cancer patients is to clarify that it makes no sense to dwell on, because life is short and you need to live every day happily. Oncological patients, whom specialists did not help to recover, but provided psychological assistance, meet death with calmness and dignity, which surprises not only relatives and friends, but even themselves. In this respect, oncology can be considered defeated.

For recovery, two factors play an important role: third-party assistance to cancer patients, provided by many people (doctors, volunteers, relatives, friends) and personal resources that the person himself manages to mobilize. As for personal internal resources, experts consider the ability to see the disease as a natural process that has its own reasons as the main thing.

Providing psychological assistance to palliative cancer patients in their most difficult period of life is the moral duty of the entire society. palliative care just like the training of specialists in this field, this is a little-studied and virtually closed topic.

Therapists and oncologists are those specialists who no longer treat, and accompany their patients on their “last journey”. After all, the only way they can help cancer patients is to alleviate their physical and moral suffering by providing the right care.

Palliative care according to modern concepts includes an integrated, intersectoral and multidisciplinary approach. Its purpose is to provide the maximum good quality life to patients (as far as possible) with progressive, incurable disease and limited life expectancy.

Palliative care for cancer patients includes the following mandatory components:

— medical, professional (separately pharmacological) assistance;

- psychological professional assistance provided by psychologists and extending to family members of patients;

- moral support provided by spiritual mentors;

— social assistance carried out by social workers.

The disease can be not only a “cross”, but also a support. To do this, you should reject her weaknesses and take her strength. And let the disease become for the oncological patient that refuge that will give him strength at the right time.

The basis of effective palliative care is actually psychological and psychotherapeutic support for cancer patients and their families.

When an individual comes to an oncologist with an established diagnosis, he immediately transfers part of a certain responsibility to the doctor. Often a patient comes in with an aggressive mood, and the medical staff has to be sensitive, attentive, and stress-resistant, not reacting to it. aggressive behavior. This condition of the patient is explained by being in constant fear of death.

Assistance to cancer patients in such cases is expressed in the provision of emotional support in the ability to help patients feel safe, be able to lead in difficult conditions full life. To accomplish this task, the patient needs financial resources, it is required to be imbued with confidence in the doctor, to feel competent psychological assistance and support from relatives. If a patient with oncology has all of the above components, then he needs psychological support as a supplement to correct behavior. It is necessary to accompany the patient with a psychologist at the initial stage of therapy, when the sick person comes to the department for the first time to receive the required treatment. Being in a state of extreme stress, the patient is not able to remember all the recommendations of specialists the first time and navigate the clinic.

Palliative psychological care for cancer patients is to convey to patients that life will never cease to have meaning.

Three types of values ​​give meaning to human life: creation (what is able to give to the world), experience (what the individual receives from the world) and attitude (the position that the individual takes in relation to the current situation).

Even if a palliative cancer patient is deprived of the values ​​of experience, he still has a destiny that needs to be adequately fulfilled - to cope with suffering. Cancer patients should be aware that the main point in prescribing opium group drugs is not medical decision but the requirement of the patients themselves. Only the patient himself knows how much he needs an anesthetic, since the strengthening pain syndrome noted with the progression of the disease, which needs to be prescribed higher dose drug. First of all, during pain therapy, oncological patients are prescribed anticonvulsants, and then opioids, since the latter are ineffective for neuropathic pain and have an immunosuppressive effect. Therefore, if possible, it is necessary to replace opioids with painkillers of other pharmacological groups or reduce the patient's need for opioids through combination treatment.

Psychological assistance to cancer patients also consists in the correct preparation of people for the importance of palliative care. Continuing standard treatment is the wrong technique, as a person receives an unjustified hope for a cure, when he needs palliative care. This issue remains the most difficult and not only doctors, psychologists, but also the relatives of the patient should take part in its solution.

Currently, there is a topical issue with the lack of full-time psychologists and psychotherapists in the oncology departments, and therefore the patient transfers all problems of a psychological nature to his attending doctor. Of course, the attending physician in the field of communication psychology has certain knowledge, but the main task of the oncologist is to conduct effective therapy, while discussing their psychological problems with patients requires a huge amount of time, which the doctor simply does not have.

When a person learns about his diagnosis, he is horrified and, there is denial or shock, then comes, bargaining, the person falls into, and after some time he begins to accept the diagnosis. These experiences are fundamentally different from other diseases in the past that happened before, because in those situations it is clear how to be and what to do. And in the face of something unknown and real danger, a person is confused and in a panic. These feelings should not be succumbed, because right now spiritual strength, the will to fight and a clear mind are important. It is necessary to carefully ask the attending physician what actions should be taken in your situation.

Next, you should think about who you can discuss your problem with. It is impossible to carry the received information in itself. Constantly pondering, weighing disturbing facts, a person always involuntarily aggravates his personal reaction to them, intimidating himself. The interlocutor should be chosen carefully. It is necessary to be afraid of those who can gasp at the upcoming difficulties, “adding fuel to the fire”, recalling sad examples. AT this case we need an active and reasonable interlocutor, which can become spiritual mentor, psychologist. Be sure to talk to those who are really dear to you from close people. It is important to feel how they are going through, because this is an expression of their care and love. This will make it clear that they need you.

In oncology an important factor time comes, and here it is necessary not to delay, not to torment yourself with doubts: is it necessary, is it not necessary? And to do all the actions clearly, quickly and in a timely manner. Doctors are often rushed precisely because they see good prospects for a cure.

An oncological diagnosis does not always mean a path to a recurrent, chronic disease, it’s just that often you need to spend certain time for treatment. The sick person himself should collect all mental, reserve forces, analyze his available psychological resources and become an active participant in the treatment process.

Psychologists say that accepting a diagnosis is like constituent part yourself and let the disease into your life is very dangerous. Therefore, it is necessary to learn to rule over yourself. Considering the nature of oncological disease, the body took the cells to be destroyed for valuable and new elements of its structure, which it actively grows and nourishes. This "failure" is the spread of tumor cells. Therefore, the human psyche must tune in to the rejection of the disease. You can not perceive this problem as if it entered life forever. It should be believed that the stage of recovery will come after the treatment, because the one who believes in himself wins - this should be remembered everywhere and always, and not only in the case of diseases. Psychologists recommend during treatment to inspire each cancer cell that they are gradually destroyed, that they no longer exist.

If at first a person does not have enough information about the possibilities and future prospects for treatment, then it is required to undergo additional consultations and diagnostics, and not to rush to magicians, psychics and astrologers who will deceive.

It is necessary to find a qualified doctor in a specialized oncological institution, learn all the information from him, discuss with a specialist all aspects of further steps in treatment. It is important to trust the oncologist, hospitals and oncology departments work qualified specialists. Currently, the world annually appear the latest technology treatments for which oncologists undergo special training courses. Their knowledge is an important resource, so it is necessary to fight the disease together with doctors. During an illness, it seems to a person that the disease has separated him from his usual worries, circle of people, interests, and thus made him lonely. Life is presented to patients as divided into time before and after the diagnosis, but often people make themselves lonely.

You should look for those who can help and in fact there will be many such people. It is important to always keep a clear head, not to trust your fate to vague fears and annoying wizards.

“A woman calls me and says: “Doctors have diagnosed my mother with cancer. How can I tell her about this? She doesn’t know anything, ”says a psychologist, oncologist, founder of a group for helping people with disabilities, about a case from her practice. cancer"Live" Inna Malash.

Inna Malash. Photo from the archive of the heroine of the publication.

- I ask: "What do you yourself feel, how do you experience this event?" The answer is crying. After a pause: “I didn’t think I felt so much. The main thing was to support my mother.”

But only after you touch your feelings, the answer to the question will appear: how and when to talk with your mother.

The experiences of relatives and cancer patients are the same: fear, pain, despair, impotence... They can be replaced by hope and determination, and then come back again. But relatives often deny themselves the right to feel: “This is bad for my loved one - he is sick, it is more difficult for him than for me.” It seems that your emotions are easier to control and ignore. After all, it is so difficult to be near when a close, dear and beloved person is crying. When he is scared and talks about death. I want to stop him, calm him down, assure him that everything will be fine. And it is at this point that either closeness or detachment begins.

What cancer patients really expect from their loved ones and how relatives do not destroy their lives in an attempt to save someone else's - in our conversation.

The best thing is to be yourself

- Shock, denial, anger, bargaining, depression - loved ones and a cancer patient go through the same stages of accepting a diagnosis. But the periods of residence of stages in a cancer patient and her relatives may not coincide. And then the feelings enter into dissonance. At this moment, when there are no or very few resources for support, it is difficult to understand and agree with the desires of another.

Then relatives are looking for information on how to “correctly” speak with a person who has oncology. This “correct” is necessary for relatives as a support - you want to protect your loved one, save you from painful experiences, and not face your own impotence. But the paradox is that there is no "correct" one. Everyone will have to look for their own unique way of understanding in the dialogue. And this is not easy, because cancer patients develop a special sensitivity, a special perception of words. The best thing is to be yourself. This is probably the hardest one.

“I know for sure: you need to change the treatment regimen / nutrition / attitude to life - and you will get better”

Why do loved ones like to give such advice? The answer is obvious - to do what is best - to keep the situation under control, to correct it. In fact: relatives and friends who are faced with the fear of death and their own vulnerability, with the help of these tips, want to control tomorrow and all subsequent days. This helps to cope with their own anxiety and impotence.

When giving advice on treatment, lifestyle, nutrition, relatives mean: “I love you. I'm afraid to lose you. I really want to help you, I'm looking for options and I want you to try everything to make it easier for you. And the cancer patient hears: “I know exactly what you need!”. And then the woman feels that no one takes into account her desires, everyone knows better what to do with her ... As if she is an inanimate object. As a result, the cancer patient becomes isolated and withdraws from loved ones.

"Be strong!"

What do we mean when we say to a cancer patient “hold on!” or "be strong!"? In other words, we want to tell her: “I want you to live and overcome the disease!”. And she hears this phrase differently: “You are alone in this struggle. You have no right to be afraid, to be weak! At this moment, she feels isolation, loneliness - her experiences are not accepted.

"Take it easy"

From early childhood, we are taught to control our feelings: "Do not rejoice too much, no matter how much you have to cry", "Do not be afraid, you are already big." But they do not teach to be near those who experience strong feelings: cries or gets angry, talks about his fears, especially the fear of death.

And at this moment it usually sounds: “Don't cry! Take it easy! Don't talk nonsense! What have you got in your head?"

We want to avoid the avalanche of grief, and the cancer patient hears: “You can’t behave like that, I don’t accept you like that, you are alone.” She feels guilty and ashamed - why share this if loved ones do not accept her feelings.

"You look good!"

“You look good!”, or “You can’t tell that you are sick” - it seems natural to compliment a woman who is going through the ordeal of an illness with a compliment. We want to say: “You are doing great, you have remained yourself! I want to cheer you up." And a woman who is undergoing chemotherapy sometimes feels after these words like a simulator who needs to prove her point. bad feeling. It would be great to give compliments and at the same time ask about how she really feels.

"Everything will be fine"

In this phrase, it is easy for a person who is sick to feel that the other is not interested in how things really are. After all, a cancer patient has a different reality, today he is unknown, difficult treatment, recovery period. Relatives seem to need positive attitudes. But they repeat them out of their own fear and anxiety. “Everything will be fine” the cancer patient perceives with deep sadness, and she does not want to share what is in her heart.

Talk about your fears

As a kitten named Gav said: “Let's be afraid together!”. It is very difficult to be frank: “Yes, I am also very scared. But I’m there”, “I also feel pain and want to share it with you”, “I don’t know how it will be, but I hope for our future.” If it's a friend: “I'm so sorry this happened. Tell me, will you be supported if I call you or write to you? I can whine, complain."

Not only words can be healing, but also silence. Just imagine how much it is: when there is someone nearby who accepts all your pain, doubts, sorrows and all the despair that you have. Does not say “calm down”, does not promise that “everything will be fine”, and does not tell how it is for others. He is just there, he holds your hand, and you feel his sincerity.

Talking about death is as hard as talking about love.

Yes, very scary to hear from loved one phrase: "I'm afraid to die." The first reaction is to object: “Well, what are you!”. Or stop: "Don't even talk about it!". Or ignore: "Let's go breathe air, eat healthy food and restore white blood cells."

But this does not stop the cancer patient from thinking about death. She will just experience it alone, alone with herself.

It is more natural to ask: “What do you think about death? How do you feel about it? What do you want and how do you see it? After all, thoughts about death are thoughts about life, about the time that you want to spend on the most valuable and important.

In our culture, death and everything connected with it - funerals, preparations for them - is a taboo topic. Recently, one of the cancer patients said: “I must be crazy, but I want to talk to my husband about what kind of funeral I want.” Why abnormal? I see in this concern for loved ones - the living. After all, that very “last will” is most needed by the living. There is so much unspoken love in it - it is as difficult to talk about it as about death.

And if a loved one with cancer wants to talk to you about death, do it. Of course, this is incredibly difficult: at this moment, your fear of death is very strong - that is why you want to get away from such a conversation. But all feelings, including fear, pain, despair, have their own volume. And they end when you speak them. Cohabitation such uneasy feelings makes our life authentic.

Cancer and children

It seems to many that children do not understand anything when loved ones are sick. They don't really understand everything. But on the other hand, everyone feels, catches the slightest changes in the family and is in great need of explanations. And if there is no explanation, they begin to show their anxiety: phobias, nightmares, aggression, poor school performance, withdrawal to computer games. Often this the only way for the child to convey that he, too, is going through. But adults often do not understand this immediately, because life has changed a lot - a lot of worries, a lot of emotions. And then they begin to shame: “Yes, how are you behaving, mom is already so bad, but you ...”. Or blame: “Because you did this, mom got even worse.”

Adults can be distracted, support themselves with their hobbies, going to the theater, meeting with friends. And children are deprived of this opportunity because of their little life experience. It’s good if they somehow win back their fears and loneliness: they draw horror films, graves and crosses, play funerals ... But in this case, how do adults react? They are scared, confused and do not know what to say to the child.

"Mom just left"

I know a case when a preschool child was not explained what was happening with his mother. Mom was sick, and the disease progressed. The parents decided not to injure the child, rented an apartment - and the child began to live with his grandmother. They explained to him simply - my mother left. While mom was alive, she called him, and then, when she died, dad returned. The boy was not at the funeral, but he sees: grandmother is crying, dad is not able to talk to him, from time to time everyone leaves somewhere, they are silent about something, they moved and changed Kindergarten. What does he feel? Despite all the assurances of mother's love - betrayal on her part, a lot of anger. Strong resentment that he was abandoned. Loss of contact with his loved ones - he feels: they are hiding something from him, and he no longer trusts them. Isolation - no one to talk to about your feelings, because everyone is immersed in their experiences and no one explains what happened. I do not know how the fate of this boy turned out, but I never managed to convince the father to talk to the child about his mother. It was not possible to convey that children are very worried and often blame themselves when incomprehensible changes occur in the family. I know that for a small child this is a very heavy loss. But grief subsides when it is divided. He didn't have that opportunity.

“You can’t have fun - mom is sick”

Because adults do not ask children about how they feel, do not explain the changes at home, children begin to look for the reason in themselves. One boy, junior school student, hears only that her mother is sick - you need to be quiet and not upset her in any way.

And this boy tells me: “Today I played with my friends at school, it was fun. And then I remembered - my mother is sick, I can’t have fun!

What should be said to the child in this situation? “Yes, mom is sick - and it’s very sad, but it’s great that you have friends! It's great that you had fun and that you can tell your mom something nice when you get home."

We talked with him, 10 years old, not only about joy, but about envy, about anger towards others when they do not understand what is happening to him and how things are at his place. About how sad and lonely he is. I felt that with me a little boy rather a wise adult.

"How are you behaving?!"

I remember a teenage boy who heard somewhere that cancer is transmitted by airborne droplets. None of the adults talked to him about it, did not say that it was not so. And when his mother wanted to hug him, he recoiled and said: "Don't hug me, I don't want to die later."

And adults condemned him very much: “How are you behaving! How cowardly you are! It's your mom!"

The boy was left alone with all his experiences. How much pain, guilt before his mother and unexpressed love he has left.

I explained to my family: his reaction is natural. He is not a child, but not yet an adult! Despite the male voice and mustache! It is very difficult to live such a great loss on your own. I ask my father: “What do you think about death?”. And I understand that he himself is afraid even to utter the word death. What is easier to deny than to admit its existence, its powerlessness before it. There is so much pain in this, so much fear, sadness and despair, that he wants to silently lean on his son. It is impossible to rely on a frightened teenager - and therefore such words flew out. I really believe that they were able to talk to each other and find mutual support in their grief.

cancer and parents

Elderly parents often live in their own information field, where the word "cancer" is tantamount to death. They begin to mourn their child immediately after they find out his diagnosis - they come, are silent and cry.

This causes great anger in a sick woman - after all, she is alive and focused on the fight. But she feels that her mother does not believe in her recovery. I remember one of my cancer patients said to her mother: “Mom, go away. I didn't die. You mourn me like I'm dead, but I'm alive."

The second extreme: if there is a remission, the parents are sure that there was no cancer. “I know that Lucy had cancer - so immediately to the next world, and you pah-pah-pah, you’ve been living for five years already - as if the doctors were wrong!”. This causes great resentment: my struggle has been devalued. I went through a difficult path, and my mother cannot appreciate it and accept it.

cancer and men

From childhood, boys are brought up strong: do not cry, do not complain, be a support. Men feel like fighters on the front line: even among friends, it is difficult for them to talk about what they feel because of their wife's illness. They want to run away - for example, from the room of the woman they love - because their own container of emotions is full. It is also difficult for them to meet her emotions - anger, tears, impotence.

They try to control their condition by distancing, going to work, sometimes alcohol. A woman perceives this as indifference and betrayal. It often happens that this is not the case at all. These eyes outwardly calm men give away all the pain they can't express.

Men show love and care in their own way: they take care of everything. Clean the house, do homework with the child, bring your favorite food, go to another country for medicine. But just sitting next to her, taking her hand and seeing her tears, even if they are tears of gratitude, is unbearably difficult. They don't seem to have the stamina for that. Women so need warmth and presence that they begin to reproach them for callousness, say that they have moved away, demand attention. And the man moves away even more.

Husbands of cancer patients rarely visit a psychologist. Often just ask how to behave with his wife in such a difficult situation. Sometimes, before talking about his wife's illness, they can talk about anything - work, children, friends. They need time to start a story about something that really deeply cares about. I am very grateful to them for their courage: there is no greater courage than to confess sadness and impotence.

The actions of the husbands of cancer patients who wanted to support their wives aroused my admiration. For example, in order to support their wife during chemotherapy, husbands also cut their heads or shaved mustaches, which they valued more than hair, because they had not parted with them since they were 18 years old.

You cannot be responsible for the feelings and lives of others.

Why are we afraid of the emotions of a cancer patient? In fact, we are afraid to face our feelings that will arise when a loved one starts talking about pain, suffering, fear. Everyone responds with their own pain, not the pain of someone else. Indeed, when beloved and dear person hurt, you may experience powerlessness and despair, shame and guilt. But they are yours! And your responsibility is how to deal with them - to suppress, ignore or live. Feeling is the ability to be alive. It's not the other's fault that you feel it. And vice versa. You cannot be responsible for other people's feelings and for their lives.

Why is she silent about the diagnosis

Does a cancer patient have the right not to tell her family about her illness? Yes. This is her personal decision at the moment. Then she may change her mind, but now it is. There may be reasons for this.

Care and love. Fear of being hurt. She does not want to hurt you, dear and close.

Feelings of guilt and shame. Often, cancer patients feel guilty for being sick, for everyone worrying, and who knows what else! .. And they also feel a great sense of shame: she turned out to be “not like she should be, not like others - healthy” , and she needs time to experience these very difficult feelings.

Fear that they will not hear and will insist on their own. Of course, one could honestly say: “I am sick, I am very worried and I want to be alone now, but I appreciate and love you.” But this sincerity is more difficult for many than silence, because often there is a negative experience.

Why is she refusing treatment?

Death is a great savior when we don't accept our life as it is. This fear of life can be conscious and unconscious. And perhaps this is one of the reasons why women refuse treatment when the chances of remission are high.

A woman I know had stage 1 breast cancer and refused treatment. Death for her was more preferable than surgery, scars, chemo and hair loss. This was the only way to solve difficult relationships with parents and with a close man.

Sometimes they refuse treatment because they are afraid of difficulties and pain - they begin to believe sorcerers and charlatans who promise guaranteed and more easy way come into remission.

I understand how unbearably difficult it is for those close to us in this case, but all we can do is express our disagreement, talk about how sad and painful we are. But at the same time remember: the life of another does not belong to us.

Why Fear Doesn't Go Away When Remission Comes

Fear is a natural feeling. And it is not in human power to get rid of it completely, especially when it comes to the fear of death. From the fear of death, the fear of relapse is also born, when everything seems to be in order - the person is in remission.

But taking death into account, you begin to live in accordance with your desires. Finding your own dosage of happiness - I think this is one of the ways to treat oncology - to help official medicine. It is quite possible that we fear death for nothing, because it enriches our lives with something really worthwhile - genuine life. After all, life is what is happening right now, in the present. In the past - memories, in the future - dreams.

Understanding our own finiteness, we make a choice in favor of our life, where we call a spade a spade, do not try to change what is impossible to change, and do not put off anything for later. Do not be afraid that your life will end, be afraid that it will never begin.

How to give hope to the patient

Would you like to know how to help your loved one in a situation of illness to cope with anxiety and depression, to believe in yourself and the success of treatment? Really, positive attitude and the desire to fight, despite all the difficulties in the treatment process, are the basis of recovery.

Have you ever wondered what hope is? First of all, this is a certain image of the future, these are our aspirations, expectations of something better. And in a situation of illness, a person is primarily afraid that he will no longer be the same as before, that his expectations will not be fulfilled. Therefore, you can inspire hope in a person in two ways: as long as there is a chance to restore health and strength, you need to talk with a person that his hopes are not crossed out, but only postponed. You just need to take your time, find the strength in yourself to first devote some time to getting out of disease state, and then it will again be possible to make plans and realize the hopes that were. If you see that it is not possible to get out of the disease without losses and such as earlier life definitely not, work to ensure that the person sees new horizons and forms new expectations. The values ​​that are so noticeable for any patient will help here: the joy of communicating with loved ones, the pleasure of a clear sunny day, interest in a new film or book, etc.

It's no secret that many of medical measures are often hard to bear by a person, can cause discomfort, fear, anxiety, a feeling of fatigue. But outstanding success modern medicine convincingly prove that any disease can be successfully dealt with at all stages of the process. However, in a situation of uncertainty and anxiety in which a person is, especially in severe chronic disease It is not easy to accept this and deal with negative experiences. In this case, it is close people who are able to provide psychological support, inspire self-confidence and a desire to fight the disease.

There is an opinion that relatives should maintain external composure in order to psychologically support the patient. But he understands the unnaturalness of this state, and this blocks the free expression of his own emotions. In this sense, it is important to avoid superficial optimism, the insincerity of which a loved one always feels. It is important to be natural, to allow yourself to speak freely with your loved one about his pains, fears, worries, and to receive your support. This support should feel calm, unconditional, self-evident, based on your complete faith in his recovery. Become yourself a conductor of this faith and desire to fight. It is very important to believe in the strength of a person, because your faith will give faith to your loved one.

It is important that very often a person who claims that treatment is meaningless wants most of all to be convinced, to return this lost hope to him. In him, like in no one else, there is this desire and desire to believe, hope and fight, which you need to turn to, activate it.

You probably know well what things in life your relative values ​​​​most of all (family, children, grandchildren, hobbies, favorite activities, life goals and plans). Use this resource to give a person faith in the future, plan upcoming events together, create a favorable emotional climate around him. The most important support and foundation on which a person will build his faith in the future and draw strength for the struggle is now your family and close people.

In general, it is easier for a person to think and talk about everyday worries and affairs than to constantly be afraid of some global threat, and it is to the daily steps to improve health that the patient's attention should be switched (observance of sleep and wakefulness, diet, walks, regular follow-up of doctor's orders, making a list of questions to ask the doctor, doing household chores, hobbies, gardening, etc.).

Try to convince your loved one that the main task now is to stock up on patience and courage, just wait out the hard times for the sake of your health and future life. And also to assure that you will be there all the time, helping together, step by step, to overcome the disease.

The state of anxiety and fear can arise, among other things, due to a lack of information. Perhaps, in this sense, a conversation with a doctor, an expert, or a call to our hotline 8-800 100-0191, where experienced psychologists will help you understand the current situation, give recommendations on interaction and communication with the patient, and provide psychological support.