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HomeBlogThriving beyond surviving: how to handle the emotional consequences of serious illness

Thriving beyond surviving: how to handle the emotional consequences of serious illness

By: Medix Team
Thriving beyond surviving: how to handle the emotional consequences of serious illness

Getting the all clear is the just first stage on an, often, bumpy road back to living a full life again. Here in part one of a special series on rehabilitation, we examine the need for better emotional support.

What does it mean to be called a survivor? At it’s most simple level, the English term derives from two Latin words for: to live (vivere) and beyond (super).

 

It conjures up an image of someone who’s strong, who’s resolute and who’s, quite possibly, feeling on top of the world after overcoming a difficult situation, usually a brush with death. It’s a very positive image when the reality is often the complete opposite.

 

Many people feel more anxious and depressed after they’ve received the all clear than they did when they first received their diagnosis. Many struggle to get back to normal life after they’ve been told their disease has been successfully treated.

 

The answer why is twofold.

 

Firstly, hospitals can be daunting places, but knowing that a doctor is on hand is also very reassuring. It can be frightening leaving the medical world behind to face “normal” life.

 

Secondly, many people don’t receive the emotional support they need to understand, process and handle what’s just happened to them. The time when an acute threat has been overcome is usually when the emotional trauma bubbles up.

 

The English word for this recovery process is rehabilitation. It also comes from another two Latin words for: to make fit (habitare) and again (re).

 

It may seem obvious that illnesses have an emotional impact and that the intensity of the fallout is likely to match the severity of the illness. But even in countries with developed healthcare systems, there’s still a lack of awareness among the medical establishment.

 

As recently as three years ago, a Scottish study found that one in three of the cancer patients surveyed was suffering from anxiety and depression.

 

But what was more startling was the finding that half of the survey respondents had received no support or advice about how to handle the emotional consequences of their illness. An even larger group, two-thirds, had not been told about the likelihood of experiencing emotional distress after they’d finished their treatment.

 

Studies of cardiac patients have come up with similar findings. One Australian study found that a third of cardiac patients were suffering anxiety a year later.

 

Some might say that’s typical of Western medicine, which has a long history of separating the mind from the body. Doctors are mechanics that fix the body. Their focus is bio-medical, not bio-psychosocial.

 

In Eastern medicine, the mind and body are viewed as one. The mind affects the body and the body affects the mind.

 

But that doesn’t seem to change the emotional outcome for cancer patients in the region.  A 2017 study covering Australia and nine Asian countries, including China, Hong Kong, India, Singapore, Thailand, looked at how 1,873 former patients were faring 62 months after they’d finished their treatment.

 

What they discovered was that 67% were struggling with tiredness, 60% with sleep issues and 57% with weight problems among a whole host of other issues.

 

The researchers concluded being cured doesn’t mean that someone will automatically spring back to full health again. They also called for more tailored treatments to help former patients to cope with the aftermath of their disease.

 

What doctors should be doing?

 

The first step for doctors and patients lies in de-stigmatising emotional upset. Giving it a medical name - mental health - helps to give these feelings a more physical form: ones that can be understood and treated.

 

A number of hospitals also now attach psychologists to departments treating cancer and heart patients. This helps patients in many ways, not least by making it clear that it’s perfectly normal to face emotional distress and certainly not a weakness. Help is on hand. 

 

Just over a decade ago, the UK’s Royal College of General Practitioners came up with a set of recommendations that have wide applicability:

 

  • Part of a medical student’s training should be learning how to spot emotional distress in patients.
  • This training should include how to give patients basic tips in psychological self-help.
  • There should be better co-ordination and liaison between hospitals, primary care and other services so that patients are referred to someone who can help them to process how they are feeling and resume normal life again.

 

Put the right support structures in place and the results speak for themselves.

 

One German study showed this in action. It analysed a group of cancer patients and found that only 3% of patients receiving standard care got a referral to counselling services.

 

However, that rose to 22% if stepped care was put in place: screening for emotional distress, followed by a consultation between a patient and doctor and then referral to a psychologist.

 

How can psychological support help?

 

Many referrals are to psychologists specialising in cognitive behavioural therapy (CBT). This kind of therapy helps people to break negative thought patterns and create positive ones by learning new patterns of thought and behaviour.

 

One important step for former cardiac patients is learning how to distinguish between anxiety and their former illness given that so many symptoms are the same: palpitations, sweating, breathing difficulties.

 

Sleep training can also be a big help. The American College of Physicians recommends CBT for insomnia (CBT-I).

 

A 2019 study showed how this helped cancer patients. Training included:

 

  • Shortening the time spent in bed
  • Improving sleep hygiene – limiting caffeine and other stimulants, exercise and screen use before they went to bed
  • Optimising the sleeping environment – reducing noise and other disturbances
  • Changing negative thinking about sleeping patterns
  • Relaxation therapy such as whale music.


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