The moment time stops: RECEIVING A CANCER DIAGNOSIS!

Receiving a cancer diagnosis brings a broad range of intense, different emotions. Before reading, take just 1 minute to imagine being diagnosed, or, if you already have a diagnosis, try to recall that moment...

We must give that experience its due, must we not? Merely imagining or remembering it can trigger complex, intense, indescribable feelings: shock, bewilderment, confusion, disbelief, distress, worry about yourself, loved ones and the future, restlessness and above all fear—intense fear! Sometimes the opposite occurs: numbness, feeling nothing, a blurred moment, emptiness as though you are not yourself or events are unreal...

In our previous cancer psychology article , I noted that each of us is unique. Beliefs, worldview, culture, social support, expectations, past trauma, coping strength and personality all shape how we perceive and feel about cancer. Frightening to many, cancer may paradoxically bring relief to someone hospitalized for months without a diagnosis: uncertainty ends and the challenge becomes clear.

There is no right or wrong emotion

Remember, there are no right or wrong feelings... There are fluctuating, sometimes manageable and sometimes difficult emotions that cannot be dispelled with “Nothing to fear,” “No need to worry” or “Everything will improve.” They must be accepted without judgment as “natural” emotions. Let us examine possible feelings and their associated thoughts.

Early days: shock and denial

Where you learn the diagnosis, who tells you and how matter greatly. Hearing a pathology result and diagnosis suddenly, perhaps while standing and from a doctor who barely knows you, may feel devastating or unreal. Hoping you never face this, a simple explanation from a trusted physician, stripped of medical terminology and delivered gradually, usually begins the emotional process.

The phase beginning here is called the “Shock Phase” . Especially if the news is entirely unexpected, you may experience:

• Freezing
• Inability to feel or express anything
• Confusion
• Inability to understand or follow the physician
• A feeling the moment is unreal 
• Disbelief 
• Unusual bodily sensations: hot flushes, numbness, tingling 
• Shortness of breath, palpitations, a need to sigh, tension and panic may ALSO occur.

This can last hours or days. If investigations have been ongoing and you partly anticipated a diagnosis, shock may be milder and shorter.

What should you do to cope?

Nothing...

Please do not burden patients or relatives with controlling emotions during this difficult time. Whatever you feel is natural and necessary. Avoiding pain is human, but every emotion has a function. Sadness and grief are as valuable as happiness and peace; though labeled negative, they provide what we need to continue. In this context, shock and the subsequent denial phase may seem negative but offer a safe, conflict-free space. Mind and spirit are telling us: “This information is too much and too heavy. I will feel nothing for a while and become numb. Give me time to understand what happened, absorb the impact and digest it before moving forward.”

My suggestion: you probably missed some information from your doctor, or heard it without retaining or understanding it. Request another brief appointment soon. Write down key questions and, with a clearer mind, ask about the disease, process and treatment. Bringing a relative provides someone who can catch details you miss.

“The Denial Phase”

Intertwined with shock, this phase involves an unconscious inability to believe or accept illness despite apparent evidence. Patients may: 

• Act as though they are not ill.
• Show indifference to illness and the process.
• Avoid discussing it or speak little about it. 
• Attend treatment consultations but avoid saying “cancer.”
• Receive treatment yet not consider themselves a cancer patient.

Does this seem strange? It is not; these are natural responses. Mind and spirit are trying to digest the news and will eventually do so. If denial or partial denial does not cause refusal of treatment or self-harm, intervention may be unnecessary because it will resolve spontaneously.

If:

• Beliefs that there is no cancer, the diagnosis is wrong or a better doctor is needed recur with every new physician,
• Recommended investigations are refused, delayed or indefinitely postponed,
• Treatment is entirely rejected in favor of only alternative or complementary methods, seek a psychiatrist or specialist clinical psychologist to address denial.

Rarely, a patient accepts illness while relatives deny it. The mechanism is similar: relatives must grieve to absorb their loved one’s cancer and move forward. If they do not obstruct treatment and maintain support, it may resolve naturally. More serious situations require professional mental health support.

Denial may weaken intermittently with acceptance, but the process fundamentally moves back and forth between them. Before acceptance replaces denial over hours or days, anger and bargaining may occur.

“Anger and Bargaining Phases”

Learning you have cancer may shake “the belief in a fair, protected world and a future full of good things” and create deep disappointment at “not living in a predictable, controllable, safe world” . Emerging from denial with greater awareness, people seek answers. Finding meaning in suffering is natural, but often brings anger. For example:

• Toward the ill body... “I thought I still had a young girl’s body,” a woman in her 40s once told me. • Toward oneself for not caring for the body...
• “Why me, when others in the world deserve this illness?” or “Why now?” sometimes directed at God...
• Intense anger may target an upsetting spouse, a son-in-law who divorced a daughter, a sibling forcing fruit, a neighbor calling to check in, a nurse causing arm pain, a doctor making a rushed round, or even an attendant leaving without saying goodnight.

Bargaining is the mind’s unconscious negotiation with fate to escape pain—with God, the universe or whatever is seen as causing illness. It tries to correct the past and plan the future, recover the days, weeks or months before learning the diagnosis, fix mistakes and live again.

• “What punishment / sin led to this?”
• “God, from now on I will... please let this not be real...”
• “If I recover, I will make sacrifices,” “If I get through this, I will go on umrah,”
• “Once this is over, never again...”
• “If I give this in exchange, let this disease disappear...”
• “It is all that cursed smoking; if only I had not smoked more last month...”

Anger covers anxious, fearful feelings. It is natural and must be understood. Acknowledge the difficulty and the right to feel angry, and communicate that every effort matters. Nothing increases anger like feeling misunderstood. But one point is vital: acknowledge anger’s presence, while not approving destructive expression. Anger becoming verbal or physical aggression requires prompt intervention and psychiatric / clinical psychological help with stress and anger management. Psychotherapy is among the most appropriate supports.

When anger and difficult feelings become overwhelming, inappropriate relaxation methods may be chosen. Though less common in our culture, alcohol or substance use may increase. Denying, suppressing or soothing pain with medication, alcohol or substances does not resolve grief; it prolongs it unresolved.

Knowing it is easier said than done, I encourage expressing frustration and anger. Given cultural difficulties expressing emotions, seek support if they overwhelm you. Relatives may experience the same processes and anger; psychological support is appropriate for them too.

These phases do not progress like steps on a staircase; people may move between denial, anger, partial denial, bargaining, acceptance and denial. Remember that bargaining and anger are healthy signs of beginning to accept reality. Completing grief and continuing life while accepting lost health also involves depression and acceptance.

“Depression and Acceptance”

Accepting the risk or reality of loss and moving on, adapting healthily to absence and reaching reconciliation are important parts of grief. Acceptance may bring sadness and sorrow rather than anger and anxiety. While adapting to a new life, sleep, appetite, energy and motivation may deteriorate. Emotional sensitivity, reluctance, hopelessness and “I am a burden to my family” guilt may occur. If unhappiness, grief, loss of enjoyment, low energy, sleep/appetite problems, concentration difficulty, hopelessness and feeling nobody can help are severe, persistent and disruptive, depression is likely and psychiatric consultation is needed. Sadness that does not disrupt life is part of grief.

After crises pass and acceptance arrives, people often review past experiences and close relationships and question life’s meaning. Whatever the loss, “secondary losses” may accompany it. Cancer means grieving lost health, but accompanying losses of social roles, finances or self-confidence are secondary losses also mourned.

Loss and Grief

All stages above are stages of the “GRIEVING PROCESS” after any loss. Humans begin life losing the womb’s warm, protected world and experience losses from preceding stages at every step forward. Grief is therefore as natural as sleeping or hunger. The greater the loss or threat of loss, the harder it becomes.

For patients with cancer, lost health and life-threatening illness begin grief. A family history of cancer, death or suffering, or witnessing bereaved people’s difficulties, can make the path from diagnosis to acceptance harder. Relatives’ difficulty accepting illness and grieving also complicates patient adaptation.

These natural emotions are part of the journey: evolving, changing, dynamic processes. Recognizing and accepting them without judgment makes the road smoother. If you feel stuck, unable to progress, and this severely affects life, relationships or treatment, please seek psychiatric support.