Sunday, December 27, 2015

Taking Time to Take Care of Mental Health, Too

I've had a lot of ideas bouncing around my head for a post but the problem is, I can't seem to perfect the post in my head so it rattles in and rattles out and the page sits empty. The challenge of being a writer who blogs -- as opposed to someone whose blogging and writing career started simultaneously -- is, as I've told my therapist (more on that later), that I can obsess over the writing instead of just writing. 

Most of the ideas that have bubbled under my idea volcano have been about mental health.  I started seeing a new therapist about a month or so ago. Well, new might be stretching it as it implies that I was seeing a therapist before. I was, but I wasn't. I sort of saw Dr. F occasionally when I was first diagnosed, but only in conjunction with another appointment and that was, at best, once every couple months. To complicate things, we both work for Dana-Farber, so I would see her increasingly in co-worker settings, making the patient/doctor roles a little awkward. Although I haven't seen her in a patient-doctor role for probably two years, ironically, it was working with her in my communications role that made me realize that I really needed to see someone. It's not that I'm not fine. I am.  I just think I can be finer.

There are times, even surrounded by cancer as I am at work, when I don't think about having cancer; there are times when I can't even recall how long it was since I did chemo. (Three years, I looked it up). But that distance doesn't mean that cancer isn't still part of me. It may be below the surface; but it's there and it's real. Sometimes the enemy you see is easier to deal with than the enemy you can't see. That's part of the reason that it can be challenging to move from treatment to "after treatment." To those looking in, that seems preposterous. You're done. You're finished. You should be celebrating.  So just at the time that you're probably most in need of mental health help, you may be most likely to tell yourself that you don't need it. That you should be moving on and closing that chapter in your life. So, if you're like me, you do nothing and that lack of action can make you feel powerless while cancer lurks.
A lot of patients talk about being angry at cancer. But I wasn't just angry at cancer. I was getting angry at myself for being angry at cancer. I have no right to be angry, I thought. I have the "good" cancer, after all. (Repeat after me: There is no good cancer.) I was feeling fine. I wasn't in treatment any more. There were no lingering effects that so many patients suffer from - no neuropathy, no lymphedema. I should just suck it up, stop complaining and move on.  

Move on.

Moving on doesn't just happen. You don't shake off your cancer diagnosis like a winter cold. The diagnosis stays with you long after the chemo has left your body. That can wear you down. You may look fine and even feel fine, but inside it's peeling away your emotional skin and leaving you exposed.

We at Dana-Farber write often about the mental health of cancer patients -- and we are fortunate to have a very strong psychosocial oncology group. But I think many patients overlook, under-think, and even undervalue the importance of taking care of their mental health. Some times we are so focused as patients on treating the cancer that we forget that we should be treating the patient -- and that's not just the body but the mind as well. That's why I started seeing my new therapist, three years post chemo. 

Sometimes I feel a little silly sitting in my therapist's office. Part of it is because unlike my appointments with Dr. F, this feels like real therapy, like something that's not just tacked on to the end of another appointment, but therapy with a purpose. And part of it, too, was  because I felt better about my mental health almost as soon as I made my first appointment. I felt like I was finally doing something and that gave me the slightest hint of control. And if we know anything about cancer, it's a disease that is completely out of control.

What Dr. D's sessions have done so far is to raise my awareness. At first it seems counter-intuitive. It's gotten me thinking more about cancer when every instinct tells me that if I want to feel better, I should stop thinking about it. But thinking about cancer is not the same as worrying about cancer. 

And thinking about -- and gaining tools and understanding about  how I think about it -- in the controlled setting of Dr. D. or any qualified therapist should be a routine part of ongoing cancer care.