Monday, February 21, 2011


I mentioned here just a few days ago that doctors are at risk when they don't express their feelings. Now comes a study ( that suggests patients are similarly jeopardized.

Some point to other cultures--say, the Italians--as overly expressive. They're hyperemotional, we claim, even gesticulating with every statement. Well, compared to Americans, this might be true. I wonder if the Italians see our culture as underexpressive.

If we are, this can beg trouble, since buried feelings are buried alive. Indeed, that's the source of Post-Traumatic Stress Disorder. Soldiers have always suffered this, and so, too, have a good number of people with cancer.

Imagine--or remember--being diagnosed with cancer. Once you hear the C word, your hearing shuts down, a sign of emotional emergency. You can't process this overload since you're also informed that treatment ought to begin ASAP, and treatment generates even more emotional activity. 

I wouldn't say it's unhealthy to submerge all this furor temporarily in order to focus on survival. But six months after treatment, when everyone around you figures your cancer is past history, you find you're inexplicably mercurial. You're depressed, you get inappropriately angry, you can't sleep. You're suffering PTSD.

Cancer-affected families often emphasize the need to be "positive." What does that mean, after all? I recall the wife of a man with lung cancer warning anyone entering their home that positivity was an absolute requirement. So it was that the place was a sea of smiles. But these smiles looked less like contentment than a pandemic of rabies or tetanus. Any casual observer would have recognized the elephant of denial in the living room. This strategy effectively keeps emotions buried but nonetheless active.

To me, "positivity" has come to mean honesty or, as one member of our support group defines it, "rigorous honesty." Genuine expression of what's happening is truly therapeutic.

We can balk, though, assuming we'll fall permanently into our current emotion. "If I start crying," some say, "I'll never stop." But that's not so, ever. When we get accustomed to expressing ourselves, we learn that every emotion is finite.

I find myself referring repeatedly to Elisabeth Kubler-Ross' On Death and Dying. What most readers take away from that book is that absorption of any bad news impels the listener into emotional "stages," the final stage being acceptance. But what Kubler-Ross actually said was that one reaches acceptance--defined as absence of emotion--once one has completely expressed whatever emotions have arisen.


  1. Thank you for this, Doctor! I enjoy your writing very much. Could you address the "deep acting" spoken of in the article, that is, working to change the thoughts and memories in order to evoke real happiness, as in cognitive behavioral therapy? Also, is there any way your posts can be sent directly to my email?

  2. Thanks for your kind words, Kathleen.

    I understand “deep acting” as behavior that flows from authentic feeling, acting from the heart. The most convincing actors are those skilled in creating such feelings.

    Those of us who aren’t up for Oscars still have a therapeutic strategy available. We can express our already-resident feelings, whatever their nature. That can mean crying, screaming, pounding the wall. When we’re undeniably ravaged, it’s a mortal challenge to enact anything other than our misery.

    But when the darkest hour has passed, we can choose to focus on the glimmers of hope, support, and especially gratitude that inevitably emerge. In fact, one of the most frequent comments in our cancer support group is, “You know, things could be worse.”

    As to your question about feeding posts to your e-mail, I’ve begun to look into that. It may take a little time, as I’m not much of a nerd. If any readers know how to do that, please leave a comment here.

  3. Thank you very much, Doctor Kane. As a cancer survivor, I understand this completely. The best way out is through.

  4. In my personal experience when going through a sad and difficult time, faking it till I could make it was very instrumental in my becoming happy again. Just saying.

    I realize this study was with "normal" buss drivers :-)