Tomorrow’s Pain

It was the size of the needle that made the biggest impression on me. Cindy Sanderson, a clinical psychologist in her mid-40s, was delivering a lecture to the psychiatry service of the cancer hospital where I was training. She didn’t offer the usual research on this or that psychiatric issue; instead, Sanderson described coping with her own advanced breast cancer. She spread her thumb and forefinger as far as they could go to illustrate the largest needle that doctors had used on her. “One of the toughest moments,” she confessed, her cheeks flushed in the warm room, “was dealing with that needle.”

Sanderson’s lecture comes to mind whenever I hear about the power of positive thinking, an idea that remains popular in our culture despite the lack of any consistent evidence. Ironically, its very popularity has become an albatross for many patients. Renowned psychiatrist Jimmie Holland calls it the “tyranny of positive thinking.”

For those to whom it comes naturally, optimism can buoy their spirits and help them through painful and exhausting days. But for those who tend to be more anxious, a focus on positive thinking can backfire. Fears about their prognosis expand into the fear that their fears will get in the way of survival. Suddenly, patients find themselves anxious and depressed, not only over their cancer but also over their anxiety and depression about their cancer. The problem is compounded by the many well-meaning friends who try to talk them into being “better adjusted.” Is there another coping option if trying to stay optimistic feels as bad as feeling pessimistic does?

That question became more than a clinical exercise for me when I was diagnosed with stage II breast cancer a few years after hearing Sanderson’s talk. My professional experience could go only so far. I knew too many women who’d died despite the heartening statistics. And I knew too much about how chemotherapy would feel to conjure up a can-do attitude — an attitude that often eluded me even in the best of times. The thought of the IV needle alone was enough to arouse panic. I remembered the lecture and decided to contact Sanderson. The first Google entry I found was her obituary. My panic rose even higher.

Until I thought about her needle. Perhaps it had loomed so large for me because of my experience trying to help patients relax when they thought about their upcoming treatments. But it was also true that I’d always hated needles, just as nurses often hated injecting me, cursing my bad veins for scurrying away when they tried to take blood.

Sanderson had an asset most of us don’t. She’d been an early practitioner and teacher of a psychotherapy based in part on the concept of mindfulness, the ability to focus one’s awareness on the present moment. Originally a Buddhist notion, mindfulness was making its way into Western psychology as a method of teaching people to take hold of their own consciousness.

Even the basic act of washing the dishes can be a mindful act if one is focusing only on washing the dishes and not on what activity comes next. As Buddhist monk Thich Nhat Hanh explains in “The Miracle of Mindfulness,” when we let ourselves get sucked away into the future, we’re not really living; for every next activity that comes, we’re already thinking about the one following.

Sanderson realized that this was what she was doing with her needle and, ultimately, with her illness: letting her experience of the present moment be overtaken by her fears for the future. Every hour she spent ruminating about the pain that was awaiting her was another hour she wasn’t fully engaged with her life, another hour she couldn’t enjoy. She couldn’t pretend she didn’t know her prognosis. So she chose a different route.

“I realized,” she told us, “that the moments of pain — even if the pain was excruciating — were actually very short compared with the pain I put myself through by thinking about it ahead of time.” If she could stay focused on the present moment no matter what she was doing — washing dishes, talking to a colleague, even chatting with the doctor just before her treatment — up until the moment the needle actually pierced her skin, she could cope. Even more, if she could keep that same focus from meandering to thoughts about what lay ahead in the future in general, she could continue to make the most of every moment that was not painful.

Some people think being positive means being certain of a cure. For others, it means enjoying the kindness of a friend or the mischief of a child or a rerun of “Battlestar Galactica” today, and leaving tomorrow’s sorrows for tomorrow. For me, it meant looking at the clock at noon every other Monday, knowing my chemotherapy needle was only 24 hours away but remembering that I still had 23 hours and 59 minutes to enjoy riding my bike with my children or having dinner out with my husband. Feeling my fear of whatever my illness or treatment might do to me, but living my life.

I guess she was able to help me after all.

Editor’s Note: This article was originally published in the Washington Post.

Category: Experts Speak

Tags: advanced breast cancer, anxiety, Breast Cancer, cancer, Caregivers, chemotherapy, clinical psychologist, depression, mindfulness, Pain, psychiatrist Jimmie Holland, psychotherapy