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Psychiatric Times. Vol. 25 No. 13
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COMMENTARY 

Two Stories We Tell Ourselves About Cancer

By Paul Genova, MD
| November 1, 2008
Dr Genova contributed extensively to Psychiatric Times from 1993 to 2005, most often as a columnist whose byline was “No Shows.” Some of his work from here and elsewhere is collected in The Thaw: Reclaiming the Person for Psychiatry (Analytic Press, 2002). He was diagnosed with multiple myeloma in 2003 and retired from practice in 2005. Dr Genova would like to thank both Dr Ron Pies, current editor-in-chief of the Times (who invited this piece), and Dr John Schwartz, its founding editor, for their ongoing support through the ensuing years.

The need to know “why”

So, our 2 stories differ more in style than substance. There is a standard of judgment, there are the people who have supposedly aced one or the other narratives, and we read or hear and compare ourselves unfavorably to their stories. Who really knows the inner lives of these “heroes”? My years of sitting next to some of them in chemotherapy chairs from Birmingham, England, to Little Rock, Ark, as well as my own struggles with myself and with people’s “hero” projections onto me, tell of more complicated and individual inner situations. But one thing we all share. This is the dread of flunking out. It’s the same sort of reaction most of us have already had to the simple-minded “single solution” tales we heard at the time of first cancer diagnosis: so-and-so did a macrobiotic diet. So-and-so did watercolors every day, etc. I’m flunking, I’m flunking. . . . But somehow, either early in the course or later, it’s much harder to accept that “the race is not to the swift [my emphasis] . . . time and chance happeneth to them all,” as the author of Ecclesiastes wrote in the third century B.C.

Creating some quasi-parental judge in one’s mind or in Heaven, even if we ourselves don’t make the grade, is apparently easier to take than unpredictable, random loss. Martin Seligman’s famous monkeys needed a reliable warning, a knowledge of “when” to survive repeated electric shocks without developing posttraumatic stress disorder–like symptoms. I have often written that we humans, in comparable life situations, will do almost anything with our superior cognitive powers to invent a reliable “why.” One must assume that nature knows best and that these explanatory “why stories” have survival value, even healing potential. But this is only true up to a point for some of us who are blessed or cursed with insight into the process (and living long enough with cancer does tend to confer this dubious blessing). Sooner or later the stories let us down.

Telling myself a story—for example, a dramatic story No. 2 of a hero trying to stay exquisitely aware and honest, writing feverishly through long winter nights in England as I faced my own possible death—got to be a trap. What if I woke up and wanted to be unaware one day, or wanted to lie to myself, or do nothing but play guitar for the duration? Or, most important, what if I didn’t die, but just dragged along in some boring long-term illness. Or even: what if mundane, linear Western medical science progressed and I got totally better? But such was not the stuff of myth, I realized. One had to admit that either tragic-but-enlightened death or retreat to a Himalayan monastery made by far the better story! In the mythic story I would have to become fully, gloriously alive in some idealized way that does not correspond to the textures of real human liv-ing, manifesting through my written words, perhaps, a Bodhisattva! Some of my well-meaning correspondents seemed unconsciously to encourage my inspiring literary performance. I switched to guitar in the nick of time.

This personal example applies only to me, but I submit that all such stories, whether they fall into my rough No. 1 and No. 2 categories, can wield incredible yet subtle power over those of us who live and die with cancer. They create inward attitudes that become self-fulfilling prophecies. They foreclose possibilities for new endeavors, new relationships, and unexpected sources of healing or of solace. They may also lead us to ignore or minimize promising options for further medical treatment.

Returning to my own example, I also need, at the present moment, to be able to look at the reality of my quite possible early death without a myth in the way. If I die it will be a mess, not a heart-warming movie scene. There will be a lot of loose ends, hurts-never-apologized-for, poems half-written, songs never learned, events in my children’s lives not participated in, lovely years with my wife never lived, friends never seen again, great meals not eaten, etc. And getting there will be no fun either. I am a person of flickering but persistent faith, a faith based not on the promise of happy endings but instead on recurrent perceptions of an underlying connectedness in things. I have no particular belief in an individual afterlife in which I remain recognizably me. Something of me may go on but perhaps only the deepest part, of which I have been only occasionally, indirectly aware. The fact is that I love this ego-based life of being me as I know me, doing what I like to do. I do not want to leave it.

To conclude. Among my best allies against the tyranny of collective stories have been the kinds of simple solace that are unique for each of us: in my case, reading, traditional prayer, walking the dog, playing my instruments. Beyond those, I have found that starting new things is the best defense against the suffocating demons of “closure” and “tying up loose ends.” Make more loose ends! As long as you are really living, there will be loose ends! And the best allies of all remain the friends, family, and colleagues who have been able, through it all, to finally hear what I am really saying about my experience. I thank God for them. I also hope that these words may help some who find themselves telling a cancer story, or trapped in one, that does not fit and that saps the unpredictable force of even a seriously threatened life.

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