"I have cancer and I don't feel like a warrior"

Receiving a cancer diagnosis is never part of anyone's life plans. Unlike certain transitional phases and the changes they bring, which we usually want for ourselves (a pregnancy, say, or children leaving for university), the changes caused by cancer are neither anticipated nor desired, nor are they easy to understand. Some may be relatively small, but others can be profound, producing an internal transformation — a shift in values, in aspirations and even in spirituality — or an external one, with changes in behaviour.

A cancer diagnosis is, in fact, often described as an emotional rollercoaster. The analogy serves to explain that, just as on a rollercoaster, cancer takes us along a path of highs and lows where we need to hold on tight, scream, laugh, cry, breathe in and breathe out in order to get through the ride.

At any stage of the diagnosis, then, the patient may feel a range of powerful emotions: anguish, disbelief, fear, sadness, anxiety and anger. Yet there is often an attempt to suppress these emotions which, although regarded as negative, are in truth natural reactions: suffering is to loss what laughter is to joy! In other words, there are moments when deep sadness can be considered "the right response", and having cancer is one of them.

The impact of self-compassion and the weight of loss

Feeling sorry for ourselves is a natural reaction when something terrible happens to us. Feeling sadness and pain in fact demands strength and courage, both of which are central to human dignity. Unfortunately, self-compassion is not an acceptable emotion in most social settings. How simple it would be if we could just say "I feel sorry for myself that this happened to me"!

If we are sensitive, if we care, we will be able to extend that compassion to others. It may sound like a basic idea, but in reality we cannot give others what we do not have; compassion and respect must therefore begin with ourselves. This is different from self-pity becoming a habit, because the problem arises when we let ourselves become mired in that pity and fail to properly grieve our losses (temporary or permanent changes in appearance; chronic illness; being unable to work or carry out routine activities; disrupted financial plans, with a loss of independence; changes in relationships; and so on). Someone who has suffered many losses naturally needs time to adjust, since their capacities — physical and mental — have often been pushed to the limit.

Sadness vs. depression during the cancer process

When someone feels "low", "without strength" or sad, it does not mean they are mentally ill, nor that they are ungrateful or weak. It simply means they are feeling very sad — which is different from being depressed, even though both are very common reactions to cancer.

Sadness commonly appears as one of the emotions involved in adapting to cancer. It is in fact a basic emotion — by definition universal, innate and automatic, and one that triggers behaviours necessary to our survival. Its function is to aid recovery, in that expressing the emotion helps us process difficult events and signals to others that we need support or comfort.

Depression, on the other hand, is characterised by a set of symptoms — some in the body, some in behaviour and some in thinking — which together make us feel different, unhappy and unable to move forward. Current theory around the illness indicates that it results from a combination of life events, biology and genes. In general, one in every four or five people, regardless of sex or age, will experience at least one episode of depression in their lifetime. And when a cancer diagnosis is received (which extends even to the post-treatment period), the figures for depression worsen. Although an exact number cannot be estimated, it is thought that 25 to 40% of people diagnosed with cancer suffer from depression.

Depression is not a sign of weakness or self-indulgence, it is not the person's fault, and it is not something we can simply free ourselves from. It is considered a clinical condition, defined by a set of symptoms, and differs from negative emotions and feelings on their own.

The danger of "toxic positivity"

As already noted, it is natural for negative feelings to arise during the cancer process, and they in fact play a beneficial role. In a study carried out by researchers at Concordia University and the University of Toronto, in Canada, with breast cancer survivors, guilt and anxiety were found to motivate the women to set new goals and commit to them, notably regular physical exercise. Adopting a new and healthier lifestyle allowed them to counterbalance the less beneficial side of those emotions.

Where cancer is concerned, there seems to be a certain "toxic positivity" that frequently leads patients to believe they cannot openly express what they feel if it does not match the social script around the illness. In other words, the people around them tend to tell them how they should think, feel and act, and within that triad there is no room for sadness or hopelessness. What prevails instead is the image of an unshakeable patient, sure of their choices and in full emotional control, for whom "being positive" is a precondition for treatment to succeed.

In a survey by Macmillan Cancer Support, in which around two thousand people diagnosed with cancer took part, divergent views were found even about the words commonly used to talk about a cancer diagnosis or to refer to cancer patients. Those words were considered inappropriate rather than empowering. Specifically, for some patients the words "hero" and "warrior" are labels as unwelcome as "cancer victim", leaving them feeling pressured to be positive and, often, emotionally weakened or isolated. The study also highlighted that even for patients themselves it is frequently difficult to make sense of their own whirlwind of emotions.

Respecting your own pace and seeking support

There are different ways of coping with this; as the saying goes, one size does not fit all. It matters that the person with cancer cries and talks with the people who love and understand them; it matters that they share their feelings with those who can tolerate pain and will not judge them as "weak". Those people should not try to talk them out of their real feelings, nor impose how they ought to feel or behave.

During treatment and in the period after cancer, it is important that the person focuses not only on physical recovery but also on emotional well-being, so they can grieve their losses and heal their psychological wounds. Seeking a mental health professional to help manage those emotions, or to work through other difficulties, can make all the difference to a better and faster adjustment.