Healing: Receiving Serious Health Diagnoses, Anger & Bargaining Responses

 Today we are briefly discussing the anger and bargaining phases of the grief model outlined by Elisabeth Kübler-Ross. 

Receiving Serious Health Diagnoses

When a person receives a cancer or aortic dissection or aneurysm diagnosis, after the initial shock and denial phase, they may experience the anger and bargaining phases. These stages are characterized by anger directed at various sources, manifesting in numerous ways and also often an attempt to negotiate, usually with a higher power, in a desperate hope to reverse or lessen the reality of their situation.

During the anger phase, it is crucial for the individual with the diagnoses and their loved ones to understand that this reaction is a normal part of the shock and grieving process. As we mentioned in the previous post, mental health professionals can provide essential support during this time, helping the individual express their anger in healthy ways and explore the feelings underlying their anger.

Some of the ways anger may be expressed by persons diagnosed with aortic dissection and/or cancer can include:

Anger at the Unfairness: After the reality of the diagnosis sets in, it is common for individuals to feel a deep sense of injustice. They may question, "Why me? Why now?" This anger can stem from the perceived randomness and unfairness of their situation, especially if they have been living a healthy lifestyle or are young with many unfulfilled plans. I personally have asked the ‘why me’ question time and time again.  This reaction is normal and I now acknowledge these feelings as valid when I begin to dwell on the ‘why me’ questions.

Anger at Physicians and Health Care Providers: Some people may feel anger towards their physicians or healthcare providers. This can result from frustration with perceived delays in diagnosis, dissatisfaction with the course of treatment, or simply as a transference of their fear and helplessness.  I personally am so over directing anger at my doctors.  After years of dealing with both my diagnoses and my doctors I am frankly just tired of blaming anyone, including my attending health care professionals. However for others, blaming doctors is a recognized emotional response.

Anger at God or a Higher Power: For those with spiritual or religious beliefs, anger may be directed towards God or a higher power. Individuals may feel abandoned or punished and may struggle with their faith during this challenging time.  I've been there done that with this type of anger.  Today my world view has more of a Daoist flavor so there aren’t really any ‘Gods’ or ‘Personal Higher Powers’ that could even hear me.  But for those with beliefs in a higher power, this avenue of blame is normal.

Anger at Oneself: There can be feelings of self-blame, especially if the individual believes their lifestyle choices may have contributed to their illness. They may also feel frustration at their body for "betraying" them.  Today, after many years, I’ve learned to love myself for whom I am, dissection and cancer and all.

Anger at Family and Friends: It's also common for individuals with a terminal illness to experience anger towards their family and friends. This can stem from a perception of being treated differently or from frustration over others' inability to fully understand their experience.  Caregivers, family and friends have it as hard as us, IMHO, in dealing with those of us that were diagnosed with these serious illnesses.

It's important for loved ones and caregivers to practice patience and empathy, avoiding taking any anger personally. Encouraging communication and providing a safe space for the individual to express their feelings can be beneficial. Over time, as individuals processes their anger, they may move towards the other stages of grief, such as the other phase we are going to briefly discuss here, the bargaining phase.

As for the bargaining behavior often experienced, here are some ways bargaining behavior may present:

Negotiations with a Higher Power: A person may seek to make a deal with God or a higher power, promising to live a better life, devote themselves to service, or make other significant changes in exchange for a cure or more time. 

Regret and Remorse: The individual may spend a lot of time thinking about what they could have done differently to prevent their illness. They may regret past lifestyle choices or not taking symptoms seriously earlier. This period is often characterized by guilt and self-blame.

Revisiting Past Choices: The person may start obsessively considering different scenarios in which their illness could have been prevented. They might think about what could have happened if they had made different decisions about their health, diet, or medical treatment.

Seeking Alternative Treatments: In their desperation to find a cure, the person might start exploring alternative treatments and remedies, often in cases where conventional medicine has provided no solution or hope.

It's important to note that, like all the stages of grief, both the anger and bargaining stages are not experienced by everyone, and can occur in any order. Additionally, these stages are not rigid categories, but rather part of a framework to help us understand the typical emotional process involved in dealing with terminal illness.

It's also crucial to approach a person in the anger and bargaining stages with empathy and patience. Many of us are grappling with the harsh reality of our imminent mortality and are seeking to exert some control over our situation. Mental health professionals can provide invaluable support during this stage, helping us process our emotions and gradually move towards acceptance of our diagnoses.  Like my mother used to say, “after ten years its not the first thing we think of when we wake in the morning”.

I’ve found that dealing with these serious medical diagnoses is a journey, one that has many twists and turns.  For me, acceptance of my diagnoses took time.  Today my understanding of the grief processes has led me to appreciate each and every breath and moment.  Next post we will discuss the last two remaining phases of diagnosis grief; depression and finally acceptance.  Many blessings as always, Kevin.

Healing: Receiving Serious Health Diagnoses & Survivorship

 When diagnosed with a life-threatening illness, such as cancer or as in many of our cases an aortic rupture or dissection, we may often experience a range of emotions and psychological responses. 

Me wearing a wound vac and chillin after my second open chest aortic procedure

The response to such life impacting news can be likened to grief, as we grapple with the loss of our former "perceived as OK" health status and we begin to confront own own mortality. The processes we encounter often mirror the five stages of grief and loss initially outlined by psychiatrist Elisabeth Kübler-Ross in her book “On Death and Dying”.  If you've never read this book you should.

Here's a brief look at these stages as applied to any diagnosis of a significant medical condition or illness but especially written here for aortic dissection/aneurysm or and/or cancer survivors as these challenges are two I am personally familiar with:

1. Denial: This is often our first reaction. We may not accept the diagnosis or may think there has been some mistake in the test results. Denial serves as a psychological defense mechanism that helps us cope with the initial shock of diagnosis.
2. Anger: As the reality of the situation sets in, we may feel anger and resentment. This can be directed toward ourselves, our doctors, loved ones, or even a higher power. I kept asking myself, "Why me?"
3. Bargaining: This stage involves negotiating or pleading with a higher power, doctors, or even oneself. We may seek to make lifestyle changes, try alternative treatments, or adopt healthy habits in the hope of reversing the disease.
4. Depression: This stage is characterized by feelings of sadness, hopelessness, and despair. We may become overwhelmed by the potential implications of our disease, including pain, disability, and especially the prospect of our untimely death.
5. Acceptance: Over time, we may reach a stage of acceptance. We acknowledge the reality of our situation and may start to make plans for our future care or end-of-life arrangements. This stage is not about being okay with the cancer or aortic dissection but rather about acknowledging our physical and mental challenges and working with our diseases rather than fighting against them.

These above stages are not linear and we may cycle through them multiple times, even experiencing more than one stage simultaneously. Importantly, not everyone will experience all stages, or in this order.

Receiving support from mental health professionals, such as psychologists or counselors, can be vital during this time. Health care professionals can provide strategies to cope with our trauma and emotions associated with our diagnoses. Additionally, joining support groups, either in-person or online, can also be beneficial, providing a platform to share experiences and feelings with those who are going through a similar situation.  Facebook support groups have been a tremendous help for me and I know for many others.  I've also met some awesome people in these support groups who inspire me and give me hope.

It's also important to note that our journey with our challenging illnesses is unique, and there's no 'right' way to react or cope. The primary goal is to find ways of managing the illness and maintaining quality of life that work best for us.

As discussed above, one of the initial stages we may encounter is denial.  Denial serves as a psychological defense mechanism that buffers the immediate shock of our diagnoses. It is a normal and in some ways, a healthy initial response, as it allows us some time to adjust emotionally to the diagnoses and to gather strength for our journey ahead.

I've personally found that denial can manifest in various ways and progress through several stages, including:

1. Shock and Disbelief: This is the immediate reaction to our diagnoses. We may feel numb, and there's often a sense of disbelief, as if what we've just heard can't be possible. We might think, "This can't be happening to me."
2. Dismissal of Diagnosis or Prognosis: We may question the competence of the medical professionals involved or insist on multiple retests, seeking a different opinion in the hope that the initial diagnosis was mistaken. We may also downplay the seriousness of the disease or believe that we will be the exception to the prognosis. This was especially true for me.  I spent so many hours on the internet researching how I would be spontaneously healed of my extensive aortic dissection.
3. Avoidance: In this stage, we might avoid medical appointments, refuse treatments, or avoid talking about the disease with friends and family. We might keep ourselves extremely busy so as to not have the time to confront the reality of our condition.  Again, I see a period of time where I did everything possible to try and get my doctors to allow me to stop taking the meds I was prescribed, including anticoagulants, beta blockers, statins, aspirin and others.  I was convinced that if I was not taking these prescriptions then I’d wouldn’t necessarily be sick.
4. Rationalization: We may also try to find explanations that could discredit our dissection or cancer diagnosis. For instance, we might attribute our symptoms to less serious conditions or to factors like stress or fatigue. We may also overemphasize stories of misdiagnosis we’ve heard or read about.  I too, to an extent was guilty of thinking my doctors may not have really known what they were seeing on the CT scans.  Ditto me on that.

While denial can serve us as a protective function initially, prolonged denial can be harmful.  Unreasonably prolonged denial can delay necessary treatment and prevent us from taking steps to manage our condition effectively.  For a caregiver, friend or medical professional it’s important to approach those of us in denial with frankness and truth but also with empathy and understanding, providing us with emotional support while also encouraging us to face the reality of our dissection or cancer.

Professional help from a psychologist, counselor, or a psychiatrist can be very helpful during our denial phase. Mental health professionals can use various therapeutic techniques to guide us gently towards acceptance of our conditions, providing us with the psychological tools needed to handle our diagnosis and the implications. As we mentioned above support groups can also be beneficial, as they allow us to interact with others who are facing similar challenges.

Both cancer and aortic dissection have been a challenge for me.  Its been well over a decade since my ascending aortic repair and I’m still living with a  complex descending dissection. It’s been seven years since my melanoma surgery, fifteen years since most of my large colon was removed and three years since half of my kidney was ablated for renal cell carcinoma. During these times I’ve experienced denial on a regular basis. Today, with the help of family and health care professionals I find myself able to recognize the stages Mrs. Ross describes in her book On Death and Dying.  Living with serious health challenges is just that, a huge challenge.  Kudos to us survivors.  Next blog post I’ll be discussing the second dimension of dealing with this type of trauma, the Anger phase.

Many blessings, Kevin