Monday 22 February, 2021

Stages of Grief: Denial and Anger during Cancer

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In 1969, Elizabeth Kübler-Ross, a psychiatrist, came up with what is commonly known today as “the five stages of grief.” This model was derived from her observations from working with over 200 terminally ill individuals, and outlined in her book “On Death and Dying.” In the coming few weeks, we’ll be talking more about the process of grief during cancer by using this framework. Though the 5 stages of grief are originally intended for people with a diagnosis, many have found it helpful as a loved one as well. 

What we’ll cover in this article:
What are the 5 stages of grief?
Denial during cancer
Coping with denial
Anger – why are we angry?
Coping with anger

The 5 stages of grief and cancer

This framework breaks down grief into five stages: Denial, Anger, Bargaining, Depression, Acceptance. The model is widely spread, perhaps because so many can relate to it, but it’s important not to take the model out of context. A common misconception is that the five stages of grief pertains to everyone, when in reality Kübler-Ross’ 5 stages of grief was originally intended to break down the process of grief for those who experience life-threatening illnesses. However, since its origin, the understanding of these stages and the explanation of them have been broadened by Kübler-Ross herself, and other psychologists. This makes it a framework that loved ones can identify with, and even those who go through cancer but aren’t terminal. 

As Kübler-Ross says herself, the stages are not a linear and predictable progression. Instead, professor Kenneth Doka explains them as a reflection of “how people cope with illness and dying,” rather than “reflections of how people grieve.” Human beings are not one-dimensional beings built to fit frameworks. See these five stages as a means in better understanding what it is we may be going through, not something you’re expected to adhere to. Maybe you’ll never feel some of these emotions at all. But, it can help us put words to feelings so that we’re better equipped to discover and process where we’re at in our experience with cancer. 

In this article, we’re breaking down the first two stages of grief, denial and anger, how they can come about as a result of cancer, and what we can do to cope. Over the course of the next few weeks, we’ll be diving into each stage, so stay tuned on Mondays to journey through these stages together. 


What is denial? 

In psychology, denial is defined as “a defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality”, and was postulated by Sigmund Freud. It’s usually temporary and acts as a response to overwhelming information or fears about loss of control, uncertainty, or suffering. In addition to avoidance, other emotions that are tied to denial include shock, confusion, and fear.

In and of itself, denial is no bad thing. It’s a way to help pace the process of loss, and nature’s way of letting us know how much we can manage. It’s part of the process of accepting a new reality, before the emotions hit. Kind of like holding your breath before knowing what’s coming. 

Denial during cancer

Some research has broken down denial in different stages of cancer. According to this study, the prevalence of denial upon diagnosis ranges from anywhere between 4-47%. However, when looking at the impact the cancer has on your life, denial ranges from 8-70%. Both ranges are large, but the latter points to the fact that the majority of people experience denial when thinking about the effect cancer has on their lives. 

The effect that denial has on our psychological well-being depends on the way in which we cope with denial. This study showed that distractive strategies (i.e. coping by focusing our attention on other things besides the stressor), were found to reduce distress. On the other hand, whereas “passive escape mechanisms” (aka avoidance coping such as procrastination, passive-aggression, and rumination) decreased mental wellbeing.  

Coping with denial

Distraction isn’t all too bad for us, after all. It’s a way for us to step away from something that causes stress, which is different than avoiding the stressor at all costs. According to research done on people who are treated for advanced cancer, distancing ourselves from the situation is also a popular coping mechanism that helps us decrease psychological distress because it helps reduce the significance of the situation in our lives, and perhaps gain a different perspective.

Remember, denial is a completely natural reaction and it’s totally fine to distract yourself from the news or effect of cancer by doing something you enjoy and can set your mind on, or ask the people around you to take a break from talking about cancer during this phase. 


Why are we angry?

Anger is an emotional response to perceived threats. It’s not exactly seen as positive, but when it comes to grief, can be an essential part of the process. It can help signal your conscience to whether something is unjust, what your concerns are, or other threats. Oftentimes, people can be afraid to express their anger because it’s simply not a nice emotion to feel and takes a lot of energy emotionally and physically, they don’t want to hurt others, or are afraid of its effects. 

The official site for the Five Stages of Grief explains the context of anger in grief well: “Underneath anger is pain, your pain. It is natural to feel deserted and abandoned, but we live in a society that fears anger. Anger is strength and it can be an anchor, giving temporary structure to the nothingness of loss.”

But keeping anger inside negatively impacts your mental health and ends up expressing itself in a different format instead: through criticism, cynicism, depression, or victimization. Instead, see anger as a natural emotion and allow yourself to feel angry about or with cancer if that’s where you’re at. The trick is finding a way to release the emotion without causing yourself or others harm. 

Coping with anger healthily

Recognize when you’re feeling angry and try to dig into the cause. Express your anger when you feel it coming on, rather than bottling it up, where you allow it to fester and build. Letting yourself feel angry will also help in ridding yourself of the emotion itself, the anger will dissipate. So let yourself feel angry, but try to direct anger at the root cause, not the people around you. You are angry at the cancer or the loss of your freedom or identity or health, not your friends or family or colleagues or strangers on the street.

Instead, exercise is a great physical release for angry emotions, as it also releases endorphins, a feel-good hormone. For some, exercise during or after cancer treatment might not be possible and that is okay. If that’s the case, simply trying to move your body in a way that’s comfortable for you throughout the day will help in not letting angry thoughts fester.

Creative expression, such as creating or listening to music, writing something, drawing, dancing can all help release the emotion in a way that’s beneficial for you. Let it all out.

A place that can help you cope with grief and share your thoughts about where you’re at is the War On Cancer app. Connect with others who get it and learn from people who’ve been there before. 

The information shared does not constitute a medical consultation and is not intended to replace professional medical advice, diagnosis, or treatment. Consult with your doctor or other qualified health providers for questions regarding a medical condition, especially during the active period of Corona / Covid19. Please do not disregard professional health provider advice or delay in seeking it because of something you have read here.  In the event of a medical emergency, call a doctor, 112 or 911 immediately.

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