Sadness, worry, surprise – these are some of the reactions you’d probably expect in the face of a cancer diagnosis. You may be surprised to hear that another very common emotion for people diagnosed with cancer is guilt. Guilt is a complex, negative emotional state that includes feelings of despair, isolation, sadness and worry. People dealing with cancer may experience several specific types of guilt for a variety of reasons. Some of the most common:
Some people undergoing cancer treatment can’t help but think about, even hyper-focus on, their pre-cancer lifestyle or habits (before they got diagnosed). Smokers often have a great deal of guilt about tobacco use that increased their risk, or may have even caused, their cancer. The same is true for people who drink alcohol in excess. Pre-cancer guilt is also experienced by people who believe they caused their cancer by leading “stressed out” lives, either in terms of their relationships or work. “I knew being in this awful marriage was going to kill me one day.” “I was always staying late at work, I never had time to exercise!” “My boss yelled at me daily, and it made me sick!”
The way to manage pre-cancer guilt is to refocus your attention to the present time. We can’t change history, but we can learn from it, and develop habits today that foster healing and well-being. Some patients make major relationship or work changes after cancer; they see cancer as a “wake up call” to live a healthier lifestyle including relationships that are supportive and work environments that are better suited for them.
Burden guilt is experienced by patients who are upset or frustrated that they can’t fully take care of themselves without the help of a friend or family member. During cancer patients need help with transportation to appointments, managing the treatment plan, dealing with medications, and taking care of their homes, pets, or kids. All of this “neediness” makes people with cancer feel guilty that someone they care about has to miss work, lose free time, and do more of chores at home. Patients with burden guilt say things like “I used to be the one taking care of people, now I can’t do anything.” “He works so hard, and seems so tired, I don’t want to burden him with my problems.” “I hate asking for help, I don’t want to be dependent on anyone!”
Burden guilt can be controlled, but it is a challenging emotion to manage, especially for people who, pre-cancer, had prided themselves on being independent. Recognize that other people often feel good when they get a chance to help you. You are actually giving that good feeling by allowing them to help. Remind yourself that no one does cancer all alone, in fact, the medical recommendation is to have someone with you through treatment. When treatment is done, you will have a chance to do for others. Breathe deeply, and let it be.
Some people who respond favorably to cancer treatment actually end up feeling guilty after treatment. This kind of guilt, survivor’s guilt, happens because during the process of being treated for cancer they have met other patients who had complications from treatment, more aggressive and difficult to tolerate treatment or may have died from cancer. There are many factors that determine who is going to live longer with cancer treatment including stage, age, tumor type as well as the body’s response to treatment. Patients with survivor’s guilt may say things like: “Why did it work for me, not her?” “Why do I get more time?” “We went through everything together, and I don’t know how to fight cancer without him.”
For some who have survivor’s guilt, being involved in support groups or activities that raise awareness about cancer may not actually be helpful. What matters most is to think about what works best for you. Some people are so busy with chores and errands and work that they don’t pause, breath, think or journal about what matters most to them in life and what they really want to do with their life. Let the cancer experience, and life you have because treatment worked, motivate you to think about what matters to you and how you may get the most out of your days. Dealing with survivor’s guilt can be tricky, but letting your friend or family member’s voice guide you can be helpful. What would they be saying right now to encourage you? Certainly all those who have come through cancer treatment would not want us to get stuck in the negative emotions of survivor’s guilt, but rather, fondly remember those we have lost and live our best lives while we can.
When people have guilt to the degree that they think all of the world’s problems are their fault, or they caused all the cancer misery on the planet, or every bad outcome is their fault and only their fault, they are likely experiencing pathological guilt. This is a symptom of clinical depression and is typically resolved when treated with medication or talking therapy. Ask your oncology team about an evaluation for depression if you experience this type of guilt.