Balance of control- sculpture in park

The Victim and the Guilty Survivor

One of the greatest challenges in life is understanding what we can control, what we can’t, and taking responsibility accordingly. It’s such a common challenge that many cultures and religions have a saying or prayer to help with understanding which is which—knowing when to take responsibility and when to accept what is beyond our control—and finding the wisdom to thread the needle. 

Understanding this difference is important because if you assume responsibility when you have no control, you are bound to feel anxious, frustrated and inadequate when you fail. Similarly, not taking responsibility for something you should leads to self-recrimination when the worst happens, and a feeling of pulling a fast one on the world when everything goes well. And when bad luck hits and we have no control, we can’t help but feel victimized. Nowhere is this challenge more evident than when we get cancer. 

Guilty Victims

It’s not unusual for a newly diagnosed patient to ask, “Why me?” Whether a silent, self-directed question or actually posed to a doctor, the answer inevitably comes back, “Who knows.” There are so many variables in the cancer equation that even when there is a known genetic mutation or carcinogenic exposure, divining why any one of us develops cancer is impossible. There is an element of bad luck that plays a role. And it is that very unknowable nature of cancer that makes us feel so victimized. If it could happen to anyone, why was I the unlucky one? Of course, neither you nor I were singled out for mistreatment. There are hordes of us—40% of us over the course of a lifetime. But even if you accept the random ubiquity of cancer, it’s still hard to not feel like a victim. 

There are so many variables in the cancer equation that even when there is a known genetic mutation or carcinogenic exposure, divining why any one of us develops cancer is impossible.

On the other end of the experience, if we are lucky and treatment ends and we are declared cancer-free, and months or even years have gone by with no further threat, it’s not unusual to feel guilty about having survived. So many people with cancer recur, progress, even die, why was I the lucky one to survive? Why did I respond well to treatment when others don’t? Why did my friend die of her cancer and I survived mine?

In the United States, upwards of 90% of folks diagnosed with the five most common cancers recover from their disease. So, we aren’t really special as survivors either. But because cancer is so common, we all know someone who didn’t recover, who was diagnosed late, didn’t respond to treatment and died of the disease. Thus, the guilt. 

Luck, Karma, A Grand Design

Contributing to the sense that we have been singled out by cancer or survivorship is the misplaced assumption that there is a fixed amount of luck, good or bad, that is shared among us all—that my bad luck in getting cancer means you won’t, or that my good luck in recovering decreases your likelihood of the same. But it doesn’t work that way. There is no connection between my cancer and yours. Some of us is going to get cancer whether or not you or I are included in that number. Similarly, your survival did not deprive someone else of care that would have allowed them to survive. You are not personally responsible for the failures of global healthcare.

Both of these thought patterns—the sense of being victimized by cancer and the guilt of surviving it—relate to our complex relationship with control. We want to think we are in control of our lives, and the recognition that we aren’t is destabilizing. Some of us dismiss both of these feelings with a shrug, accepting that science hasn’t yet uncovered the mystery, or recognizing the hand of karma, destiny or the power of a high authority with a plan. But even among the most faithful, it is not unusual to question, or even rail against, the injustice and inequity of the diagnosis and treatment response. 

Chaos and Control 

wise philosopher once described a “tricotomy” of control. There are things we can’t control, like the weather, there are things that we fully control, like our values—how we respond to the weather—and there are things we can take responsibility for to better meet the challenges of the next uncontrollable event. There is also a temporal element to control. We have no control over things that happened in the past, have control over how we respond to things in the present, and can plan and train for things that might happen in the future.

Clearly, cancer is a lot worse than a thunderstorm, but like an unexpected storm, once the diagnosis comes, there is nothing to be done but get wet. It happened in the past. Now that we are wet, the only thing we can control is how we respond to being wet. And, we can learn to listen to the forecast and take precautionary steps when appropriate—like carrying an umbrella—when the next downpour is predicted. 

Now that we are wet, the only thing we can control is how we respond to being wet.

Of course, it’s never as easy as we might want it to be to control the emotional response. Anger happens in a flash, joy overcomes us without time to think about why we are grinning, anxiety sneaks up on us or hits us with an instant panic attack. Depression builds over time often going unnoticed. And with cancer, there are some very real changes in brain chemistry as a result of the disease and its treatment that influence our emotions and contribute to the challenge of controlling them. 

Taking Charge

There are some things you can do to help with these feelings of victimization and guilt. The first is to understand that while there is an interplay between the choices we make and the likelihood of getting cancer, there are no guarantees. Stories abound of people who smoke for years and never get cancer while those who live healthfully do. Although there will always be a risk of random mutations, you can minimize your risk of getting cancer and improve your chances of recovering from it by exercising, eating right, minimizing stress and supporting a healthy immune system. But that doesn’t mean you can prevent it from raining. You can take charge, but you can’t take control.

Sometimes, misplaced guilt is really driven by the desire to avoid dealing with loss and grief. Feeling bad about ourselves allows us not to acknowledge and accept the losses we have faced, and cancer is all about loss. Maybe it’s just the loss of innocence that comes from understanding we are not immortal. Or maybe it is the loss of vitality, self-image, a whole body, fertility, a year (or more) of life dealing with treatment. Or maybe the disease deprived you of a job, a relationship you counted on, an imagined future. There is so much to grieve after a cancer diagnosis. And for many, it is easier to feel guilty about surviving, placing the blame on yourself, rather than accepting and coping with all that is lost through the random act of cancer.

Changing Direction

If you are feeling guilty about surviving, remember, there are so many people around you that are glad you are here. Whether it is the partner or child or sibling who can’t imagine life without you, the boss who counts on you to know exactly how to do what you do, the neighbor you wave to every morning or the friend who calls you for advice out of the blue, there are so many people that are glad you made it through cancer treatment and look forward to your continued health. Keeping them in mind can make your survival feel a little less selfish.

Meditation, yoga and other practices that help us separate our physical sensations from how we think and feel about them can be helpful too. Experts think these practices allow us to stop and even reverse the stress reaction and give us a bit more control over the physiological changes that drive emotion.

Cancer is Not a Gift

Cancer itself is like another tool psychologists use to help people in distress—a negative visualization exercise. It forces you to think about your mortality—the possibility that so many things you love will be taken from you—and tends to make you much more appreciative after the fact. Not that cancer is a gift, but the gratitude and sharper focus on priorities that comes from facing mortality and being given another chance can be a welcome legacy.

Many patients find they can take this legacy and pay it forward. While most life lessons need to be learned the hard way, by sharing your experience with newly diagnosed patients, you can help them anticipate and understand what to expect. Offer a consoling word. Be there for those that are just beginning. As the Chinese proverb says, “To know the road ahead, ask someone returning.” We can’t control whether or not we get cancer. But by taking an active role in our physical and emotional recovery, we can help ourselves cope with what truly is a big ordeal.

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