Elephants and Tea - December 2021 - 22

Survivor's Guilt
like fighting because they fought so hard.
If they did not survive, is it only a matter
of time until I too get unlucky? When will
my luck run out? The sheer injustice of it
all is suffocating.
Survivor guilt isn't just tough emotionally;
it can also lead to suboptimal medical care
and reduced quality of life. For example,
if you are experiencing survivor guilt, you
may not ask your doctor about topics like
mild aches and pains, decreased libido,
depression or anxiety, or other seemingly
" minor " concerns compared to, say, dying.
Even the most brilliant of doctors cannot
read minds; they have no way of knowing
what physical and emotional barriers are
keeping you below the quality of life you're
capable of, and cannot intervene or offer
solutions. Survivor guilt can make you feel
unjustified to ask questions about what you
may come to think of as the " first world
problems " of cancer survivorship.
So what the heck do you do about survivor
guilt, because after all, as with any other
emotion, it typically doesn't do much good
to try to just NOT feel it, even if intellectually
you understand that it isn't a very
productive emotion. Here are a few ideas to
consider, all of which are skills developed
over time, sometimes with the help of a
professional:
1. Shift your goal from getting rid of distress
(including survivor guilt) to tolerating
distress. You can learn to coexist
with survivor guilt, and, by creating space
for it as one of a range of natural survivor
emotions, reduce its weight and its day-today
impact. A motto I often encourage my
patients to adopt is " do it anyways. " Think
that talking about sexual functioning
or intimacy issues feels silly
or embarrassing when
you should just be
DEAR JACK FOUNDATION
grateful to be alive? Fine - feel silly or
embarrassed - but ask your doctor anyway.
Do you feel that you're not justified
in asking for help for depression or anxiety
after all you've already put your loved
ones through with your cancer, and that
feeling anything other than grateful and
happy is shameful? Fine - feel unjustified
and ashamed (I wish you wouldn't) - but
ask for help anyways.
2. Externalize the voice. It is helpful to differentiate
between thoughts and reality.
Our brains, even when not exhausted
from surviving cancer, come up with all
sorts of unhealthy and unhelpful inner
narratives. Learn to " externalize " or even
personify thoughts driven by survivor
guilt, and to recognize those thoughts
as the voice of Survivor Gui lt versus
a reflection of reality. This empowers
you to listen for other voices, such as
the voices of Reason, Self-Respect, and
Self-Compassion. When you recognize
thoughts as simply thoughts, you then
have a choice about which thoughts and
voice you attend to at any given time (and
I recommend picking the most helpful
voice!). You might then even learn to " talk
back " to unhelpful thoughts and learn to
reframe or change them into more helpful
ones.
3. Accept that conflicting emotions can
and do co-occur, and that this is okay.
It is perfectly acceptable and appropriate
to be scared out of your mind, relieved
that you're still here, incredibly sad that
others are not, angry beyond belief, and
grateful all at once. Survivor guilt is one
of a plethora of emotions you'll continue
to feel throughout survivorship. Don't
give any single emotion too much of a
platform, and above all, give yourself perUltimately
I do not
know the answer
to why some people
survive cancer and
others do not. I DO
believe that as human
beings we crave a
story that makes
sense, because the
world is less scary if it
makes sense.
mission to experience all these emotions
and move through them at your own pace.
Ultimately I do not know the answer to
why some people survive cancer and others
do not. I DO believe that as human beings
we crave a story that makes sense, because
the world is less scary if it makes sense. I
also very much believe that we are authors
of our own story, at least in the sense that we
decide what we do with the great plot twists
that happen to us along the way. If you're
reading this, your story is not over. I don't
think the question of why that's the case is as
helpful as the question of what comes next.
How will you live your life since you are in
fact still alive? How will you integrate into
your own life the attributes and strengths
of those who no longer are, and by doing so
carry their spirits forward? What values will
you align your life around as you move forward?
And will you give yourself permission
to continue to hope and love and be grateful,
even amidst the sadness and fear? l
ANDREA MAIKOVICH-FONG, PHD, ABPP IS A BOARD-CERTIFIED CLINICAL HEALTH
PSYCHOLOGIST WHO HAS WORKED EXTENSIVELY WITH CANCER PATIENTS AND SURVIVORS.
SHE IS CURRENTLY WORKING FOR KAISER PERMANENTE IN DENVER, COLORADO.
22
ELEPHANTSANDTEA.COM
DECEMBER 2021
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Elephants and Tea - December 2021

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