Sunday, September 22, 2019
Emotional Shock: The First Two Days
Perhaps the strangest feature of living as a human being, we basically create a fiction we call “our lives” or “our inner world.”
It seems real to us.
Carl Jung, the Swiss psychoanalyst, called this the dream bubble. He believed that, within the dream bubble, exists a smaller bubble of rationality. We anticipate the future, imagining, say, our life unfolding on a typical weekday. When we hear highly disturbing news, our fiction, our dream bubble, shatters.
I devote this post to describing what you might expect to happen to your own dream bubble when—and it’s definitely a when—something frightening, potentially tragic, happens to you or someone you love.
I focus on the first two days, hoping to educate readers about what feelings to expect and how to best cope.
To protect the privacy of the parties in this case, I fictionalized this example, writing as if it involved a close friend. The friend, who I shall call Jill, experienced occasional dizziness and some numbness in her left leg over the past six weeks. She and her husband consulted their personal physician who, in turn, referred them to a neurologist. Because of my personal closeness with Jill, she and her husband informed me of the situation—even before the neurological consult.
The neurologist ordered a standard MRI of the brain which revealed, completely unexpectedly, a lesion in the right frontal lobe of the brain. Next, the neurologist ordered an MRI with contrast. It revealed five distinct lesions in the brain. She referred the couple to the neurosurgical team at UCLA.
THE FIRST DAY
Because I love and hold Jill dear, the first day’s reaction consisted of shock, terror, and sadness.
How could a perfectly healthy person suddenly present with lesions in the brain?
I imagined the UCLA neurosurgeon would admit her, perform a craniotomy to biopsy one of the lesions, and send the tissue to a pathologist to determine the nature of the lesion—cancer, cystic disease, a benign growth, multiple sclerosis or some other pathology.
The possibilities were many.
My personal fiction all but dissolved. Whatever I looked forward to that day, that week, that month, disappeared from view. My various ways of identifying myself—husband, father, psychoanalyst, friend—dissolved. I became essentially obsessed with thoughts of the medical crisis. The world looked gray, even black. Panic set in when I entertained thoughts like:
What if the neurosurgeon tells Jill and her husband to prepare for her death within six months?
What if the procedure itself is life-threatening, or leaves her with brain damage?
The entire day was filled with terror. I stayed in close touch with the couple, reminding them they were part of a close-knit, loving group. The husband was, in my view, just as ill as Jill. I told them that, in addition to the two of them, they lived embedded in a group of family and friends who held them in their minds and hearts. I reached out to a few of my own family members and friends—only the closest. I sought comfort and, also, wanted to bring them into the loop.
Early the next morning, the neurosurgeon offered, kinda, good news. He thought the lesions were likely cancerous. However, because of their distribution, he anticipated being able to eliminate them through focused radiation therapy of short duration. He referred them to a radiation oncologist for evaluation.
Meanwhile, the neurosurgeon anticipated the lesions could have come from another primary source—a melanoma, for example, or a cancer of the lung or some other organ. He referred Jill for multiple CT and MRI scans. One scan revealed a few suspicious lymph nodes in the abdomen. Fortunately, no large masses were found. Jill and her husband await the results of the other scans.
Balancing the desire for help with their understandable need for privacy (not to mention space for processing this themselves), I reached out to Jill again the second day. I informed her of my personal relationship with two oncologists—intending to provide them with a more personal connection should they have questions or seek a second opinion.
My own panic subsided. The risk of rapid death, or even deterioration, now seemed remote. The UCLA medical team was unusually caring, involved and proactive. The neurosurgeon, for example, got Jill in to see a radiation oncologist that same day.
Quick side point on the awful, Mafia-like nature of the failing American health care system, Jill’s insurance company denied authorization for the same-day scans.
Did they think they should be done three weeks later or something?
Our national health care system is true evil—corrupt, inefficient, begging for reform. Although they are far from wealthy, Jill and her husband proceeded with the scans at their own expense. They’d pay for them on their own or argue with the insurance company later.
Returning to the idea of the personal fiction, the dream bubble, my fiction, has already begun morphing. Perhaps it remains possible the lesions will turn out to be non-cancerous, and the situation will resolve quickly and completely.
Much more likely, and somewhat paralleling my own twice-occurring aortic valve replacement which requires regular monitoring by a cardiologist, Jill and her husband likely face an ongoing program of evaluation and treatment. They will soon learn the exact diagnosis, receive a treatment plan, and get information regarding prognosis.
Meanwhile, and with lingering darkness, I have already begun to see Jill and her husband in a new light. They are fellow travelers on this scary, uncertain road of life. However, now, the normal veil of denial has been abruptly pulled back. They face the uncertainty and pain of an ongoing medical misadventure. I shall stand by their side. I shall offer any way I can help, and, along with their other friends and family, assist in building a strong collection of supporters.
The situation, particularly because of its recency, has already altered my personal fiction. My images of hanging out with them in the future—on hikes, picnics, vacations, dinners-out, and more—are shadowed by this situation. I have had spells of weeping. Feelings of powerlessness, impotence, and humility dominate my consciousness. Although no longer panicked, everything has changed for them, for me, and for our entire social group.
INITIAL ADVICE FOR JILL
Jill’s a grown-up, a mature, consenting adult. I offer these ideas based on my 40 years as a psychoanalyst, my friendship with you, and the knowledge gained from my own not-insignificant medical adventures. Per usual, these recommendations will be necessarily incomplete:
- Bring courage to what should be spun as a fight. Many years ago, I had a pathologist-patient who used to say, “it only takes a second for your life to go to shit.” Big surprise—he struggled with depression. Nonetheless, he was correct. This can happen to any of us—in an hour, a day, a week, or later this year.
- Along these lines, remember we all face the same vulnerability. People die in car accidents daily. You’d be surprised at the number of people who die from falling down in bathtubs. For you, painfully, this normal vulnerability has just smacked you in the face. We’re all sorry about it. But the game is on. Time to face it with proactivity, bravery, and assertion.
- Live by the minute, the hour, and the day. I’ve always hated this advice, perhaps because I personally am so bad at it. But isn’t this an inarguable truth, particularly given the vulnerability facing all of us?
- Cling to those who love you. You will feel terrifically alone at times. You are not. Because we swim around in a small interpersonal pond, your adventure is felt by many others. Millions of others are living a similar, sometimes exact, situation. Please remember your own loved ones. Strive to feel them walking closely by your side.
- Allow the change in your own fiction to unfold. The Buddhists correctly view the self as delusional. They might laugh, with kindness, at the situation, saying something like, “did you really think nothing bad would ever happen to you?” We are like plants: we grow, seek the sun, and eventually wither and die. And, in the meantime, sometimes we get stepped on. We hold onto our delusional fictions for dear life. When they suddenly change, like is occurring in your life, Jill, it takes time for your own narrative to change. Allow the time. Watch it.
- Forget the common knowledge, “expect the worst, hope for the best, and take what you get.” It doesn’t help. You will be having vacillations in mood, attitude, and thoughts. It’s ok. You have to go through your own unique adjustment. Expect it to be wave-like.
- Paradoxically, seek support from others while, at the same time, boldly setting limits when you wish to be alone—by yourself, with your husband, or with immediate family and friends. You call the shots.
- Distract yourself. Some might take a month or more off at this point. Since you were not admitted to the hospital, and so far it looks like the process will go on for a while, don’t be afraid to return to work, socialize, read a good book or see an engaging film.
- In like manner, exercise like crazy. Try Yoga, or pursue other self-soothing activities like meditation. An opportunity exists here for personal expansion. In fact, there is no way you will not grow from this experience.
- Write about what’s occurring to you. Empirical research supports that writing helps people cope with such scary situations. If not in the mood to write, then talk to your husband, or your closest friends or family members. Your narrative will be shaped, in part, by these actions.
I could continue writing myself, page after page, but my own pain, my empathy for you, and adapting to my own narrative alteration, calls me to stop.
Perhaps I’ll update this exploration of coping with an acute emotional shock at a later date.
Meanwhile, Jill, I send you immense love.
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