Cecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for us in many articles over the years. This week she counsels a woman who endured both treatment for breast cancer and the loss of a job this past year, and whose post-crisis anxiety robs her of sleep at night.

 

woman sleepingPhoto by drocpsu via Flickr

Dear Dr. Ford:

I am ready to begin the new year with some hope and purpose.

In 2013 I had breast cancer and am fully recovered. I lost my job but found another after my health crisis was over. My husband and children were great throughout this last year, with its ups and downs. The only issue that I am dealing with at 50 is this nagging feeling that something else is going to happen. I have been unable to sleep soundly since I lost my job, even though I now have another with similar pay and responsibility. My husband has a decent job but we both have to work to finish the payments for the three children’s college and our mortgage. I slept so well before this last year, but now I don’t seem to know how to turn off my brain at night. I fall asleep but wake up several times, and often have trouble getting back to sleep. Is this a normal reaction to the stress I had last year?  Is there something that I can do to lower the noise in my head?

RoseMarie

 

Dr. Ford Responds:

Dear RoseMarie:

I’m glad to hear that your health-care crisis has ended and you have recovered physically. Often, however, the psychological pain of an illness can take much longer to heal. Your description of “the noise in your head” and the feeling that something else is going to happen makes me think that you are indeed reacting to the stress you had last year. Very often we put off feeling the full impact of a distressing experience until we are past it. It is almost as if we “hold off” in order to reserve our strength for the crisis itself, and it is not until it’s over that we feel its full impact.

In fact, you may be suffering from a form of post-traumatic stress syndrome (PTSD). This condition, frequently associated with soldiers who have been through stressful combat experiences, can develop in anyone who has been through a shocking or emotionally difficult experience. You have had two in one year—breast cancer and a job loss. Feelings of being “on guard” are particularly common in someone who has had a traumatic experience. Your inability to relax and sleep restfully is also indicative of PTSD. It is neither unusual nor abnormal, but it does need to be attended to.

The first step is for you to recognize just how much you have been through and give yourself time to work it through. A cancer diagnosis is always devastating, and inevitably causes us to confront mortality. Even when in remission or recovered, cancer patients have a much higher awareness than those who have not been through it of how everything can “change overnight.” At 50, women are already facing multiple issues; aging and health concerns are usually right at the top of the list. But most of us fight having to imagine our own death as long as we can. Unfortunately, you have lost that “fight” and have had to face it head-on. It can take years for former cancer patients to stop reacting to every minor symptom as if it might be a harbinger of death—much the way combat veterans have been known to dive for cover when they hear a car backfire.

Another thing that keeps us secure in the world—employment—was also lost this year, so your sense of fragility can only have intensified. Few of us have enough of a nest egg not to feel threatened when unemployed, and you report that you and you husband are saddled with a mortgage and outstanding college loans for your three children. Recent research into the psychology of well-being indicates that beyond providing financial security, our work provides most of us with a primary sense of identity and self-worth, and it is a key element in personal satisfaction. As Harvard psychologist Daniel Gilbert showed in his work Stumbling on Happiness, people are often mistaken about what will make them happy. It’s not a better vacation but a better job that increases our sense of well-being, and losing a job can quickly lead to despair.

Ideally, your new job, as well as your clean bill of health, has put you out of “danger,” but you still haven’t escaped a feeling of being “at risk.”  If your symptoms persist it might be worthwhile finding a cancer survivor’s support group. No one but a fellow patient can understand the experience of cancer and the feelings it unleashes.  (A 1991 movie with William Hurt, The Doctor,  portrays this beautifully through the story of an arrogant physician who does not empathize with his patients until he himself gets cancer ). If a group is not available, you should consider short-term counseling or therapy. Many medical centers offer this kind of treatment for cancer survivors. They recognize that survivors often feel they have already burdened their families so much during the “physical” part of the illness that they are reluctant to ask for the appropriate emotional support—or even, like you, fail to realize how much they need it.

Dr. Ford