fordCecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for Women’s Voices in many articles over the years. This week she counsels a daughter whose mother’s usual coping mechanisms—busyness and exerting control over others—have frayed after a colon cancer diagnosis.

 

Dear Dr. Ford:

My mother is a certifiable drama queen—even if she may not have some real psychological disorder. She controls the family schedule (even though her three daughters are married and have their own in-law schedules to manage). She works more than full time in her 60s but still has time to manage all of our lives . . . even though we don’t need it. She has recently been diagnosed with colon cancer and must have a big surgery. And, since she had to have surgery, she actually saw a doctor who did a thorough evaluation and found a small melanoma, an overactive thyroid, and osteoporosis. So not only has she had some bad news but she has to have lots of tests and treatment just to get her ready for the colon cancer surgery. She has gone into a real depression.

She is divorced and really not equipped emotionally for this constant stream of bad news. She refuses to see a psychiatrist for an evaluation. She keeps on working and working and takes no time for herself. My sisters and I are terrified that she won’t have any resilience for dealing with the upcoming colon cancer surgery and its aftermath.  What can we do to manage this?

Sarah

 

Dr. Ford Responds:

Dear Sarah:

You are right to be concerned about your mother at this time. The person you are describing is someone who is likely to have a very difficult time coping with the challenges of being ill. In fact, your mother is probably unable to handle any situation well that she does not personally direct.

You refer to her as a “drama queen”; your portrait makes her sound, above all, like someone who is extremely controlling—I assume the “drama” comes when she is not in charge or able to have things her way. People like this usually rely on a psychological structure of defense that allows them to feel “safe” as long as everything is under their control. By expending the effort to keep everything just so, as well as being busy all the time, the drama queen assumes, frightening feelings are less likely to cloud the horizon. The problem with defenses like these is they are very “brittle”—an individual like this cannot “roll with the punches.” Instead, when her defenses are threatened she is not able be resilient, but instead is fragile and “breakable.”

This is precisely what you and your sisters are worried about, with good reason. Nothing challenges our sense of control as keenly as illness. In addition, problems like cancer, whose etiology can be difficult to understand and whose treatment must be handled by professionals, can be particularly difficult for someone who has the characteristic response to try to “fix” everything herself. And, adding another stressor to the mix, she will not be able to pursue proper treatment and keep up her pursuit of constant busyness—the busyness itself, a way to dull her emotions, will be particularly missed now that she will be, understandably, more fearful than ever.

You have already tried recommending that she see a psychiatrist, but I believe it is vital. Antidepression treatment might help lessen your mother’s “situational” malaise (see our June 23 article, by Dr. Marianne Gillow, which describes the use of antidepressants in cases or depression caused by some painful life event.)

You will need “outside” help in your mother’s case to persuade her to get psychiatric help. Enlisting your mother’s oncologist would be helpful: if he (or she) recommends this, it may be persuasive. At the very least, he might know of support groups or services for cancer patients.

I think, however, that you and your sisters are going to have to organize an “intervention” along the lines of the process that is sometimes used with alcoholics and other substance abusers. This involves having everyone who cares about your mother get together at once and confront her with the fact that she needs treatment. The “intervention” technique was developed because alcoholics are often in denial about the extent of their problem and are afraid they won’t be able to cope without drinking. Your mother’s situation is very similar: she needs her “defenses”: being in control and busy all the time are coping mechanisms for her.

Unfortunately, her health situation means that her coping mechanisms are being compromised, whether she likes it or not. You have noted that she is already depressed, and this is not likely to improve without treatment. You are wise to anticipate this problem and try to intervene right away. And if she can get the support she needs to make it through this crisis, it can be an opportunity for her to reevaluate her whole approach. While serious illness makes people vulnerable, it can also open them up and allow them to see life in a new way. Perhaps this can even be the beginning of a new chapter for you and your mother.

 

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