Fighting cancer with mental solace By Marisa de Silva
Sahanaya selected this topic in accordance with this year's World Federation for Mental Health's theme, "The Relationship between Physical and Mental Health - Co-occurring Disorders" to mark World Mental Health Day on October 10.
“There is a very close link between physical and mental health, as the manner in which one psychologically deals with one's illness can even affect one's physical state as well,” said Dr. Sunera Fernando, Registrar, Kalubowila Teaching Hospital.
Creating awareness on mental illness/health among the public and relevant government bodies is vital to the advancement of mental health issues in the country, added Prof. Mendis. "There wouldn't be a Sahanaya here today, if not for the immense assistance received by volunteers, caregivers (families of clients) and recovered clients," he said. Therefore, it's very important to realise the crucial role the lay society plays, he said, adding, that medical professionals cannot do it alone.
Government should make it a priority to invest in mental health, as the more mentally ill citizens there are, the more the burden on the economy, says Prof. Mendis. It also results in immense lack of productivity at the workplace, he added. Twenty-five percent of absenteeism at workplaces is caused by mental illness, resulting in a 25% loss of productivity, he says.
Mental health can be brought on by simple factors such as biological (hereditary), psychological experiences in one's lifetime or various social circumstances, he said.
A patient diagnosed with cancer five years ago stressed the importance of early detection and urged women in particular, not to feel embarrassed about their illness. Once diagnosed, one needs to have faith in God and their doctors and take their medication, she said.
Dr. Damayanthi Pieris, Consultant Oncologist, Cancer Institute, Maharagama, said that more than 10,000 patients were treated for cancer last year, and that most paediatric and some adult cancers were in fact curable, if detected in time. The most susceptible age for cancer seems to be between 45-65.
Dr. Pieris also spoke of the average cancer patient’s initial personal fears (referred to by her as the Six Ds): Death/suffering, Dependence on spouse, family and doctors etc, Disfigurement of their bodies or appearance, Disability, Disruption of their day to day lives and Discomfort/pain they may have to endure.
This is when one's psychological state influences one's physical state, she says. Due to often unnecessary anxiety and stress caused by the diagnosis alone, the patient could tend to wear him/herself out. This could very likely result in a speedier decline of the patient's health, than in the case of one who completely understands the cancer, how it works and what steps, medical or therapeutic should be taken.
The ability to deal with the illness also depends on aspects like the nature and extent of the cancer, the age and education level of the patient, the character (optimistic/ pessimistic), amount of change in one's lifestyle etc, she added.
Dr. Nishanthi Dolage, Consultant Psychiatrist, Teaching Hospital, Kalubowila spoke of the causes of psychological stress when diagnosed with cancer. She explained how apart from the actual diagnosis, even waiting for the initial test results, the learning of failed treatment, the re-occurrence of the cancer, reluctance to try out new medicine and the pain and fatigue could result in much psychological stress.
A survey conducted by Dr. Dolage on 800 patients (400 inpatients and 400 out-patients) at the Maharagama Hospital revealed how 92% of in-patients were depressed, 97.5% wanted more information about their illness, 92% asked for counselling and 60% asked for religious help.
She also showed the ideal and 'not so ideal' ways in which doctors break the news to their patients, through two role-plays. The humorous yet, very real situations made people see the importance of the initial delivery of bad news to a patient. A matter-of-fact approach could leave the patient distraught, confused and completely in shock as opposed to a more delicate, humane approach.
She also spoke of the non-disclosure approach practised by doctors in the past, where doctors would only disclose the bare essentials. Deemed ineffective this method was dropped for the full-disclosure approach, which adhered to the thinking that patients deserved to know everything about their illness and therefore, must be made completely aware.
As this too was too much of an extreme, the individual disclosure approach has now been adopted where, depending on the awareness/education levels and wanting to know more basis of each patient, the doctor would use his/her discretion to disclose information accordingly.
(http://www.sundaytimes.lk/041024/plus/8.html)
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