Prostate Cancer

The Journey Begins

Life-threatening illness takes us rapidly, and without warning, to a place of profound fear and deep soul searching.  And when illness is further complicated by a rapid series of disappointments, soul searching defers to the fear and fundamental struggle to survive.  Such a chain of events propelled me into my “dark night of the soul,” and was perhaps the bleakest period of my life,  Dark night of the soul, refers to an archetypal journey involving a psycho spiritual death and rebirth; and it was through this experience that I was moved to heal beyond the physical; to heal those aspects of my life that blocked deep emotional connection to others.

By age fifty-seven, I had experienced a meaningful life.  I parented two sons from early life through college and was gratified to see them develop into wonderful, loving and capable young men.  With a Masters degree in Social Work, I had built a satisfying career that included a position as Vermont Director of Field Operations in Social Services and Child Welfare and a private clinical social work practice in Vermont and then in New Mexico.

Moving from New Mexico to San Diego in January 1997 marked another milestone.  I was in a new relationship, pleased about living on the Coast, optimistic about work and had no physical complaints.  I was dealing with licensing exams in Clinical Social Work and was approved to sit for the written and orals.  I had passed the written while in New Mexico and spent the first three months of the move preparing for the orals and acclimating to my new life.  Then within the span of the next three months, I failed the exam, received a cancer diagnosis, the relationship ended, my financial resources became severely strained and I was forced to move in with friends.

These developments catapulted me into a major life crisis and my overwhelming fear led me to believe I could not overcome the obstacles.  I began telling myself my situation was hopeless and remained in a state of crisis for several weeks; feeling I was losing all that I had worked for and would not make it to the other side.  However, I did not isolate but instead stayed in contact with family, friends and colleagues who empathized with my feelings but challenged the logic of my extreme fears.  I became aware that my negative “can’t do” thinking was, in itself, a serious problem and consciously forced myself to claim a new mantra that I repeated day and night.  Not long after, I was driving to work on the freeway repeating over and over with increasing conviction: “I can do this!  I can do this!”  A car passed and pulled in front; it had a personalized license plate that read “YOUCAN2.”  While I am typically skeptical about signs from God, the synchronicity of this event appeared to be such a direct response to my words that I felt surprisingly comforted and encouraged.

The Search for Meaning

The writings of Lawrence LeShan, Carol Pearson, and Jose Stevens were pivotal in my journey through this ‘dark night.’  Dr. LeShan spent thirty-five years researching and working with people with cancer.  He concluded that certain forms of psychotherapy do not work for cancer patients.  These include psychoanalysis and any other therapy that focuses on what is wrong with us, on our weaknesses, our deficits.  He maintains that to alter the progression of this disease, we must discover our unique talents and interests and release any blocks to their flow.  When he shifted his focus from looking at what was wrong, to helping his patients find their right “fit,” approximately fifty percent went into long-term remission, including those with metastatic cancer. His work was inspiring and led me to a self-evaluation process.  I acknowledged that, in fact, I had found a “right fit” with my life’s work, but also learned that my healing required a journey into my past to release self-deprecating belief systems. Carol Pearson, Ph.D., states that the quest to find our selves, to find deep meaning in living, is a heroic journey.  To grow and transform our lives we must experience a fall or a decent from feeling safe.  To have our dream we need to face our fears, including our fear of death.  In the end, we have to take full responsibility for our lives.  And, as I experienced, the journey is not easy, the lessons are difficult and the knowledge is hard won.  Time is often spent in what feels like a wasteland in which suffering seems to have little if any value.  Pearson asserts that if the seeker refuses to give up and continues to face the unknown, the reward is a new level of meaning often about the deeper nature of our being, the purpose of life and how we choose to use our time and talents.  In a psychological sense, it is by facing our pain that we eventually come to experience joy, by facing our ignorance we gain wisdom, and through confronting our fear we come to freedom. Unwittingly, this was the time for me to face my pain, ignorance and fear. 

Pearson’s writing, specifically her description of the “destroyer” archetype was especially helpful.  However, when I was initially introduced to this stage by a colleague who had studied with Pearson, I freaked, thinking this must be about death, physical death.  I then understood that the “destroyer” refers both to death and rebirth and that death is about dying to a way of being that has ceased to honor who we are becoming.  It is a shift of consciousness from fear to one of greater faith and sense of purpose beyond health, relationship, professional identity and security.  Cancer, the failed relationship, the threat to my professional identity and loss of financial security were the ingredients that initiated my journey into the “destroyer.”

Jose’ Stevens, Ph.D., author, mentor and colleague also significantly influenced my evolution through this crisis.  Dr. Stevens, helped me understand and address several areas of my emotional life, present and past, including self-deprecation.  He reassured me, against my skepticism, that the crisis would end, and that there was the potential for a spiritual, emotional and physical healing and transformation.  He writes: “Aside from exposure to toxic materials and grief over loss, battered self-esteem is perhaps the leading cause of cancer formation.”

Healing the Body

Despite repeated medical advice to have immediate surgery, I decided to wait until I retook the licensing exam before beginning treatment.  Three months following diagnosis, I passed the exam and started making decisions about medical treatment.  I was in the process of making arrangements for surgery when, in my research, I located two prostate cancer support groups.  One had been organized by patients and had such a strong reaction against surgery that it was difficult to separate fact from bias.  The other had been established by Israel Barken, MD, a local urology oncologist.  Dr. Barken’s group focused on medical management and a partnership between medical provider and patient. I liked this approach because it was consistent with my knowledge of immune-enhancing behaviors and practices I had gained from professional experience with HIV+ individuals and groups.  While a patient/doctor partnership is non-traditional and a stretch for some physicians, it requires the patient’s active participation.  This active involvement is empowering for the patient and thus good for health and well being.

Through discussion in these groups, I decided to delay surgery until I could gather more information.  I learned that there are no clear definitive answers when it comes to treatment and all procedures have potentially serious side effects.  Initially I thought that, with sufficient information, I could make a reasoned and assured decision.  However, with additional information, the choices became more complicated and I found myself moving from certainty to confusion about the many options: surgery, radiation, seed implantation, cryosurgery, hormonal therapy or watchful waiting.  I chose to initiate hormonal therapy to arrest the cancer’s growth, giving me time for further evaluation.  After months of investigation, I decided to pursue treatment with external beam radiation.  Throughout the forty treatments, I continued to work full time, checking my endurance each day by running down the medical facility’s two flights of stairs prior to each session and then up again afterward.

Healing the spirit

Along with healing the physical aspects of this disease, I had become equally committed to healing emotionally and psychologically.  My tendency to worry created stress and unhappiness and although following what I believed to be my life’s purpose, I knew I needed to go deeper.  To maximize my healing, I needed to release the deeper emotional blocks that continued to have a hold on me.

I was the fourth son born in five years to economically and emotionally overburdened parents. When I was five, my eight-year-old brother, Philip, was hit by a truck and killed.  Years later we continued to suffer this tragedy in a cloak of silence.  The ensuing emotional deprivation and pain led me to feel overly responsible for others.  I thought it was my fault when things went wrong and that I just wasn’t good enough.  This was the foundation for a life-long struggle with self-deprecation.  My parents’ conflicts became mine. I felt my mother’s pain and sided with her against my father, who responded to me in kind.  As I aligned with my mother, the relationship with my father became more painful.  Throughout my youth, emotional coldness, criticism and anger characterized my paternal relationship.

The correlation between the father-son relationship and cancer was the subject of a study of 11,000 male medical students at John Hopkins University Medical School in the 1940’s.  The participants completed a  “closeness to parents scale” questionnaire and the subjects still continue to be followed.  The findings are striking; the best predictor of cancer risk years later is a negative father-son relationship.  The significance of this predictor has not changed with time and is not explained by other factors including smoking or drinking.

To heal the early relationship wounds, I had to recognize, acknowledge, and release my feelings of self-deprecation as well as the impact of my painful relationship with my father.  With the support and guidance of my therapist, I began to release these layers of childhood trauma and with them, my feelings of powerlessness, victimization, and fear.  And, as I learned to recognize unhealthy relationship patterns, I allowed certain people to move out of my life.  I became aware that by holding resentment I was, in effect, draining myself of energy needed to support my immune system and healing.  With deeper reflection and insight, I began to understand these experiences in a different way.  I started to see that the people I believed had hurt me were also instrumental in my personal drive to grow, change, and respect myself more deeply.  This process of reframing and recasting events from negative to neutral or positive, was another significant turning point in my healing.  I was able to reach acceptance and compassion toward my parents and others knowing they had done their best.

The Gift

As the unfolding continued, I began to understand that my work with people with HIV and AIDS, as well as my personal experience with cancer and subsequent inner journey and insights, could be combined to help others learn about themselves, about the mind-body connection, and ways to support and enhance health and immunity.  Thus, in the summer of 1999, I submitted a proposal to the Prostate Cancer Research and Education Foundation to support a seven-week psycho-educational group at the Wellness Community in San Diego.  The group would focus on caring for our bodies, caring for and honoring our emotions and feelings, caring for our spirit, and doing what we love.

The proposal was approved in September and in the following two years the Prostate Cancer Research and Education Foundation and the Wellness Community co-sponsored six groups for a total of sixty men ranging in age from 50 to 75.  The mind-body approach emphasizes the importance of viewing this illness as a chronic rather than acute disease and on dispelling the fear-based belief that prostate cancer is equal to a terminal diagnosis.  The men learned about the connection between the mind, body, and emotions, and how thoughts affect feelings, and feelings affect the immune system.  Each night included meditation and healing visualizations.  We explored the nature and impact of stress, early life experiences, intimacy, potency, emotional vulnerability, the concept of “doing” vs. “being,” and “wants” vs. “shoulds.”  Resentments and hurts were examined along with the importance of forgiveness and acceptance.  Finally, we explored the significance and value of living fully in the present, pursuing our life’s purpose.

Before and after group sessions, the men discussed typical subjects such as sports and world affairs, but once in session, they allowed a deeper level of personal sharing that included self-exploration, self-disclosure, and soul searching.  They often spoke of how surprisingly safe they felt with each other despite an initial nervousness.  For many, this was the first experience in a male environment that was non-competitive, supportive, and encouraged bonding.  One member, for example, disclosed that he’d never had a close male friend and always felt the absence of this.  He credited the members of the group for meeting this need.  Another likened his group experience to the deep connection he felt with those he fought side by side with in Viet Nam.  Given the opportunity of a safe, caring, structured environment, the group members were eager to share and be open to others with similar concerns. 

Looking Back

More personally, prostate cancer, a failed exam, a disappointing relationship, and threatened finances were the catalyst spurring my dark night.  Yet these were also the ingredients that served as a wake-up call, facilitating my most profound growth experience.  Many times I wanted to stop, to retreat, and give up, but with support and persistence, I slowly recognized light ahead.  Now, as I reflect on these last several years, I can see that there has been a deep shift in my life that would not have occurred without the introspection and changes that cancer forced.  Five years post-diagnosis, my PSA (prostate specific antigen,) continues at a near undetectable level with no further medical intervention.  The urologist expresses cautious optimism about a cure.  The pain of the failed relationship has been replaced by greater emotional depth in all my relationships.  My professional life is deeply satisfying as I facilitate a prostate cancer support group while continuing my clinical practice.  In the end, cancer, paradoxically, helped me become more aware of and connected to myself, to others, and to those aspects of life that give meaning as well as an ever-deepening appreciation and passion for living.

Epilogue

My decision to write an article of such personal nature came from several fronts.  As a psychotherapist I understand the value of sharing our journey, and of the healing that comes from speaking from the heart and speaking our truth.  Few experiences cause greater emotional discomfort than a diagnosis of prostate cancer and there is too much silence about prostate cancer in general.  This is in part because the word “cancer,” has been synonymous with death, and because patients and families are uncomfortable talking openly about cancer, about death and about bodily functions such as incontinence and sexual potency.  This silence keeps us less informed, more vulnerable and at greater risk of poorly considered treatment decisions.

In this culture, men struggle with expressing feelings of fear and vulnerability.  The stereotype of the “real man;” tough, unflappable, nerves of steel is unfortunately alive, especially among older men who grew up in the “John Wayne” era.  And in some ways, this icon of what it means to be a man may be doing as much harm as the disease itself.  Generally, the initial reaction to a diagnosis of cancer is something like:  “What can I do to get this out of my body?” and “How much longer do I have to live?”  In this crisis state it is natural to concentrate attention on the physical, on ridding ourselves of the cancer.  While this may give some feeling of control, the feeling is generally short lived.  Treatments are often of limited success with troubling side effects such as impotency and incontinence.  Unfortunately, because of the fear engendered in the initial diagnosis, we tend initially to minimize these considerations and later regret not taking enough time.  In fact, more often than not, sufficient time is not taken and the medical treatment is not adequately weighted in light of its full impact on the whole person.

The general trend in our culture is to put our health care, including treatment, in the hands of the physician.  However, with prostate cancer there are many treatment options, and it behooves the patient to become an informed consumer and to take responsibility for the final decision.  It is important to come to terms with the fact that there is seldom one “correct” answer and all treatments have potentially serious side effects.  In general, I do not have a bias against any approved medical procedure, other than an orchiectomy, i.e., the surgical removal of the testis (due to the risk of serious side effects and availability of less invasive medical alternatives.)  In fact, given our current understanding about the treatment of this disease, all other medical interventions need to be carefully considered.  I am however cautious and I do have difficulty with physician statements that move a vulnerable patient in a particular direction.  For example, when urologists tell their patients that surgery is the “gold standard” in the treatment of prostate cancer.  This tends to imply that all other procedures are less than adequate or appropriate.  Interestingly, when I mentioned to a consulting oncologist that urologists had used the term “gold standard,” he replied: “but we are no longer on the gold standard.”  The saying among some physicians and knowing patients is: “a surgeon will recommend surgery, and a radiologist will recommend radiation.”  This calls for more comprehensive training of medical personal and professional cooperation between those who treat the body and those who treat the individual in the context of their psychosocial environment.

Charles Myers, M.D., Medical Oncologist, Editor: Prostate Forum, and prostate cancer survivor states in Prostate Cancer Communication:  “I have come to the conclusion that you, as a patient, simply cannot allow the management of your cancer and your life to be limited by the narrow views of the physicians you encounter.”  He further states:  “It is apparent that the behavior of this cancer is influenced by many things; it’s controlled by your life-style as much as by anything the medical profession typically provides.” 

I urge patients and loved ones to utilize the help of qualified therapists and cancer support groups, and encourage men to become informed consumers and equal partners with their health care providers.  In the end, the crisis of prostate cancer can be a vehicle to achieve greater quality of life.  Finally, as an elder, I hope those who come to face similar struggles will benefit from sharing my experience.

Recommended Resources

Prostate Forum, Editor-in-Chief, Charles E. Myers, PO Box 6696, Charlottesville, VA 22906.6696.  Ph. 434-974-1303, www.prostateforum.com

Prostate Cancer Communication (PAACT, Inc.), Editor, Rick Profit, 1143 Parmelee NW, Grand Rapids, MI 49504.  Ph. 616-453-1477, www.paactusa

Prostate Cancer Research Institute, Executive Director, Glenn Weaver, 5777 Century Blvd., Suite 885, Los Angeles, CA 90045, Ph. 310-743-2116, www.prostate-cancer.org

Prostate Cancer Research and Education Foundation, Director, Israel Barken, M.D., 5480 Baltimore Dr.#202, La Mesa, CA 91942.  Ph. 619-4618181, www.pcref.org

Ross, David M., LCSW, 426 Pennsylvania Ave., San Diego, CA, 92103, Ph. 619-876-2014, rossdm@mac.com

References

1.  Le Shan, Lawrence: Cancer As A Turning Point.  New York. Penguin, 1994.

2.  Pearson, Carol:  Awakening The Heroes Within.  New York, Harper Collins, 1991.

3.  Stevens, Jose:  Transforming Your Dragon:  How To Turn Fear Patterns Into Personal Power, Bear & Company,  NM, 1994.

4.  Graves, P.L., Thomas, C.B. and Mead, L.A. Familial and psychological predictors of cancer.  Cancer Det. Prevent., 15:59, 1991.

5.  Prostate Cancer Communication Newsletter, Ed.: Rick Profit, April, 2002.