An oncological diagnosis affects far more than physical health. It changes one’s sense of security, relationships, the perception of one’s own body and of the future. We speak with Dr Margarita Tareyn about the psychological experience of cancer, femininity, the place of loved ones, and the need for psychological care to be part of treatment.
Dr Margarita Tareyn holds a doctorate in clinical psychology in the field of analytical psychosomatics of oncological diseases, and is a clinical psychologist and psychotherapist. She has trained in psychotherapy, psychoanalysis and analytical psychosomatics in Bulgaria and Paris. She has many years of clinical and teaching experience in the field of psycho-oncology, psychosomatics and psychotherapy with people suffering from severe illnesses. She is a founder and honorary member of the Bulgarian Association of Psycho-Oncology and is part of the team of the Institute of Medical Psychology, Psycho-Oncology and Psychosomatics.
Dr Tareyn, what does a person experience when they hear the diagnosis “cancer”?
Despite advances in medicine, oncological diseases continue to be associated with hopelessness. The moment of learning the diagnosis can be shocking. Within a matter of minutes, a feeling of complete devastation sets in, as though one’s entire life has been overturned – the sense of security, trust in oneself and in life, plans and expectations for the future.
This unleashes a storm of painful emotions – fear, uncertainty, anger, despair, a sense of injustice. Numerous questions arise without clear answers, loved ones are also frightened, and everyday routines, plans and dreams may suddenly seem impossible.
This is a moment in which it is extremely difficult to maintain a sense of reality. Catastrophic assumptions arise, old fears intrude, along with prejudices, inadequate messages from those around, and confusing advice.
The suffering is not only psychological. It can have physical, social and spiritual dimensions. Experiences differ from person to person, but the confrontation with illness carries one common theme – the threat of loss, real or presumed.
Sometimes denial also appears – the hope that a mistake has been made, that the results are mixed up, or that a second opinion will overturn the diagnosis. These are understandable reactions. Tension usually begins to gradually ease once it becomes clear what lies ahead, a relationship is built with the treating team, and treatment begins.
The patient and their family need time to accept the change and reorganise their lives around it. This is not a linear process. There are better and more difficult moments – doubts, discouragement, fatigue, tears.
Tears are not a bad sign. They can be part of the psyche’s normal way of coping with what a person is going through. They come from our will to live.
What happens to a woman’s sense of femininity when she has an oncological illness?
The diagnosis can raise very profound questions about femininity for a woman. Femininity, like masculinity, cannot be reduced solely to physical and sexual characteristics. It is also a psychological position, built throughout the entire process of development.
With an oncological illness, the body can change significantly. A woman sometimes feels that she no longer recognises herself. The challenge then is to preserve her sense of herself as a woman, and the possibility of a fulfilling emotional and sexual relationship, despite the physical changes.
For some women, this very difficult period becomes an opportunity to experience themselves and their relationship with their partner in a deeper and more authentic way – to discover trust, to receive support, and to find answers to questions that existed long before the illness.
As one patient put it: “Cancer helped me discover so many ways to be a woman.”
How can this be achieved?
By daring to think beyond appearances and not limiting ourselves with imaginary clichés. By not projecting our fears onto the other person, but instead being able to be honest and sensitive both towards ourselves and towards them.
The onset of illness sometimes makes it impossible to continue avoiding important questions. It demands change, reconsideration, and setting out on the path of treatment not only on a bodily level, but also on a psychological and life level.
Old problems that had until then been set aside in daily life, and in the sense that there was endless time ahead, may resurface. This is painful – it brings fear, sadness and regret. But sometimes it also brings us back to values and priorities we had left behind.
Questions arise that require attention. And with them, new possibilities sometimes appear as well.
What is the place of psychological support in oncological treatment?
Psychological support must be an integrated part of medical treatment.
A good quality of life, even in advanced illness, does not mean solely good medical control over the disease. It includes the person’s emotional state, their relationships, the ability to preserve meaningful roles, and to continue pursuing their aspirations despite the illness.
In medicine, there is still a tendency for the psychological to be left in the background – both by specialists and, at times, by patients themselves. Physical illness is present so powerfully that feelings and emotions can seem secondary. But they are not unimportant to how a person goes through treatment and life during it.
Therefore, seeking psychological help must not be regarded as capitulation to the illness or as a sign of weakness. It is a form of adequate self-care and an expression of high health culture.
And what is the place of the family?
An oncological illness does not happen to the individual alone. It enters the life of the whole family. Loved ones also experience fear, uncertainty and helplessness, and sometimes, in their wish to help, may unintentionally increase the tension.
The patient does not necessarily need constant encouragement or insistence on being “strong” and “positive”. Sometimes what is needed is simply the ability to say that they are afraid, that they are tired, or that they do not know what lies ahead – and to have someone remain by their side, without immediately trying to fix their experience.
The support of loved ones is extremely important, but they themselves may also need psychological support. Caring for the patient also includes caring for the relationships and the people around them.
How does society view oncological illnesses?
The social context is of enormous importance for how a person goes through the illness. Prejudices, fears, and misconceptions about treatment, diet or prognosis can place an additional burden on the patient.
Today, the vast amount of information available on the internet can also be a powerful source of anxiety. A person who has just received a diagnosis can easily encounter contradictory stories, statistics, advice and categorical claims that do not necessarily relate to their particular illness.
At the same time, society places us under constant pressure to be fit, resilient, productive, to recover quickly and to keep moving forward. But the experience of a serious illness has its own rhythm.
As professionals and as loved ones, we must have enough patience to give the patient the opportunity to go through what is happening at their own pace and in a way that is possible for them.
As a society, we must be able to open a little more space for suffering.