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Section 15
Coping with Terminal Illness

Question 15 | Test | Table of Contents

At the very beginning of his book, Love & Survival, Ornish (1998) stated, "Our survival depends on the healing power of love, intimacy, and relationships. Physically. Emotionally. Spiritually. As individuals. As communities. As a country. As a culture. Perhaps even as a species" (p. 1). Weil (1997) asserted that human beings are highly social, communal animals who are meant to live in families, tribes, and communities, and when we lack those connections, we suffer.

However, our Western industrialized society glorifies individualism and independence and fosters a spirit of every man to himself. Weil (1997) maintained that many people pride themselves on their independence and seem to habitually distance themselves from others. Some may indulge in isolation as a defense strategy, possibly as a consequence of emotional pain; others may never have learned how to meaningfully connect to anyone beyond themselves.

Kohut (1977) asserted that establishing and maintaining relatedness to others is a pervasive human concern, believing that "through interpersonal interactions people survive, develop and grow" (Hagerty, Williams, Coyne, & Early, 1996, p. 235).

Sleek (1998) suggested that technology such as the Internet was geared to help us establish relationships. But the very same technology that has allowed people to strengthen their contact with distant family members and friends and to develop friendships with people around the world is actually replacing necessary day-to-day human interactions. As easy as it may be to connect via the Internet with people who are thousands of miles away, "a computer monitor can't give you a hug or laugh at your jokes" (Sleek, 1998, p. 1).

In fact, Kraut et al. (1998) reported that increased use of the Internet leads to shrinking social support and happiness and results in depression and increased loneliness. Ornish (1998) echoed those findings by observing that "at their best, e-mail and chat rooms can be another way of staying in touch and keeping up with loved ones who may be thousands of miles away in real space but instantly available in cyberspace. All too often, however, technology provides a way of numbing loneliness without experiencing real intimacy" (pp. 100-101).

Weil (1997) unequivocally stated his concern that the widespread isolation in our Western society is unhealthy physically, emotionally, and spiritually. "I do know for sure that connectedness is necessary to well-being. You can eat as much salmon and broccoli as you can, take antioxidants for the rest of your life, breathe terrifically, and walk all over the earth, but if you are disconnected [from others], you will not achieve optimum health" (p. 153). This connectedness to others is so important that its nature affects the bio-psycho-social process that influences behavior and promotes or impairs health.

Earlier researchers also focused on the role of social support in relation to both physical and mental health (Cohen & Syme, 1985; Ganster & Victor, 1988; House, Landis, & Umberson, 1988). Others explored the effects of loneliness on health (Lynch, 1979; Russell, Cutrona, Rose, & Yurko, 1984), on social integration (Case, Moss, Case, McDermott, & Eberly, 1992), and on attachment (Sperling, Berman, & Fagan, 1994).

Ornish (1998) reviewed numerous studies that suggested that "anything that promotes a sense of isolation often leads to illness and suffering. Anything that promotes a sense of love and intimacy, connection and community, is healing" (p. 14).

Loneliness has been linked to depression, anxiety, and interpersonal hostility (Hansson, Jones, Carpenter, & Remondet, 1986) and to an increased vulnerability to health problems (Jones, Rose, & Russell, 1990). Psychosomatic theories of cancer speculate that there is an association between a history of tragic personal loss and the development of cancer (see also Hartog, 1980).

Current research suggests that psychological variables--including loneliness--have been associated with changes in immune functioning and may weaken the body's capacity to fight disease (Kennedy, Kiecolt-Glaser, & Glaser, 1988). The immune system protects the body from illness through the recognition and destruction of antigens, disease-causing substances like bacteria, viruses, and cancer cells.

Once an antigen enters the body, lymphocytes (T cells or B cells) multiply in order to combat the antigen. T cells directly attack and destroy antigens, whereas B cells create immunoglobulins that act as antibodies that combine with and neutralize harmful antigens (Barlow & Durand, 1995).

Cohen (1985) observed that life events, including separation, loss, and feelings of hopelessness that are associated with the experience of loneliness, are hypothesized to affect the endocrine system through abnormal secretion levels from the pituitary and adrenal glands. That process may adversely affect the immune system and therefore decrease the body's ability to fight illness, resulting in an increased vulnerability to cancer.

A deterioration in health through this process is most probable in persons with already compromised immune functioning, especially persons with Acquired Immune Deficiency Syndrome (AIDS), an immunosuppressive disease (Kiecolt-Glaser & Glaser, 1992). High loneliness scores are also correlated with significantly lower levels of natural killer cell activity; killer cells are the lymphoid immune cells that play a role in cancer protection and appear to have anti-tumor and anti-viral capabilities (Kennedy et al., 1988).

Loneliness and Cancer
The literature suggests that constraints and restrictions associated with their illness cause cancer patients to experience difficulties in interpersonal relationships (Dunkel-Schetter, 1984; Engleberg & Hilborne, 1982; Revenson, Wollman, & Felton, 1983). As the ability to cope with the disease decreases, the quality of cancer patients' social interactions also decreases (Bloom & Spiegel, 1984; De Haes & Van Knipperberg, 1985).

Weisman (1979) proposed four psychosocial stages that cancer patients experience: (a) the "existential plight" stage--a period of about 100 days beginning with the diagnosis and extending through primary treatment; (b) the "mitigation and accommodation" stage--when the patient's behavior is the psychosocial equivalent of having the disease, even during remission; (c) the "decline and deterioration" stage; and (d) the "preterminality and terminality" stage.

Feelings of hopelessness, helplessness, and fear of death are present in the minds of patients during each stage, and patients typically lack the social and emotional support they desperately need, which may lead to feelings of loneliness (Cohen, 1985; Friedman, Florian, & Zernitsky-Shurka, 1989).

Cancer also produces physical changes that may be aversive to others (Wortman & Dunkel-Schetter, 1979). For example, during treatment, patients may experience bleeding tendencies, hair loss, mouth sores, and unattractive skin reactions (Steams, Lauria, Hermann, & Fogelberg, 1993). Having cancer may evoke fears in others about contracting the disease from the patient (Cohen, 1985; Mages & Mendelson, 1979).

Furthermore, in order to avoid further distress, patients may avoid open communication about the disease, especially with family members and medical personnel, which may add to the lack of social interaction (Cohen, 1985; Holland, 1977; Schwartz, 1977; Silberfarb & Greet, 1982).

Singer (1983) asserted that because it is part of human nature to avoid pain, cancer patients and their families often experience tremendous difficulty relating to each other and working with the problem in a constructive way. Finally, as the cancer progresses, opportunities for social activities decrease due to disabilities caused by the disease (Bloom & Spiegel, 1984). Friedman et al. (1989) observed that approximately 50% of their 60 patients felt their loneliness was associated with illness or illness-related situations.

- Rokach, A. Terminal Illness and Coping with Loneliness. The Journal of Psychology. May 2000. Vol. 134 Issue 3.

When Someone You Love Has Advanced Cancer

- National Cancer Institute. (2014). When Someone You Love Has Advanced Cancer. U.S. Department of Health and Human Services.

Personal Reflection Exercise #8
The preceding section contained information regarding terminal illness and coping with lonliness. Write three case study examples regarding how you might use the content of this section in your practice.

Fear, Anxiety, and Coping
Self-efficacy of Individuals with Cancer
During COVID-19 and Predictive Risk Factors:
A Descriptive and Correlational Study

Karataş, T., Ayaz-Alkaya, S., & Özdemir, N. (2023). Fear, Anxiety, and Coping Self-efficacy of Individuals With Cancer During COVID-19 and Predictive Risk Factors: A Descriptive and Correlational Study. Seminars in oncology nursing, 151420.

Peer-Reviewed Journal Article References:
Beller, J., & Wagner, A. (2018). Loneliness, social isolation, their synergistic interaction, and mortality. Health Psychology, 37(9), 808–813.

Colosimo, K., Nissim, R., Pos, A. E., Hales, S., Zimmermann, C., & Rodin, G. (2018). “Double awareness” in psychotherapy for patients living with advanced cancer. Journal of Psychotherapy Integration, 28(2), 125–140.

Gómez, B., Vega, E., Kirszman, D., & Fernández-Alvarez, H. (2019). Coping with the terminal illness of a colleague in a mental health organization. Journal of Psychotherapy Integration, 29(2), 224–234.

What are the four psychosocial stages that cancer patients experience? To select and enter your answer go to Test.

Section 16
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