The psychological impact of mastectomy

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Perhaps one of the most distressing events that can happen to a woman is to be told she has breast cancer and needs to have a mastectomy. The psychological impact on a woman can be devastating.

While mastectomy as a treatment for cancer can be very effective, it is nevertheless a very radical and in some cases life changing event. For many women it can impact on the way they see themselves and also how they feel about themselves. It can alter their view on the world and life itself.

For a woman (and I want to add man too, as breast cancer can and does affect men) it can severely impact on self-esteem, her sex drive and how she feels about her body, her body image and herself as a woman.

Journalist, Thandie Fletcher recipient of the 2012 Michelle Lang Fellowship conducted a year long study into the effect of breast cancer and breast reconstruction on Canadian women; describes how women can feel a sense of disconnection from their bodies and a diminished sense of femininity. She considers that breast reconstruction can improve self-esteem and their sense of wellbeing (1)

While it may not be an easy road, with support and understanding of a loving partner it is possible to come to terms and accept the reality of a mastectomy. Communication and love is really vital if she is to learn to love her post-mastectomy body and feel good about herself again.

The key is communication and it is vital that she has the opportunity to talk about things from the outset. Seeing a counsellor can help and there is a place too for couple counselling. Just as any couple will need to come to terms with a major illness within the relationship they will need to grieve and move to a different place psychologically. This applies equally to both parties. Having the opportunity to talk can help to mentally prepare for what is in effect a, life changing event.

It is important to consider that the psychological impact of a mastectomy are as important in terms of healing as is the physical wound. Seeing a counsellor or psychologist prior to surgery can help in preparing for the event. Even if a woman knows intellectually that surgery is the right option, at a heart level she may want to resist this invasive and radical treatment as she wants to hold on to her pre-surgery self. It is because our relationship with our body is so intensely personal that we may feel very protective and resistant at the thought of losing something so precious. Even surgery such as a partial mastectomy or any reconstructive procedure can have a major impact on the psyche.

Because breasts are seen as nurturing and related to motherhood and also sexuality, a mastectomy can drastically alter a woman’s perception of herself and her association with her identity.  Loss of one or both breasts can have a major impact on femininity. The sense of grief may be profound.

Time, they say is a healer. Given time as a woman heals from mastectomy her life can return to what it was before the surgery.

What can help.

Adopting a philosophical outlook and learning to accept that while mastectomy was not something that was wanted, it was something that was medically needed.  It was Shakespeare who said, “there’s nothing either good or bad but thinking makes it so.” (2)

Try to keep a positive outlook. Keep a small notebook handy and at the end of each day write down three things that you appreciate and that you are grateful for.

Talk to others who have had a mastectomy and find out what helped them.

Consider all the options available to you such as reconstruction using your own skin tissue, implants, breast expanders or any combination of methods to enhance the appearance of your breasts. Also consider prosthetic breasts to give you greater confidence.  A prosthesis can do a lot to help normalise your image – and it is worth taking time to ensure you find the right one for you

Spend time on yourself pampering and focusing on beauty treatments for the whole you. Take up exercises such as yoga and tai-chi. Seek out a massage therapist and learn to really enjoy sensuous pleasure, touch and nurturing. As a body therapist as well as a talking therapist, I cannot recommend enough, how overcoming your anxieties about your body can help you to feel good about yourself again. Remember it may take some time to feel comfortable about yourself naked once again.

Eat well and seek out food that will enhance your well-being from the inside. What to wear initially is always a dilemma, but with some clever wardrobe tweaks and the art of layering, you can look gorgeously chic. Wear clothes that make you feel comfortable and less self-conscious initially, such as scarves and baggy tops, over time take little trips out without them and your confidence will grow.

Spend time with a counsellor or psychotherapist to reflect on your personal journey, where you have come from and where you are going. Acknowledge your sadness, loss and grief. Experience your emotions do not try to deny them

Take up mindfulness meditation, develop your spiritual side and engage in voluntary or charitable activities for others.

Talk with your partner about things that they appreciate about you, that they find attractive and womanly about you. Be open and don’t shy away from talking about difficult things. Do not assume your partner understands.

Tell yourself that you are worthy of love and attention. Learn to be “self caring.” Everyday give yourself something with love, a magazine, a coffee, a bunch of flowers, a bath in fragrant oils. As you do so, say your name out loud and say, “I am giving you this ……. with love.”

Remember, while you may have lost your breast/breasts, you have not lost you.
It is about redefining yourself as a person and as a woman. Let today be the start of the rest of your life.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

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(1) Fletcher, T. (2012).”Mastectomies can leave women with devastating emotional scars,” National Post, Post Media News.

(2) “Six principles of optimum health,”
Rodriguez, D. (2014) “Keeping your self-esteem after a mastectomy,” Everyday

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The Art of Procrastinating

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Procrastination is the thief of time – Edward Young

Most of us procrastinate at some time. I should know, I have a PhD in procrastinating! Indeed, I regard myself as a bit of an expert. How many times have I thought to myself, “I’ll do that later,”or “I must get round to that.” How is it that spring cleaning my office has more appeal than sitting down to a pile of paperwork? Or that checking twitter, Facebook, LinkedIn or Google+ assumes such great importance in the scheme of things? I suppose I would call it “the human factor.” It is the difference between us and robots, a rather quaint, old fashioned humanness.

I recall the day a client told me that she was going to “Zumba” classes. Not knowing what this was – some sort of African tribal dancing perhaps? I needed to do my research ( in the name of therapy, of course). I promptly spent the next three quarters of an hour looking at a wide variety of Zumba dances on Youtube. So much more important of course, than writing up notes.

While all of us procrastinate on occasions, some people procrastinate so much that tasks begin to build up and putting off becomes avoidance. The result, a bad case of stress, a build up of pressure and a consequential rise in anxiety. For anybody with a mood disorder this trajectory can be rather more rapid. Deliberately avoiding, putting things off, exacerbates anxiety and failure to confront the necessary.

When is procrastination most likely to occur? Well, simply, when the task either is deemed as not urgent or when what we want to do is more pleasurable. As human beings we like pleasure. Therefore, it could be said that procrastination = putting pleasure before pain.

Why do people procrastinate? Well, often it is is a matter of prioritising, deciding that the task in hand can wait until later and that it is not worthy of immediate attention. It might amount to lack of desire or commitment. Often it is because it is not a very pleasurable task.

For some, procrastination presents when “fear of failure” is imminent. The task gets left to the very last hour and with a gasp the shout goes out, ” I really didn’t have sufficient time to do the job properly.” A very convenient excuse in the face of perceived failure. Good old “denial” works wonders as it serves to protect yourself from the reality that your best efforts might come to nothing!

Then there are those with “perfectionist fetishes.” Those of us who say, “I will not start this until I have sufficient time and can do it properly, otherwise  I will feel a failure.”

Sometimes procrastination is a way of avoiding emotional connection where fear of rejection is the reason for putting things off. For example, avoiding inviting friends round for dinner in case they don’t like what you have prepared or putting off that phone call. Perhaps keeping a distance so that people cannot get to know you. All of which have there roots in “fear of rejection.”

Then there are those who “fear success” and all that comes with success. After all, if you do something really spectacularly, you might even get asked to do more!

Now we come to another valuable underpinning factor. That of punishment, yes, the perfect “passive aggressive”act. Putting something off as a way of getting back at somebody. A wonderful way of indirectly expressing anger at your boss or your partner perhaps?

Finally, just plain and simple, “Can’t be bothered.” Simple as that!

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

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Ref:  Powell, T (2009) The Mental Health Handbook – A cognitive behavioural approach  3rd edition, Speechmark

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How to become more resilient in 2014

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Resilience is the term used to describe a person’s capacity to cope with changes, face challenges and bounce back during difficult times. Most of you reading this will know someone who always manages to smile despite adversity. Indeed, you too will at times have demonstrated resilience in the face of difficulties. Look back to a time when you faced problems in your life and somehow managed to cope using your own resources? How did you manage it? What kept you going?

What I aim to convey in this piece is how to shore up and galvanise your resources to help you develop greater resilience. It may be that you are doing this already, then well done. What better to time to give it some thought though than the beginning of 2014.

Here is a description of the qualities of resilience we are aspiring for:

“The person who is resilient will be able to recognise and manage their own emotions, and acknowledge that others too have feelings and understand what they are going through. The person who is resilient will be able to stand alone, with a strong sense of self and self-worth. They will be able to make decisions, solve problems and be able to rely on their own resources to do so. They will have a clear sense of direction and purpose in life.”

Does this sound like a tall order? Well, this is something to aspire to, and should be viewed as “work in progress.” If you understand the principals it will be a set of skills you can aim to master (a bit like learning to ride a bicycle or driving a car).

Here are ten tips:

1. Even in the face of setbacks try to develop a “positive mental attitude”. Step back and look at the bigger picture if possible. Is there another way of looking at this? Can you see any other way of looking at this setback so as to draw some positive from it?

2. Believe in your own abilities and trust your own judgement. Be open and honest with others.

3. Communicate with others whenever you can and try to give positive feedback and encouragement. Try not to be critical, harsh or judgemental. Remember, they too are trying to do their best and just like us, they might get it wrong sometimes.

4. Work to build, maintain and develop support networks. Find someone you can turn to who can become a role model or mentor. Find someone to trust and confide in. Support those around you and allow them to support you.

5. Aim to foster mutual respect between those around you and the wider world. Recognise the pressures and outside influences on others. Take time out to explore new places and meet new people.

6. Take every opportunity to learn and develop yourself. Assist in the learning and development of others.

7. Strive to foster inclusion and belonging. Involve others in decision making wherever possible, celebrate diversity and promote mental well-being in your community.

8. Take time to have fun and be fun. Learn to laugh at yourself and see the funny side of things. Try to take life “less seriously” when you don’t have to.

9. Involve yourself in community projects and activities to help others. Seek opportunities to think and act in enterprising ways.

10. Remember, above all, you are “good enough” just as you are. Expect that some days won’t be great. Stop comparing yourself and embrace your failures as opportunities to learn, we all have to.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

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We all need hope in 2014.

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As Michael Schumacher lies in his bed in intensive care, the surgeons, the nurses, his wife and family all hope he will come through and make a full recovery. We are all behind them, listening to every news bulletin hoping to hear that his situation is improving.

Yet there are those who look on dispassionately, some, perhaps jealous of his motor racing success, might say that if you indulge in dangerous sports you deserve all you get. Whether motor racing, skiing or partaking in any sport where there is risk, each of us know that accidents might happen. The girl (or boy) who gets attacked by a gang walking home from a New Year’s Eve party,because they have not been able to tolerate the alcohol they have drunk, do they deserve it?

The reality is that we are human beings who deserve the love and kindness of others, not to be judged by the circumstances that led us into trouble. Love, kindness, compassion and hope are what we want for 2014.

Yes, there are many reasons for us to feel that we have had enough of migrants coming to our shores, scare stories abound about the latest group of economic refugees due to hit our shores, but that should not stop us offering hope to some individuals for a better life. Indeed, whether or not we should be open to all, is a vexed question and one I am not qualified to answer. However, perhaps offering the hand of kindness to a few people from war torn Syria is another matter. Would you turn away the boy or girl at your doorstep, injured by thugs because you were having a dinner party and your house was full?

We all need hope, hope that others will be there for us when we need it. When the chief anaesthetist, Professor Jean-Francois Payen who is treating Michael Schumacher, stated that medical literature suggest he has a 40-45 per cent likelihood of recovery from his injuries, he added, “I don’t work with statistics, I work with patients.” That is the point, we all need hope, whether it is the recovering alcoholic, the person breaking free from a bad relationship or someone recovering from a bout of mental ill health, hope and well wishes from others is what we all need.

Just as anyone recovering from a brain injury will need everyone around them to believe in the possibility of recovery, however remote, and to work tirelessly to put every ounce of energy into treating them, helping them to get better, the same must be said of the person with mental illness in that every one involved works tirelessly for their recovery. There is no excuse for sloppy mental healthcare any more than there is for sloppy physical healthcare ( not that the two should be separated anyway!) but the person tormented by voices, just as the person wracked with physical pain deserves the same high standards of treatment.

It is fitting that the two “whistle blowers” in the Staffordshire hospital scandal should get recognition. More people need to speak out. As I write this I can be sure that someone, somewhere is being treated cruelly. Whether it is the boy or girl with learning disabilities or the elderly person in a residential care.

We all need hope. Hope that someone will be there and will listen to us in our hour of need. That a Good Samaritan will stop and offer us help when we are in need. Hope that someone will take the time and trouble to comfort our family when we are not able to, to explain to them what is going on when they feel alone and helpless, not understanding what is going on. We need hope that this year will be a better one and that simple acts of kindness will replace harsh words, judgemental minds and rudeness. That health professionals will listen and not assume they know best.

Whatever any of us do, we need to speak out to get the highest standards of care for those less able to speak out for themselves. People need hope, love and care, patents are people after all, not statistics in medical literature.

Let us support each other in 2014.

Until next time, Steve Clifford, Cognitive Behavioural Psychotherapist.

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