Dealing with your Diagnosis and not Despairing! PART 3

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Welcome to Medicine and Health with Dr. Paul Anderson. This is a show about opening up the often mysterious world of how doctors think. The goal, to empower the listener to gain access to the best healthcare possible.

Good day and welcome to Medicine Health with Dr. Paul.

That's me, I'm Dr. Paul coming to you from Seattle, Washington, where it's actually sunny outside and we're enjoying that. And today we're in part 3 of a series called Dealing with Your Diagnosis and Not Despairing. So that sounds, you know, well, either it sounds interesting or a little bit of a downer when you use the word despair. And what I'm learning about people's interest on things, you know, online and on links and things is the more either interesting you make it or Happy, the more clicks you get. Or right now, if it's about COVID so there's that too. But the point of this series is we're going through my most recent book, which is actually about the diagnosis of cancer. But really, all of the same qualities of what you need to go through in the mental space, mental-emotional space, are really the same. And that is that book that you see over my shoulder here, or up over there, and it's called Cancer: The Journey from Diagnosis to Empowerment. And what I'm trying to do is take 2 chapters each week and just kind of give you the top-down on those so that you can get the salient points. Now, of course, the book is available anywhere where you get books. You know, most of those are online now. It's available in every format I can think of, so there are all of the audiobook outlets like Google Play and Audible and all the other ones, Kindle, all the e-readers that I know of. And then if you like books that are paper that you hold in your hand like these, you can get that from any online bookseller. And you can even get them through my website. So there's the new Dr.

A website, which is just D-R-A-N-O-W, Dr. A Now. And it's got a hub for all the media and books and all that.

But last week we did chapters 3 and 4.

So part 1 was chapters 1 and 2. In chapters 3 and 4, what we really talked about were, well, okay, I understand having a diagnosis of cancer, chronic illness, chronic pain is— that's not what anyone's looking for.

Right.

I understand that it's legitimate that I am not feeling great about that diagnosis. But last time we started out with, well, if that's the case, how am I supposed to feel and think so I can move forward and progress?

And then in Chapter 4, what I really tried to lay out, both in what we discussed last week and also in the book, is, okay, if we're going to buy into this idea that It's okay to, you know, be upset about these things and not like the diagnosis and all that, but it's also okay to think, can I move to a place where I am more empowered as a patient? And we know from science that— put some of it in the book, there's a lot of other stuff too— that the more empowered you are as a patient, and then being empowered is actually being realistic, but also being on top of things as opposed to being a victim. So the more empowered you are as a patient, the better your outcomes are. There's literally research that shows that pain management is more effective when you are empowered. Some other really great things that we're going to talk about today. So that's kind of what we talked about there, and we ended with, well, if there is a way to go from the shock of my diagnosis to being an empowered patient, what What is a way to do that? Is there a roadmap? And really, that's what this book is about. It's a roadmap. So in today's section, what I wanted to do then, because we did chapters 1 and 2 in part 1 and 3 and 4 in part 2, here in part 3, I want to go through chapters 5 and 6 and give the big, you know, kind of the main points, as it were. So after chapter 4, where we talked about this process and how the process mimics the normal human processing of grief, because if you think about it, if you're diagnosed with something like cancer or a chronic illness and you are facing either, you know, your own mortality or a disability or a change in quality of life or all of the above, The process is not an easy one to move through. And so while there are predictable steps in the process, one of the things is, is that we are all unique humans. And if we're being realistic about it, some of us may take longer to process some things than others. So the next part to kind of dive a little deeper in is this idea of, well, if that's true, then If the process is part of the human condition and the human experience, if we decide to go through it and try and move to being empowered, what part of that is unique to me as a human and what is common to everyone? Well, in chapter 4 we answered a little bit of it, but in chapter 5 we get a little deeper into it. Um, But the overriding concept is, is that while the process is somewhat predictable, who you are makes that process unique. It's your own. And that's why, well, you know, someone like myself who's worked with people with cancer and chronic illness and a lot of disability for a long, long, long time can say these are the patterns that we see. These are the roadblocks we see people get in the way and all of that. We also have to be honest and say you can't just shove everybody through the exact same speed of going through it. And you also cannot predict that maybe person number 1 here will really have not a lot of trouble with each step, and they kind of go through and spend about the same amount of time on each one, and they come to an agreement and feel empowered and all that. And then person number 2 might look just like person number 1, and they may do great for step 1 and 2, And step 3, they just crash, or they crash in step 3 and they get through and they move on and they move on and they go back and they kind of have to relive step 3 again, or step 2, or whatever. That's because that's about who we are. The process is part of being a human, part of the way our brains work. But the way we handle them is about us. And as I alluded to last time, Last program. That's a lot about what we've been through before. So one example I use, at least I think I did, and if I didn't use this example, it's it's not a bad one. Let's say prior to any diagnosis of cancer, chronic illness, chronic pain, any any of these things that we don't want. Let's say that. person in question really had a lot of problems with, uh, with anger and anger management. And they realized that, and they realized that it was, you know, harmful to their life and others. And they went through a lot of really deep, intensive work to work on their anger management, get to the bottom of why is it there, have strategies for dealing with anger, all this stuff. Well, if that person gets one of these devastating diagnoses, they might get to the anger phase of processing and see it, realize it, because it doesn't go away. It's always going to be there in one form or another. But they may have so many tools to deal with the anger portion of it that it really— that's maybe the easier part of the whole process. But when it comes to maybe the depressive aspects or the shock and disbelief aspects or things like that, That might hang them up. And you could say the same for, you know, anybody. So who you are makes it unique, and who you are that you bring to the table of your chronic illness is what will, what will be behind how you process these things. So one of the things, one of the reasons I wrote the book the way I did is so that you still have that, that top-down view of the roadmap, but it also honors the idea that we're all individual and We're just going to process things the way we process them.

And so we might need to recycle a step.

We might go back a few times. We might take a lot longer in a phase. We might need to get some outside help, whatever it is. That's all okay. The important part is, is that we're trying to improve our quality of life, our experience of life, our medical outcomes, et cetera. And the only way we can do that is move. from shock and disbelief and victimhood over to being on top of things and being empowered. So just like we talked about last week, one of the things we realize is that we're— we are uniquely in charge of and responsible for our life during this. And I think a really important thing that I brought up in each of the sections is That doesn't mean that you look at it and you don't believe it's there. You, you know, don't believe it's a problem or something like that. Or it doesn't mean you look at it and you only have happy thoughts about it. Um, I don't know a person who is connected to reality who I've ever seen diagnosed with cancer or any of these chronic things that we've talked about who doesn't have dark moments. Sometimes a lot of them. And the point is not that that's something that shouldn't happen. The point is that if that doesn't happen, you're not human. But the part you're in charge of and responsible for, like we said last week, is to start to look at what can I control and what can I not control or not control much? And by doing that, you can let go of some things That you have no control over anyway, and you can put your efforts into the things that you do have control over, which become very, very important. So one of the things is, if you've looked at the book or as I've talked about it, I use a counterpoint of 2 different stories, sort of a tale of 2 people as they go through. And one person decides not To participate in enlightening themselves and becoming empowered and all, and the other one, you know, does the hard work and goes through it. It sort of gives you flesh to things working. But the woman that I described who did decide to do the work, one of the things that she kept coming back to was that even on those days where she didn't want to. She would circle back to realizing that she can't move forward without doing the work of discovering where she's at in the process, what she can't control, what she can control, all of that. And if we think about it logically, that's an uncomfortable position to put yourself in.

Because not only are you dealing with some diagnosis you didn't want in the first place, You probably don't feel very good, number 2, and that doesn't help very much. And then you intellectually have this idea that you would like to move away from shock and anger and victimhood and towards being empowered. But that means a lot of tough work, you know. It's a lot like any other thing in life, you know. If you, if you are On a farm and you have a whole bunch of hay that is baled, if you leave that hay out in the field, it will get rained on and it will rot and be ruined. If you want that hay for later in the winter, which is why you baled it, probably, you ought to go into the field and load it up and move it into the barn. Now, that is a hard thing. I spent a lot of time doing that. It's not an easy thing to do, but it's far better to put the work into doing that than have all your work rot out in the field, as it were. It's the same with any other thing. So this is just an internalized version of any metaphor you want about work.

Okay.

So One of the other things to consider as you look at, you know, what's unique to me and what's kind of the same for everybody else. Last time we looked at considering where you are in the process. So am I still in the denial phase? Or am I depressed or angry? Or, you know, what's going on there? When you get to what's, you know, what's unique to you and what's kind of common to everyone else, I describe what's common in the book. But the things you have to consider are, you know, what is your individual personality? We all have one. Most of us know from feedback and living with ourselves, you know, what kind of direction we bend towards. Some people are very outgoing. Some people are very internal. Some people really like to attack problems. Some people like to avoid things. Some people have a very calculated way of dealing with problems, very almost mathematical. Other Other people have a very sort of outside-in way, you know, they might like to do mind maps and all kinds of stuff. None of those are wrong, but it really helps to know which kind you are so that you can apply that to the process as you go through it.

Real important thing to consider and ask yourself is, how do I personally— and, you know, if you've lived more than a day or two, you know. How do I deal with unpleasant situations? It's kind of the same as how do I deal with problems, only it's usually a little more specific. And the specificity of that is if you, in your past, before you had this diagnosis of whatever unfortunate disease you're dealing with, if in the past you had an unfortunate circumstance like someone ran into your car or you You know, had some other, you know, financial reversal or some other unfortunate thing happen, you know, and you can go back in your mind and think, how did I react to that? And again, it's sort of like the, you know, how's my personality for solving problems? This is how's my personality when I am challenged. And it's often real similar to what I said about solving problems, but usually there's a lot more emotion involved. Because if you've, you know, had someone wreck your car, someone took took money from you, or you did something and accidentally, you know, lost money, or some other thing, you know, unrelated to your health but unpleasant, you'll know how that makes you feel. Well, this is the same group of skills. And just like I said, where some people go faster and slower than others, if you've done a lot of work to work on how you respond to unpleasant things, you're going to know that you have some tools to deal with that. If you haven't, you've always suppressed unpleasant things, that's one of the things that is just there, and it's not bad. You just have to know that that's going to be a little, a little tough to kind of look at and, and pull through. And The other thing to consider as you're going through is, and we're going to talk about other people, but hopefully in, in your world you have at least a person or two who are supportive. And we'll talk about the other people from their point of view in a little while. But one of the things that you have to do when you're doing this discovery of where I'm at in the process, What's unique to me? How do I, how do I process bad things? And then you look at, you know, the roadmap that I lay out. You need to then enlist the support of others so that you can have them be there for you as you start to go through these things. You want to, you want to let them know, you know, hey, I'm working on this. And if they're close Friend, relative, spouse, partner, whatever. They will probably already know how you handle unpleasant things, but you know, you can talk through that with them. And their role as a support person is to be there for you. You don't often— now, you can seek professional advice, and I recommend that in the book, especially if you're dealing with, you know, a lot of anger, depression, denial. things that can be worked through, especially with a professional point of view. We talk a lot about who, who, what, and where. So certainly you can do that. But with friends, family, support people that you know, it's less about them, you know, and you need to sometimes tell them this and let them off the hook. You know, I don't really need you to be my therapist. I just need you to support me because this is not going to be easy. There's going to be some bumps in the road as we go through. And you need to keep in mind, because every day that you wake up and remember that you have this diagnosis and some either disability or pain or whatever it is you're dealing with, you're going to wake up and realize that. And you need something positive to look at in the future. And that is, is that these bumps in the road and this work you're doing is worth it because you're trying to lead not just to acceptance but to empowerment. And empowerment is where Your mind and your body allow better healing, better pain management. A lot of things go better in the world of health. Now, in the case of certain chronic illnesses and cancer of certain types and stages and grades, we talked about this last time, but I bring it up again, which is because it's a unique thing to each person, how some people. Don't really ask this question. Some people ask it every day. And that is, you know, if, if, if this is going to shorten my life and I'm going to die anyway, then isn't all this self-discovery and trying to be empowered and all that, isn't that pointless? Well, certainly in the book where I'm telling the story of the 2 different people, one person does make that decision that They don't want to do it because it's pointless. They have, you know, they have told themselves they have a death sentence and they're just going to be angry and stay that way. Now, the first thing that I say repeatedly throughout the book is there's no judgment around that, at least for me, because it's your life.

It's—

you get to decide how you lead your life and what you want to do. I did actually write the book for people who do want to do something about it, but You need to also know that everybody gets to choose their own pathway to do things. And as hard as it is to watch, if somebody decides this is pointless, I'm not gonna put the effort into it, that is up to them. It is literally their life.

The other thing to keep in mind is, and this comes in with many cancers, but also a lot of other chronic illnesses that don't tend to go away. certain autoimmune problems, chronic pain problems, et cetera, is that although a lot of people do have shorter life, a lot of people actually don't. And you can't bank on which pathway your body is going to take. But one positive thing to keep in, in, in the forefront is if you are of a mind to do things to help yourself through and move forward, there's no reason not to, and not to see if maybe you would be one of the people where we certainly know acceptance and empowerment improves quality of life. So that's a big enough thing there. But I have definitely seen people where it also improved length of life and experience of their treatment and all kinds of other things. And so really, this is all about where you are, what you decide to do and put your effort into, and what you decide to focus your time on. And one of the things everybody knows, because it's so logical and obvious, is everybody had a full life before they were diagnosed with whatever is wrong with them. So before you got a cancer diagnosis or an autoimmune chronic diagnosis or whatever else, you had plenty going on in your life. You weren't sitting around waiting for an illness to happen. So now you have your life and you've got this illness that you're dealing with. So you do have to decide and prioritize that this is important because it's literally your life you're talking about. And then you have to decide if you indeed do want to move forward and try and get past the, you know, the denial and victimhood and things and be empowered and accepting that this is worth it to you. It's worth it to put a bit of your time into it. Now, in chapter 5, I'm not going to read it because it's in chapter 5 and I give references and all, but There's a few scientific papers that have some summary in there about science and empowerment.

And one from 2019, so fairly recently if you're listening to this live, was, was a review in a very good journal. And, you know, so it talks about how the idea of empowerment is not just some pop psychology term used to make people feel good. It's an actual medical determination. And one of the things that they say in their review as they go through is that empowerment is not direct control of your condition, but actually an active relationship with everyone involved in your case and your life.

Okay.

And they go on to talk about how empowerment is an ongoing process. Empowerment is knowledge is power. Empowerment is keeping an active role in your care, etc. Empowerment is communicating with everybody, but especially your healthcare providers and your friends and family. And empowerment is being in a group or a community. So empowerment, and this of course is in a bigger paper, they go much more into it, but that's just some excerpts there. And this goes back to what I was saying in the previous chapter, in this one, where you— one of the benefits of sitting down doing the assessment of where you're at and how you handle things, but also the assessment of What can I control and what can I not control or not control much of? The idea behind this when they talk about empowerment is not the direct control over your condition is very, very realistic. And that is, you know, the beginning of being empowered is realizing I have stuff I can't control and I'm not going to ignore it. I'm going to be a participant in what others do with me about that, but I don't control most of that. You don't control— if you have cancer and you're going for radiation therapy, for example, you are not going to tell the radiation oncologist generally how much radiation dose they are going to give you. You are not going to generally tell your medical oncologist the dose of, you know, carboplatin that they're going to give you or whatever else. You might have discussions about it. They might offer you some different things depending on certain things. If you have a chronic autoimmune problem, you might be offered maybe 2 or 3 different avenues for treatment, but they're all similar avenues with pluses and minuses. So you have a little control but not complete control.

So really empowerment starts in letting go of the idea that you control everything And working on accurately controlling what you do control, which has a lot to do with your mind, your body, how you think, how you feel, what you do with yourself, and then being connected and involved in the stuff you don't control.

And that's really what they were getting at in that paper.

It was a very, very good paper all about that.

So at the end of that chapter, I go into what are the next steps, the The first thing is to realize that empowerment is not just a buzzword.

It's, it is a, it is an actual place you can be. And the other side of that coin is you want to realize that empowerment is done your way. So like we said, everybody might go through the same pathway to get there, but you're going to do it in your way, and yours might be totally different from everybody else. Like I said, some people are better at some parts than others, and you're going to take more time where you're not, you know, quite so good. Sometimes you have to keep going back to certain things. It's okay. It's okay. You want to keep in mind that the, if you will, the carrot in front of you is this is about your quality of life. This is about your relationships. This is about your quality of healing. And one of the problems— and I brought this up last time as well— is that, you know, and not all for bad, but most of us are raised, you know, to not be selfish. And we certainly don't want, you know, to be running through the world engaging with everybody, you know, taking away from people and being unpleasant and all of that. That's the, you know, that, that's being selfish. What we have to keep in mind is if we have a disabling or life-threatening or life-shortening or all of the above illness, it is not selfish to do introspection, figure out where you're at. It is not selfish to go through the process your way. It is not selfish to carve out time In your day so that you can do this. It is not selfish to ask for help. Those are not selfish things. We misappropriate them in our minds with the negative things that we were told not to do growing up.

But those negative things you were told not to do growing up have nothing to do with putting yourself last. When you are ill. It's— we should be doing it when we're not ill, but when you are ill with something especially of a chronic or life-threatening nature, you come face to face with the idea that you better become important in the equation of your life or you're not going to have very much life to deal with. So that takes us through chapter 5. Obviously there's much more if you do decide to get the book and read it or listen to it or whatever way you like to do books. Just, it was very, you know, the first cancer book that we did, Dr. Mark Stengler and myself, it was very much about, you know, treatments and things of that nature, which are very important. It didn't lend itself really to audio versions and stuff because it's more of an encyclopedia. It's that big one over on the corner there, Outside the Box. But this one lended itself to all types of media, and I know for myself, especially not so much in the last year with COVID but where I travel for work and speaking a lot, I listen to books a lot, you know, on an airplane or something, and it takes a little weight out of my luggage if I don't have to carry the book. So in this book, it was really kind of nice and freeing to be able to put it on as an audio and to have it on as a Kindle or an e-reader, Also to have it as, as a book book, as I like to call it. But chapter 6, if you get to that point, is a— is a little bit of a departure from what we've been talking about in chapters 1 through 5, only in— it's the same book and topic, obviously. But when you get to chapter 6, what you're really looking at is Other people, and that can become a very difficult conversation. Now, what about other people, right? And so the title of Chapter 6 is Family and Friends: How Do I Involve Them in a Healthy Way? Right now, just like I said in Chapter 5, where, you know, if you've never really thought about where you put yourself in the world of your priorities and all of that, having a life life-threatening, life-shortening, disabling type of a diagnosis will bring that right up to the forefront of your mind. The same with family and friends. If you have difficulties with family and friends, you know, and I have a quote at the beginning of the chapter from Ram Dass that I believe he says, if you think you're enlightened, you know, spend a week with your family. You know, it's just the nature of humans. And the closer you are to other humans, the more you know about each other for better and worse. And so with family and friends, now certainly there are families that are just naturally gifted at helping each other, coming together, you know, doing what's needed, not being overbearing, not being too distant, all of that. If you have that with your family and friends, number one, you won't need chapter 6 in the book, but also you, you are an extremely blessed human.

Okay.

Most of us are surrounded by a variety of humans who are family and friends. Some we're related to, some we're not related to. Some we are around that, you know, maybe we are friends with them because of another relationship, a work relationship, or, you know, our brother or sister is friends and so we're friends, but we might not normally choose to hang out with that person as much unless there was that third part of the relationship. It's just all sorts of dynamics with family and friends. And so when it comes to family and friends, one of the things to keep in mind is that who, who you surround yourself with winds up being a large portion of what is spoken into your mind and into your Your spirit, etc. Whatever way you want to divide up our insides and how they think and feel and act, and the things that get spoken into you and around you can make this process you're on easier or harder by quite a ways.

Okay.

Often when I'm teaching, I will remember a story. I didn't write about this in the book because the The editors probably wouldn't have let me anyway. But I had a patient and one spouse— the two spouses were separated. They weren't really divorced, but they had separated, I don't know, 6 or 12 months before the spouse with cancer was diagnosed. And so, as happens even in divorced couples, Someone gets diagnosed with cancer, they have a long— you know, these people have been married a long time, they come together for support, and, you know, and that's fine. It can be a very good thing. It can be a very bad thing, but it can be a good thing. So it's not unusual to see. Well, for whatever reason, it became apparent as the therapeutic relationship went forward This person was diagnosed with an inoperable, untreatable type of a cancer, and their spouse was coming along to be supportive. And as we worked with that patient and their tumor started to shrink, and they became more healthy and able to do things— now they still had cancer, but they had less cancer, and it was not pressing on. vital organs as much, they started to become more healthy. And there is a situation with some cancers where the cancer doesn't go away, but it becomes more like a chronic illness than a cancer. Okay, well, after about 2 months, that was going on with this person. But for the first 6 weeks When the two spouses would come in, the spouse that didn't have cancer would literally look at me with their spouse sitting next to them and say, "When are you going to put my spouse in hospice?" And I would say, "Well, they don't technically qualify for hospice right now." And they appear to be having some improvements. That's not the time you put people in the hospice. And the first time it happened, I thought, oh well, maybe they just don't get what hospice is. Uh, each time they came in, they would ask when I was going to put this other person in hospice, to the degree that I would think— I never said it out loud, but I would think, you realize your spouse is sitting right next to you.

Right.

And you're basically saying that their life will be ending soon and they need to go into hospice, and they were actually getting a bit better. Well, after about 6 or 8 weeks of asking this every week and a half, the helpful spouse quit coming to the visits because the person was getting so much better and having such improved quality of life that they were nowhere near going to hospice. And just, you know, for the record, the last time we checked on that patient who was supposed to die within a year or less, and it was bad, whatever cancer they had, it was bad, bad news. They were alive 6 years later. So they still had cancer, but they were just— they had a quality of life, right? So that's a pretty extreme example. Somebody sitting next to you asking when you should go into hospice when you don't need to go to hospice. Now, if you need to go to hospice, That's a great question. This was not that, like, completely inappropriate. And I just kept thinking, well, that's not the person I want on my team, right? So when I write in the book that family and external influences can be medicine or poison, I'm writing that from personal experience of seeing people who literally are either therapeutic in a positive way, or actual poison in the person's life. So the other thing, and I talked about this in chapter 1, but I want to just take a couple of minutes with it here, is we have to remember that if you are the patient with whatever the problem is, You need to remember, it is not your responsibility other than to know and to understand this is going on, not your responsibility to fix. But you need to remember that everyone in your circle who loves you and cares for you is going through all these same steps as well. When you're first diagnosed, they are going to be in disbelief and shock. And, and then, you know, angry, etc., etc. Now, as I said, and especially if you have a caregiver sort of personality, you may want to try and do things for that person. And it's not that you want to ignore all of that, but you need to remember that your efforts towards the process need to go towards yourself so you can process through. But you also need to be mindful that they just got a shock too. They love you. They care for you. They're your friend or family member, etc. They don't want you to have this diagnosis either. Okay, so you need to remember that they've got those things. And all that stuff that we just talked about in the prior chapter about how, you know, if you have an anger management problem and you've really dealt with it and worked through it and you got all these tools for anger, anger may not be your your stumbling block.

If they have anger management problem and they've ignored it and they've never done anything about it, anger might be the place that they really flourish and that's not really great and they need to get some help with that. Same thing with depression. Okay, a lot of people have ways of coping with depression and kind of working around stuff and they do pretty good. And then they get hit with this or they get hit with a loved one who gets sick and they hit that stage where you, you hit towards a depressive stage in, in your processing, and, and it can really take a person down. So again, for your family and friends— and, and I'm not saying this is your responsibility other than to just know it's going on— if, uh, your diagnosis, you know, submarines them into, uh, any, you know, uh, unhealthy sort of pattern, whether it's anger or depression or Denial, etc., they need to get with somebody, a professional, to work through that. And the book we talked about, there's a plethora of types of professionals, but they need to do that.

Otherwise, inadvertently or advertently, but I've seen a lot of times where the loved one didn't mean to, but they just brought all this poison to the relationship because they hadn't let go. their depression or their anger. And so when they would try and help the loved one, their other loved one, it would come out through this filter of whatever they were dealing with. So you do want to remember, although it's not your job to fix the other person, you need to know that they're human too, and they're going through all of these sorts of things. Now, in this chapter, uh, I mentioned one or two, uh, studies also that have gone on And one of them I thought was interesting. I'm going to really summarize a whole lot of words here. But as a study around families, you know, so friends and loved ones, your families, usually the closer people to you. But they looked at 2 primary things that we talk about in the, in the steps of going through the process of getting to acceptance and empowerment. And those 2 they looked at were depression and anxiety. And so what they summarized in this research that they did was families that act openly, express feelings directly, and have a problem-solving focus or problem-solving nature Overall, we're much less depressed. Now, if you think about that, this is one of those things where, again, our own, you know, our own internal constitutions or way our personalities play out, etc., become huge here. So if you are in a family or a care unit or whatever it is that you have going on around you, And no one is used to acting openly and directly expressing feelings and working on solving problems. What's the opposite of less depression? It's more depression, right? This is the same thing as I was saying, if you get to the step where, you know, anger is a big deal and you never dealt with your anger, it's going to be there, right? In families where especially the person, the patient, is very, very ill, sometimes there needs to be intervention on a family level that may or may not involve directly the patient all the time. But sometimes the family needs to work through this and have a way of, you know, being able to act openly and express feelings without doing it in a in a harmful and negative way. And that's one of the biggest reasons, I think, why people don't, you know, act openly and give direct feelings and all that, is they maybe have only seen that modeled in a way that's very abrasive and aggressive and, you know, not— doesn't have a healing outcome, doesn't have, like they were saying, the problem-solving outcome.

What about anxiety?

Well, it turns out that just like lowering depression, the families that had more direct communication had less anxiety.

Now, what's the opposite of direct communication? The opposite of direct communication is stuffing things under the rug and avoidance behavior and avoidance of, of normal and difficult discussions and all that. Now, there are whole books written about those things, and there are people who are very adept professionally at helping.

But you can just sit and think about it, you know, if your family or your friend unit or whatever, if you have a way in a nonviolent manner to be able to bring up a problem and hash it out and work through it, it turns out that as a family unit, even with someone dying, you will be less anxious about things.

If your MO in your family or your care group unit or whatever is to never discuss these things and to never try and, you know, get to a resolution where everyone at least sees each other's point of view and moves on, that will just engender more anxiety and usually anger, etc. And that's from, you know, as I said, that's from some pretty you know, hardcore science, really. And I do that throughout the book. The book is not over-sciency. I don't quote, you know, a million studies and all of that. The first book, which was about therapies, that one over there on the side, Outside the Box, we have over 1,000 scientific references because it's about therapies and things. And this one, I just put them in to give a flavor that a lot of people don't realize that in the behavioral and medical sciences, Empowerment and the way you deal with other people and the way it makes you feel is a real scientific part of the healing process. And so I just, I put enough in so, you know, not so much that it gets old or boring. Now, you want to keep in mind friends and family can be, you know, neutral, meaning they're not hurting you, they're not helping you, but They're there. They can be a healing force, especially if, you know, you've got all those things going on, or they can actually be toxic.

Now, in the rest of the book, in the rest of this chapter anyway, about family and friends, we get into a lot of depth about what do you do if, you know, this is somebody that you can't really distance yourself from. Some tips in there about that. What do you do if the person refuses to get help and they really do need some help? The biggest thing to keep in mind is that all of this interpersonal stuff that the family and friends bring around you is normal. And as I said, it's your responsibility to realize it's there, but it's about them. It's not about you. And so you cannot take on the responsibility of trying to heal the people around you when you need healing, and you cannot take on whatever they're projecting as your problem, because it's not. What you do need to do is be realistic that they're all human just like you are. They've had a very big shock just like you have. And for the most part, people want what's best for you. But they just got the shock like you did. And they don't know how to navigate to the other side. There's a number of tips and ideas in the rest of the chapter on how to deal with friends and family. There are some really great concrete ideas about if it's not someone you live with, ways to communicate with them to just say, you know, I need a little space, or, you know, kind of limit your timeframes with certain people who just can't help but bring, you know, toxicity and negativity towards you. People who you do live with, often you might need to get some outside help and work through it because by and large, people that you live with want the best for you. They just, they don't know what to do or how to handle it. And they're grieving themselves. But as we sum up chapter 6, and that'll where we'll end today, and so in part 4 we're gonna move on into other stuff. Just want to remember that you and your health are the most important thing, and that's not being selfish, that's taking care of you. Because if you take care of you, it'll definitely improve your quality of life, probably your experience of your medical care. Bunch of other stuff, but then you will have something to give back to others. You don't take care of you, you can't do anything with others. You will need to have some difficult conversations, but in the book I put a lot of resources for ways to do that, and if they're real difficult, there's others who can become involved to shepherd you through those things. And the other thing is, while none of that is your responsibility— what is the other person's is the other person's—

you do need to take responsibility to ask, to be open, and to communicate, because they don't know what you're thinking either.

Well, that gets us to the end of our time today.

I'm Dr. Paul Anderson for Medicine Health with Dr. Paul, and we're working through our book Cancer: The Journey from Diagnosis to Empowerment. We're talking about all these ways that we can both become empowered on our own and be have a better medical experience and quality of life, but also those around us. You can find me at dranow.com, and all the links to the books and the media and everything is in one. One home now. D-R-A-N-O-W, dranow.com. But this is Dr. Paul Anderson for Medicine and Health, and I will see you all on the radio with part 4 next week. Thank you.