The Emotional Toll of Prostate Cancer

There are many life events, including a cancer diagnosis, that can erode the quality of one’s mental health. I think of my own mental health as being comprised of three general categories of well-being: psychological, physical, and spiritual. The best indicator for me of good mental health is positive, honest self-talk. When the voice in my head gets negative, or when I start deceiving myself, I’m headed for trouble. Over time, I’ve learned to use all the resources available to me to maintain good mental health. “Out of the darkness, into the light.” In 1993, I was forty-four years old, married with three children, a teacher with a good job teaching high school English, living in a comfortable home in a beautiful coastal town in California. On the outside, everything looked good. On the inside, I was falling apart. Long term alcohol use had turned into alcohol abuse, and by the time I realized it I didn’t have the power to control it. My self-talk had turned toxic. Anxiety and fear became so great that there were mornings when I didn’t want to get out of bed. I started seeing a psychologist who guided me to a doctor. I was honest with him and after a physical he told me what I needed to hear: I was an alcoholic. The next morning, after a few too many drinks the night before, I woke up and had a moment of clarity. I was determined to never drink again, and so far, twenty-six years later, I haven’t. I continued with therapy, I increased my exercise and I started and maintained a spiritually-based program of recovery. I also spent a period of time using anti-depressants until my self-talk became healthier, contained much more light than darkness. In fact, my mantra for that stage of my life became, “Out of the darkness, into the light.” Finding emotional support through therapy Eleven years later, my career and private life thriving, I was now the principal of the same high school, starting my third year in that position. It’s a demanding job. A serious personnel issue, that included false allegations about me, pushed me back to the edge of high stress anxiety. I thought I could handle it, but one day I was overwhelmed and had a full-blown panic attack. Once again, my self-talk had turned against me, and I was powerless to redirect it. I returned to a therapist, went back on an anti-depressant, weathered the storm and continued as principal for another seven years. After two years I weaned off the anti-depressant and haven’t needed it since. Battling heart disease Despite regular exercise, a balanced diet, and normal blood pressure, in the summer of 2010, after a very stressful year on the job, I experienced symptoms of heart disease that led to the discovery of two blocked arteries in my heart. A stent was installed and I started taking a statin to reduce my cholesterol. For the first time in my life, mortality became a constant consideration. My self-talk remained positive and honest, but I was beginning to see the handwriting on the wall, and I initiated conversations about retiring, which I did in June of 2011, a few months short of sixty-three. With more exercise and an even better diet, I lost fifteen pounds in less than a year and felt great. Nonetheless, after a big high altitude backpacking trip, I had a mild heart attack in September 2012. Another blockage was found, another stent installed. My intuition about self-preservation, the product of being open and honest with myself, may have saved my life. My journey with prostate cancer begins Then, four years later, my journey with prostate cancer began, which I’ve covered extensively in fifteen articles for ProstateCancer.net. Once again faced with an existential crisis, I sought help from a therapist, and continue to see him periodically when I feel uncomfortable, not just about cancer but about life, particularly the aging process. Exercise continues to be fundamental to maintaining good mental health. I weigh the same as I did when I ran track in college fifty years ago. And I’ve just had cataract surgery. What a revelation! I can see real colors again! Discovering harmony My spiritual beliefs come from my program of recovery from alcoholism. Very simply, they echo the old Beatles song: “I am you and you are me and we are all together.” We all play a small but important part in a big cosmos, but when we form a community based on love and service the sum is greater than the parts. If I focus on the microcosm – me, the guy with alcoholism, heart disease, and cancer – I’m doomed. My mental health turns to mental illness. If I focus on the macrocosm – a small but important piece in a big cosmic puzzle – I’m redeemed. When the three voices of my mental health – mind, body, spirit – are in harmony, my self-talk can be a beautiful melody. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] Lao Tzu wrote that a journey of a thousand miles begins with a single step - but what if we don’t want to make that journey in the first place? A cancer diagnosis is often described as the start of a journey, but it’s a journey into the unknown, thrusting those who make it into painful knowledge that strikes right into our desire to be seen as a person with the power to define our life’s direction. Now that diagnosis is taking away that control and often making us feel us that we are just an object for the medical professionals on which to practice their skills. How do we retain a sense of control over our destiny and become an equal partner in navigating treatment and so retain a sense of dignity during what can be both mentally and physically most undignified? Embracing a new phase of life A prostate cancer diagnosis typically comes as we men are already facing up to the fact that we are not the lithe, agile, and virile young men that we had once been. Many of us are already in mourning for the times when we had boundless energy, speed, and physical resilience so the sudden news that a component is now not only faulty but potentially threatening our life isn’t tough, it’s brutal. My perspective is that we have first to accept the end of the chapter that was our early middle age. Identify the successes that came in that period and recognize and celebrate them, but don’t dwell on the mistakes - we are all human. A new era isn’t automatically a bad one, it’s just a different one, even if it opens with a bad piece of news. As younger men, we often met a new challenge with brute force - that nut that wouldn’t turn - use a longer wrench, that girl that wouldn’t notice us, be even bolder and daring. We must find ways to support each other As we’ve matured we’ve probably found ways of working smarter, not harder - achieving the same result or even better but with less sweat. At a time of great difficulty, we can draw on that greater insight and thus apply ourselves to the many issues that cancer poses to us. Much of what we need to do is gather data about our surroundings, our allies, and our possible routes. At a time when many would rather go into denial, we need to be at our most communicative. We must seek out information from people we can trust, cross-check it and build a map to guide us on this new journey. The hard moments will pass With the map in place, we can hope that while we will still have fears we do now have information and with luck people who can support us on the route, we have already started to take. Don’t be hard on yourself if you find it tough, there will be moments of huge challenge, massive self-doubt, and great worry. But they will pass. The journey can be made. Be ready to take that first step. Let’s hope the journey is less than a thousand miles. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"],Depression is a common condition in people with prostate cancer. Even those who have been successfully treated for their cancer can develop depression and anxiety. Since depression is a serious condition that can increase the risk that you will harm yourself, it is important to be aware of its symptoms and to get help as quickly as possible. The symptoms of depression include2: Depressed mood (sadness, hopelessness) Loss of interest or pleasure in most activities Weight loss Thoughts of death or suicide Sleep difficulties Slowed or agitated behavior Fatigue Thoughts of worthlessness or guilt Inability to concentrate or think clearly If you notice the symptoms of depression in yourself or a friend or family member, alert your doctor and ask for an evaluation. Major Depression: Symptoms and Diagnosis Definition Typically involves mood states including grief and sadness Key element that sets it apart from mood swings is that mood state persists over extended period of time Diagnosis At least 5 of the 9 symptoms below Must include depressed mood or decreased interest Symptoms must have persisted for most of every day for at least 2 weeks Symptoms of Depression Depressed mood (feeling blue, down-in-the-dumps, hopeless) A significantly reduced level of interest or pleasure in most or all activities Considerable weight loss or gain (5% or more change of weight in a month when not dieting) or change in appetite Frequent thoughts of death or suicide (with or without a specific plan) or attempt of suicide Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia) Behavior that’s agitated or slowed down, which is readily observable by others Feeling fatigued or very low energy Having thoughts of worthlessness or extreme guilt A diminished ability to think, concentrate, or make decisions Treatment of depression The biggest challenge to treating depression is that people are often reluctant to seek help and follow-through with treatment. Some people believe that they need to be strong and stoic about emotional difficulties. Admitting the need for help is difficult and can seem like surrendering. However, real strength is reaching out for help when you need it. By doing this, you’ll be taking charge of your health and welfare. Mental health experts agree that the best treatment for major depression is a combination of antidepressant medication and psychotherapy or counseling. While each type of treatment can provide some relief for depression, the combination works together and can be highly effective.3 Psychotherapy or counseling for depression can be done individually or in a group by a qualified psychiatrist, psychologist, social worker, or counselor. It generally takes several months of treatment to get the best results. So, be prepared to stick with it for a sufficient amount of time. You may also consider joining a support group for people with prostate cancer. Getting support from a community of people dealing with similar problems can be a useful and powerful experience. While support groups are a useful addition to formal psychotherapy or counseling, they are not a substitute. Speak to your doctor to get a referral to a qualified mental health professional for psychotherapy or counseling. Antidepressant Treatment Only a qualified healthcare provider can determine which antidepressant medication will be best for you. Additionally, if you are being treated for prostate cancer, your doctor will be concerned with the potential for interactions between your cancer treatment and antidepressant treatment.1 A variety of antidepressants are to treat major depression. These include a group of antidepressants called serotonergic antidepressants, such as Zoloft (sertraline), Paxil (paroxetine), Effexor (venlafaxine), and Prozac (fluoxetine). An older generation of antidepressants are in a group called tricyclics, and include Elavil (amitriptyline), Pamelor (nortriptyline), and Tofranil (imipramine).Other types of antidepressants may also be useful, including Wellbutrin (bupropion) and Desyrel (trazodone). Different antidepressants cause slightly different kinds of side effects, and no individual person will react the same to every medication. You will need to work with a doctor to find the right antidepressant for you. It may take up to 6 weeks to find out how well a particular medication will work for you. Work closely with your doctor and be prepared to give the process time. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] In the 50’s John Hopkins scientists did a study on the power of hope. Using wild and tame rats, they proved that hope can be the deciding factor between life and death. The hope study The hope study was gruesome in nature as it involved drowning rats. They put tame rats in a tank put on a lid and filled the tank with water. The tame rats, raised in captivity and knowing they could not escape the tank, drowned almost immediately. They did the same to the wild rats and found they swam a little longer than their tame counterparts but drowned within minutes as well. This was the scientific arm of the trial. For the experimental arm more wild rats were put into the tank. This time however as the rats began to struggle they were plucked out of the water, put into a warm dry place, and fed. The following day they were placed back into the tank. Hours later, the rats were still swimming. One could speculate that the hope of getting out of an impossible situation encouraged them not to give up. We have been indoctrinated to believe there is no escaping cancer. Much like our 4 legged counterparts, we believe cancer is a trap we are powerless to overcome. The torch of hope has been extinguished. How? Why? Picking up the gloves Like most products of the 60’s and 70’s I grew up being programmed to believe cancer is a death sentence. Hollywood taught me year after year that a cancer diagnosis was the end. Love Story, Brian’s Song, Griffin and Phoenix, to name a few. There are literally hundreds of these movies. They all have the same common denominator. The Star Dies. The trend continues to this day. Walk to Remember, The Last Song, The Fault in Our Stars, Terms of Endearment, etc. etc. Goodbye hope. In my opinion, “Hope” is the most powerful weapon in our arsenal. It appears that there may be scientific evidence to back up my opinion. I have known many cancer patients throughout my Journey. Experience has shown that when people are diagnosed, they tend to do one of two things. They either put on the gloves and step into the ring or they pick up a shovel and go dig a hole in the ground. Why is it that some face the trials head on and others simply roll over and wait to die? I believe hope plays a role. Keeping my word Webster’s defines Hope as a feeling of expectation or desire for a certain thing to happen. I expect to do well in my fight against Prostate Cancer. Webster’s defines Faith as complete trust or confidence in someone or something. I believe I will do well in my fight against Prostate Cancer! I believe the two go hand in hand. We must have both expectations and confidence in order to persevere. My first doctor whom I had just met gave me a prognosis of one year. A family doctor whom I had known for many years told me I could still live a few more decades. I chose to believe the latter. When I married my wife a year after my diagnosis I promised her 30 years based on what he had said. Failure is not an option. I expect to live into my 70’s. I believe I will make it. My definition of faith has always been “An unshakable belief in that which cannot be seen." I cannot see tomorrow but I believe it is there. It is time to change the perception of cancer. We must speak into existence a new reality. Cancer can be defeated. There is hope...there is hope...Brothers and Sisters...There Is Hope! [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Receiving a cancer diagnosis and battling cancer can be a very distressing experience. Even if an individual’s cancer is thought to be cured, there is still a risk of the cancer recurring or a second cancer developing. Additionally, some of the side effects from common prostate cancer treatment options, including sexual dysfunction, bowel or urinary incontinence, and hot flashes, can greatly impact a man’s quality of life. All of these factors can lead to significant mental and emotional distress. It has been estimated that nearly 30% of individuals with prostate cancer experience mental or emotional distress, with roughly 25% reporting increased anxiety, and 10% being diagnosed with major depressive disorder.1 The way an individual experiences and handles these feelings varies greatly from person to person. For some, these emotions may be self-manageable, but for others, they may increase until outside support is needed. Whatever your specific situation is, it is important to reach out for support when you’re feeling down, scared, or overwhelmed. Overall wellness goes beyond physical health. Your emotions and mental state can greatly impact your quality of life and ability to handle stressful situations, such as a prostate cancer battle, as well as even your physical health. Remaining as positive as possible, staying informed, taking the journey a day at a time, and seeking additional emotional support outlets can make a big difference. Communicate with those around you If you find yourself feeling depressed, anxious, scared, or overwhelmed by your emotions, it’s time to reach out for support. One of the first, and sometimes hardest, steps in the process is opening up to others. How much information you choose to share, and who you choose to share it with is completely up to you. Additionally, communicating with others doesn’t have to mean that you’re severely struggling. Instead, you may just want to have a conversation about role changes in the household to keep things running smoothly, or ask for a partner to eat healthier or exercise with post-treatment to help you with healthy living post treatment. Emotional support does not have to be exclusive to those who are experiencing mental distress. For many, extra emotional support can act as a preventative measure to reduce the risk of developing severe depression and anxiety later on. Seeking emotional support is normal and encouraged. It does not mean you cannot handle your situation on your own, but rather, that you recognize the need to nourish all aspects of your health. Sources of support There are various sources of support and individual may choose to seek. Several of these include: Healthcare team For many individuals, their healthcare team is the first stop when seeking emotional support. Your doctors may be able to help you medically manage feelings of anxiety or depression, as well as recommend various counselors, therapists, or support groups in your area. Mental health professionals Mental health professionals include a wide variety of individuals. They can range from clinical psychiatrists who can prescribe medications, to therapists or counselors who will talk with you about your concerns and feelings. Some mental health professionals may be in a more clinical setting, while others may have more relaxed or home-like locations. It is completely up to you what environment you seek out. Also, you can choose between 1-on-1 therapy, therapy with your spouse or partner, family therapy, or group therapy with other individuals living with cancer or who have completed cancer treatment. Friends and family Opening up to friends and family about your cancer battle or emotional concerns can be liberating. It can also help you establish new roles and expectations as different aspects of your life change. Support groups Support groups can be in-person where you meet with individuals also battling or recovering from cancer, however, they can also take place online. For individuals who would rather not meet in person, or who want more frequent support than however often their group meets, online support groups are an excellent option. Facebook groups and communities like ours can be considered online support groups and can provide around the clock support to those in need. Channeling your emotions Practicing strong emotional health can also be an individual activity at times. Finding healthy ways to channel your fear, frustration, pain, or anxiety can help reduce stress and keep your mental health strong. Examples of activities that can help an individual channel their emotions include exercising, journaling, hobbies, or religious or spiritual practices.2-4 Fostering strong mental health and reaching out for emotional support is a critical part of a cancer battle or life after treatment. Although it may seem difficult to seek outside support at times, the benefits are immense. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"], In this article, I would like to talk about a few of the not-so-commonly discussed issues that are related to prostate cancer. There are many journal articles written about the direct physical effects of prostate cancer treatments, which include urinary incontinence, bowel problems, and issues with sexual performance. But I would like to focus on the emotional and psychological side effects related to sexual health. I will conclude this article with a few solutions that some men have found helpful. Let's start by saying erectile dysfunction (ED) can be a common side effect related to prostate cancer treatments. Some people may find it more distressing than other side effects, including urinary incontinence. So let's talk about the psychosexual changes related to issues with sexual health. Masculinity and ED In our society, a large part of how we view our manhood and masculinity is related to sexual conquests, performance, and self-esteem. So, when our “sexuality” is taken away due to an illness or medical treatments, what are we to do? This loss can have a profound effect on the emotional or psychological well-being of men, beyond the physical act of sex itself.1 There is the realization for people that a future sex life may be much different than their previous sex life, and that can affect their definition of manhood. Issues related to erectile dysfunction can include:1 Sexual performance Anxiety about satisfying a partner and oneself Hesitation in initiating physical intimacy Feeling that sex is awkward and unnatural Relationships Awareness of loss of potential for sexual intimacy Upsetting absence of a sexual element in everyday interaction Sexual imaginings Distressing lack of physical or emotional response to attractive people Loss of a pleasant pastime: fantasizing about sexual intimacy Masculinity Diminished sense of oneself as a man Loss of a defining feature of manhood Relearning sex? As you can see, men can report a loss in physical sexual ability along with emotional impact and psychological doubts as well. Men may also report their sense of manhood is diminished. It’s my belief that sex therapy and "relearning sex" can be a benefit to people who report these feelings. While I’m not a medical doctor, I commend the work they do to save lives and add more years to people's lives. Today, some doctors who treat prostate cancer also work with sexual therapists who help guide people to understand treatment options and the possible changes to their physical and psychological sexual response. Sexual therapists also offer options for better sexual activity and sexual health. Without question, sexual therapy should be included as a part of a patient’s treatment. I think it's good for men with prostate cancer to remain sexually active, if possible, while adhering to their prescribed medical treatment. 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The Emotional Toll of Prostate Cancer

Mental Health: Mind, Body, Spirit

The New Normal?

Recognizing Depression and Getting Treatment

The Power Of Hope

Finding Emotional Support

The Vanishing Man of Steel

The Psychosexual (Side) Effect

Mental Health is “Real” Health

The Power of Positive Thinking

Mental Health Myths and Facts

Embracing the New Me

Caregiver and Family Resources