Cancer Diary: Anger Is a Multifaceted Thing

 

Anger, in its narrow form, is one of the stages of dying that Elizabeth Kubler-Ross identified quite some time ago in her book, On Death and Dying. People go through various stages, according to Kubler Ross (though her stages have been disputed), the second of which in her model is anger (though she herself later stated that the stages are not necessarily sequential). 

While anger of the patient was the focus of Kubler Ross and of most books and posts about cancer (and other dying) patients, my recent experience is that anger comes also within and from the caregiver, who had not planned on this life-changing (and time-changing) activity and likely is not prepared for it, whether it be lack of skills, lack of knowledge, lack of medical communication or options, lack of time to accomplish all that is necessary and thereby creating considerable stress, or lack of temperament/patience, causing anger to well up as a reaction to inability to control the environment and limited to no time to plan controls or activities.

Where the anger is directed can depend very much on the source of the anger:                      

•  Anger is often directed at the patient (seems unfair, but it really does happen), especially where the patient is demanding and the skills and time (typically both) are lacking. It is a perfect storm of high demand and low resources. Big stress! Depending how one reacts to stress, irritability, loss of compassion, and patient-directed (sometimes intentionally hurtful) anger can be explosive and corrosive -- and uncontrollable even when aware that there is not likely to be a time when hurtful comments will be able to be walked back and anger put to rest and apologized for (and forgiven).
• Anger can be directed at the self, together with other directions (patient, God, the universe). This kind of anger can be complicated or even caused by a sense of guilt. If it is not caused by a sense of guilt, then it almost certainly results in a sense of guilt. Forgiving oneself is sometimes the hardest thing to do and may need to involve a therapist. Varying therapists suggest varying "steps" to self-forgiveness, but they all involve accepting what has happened and moving beyond it.
• Anger can be directed, often rightfully, at others. Perhaps they (especially medical and other support personnel) are not helping enough or providing adequate information, insight, and/or expectation. Sometimes well-placed, well-controlled, and well-directed anger against others can move mountains. Other times, though, it is displaced anger--anger that one cannot bring to direct to the real source: self, patient, or God/universe.
• Anger is often directed at God, and this is the kind of patient anger that Kubler Ross writes about. Trying to explain why bad things happen to good people has prompted a number of books, including Rabbi Kushner's book, When Bad Things Happen to Good People, Sula the Parish Cat's book, Surviving Cancer, Healing People, and many others easily found from online sellers with a quick Google search. The best response I have found to the question, "Why me?" in my own life has been "Why not me?" For me, there is a logic there that brings peace and acceptance. 
• Similarly, for those who do not believe in God or for those not willing to place blame on God, anger can be directed at the universe. At no one in particular and everything in general. It often comes from a sense of being given an unfair burden (caring for a dying relative is unfair and is a burden) or from the reality of work and even career disruption (a big stress point). With no one to blame and stress simmering ever hotter, it can all boil over into an anger expressed in general raging against life, the universe, some unfathomable, unfair, unknowable. In measuring energy expenditure, such an anger can go well beyond just letting off steam. All too often when "life" is the conspirator and support is not readily available, nothing helps until the patient dies. (Sad, but too often trouble, and the source of much remorse and guilt after the death.)

A sense of guilt from being angry both during the dying and after the death, especially remorse for that anger that was directed toward the patient, especially if it was expressed, can lead to long-term regret, self-recrimination that has no outlet or obvious resolution, sadness, and/or depression. I realized that I was not alone in my anger when I heard it expressed in similar ways by a colleague in a similar position: "I am a lousy caregiver." How many times I expressed that sentiment during the dying and after the death, both as remorse and acknowledgement that I did not have the required skills or temperament for the "job!" (It did not help that Carl was admittedly a "lousy patient" -- except for two heart attacks, which occurred after the age of 70, he had never been really sick or in a hospital before, and he did not like being sick. Although he did not think he was demanding and uncooperative and was in complete denial when presented with this perception on the part of others, in reality, he was, and each care facility was eager to move him on to another, until finally he was sent home on hospice.

Anger can be considered a cry for help when sustained (according to Ortman, it is an indication that there is a loss of wholeness), and when directed at other than at God/fate, it really is. It is a signal that the caregiver is overworked, highly stressed, and unable to find support. One of the ultimate goals of Carl's Cancer Compendium is to remedy this situation, especially in small towns off the beaten track, such as the one where Carl lived, where even social workers from the patient's city hospital are unwilling to travel the distance to conduct an assessment of in-home need, let alone being able to find helpers to assist with care and emotional support for the caregiver. Janice Snyder experienced this situation for years (compared to the few months I had to endure it); the result was a very helpful book, Survival of the Caregiver (information and excerpts HERE). Others who have gone through the experience have also written books -- a lot of them; as we know, catharsis often lies in writing about experience.

Anger is not avoidable, says Snyder, a therapist as well as a caregiver; "Show me a caregiver who says he or she never gets angry, and I’ll show you a liar or a saint." The answer to anger, she says, is to find an outlet. Otherwise, everyone gets hurt. (Read a short excerpt on anger from her book HERE.) 

Whatever the cause -- cancer or something else or cancer and something else -- anger can become a long-term problem, in fact, addictive. Dr. Dennis Ortman has written a book that has helped many get past their anger: Anger Anonymous: The Big Book on Anger Addiction (see more posts and excerpts HERE). Both Anger Anonymous and Survival of the Caregiver can be obtained on 25% discount for readers of "Cancer Diary" by using the coupon code FF25 at the MSI Press webstore.

And for a short article that proposes some strategies for managing anger, click HERE/

For more posts on anger, click HERE.

For more posts from Cancer Diary, click HERE.

For other posts on cancer, click HERE.

Blog editor's note: As a memorial to Carl, and simply because it is truly needed, MSI is now hosting a web page, Carl's Cancer Compendium, as a one-stop starting point for all things cancer, to make it easier for those with cancer to find answers to questions that can otherwise take hours to track down on the Internet and/or from professionals. The web page is in its infancy but expected to expand into robustness; updates and additional information are added every week. 

As part of this effort, each week, on Monday, this blog will carry an informative, cancer-related story or sharing of some experienced aspect of cancer, "Cancer Diary," which will also be open to guest posts.