How to Deal With a Life-Changing Diagnosis

This article was previously published July 18, 2019, and has been updated with new information.

In 2019, 1.9 million Americans are expected to receive a diagnosis of cancer,¹ and it doesn't matter who you are, hearing "you have cancer" is a devastating blow. Oftentimes, the trauma of the diagnosis is further worsened by well-intentioned people who simply don't know how to respond to the news.

A July 2019 article² in The Atlantic addresses this sensitive issue. Taylor Lorenz tells the story of Kate Bowler, a 35-year-old historian and author of "Blessed," a book that deals with "the origins of the notion that good things happen to good people."

Bowler's cancer diagnosis came like a lightning bolt from a clear-blue sky. In 2015, she sought treatment for stomach pain. It turned out to be Stage 4 colon cancer, and she was given less than a year to live.

"Many people who receive her diagnosis begin to get their affairs in order and spend their remaining time with family in between treatments.

Bowler did all that, but also launched a podcast³ called 'Everything Happens,' on which she talks with people about what they learned in dark times. She wrote another book. And she set about changing the way people view and talk about suffering in America," Lorenz writes.⁴

Everything Happens for a Reason — Or Does It?

As explained on the website⁵ for Bowler's second book, "Everything Happens for a Reason: And Other Lies I've Loved," her career as a professor at Duke Divinity School had centered around "the study of the prosperity gospel, a creed that sees fortune as a blessing from God and misfortune as a mark of God's disapproval."

Her cancer diagnosis forced her to face her own mortality, and in so doing, made her realize she'd "been tacitly subscribing to the prosperity gospel, living with the conviction that she can control the shape of her life with 'a surge of determination.'"

Like so many others, she had bought into the idea that illness (or any other form of misfortune) is a sign of personal failure — somehow, you didn't work hard enough or you weren't optimistic enough. Somehow you disappointed God and this is your punishment.

"What does it mean to die … in a society that insists everything happens for a reason?" Bowler asks.⁶ She was happily married, had a young son and a job she enjoyed. In her mind, her future was all planned out.

She intended to get her Ph.D. and become a tenured professor. Up until the day she was told she had late-stage cancer, her life had followed the script of someone on the fast-track to happiness and fulfillment — proof she'd done everything right.

"But Bowler's commitment to the notion that everything happens for a reason went out the door once her diagnosis hit," Lorenz writes.⁷ "Now she believes that idea is deeply problematic. 'We live in this culture that seems unable to allow people to suffer without trying to explain things to them,' she said.

It's common for people to tell themselves or others that the best is yet to come. But promoting that idea, Bowler argued, can be cruel to those who might consider their best days far behind them."

How to Speak to Someone Who Is Suffering

Despite a grim diagnosis, Bowler survived. Today, four years later, her focus has shifted to educating people about how to support people in the midst of their suffering. Her own experiences taught her a lot about this, and many of the things people say turn out to be less than helpful. For example, Bowler suggests that when speaking to someone who is suffering:

• Don't try to relate to their suffering — While this may sound odd, the way we experience suffering is uniquely our own, so hearing stories about someone else's situation typically isn't helpful. It also shifts the focus away from the patient, making it instead about you.
• Don't offer solutions and treatment strategies unless asked.
• Don't tell them their suffering is "part of God's master plan" or has some greater purpose — Randomness happens. Sometimes it's just bad luck. Sometimes, a tragic story will have a happy ending, but it's not guaranteed.
• Make yourself available and just be present — Lorenz writes,⁸ "Bowler had friends who faded away from her life after her diagnosis because they didn't know how to confront her tragedy. But the type of person she found most helpful when she was at her lowest, she said, was someone who just 'shows up, doesn't ask for anything, and just knits in front of you."'

Take a Cue From the One Who Is Suffering

Karen Raymaakers has also written about what to say when someone you know is diagnosed with cancer.⁹ She points out that our reactions are almost always shaped by previous experiences, hence the wide variety of reactions to something as devastating as a cancer diagnosis.

"They may show unbelievable strength you never knew they had, or be more vulnerable than you knew. They might show a number of different emotions — sadness, anger, guilt, fear, ambivalence, avoidance — and sometimes they may show all at once or change from moment to moment," she writes.¹⁰

Raymaakers suggests taking your cue directly from the person who got the diagnosis. "How your loved one feels about their diagnosis will help shape your response to it," she says. If they're in a stage where they want to talk about their cancer, try to be present and just listen. If they don't want to talk about it, don't force it.

Whatever you do, though, don't avoid the issue altogether. As noted by Raymaakers, it can be tempting to gloss it over and pretend like nothing is wrong, thinking your friend or family member already knows you care about them and support them no matter what.

"The truth is, cancer is the elephant in the room. To not acknowledge it is almost more hurtful than anything you could ever say," Raymaakers writes.¹¹

"The best advice in this situation is to say how you feel. Are you thinking about them? Then say so. Do you care about them? Then say so. Are you sorry that they are going through this? Then say so. Don't know what to say? Then say that. Here are a few more conversation starters:

• I am here if you want to talk.
• I would like to help in any way I can.
• Are you up for having visitors?
• Is there anyone else you would like me to contact?
• This must be a hard thing to go through."

What Not to Say

Like Bowler, Raymaakers warns against trying to relate to what your friend is going through by comparing it to your own experience. She also discourages people from trying to find the silver lining.

"There isn't much of a silver lining to a blood cancer diagnosis, so avoid saying things like, 'It could be worse,' or, 'At least it isn't ...' For the person with the disease, this probably is the worst-case scenario," Raymaakers says.¹²

Other don'ts include making overly pessimistic remarks, or saying things that minimize what your friend is going through. Keep pep talks like "It'll be OK" and "Cheer up" for less distressing and life altering situations. Raymaakers adds:

"Don't leave if things get tough. If the person gets angry, let them vent. If they tell you they're afraid, open up the conversation so they can unload on you. 'What are you most afraid of?' 'What can I do to help with your fears?' … [I]f you let the patient do the talking, you don't need to worry about what to say."

In her article, Raymaakers also delves into "how to handle hospital visits," and how you can help the person suffering through caring and thoughtful actions. Here are a few selections from her listings. For more, see the original article.¹³

Optimism Is a Healing Balm

While it would be inappropriate to tell a cancer patient to simply "cheer up" or "think positive," optimism does play an important role in health and healing. In "Optimism and Hope in Chronic Disease: A Systematic Review,"¹⁴ published in Frontiers in Psychology in 2016, the authors highlight findings showing an optimistic outlook on life in general leads to lower depression levels, improved physical health and increased longevity. According to the authors:

"In regards to optimism, Scheier and Carver … defined it as an overall tendency to believe that vivid experiences will lead to good results rather than bad ones. Carver et al. … explained that to be optimistic is to maintain a generally favorable expectation about the future.

Hart et al. … added that overall positive expectations are considered one of the main determinants for knowing whether people will continue to pursue their life objectives in a condition of chronic disease …"

Hope, defined as "a state of positive motivation based on three components: objectives (goals to be achieved), routes (planning to achieve these goals), and agency (motivation directed toward these objectives)," has similar benefits.

Interestingly, evidence suggests that while optimism is protective against short-term stress, optimists facing prolonged stress may actually be at greater risk of health complications, "as optimists are more immunologically vulnerable under such circumstances." Still, the authors concluded that:

"Some association between higher hope/optimism levels and a healthier profile was observed in 27 of the 29 studies. In regard to the results perceived by the study participants after intervention, only two articles found no relationship between the constructs and relevant results …

Regarding cancer, it was found that optimism predicted a year of survival regardless of other socio-demographic and clinical variables in patients with head and neck cancer … and more abilities to manage stressors while less optimistic cancer patients experienced more negative psychological changes …

The results of the studies presented in this analysis suggest that there is a close relationship between the constructs of optimism and hope and a reduction in the effects of chronic disease. However, it is important to highlight that the association between optimism or hope and physical health differs depending on the context of the disease and the subjects."

Managing Emotions When Faced With a Devastating Diagnosis

Staying optimistic in the face of debilitating and/or lethal disease is easier said than done, no doubt. Yet it's worth the effort, if not only to protect your mental health and avoid spiraling into despair.

If you're been diagnosed with an illness, be it cancer or something else, you may want to consider The Emotional Freedom Techniques (EFT) to help you move through any negative emotions that surface to prevent them from becoming permanent companions.

In the video above, EFT practitioner Julie Schiffman demonstrates how to use EFT for the grieving process. When faced with your own mortality, feeling grief is natural. But it can become a hindrance if you cannot move through it. EFT may be helpful for that.

Also, check out Bowler's podcast,¹⁵ "Everything Happens." Bowler interviews a wide range of individuals, talking to them about "what they've learned in dark times." Some discussions center around loss and grief, while others tackle living with chronic illness.