The problem with this coping mechanism is that the fundamental principal is "I can live with anything". But the worst outcome of cancer is, of course, death. Imagining "life" when I am dead...well...it doesn't quite work. I needed a new way to find serenity. Like most of the cancer experience there is not one story for everybody. People find different ways to cope. I believe that most people pick either hope or avoidance. I have thought a lot about these two choices (they are not mutually exclusive).
Avoidance is often perceived negatively. When somebody is choosing to ignore a truth they are accused of avoiding reality. This is considered cowardly, irresponsible, or even self-destructive. This point of view suggests that avoidance is an effort to refuse a truth: to deny it. However, while avoidance and denial are similar, denial generally implies complete refusal to accept a truth. Avoidance simply implies ignoring it. Denying our cancer risks ignoring treatment: probably fatal. Avoidance implies we are choosing not to think about cancer unless necessary. Humans use avoidance constantly. Our days are filled with avoiding some things in order to deal with other things.
In contrast to avoidance, hope seems to be the darling. Nobody disparages hope. This is not surprising given the western affinity to religious faith. Faith and hope are not the same but require some similiar skills: choosing to believe/ignore something without having data or facts to support it. A person espousing hope suggests that they are not avoiding anything...they are simply hoping for the best. A common mantra in cancer circles is that "we must have hope!". Curiously it can be argued that hope is more like denial than avoidance: hope is subtly denying the truth.
As mentioned it is not necessary to choose between these two coping mechanisms: most people probably use both. Personally I struggle with finding acceptance through hope. This is probably due to a life of computers and statistics. My thoughts always go to the probabilities of the outcomes. It is very hard for me to be hopeful about a 15% probability. Every part of my experience fights thinking about that hopefully. So my "go to" mechanism is avoidance.
I think many people believe that hope is the better option but there is reason to believe otherwise. Some studies have shown that persons who accept a bad experience more realistically develop better mechanisms for dealing with disappointments. I recently listened to a Vietnam POW describe his experience. The interviewer asked the veteran if he thought there were certain types of GIs who survived poorly as POWs. "That is easy", he said, "the optimists". Being realistic does not mean giving up on the most aggressive outcome. It simply means accepting that it might not be likely and accepting what comes. I am on the third round of cancer treatment. I understood the moment I saw my initial pathology report that my odds for surviving the disease were not good. I started learning to accept the most probable outcome on that day but I have never stopped fighting for my life.
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- In my opinion most people are very uncomfortable interpreting data. Statistics is probably one of the least favored subjects in most people's education. This is unfortunate at this moment in history. We are deluged with data that is often summarized by journalists who are not comfortable with data and rarely provide enough background data. The effect is third parties without subject matter or statistical skills curating our information feeds. I was reading a great cancer blog recently. The author began with "...the median time was xx months...which means I would have xx months and then....". This is a common mistake. People believe the average or median (most people do not appreciate the distinction but that is a future blog post) is the minimum expected. But that is NOT what it means. It isn't even the likely outcome. It is the 50% mark. We are NOT likely to achieve the average/median.
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