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One of the diseases with the highest incidence in the world population is cancer (INEGI, 2017). Cancer begins in the cells, which constitute the body's bricks. Normally, the body forms new cells as they are needed to replace aging cells that die (MedlinePlus, s. F.). The normal program of destruction or cell death programmed to control growth and development is known as apoptosis. However, in cancer this normal program is altered and they grow and multiply out of control.
Thus, sometimes, this process does not turn out to be as expected. New cells grow that are not necessary and aging cells do not die when they should. These additional cells can form a mass called a tumor (MedlinePlus, s.f.). When they are malignant, these tumors are known as cancer and are identified according to the area of the body where they are located (breast, colon, etc.) and can invade even other organs and is called metastases.
A change in some area of life is a duel: winning the lottery, losing a loved one, moving out of home, running out of work, leaving home for children (empty nest), infidelity, getting married, losing health, suffering an accident, graduating, buying a house, getting a job, lose some part of the body. And, all these activities are mediated by emotions and impact not only the mind and body of those who live them, it also alters the entire social environment and interaction with others for better or worse. The patient with breast cancer in addition to the "normal" duels that we all go through, goes through a series of duels that sometimes do not see the end: embrittlement of the patient and its double crisis, explained later.
- 1 Breast Cancer
- 2 Breast cancer and its relationship with emotions
- 3 Psychoneuroendocrinoinunology
- 4 Sexuality, sex and sexual health
- 5 Description of some aspects of female sexuality
- 6 sex
- 7 Sexual health
- 8 The first psycho-emotional impact
- 9 Second impact and the double crisis
- 10 Perceived Consequences of Mastectomy
- 11 Therapeutic support: Cognitive Behavioral Therapy (CBT)
- 12 Suggestions for change
There are more than one hundred types of cancer; Any part of the body can be affected. Worldwide, the five most common types of cancer in women are, in order of frequency, breast, lung, stomach, colon / rectum and cervix. Cancers with the greatest impact on public health, such as breast, cervix. Applying the available knowledge about pain control and palliative care could alleviate the suffering of patients (WHO, s.f.). Breast cancer is the most common among women worldwide, accounting for 16% of all female cancers (WHO, 2017).
In Mexico, since 2006, breast cancer has caused more deaths than cervical cancer. This condition is the second cause of death in women 30 to 54 years of age, according to data from the National Institute of Public Health. It is worth mentioning that only 10% of all cases of breast cancer are detected in stage I, due to poor coverage of public health services (INSP, 2015).
If we hit an arm we feel pain, if we suffer from a mental illness we also feel it. We even feel social pain if someone rejects us or we do it ourselves when we are not satisfied with life. However, that matters little to the brain, pain is pain, whether physical, emotional, or social, if we see that someone is also suffering empathically, we experience it, even the areas of the brain where physical and emotional pain is experienced They are practically the same.
Pain, in fact, protects not only the individual, but also their social ties. The brain contains circuits related to the most physical aspects of pain and others related to the affective aspects. As noted in the study just published by Giorgia Silani, Giovanni Novembre and Marco Zanon, in the magazineSocial, Cognitive and Affective Neuroscience, social pain activates some brain circuits of physical pain, whether we feel it personally, or when we experience it indirectly as an empathic response to other people's pain (ePsychología, 2011). Then then, when someone gets sick from breast cancer, not only does the patient get sick on the physical level (which by the way is the only one that doctors are sometimes interested in), he also gets sick on the emotional and social level and that is simply invisible to others and also makes the family and close people sick from experiencing pain empathically.
Research in the field of neurosciences demonstrates how emotional pain is processed in the brain by the same area that processes physical pain: the anterior cingular cortex, which is located in the prefrontal cortex, the area where more evolved functions occur and human (Castro, 2013).
The brain does not distinguish between reality and what you imagine, for him it is the same.
Currently, chronic pain has been characterized as a silent epidemic, in the sense that it is part of numerous diseases, most of them related to the aging processes of populations, such as degenerative osteoarthropathies, cancer neoplasms, neuropathies, neuralgia and plexopathy, among others ... Pain has its own language, composed of verbal and nonverbal expressions, a metaphorical language typical of the cultural imaginary. Pain itself can be meant as a metaphor, a figurative language that uses the body and suffering to communicate and influence their social world (Barragán, 2008).
Breast cancer and its relationship with emotions
The psychotherapist Jacques Martel mentions in his large dictionary of ailments and diseases that when it is known to decipher the ailments and diseases and when it is known to which emotions or which thoughts are linked, then it is easy to tell the person what they are living. On cancer, cancer generally mentions that it is strongly related to a great fear or great guilt, to the point of no longer being able to live, even unconsciously, and particularly with regard to breast cancer, he points out: Breasts represent femininity and motherhood. This type of cancer usually indicates certain attitudes and deep-rooted thoughts from early childhood.. There is a difficulty here in expressing my true feelings, in finding the right balance between my role as a mother and a fulfilled woman. It has been discovered that this type of cancer usually comes from a strong feeling of inner guilt towards oneself or one or more of your children.. If I judge myself too severely, all my anger and my rejection will be amplified, and my emotions will be "expelled" to the level of my breasts, which become the symbol of my failure. I may be afraid that my nest (home) collapses, in a broader sense it can group all who live on the same roof, including my partner and my brothers and sisters. The left side corresponds to the emotional field and the left to the rational field (Martel, s.f.).
The feelings of guilt are precisely the signs that indicate the traveler if their course is correct. It is an alert system similar to the one we experience in our body with physical pain, which warns us that something is wrong in the body and gives the alarm so that we can remedy ourselves. Physical pain is unpleasant, although necessary. We take painkillers to free ourselves from him. Guilt is an equally unpleasant psychological pain, but perhaps also necessary (Zabalegui, 2000).
The good news to mitigate pain because of fault is that words get sick, but positive words also heal.
Dahlke (2006), mentions that the body is the scene of psychic events, unconscious, ... is the cry of an offended soul. The form of expression of the body is the language of the symbols... when breast cancer manifests there is a conflict with the female breast that symbolizes: motherhood, food, recollection, sensitivity and pleasure. She presents herself for being excessively injured and angry, without reacting with anger towards the outside (feelings of revenge, inner spite); refusal to respond, to pressure, to be penetrating, to be proud of not being selfish.
The reflection on this is that when our emotions do not come out, somatized conflicts explode inward in our organs that symbolize and materialize the conflict. If emotions do not come outward, our body explodes inward, that is, it implies.
Psychoneuroendocrinoimmunology is an interdisciplinary scientific field that studies the interaction between psychic processes, the Nervous System (SN), the Immune System (SI) and the Endocrine System (SE) of the human body. It brings together the knowledge of different areas: psychology, psychiatry, behavioral medicine, neuroscience, physiology, pharmacology, molecular biology, infectious diseases, endocrinology, immunology, and rheumatology.
Dr. Nicholas Cohen and his romantic partner Professor Robert Ader both from the University of Rochester found that the immune system could be conditioned by the mind. His discoveries implied that the brain was somehow capable of destroying by itself the entire immune system of the organism what was considered for the eighties a true scientific heresy. The concept that stress can affect physical defenses was another challenge to orthodox thinking. Stress is in the mind and the mind was supposed to have no effect on the immune system. Along the same lines but independently the husbands Dr. Ronald Glaser and Janice Kiecolt-Glaser, both of the University of Ohio State, found evidence that after a great loss during the first year there is a major to get sick. They knew that the stressful events of life were associated with a higher incidence of illness, people who had someone's death or moving or lost their job had a greater predisposition to get sick. A study on prolonged or chronic mental stress in couples with greater conflict or more unpleasant disputes that described his marital life as poor, there is also a poor immune system, the negative impact was higher in women and weakened for longer (Glaser and Kiecolt, 2012).
Gender-related findings showed a decrease in the immune system of both (men and women) after having discussions on domestic issues (house arrangements, differences with the political family, etc.). However, chronic stress affected women more significantly compared to men, and men took less time to rebalance than their wives.
The chronic and uninterrupted stress It produces a depression of the cells of the immune system. Empirical evidence to verify the communication at the cellular level of these events was shown by Dr. Suzanne Felten of the University of Rochester NY, the lymphocytes of the immune system communicate the tissues of the muscles which are full of cells of the nervous system (Glaser and Kiecolt, 2012). This shows how muscular tension, depresses the immune system, so the events of the outside stress and make the body sick, but also the internal tensions, such is the case of the thoughts themselves, also generate the same stressing effect and end up making someone sick .
Emotions bring physiological reactions that are registered by our autonomic nervous system and lead us to feel in fear (palpitations and paleness of the face), in disgust (the reflection of sticking out the tongue emulating the expulsion of food), in the sadness (loss of energy), in anger (increased heart rate) among others.
They also generate a hormonal reaction and in a stress situation we produce cortisol (stress hormone). Small doses of cortisol are necessary to be on the alert and on the move, but if they occur for a long time they produce side effects in our body, high cortisol levels are related to: difficulties in digesting food and nutrient absorption, elevates the pressure arterial causing high blood pressure and heart disease, it causes insomnia, stimulates appetite and causes us to gain weight (due to the intake of white powders: sugar and flours), dehydrates our skin and produces premature wrinkles and aging, as well as weakening the system immunological
Although emotions are manifestations of human beings and men and women we feel them, they have no sex, but their expression in cultural terms does. Then it is expected that women can express their emotions more freely in this society and are expected to have behaviors associated with it such as being: tender, supportive, empathic, trustworthy, with more open communication ties, at least between same women.
While waiting for men to suppress their emotions so as not to look feminine, they are generally assigned socially or self-assigned stereotypes where they should be: Suppliers, Producers, Protectors and Powerful Sexually (Sinay, 2001).
In another experiment Ronald and Janice also found that during an examination with medical university students, white blood cell activity after their test was less active, and they concluded again that acute stress slows down the immune system. If acute stress temporarily affects the immune system, chronic stress weakens it more dramatically (Glaser and Kiecolt, 2012).
Sexuality, sex and sexual health
Complex concepts and sometimes controversial but all intrinsically related. It is important to differentiate in principle that sexuality and sex are two different but related elements. Sex is considered a concept that is part of sexuality, but sexuality is a much broader concept. Let's look at a couple of definitions.
The sexuality, is a complex universe in which both biological, psychological and social aspects are involved. It encompasses a series of cultural, social, anatomical, physiological, emotional, affective and behavioral conditions, related to sex that decisively characterize the human being in all phases of its development. It can be defined in a broad sense, as a form of human communication and as a source of health, pleasure and affectivity and sometimes even as a source of preproduction. Sexuality is plural in body and mind and also tri differential since it has physical, psychic and social components. It includes a set of physical and psychological characteristics of each sex in addition to the set of activities and behaviors related to the attraction between the sexes, with reproduction and with sexual pleasure (Affective-sexual education, s.f.).
Another definition of sexuality describes it as: All aspects of sexual behavior, including identity, orientation, attitudes and gender activity, as well as interest in the ability to derive pleasure from that behavior (APA, 2009).
Although there are many definitions of sexuality, all of them agree that they are in a multifactorial phenomenon which strongly influences the expected behavior that men and women will have depending on the context or environment in which they develop.
Description of some aspects of female sexuality
Female sexuality includes aspects that are often clear, but also often unknown and that are lived as a socio-cultural burden, factors include:
- Behavioral: Thoughts, Affections, Prejudices, Beliefs and Stereotypes.
- Biological / Hormonal: Impulse, Identity, Orientation, Attraction and Relationships
- For the type of couple you have: Codependent, Independent, Toxic, Open, Controlling, Dramatic and Conflictive
- For its sexual diversity: Flexisexuals, Asexual, Heterosexual, Homosexual, Bisexual and Polyamorous
- For the couple's attachment types: Safe, anxious or disorganized (avoidant and ambivalent)
Meanwhile sex is: a term that serves to classify human beings into two large groups: male and female, and also, in their colloquial use, to refer to sexual practice. It is a unique term that is used for living beings in general (Affective-sexual education, s.f.).
The dictionary of the American Psychological Association defines sex as: the traits that distinguish men and women. Sex refers especially to physical and biological traits, while GENDER especially refers to social or cultural traits, although the distinction between the two terms is not regularly observed (APA, 2009).
Sex, among mortals, is a source of immense joy (sexual intercourse and procreation) and also of major catastrophes. In the same way sex has certain characteristics I quote some of them in the case of women:
- Physical characteristics by sex: Higher voice, wider hips, poor body hair, Breast growth, Hair growth is underarm and pubic, Maturation of genital organs
- GENDER Aspects: Psychological, Behavioral, Social, Cultural
The concept of sexual health refers to the presence of well-being in relation to sexuality. Sexual health is a component of general health according to WHO and encompasses sexuality and sex (De la source & Heinze, 2014). Sexual health is defined as: a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relations, as well as the possibility of having pleasant and safe sexual experiences, free from coercion, discrimination and violence (WHO, 2017).
Living a sexuality, sex and having sexual health, is not something that is achieved overnight, but it comes from the learnings that the members of a couple have from their family of origin. The quality, quantity of sexual relations and the concept of them is reflected in the type of contact that women with breast cancer have had or who have gone through a mastectomy.
In the same way the way they have lived their own sexuality, if they have been valued for their role in the house, work or the family, they get together in these moments of crisis.
The definition of sexual health is shown as a right that we can achieve by having a partner or not, but that will depend largely on the support that women, families and partners have to face this delicate situation.
The first psycho-emotional impact
All our life is mediated by emotions, from birth to death.
When positive events are remembered it is very likely to evoke positive emotions and be pleasant, especially if we have a testimony or a memory that allows us to remember that life event. However, it also happens when we have had to go through events that leave a deep and negative emotional imprint, such is the case of a death, an accident, a divorce or loss of health, since they all involve duels.
An emotion present in this type of events is fear, which can be interpreted under the name of: fright, horror, panic, phobia, terror, fear, fright, shock, shock, vulnerability.
All emotions serve something, in particular fear helps us to survive, if we were not afraid of anything we would simply be dead. Fear can be the product of some real threat or justified mental elaboration or not, but that does not matter to the brain, it is simply fear. And, it can be a threat to our self-esteem, our image or even life itself.
Fear can be real or imaginary. However, in this first emotional impact the five universal fears come together in breast cancer and that is why it is also devastating. Information is power and if we can identify them it is easier to face them.
- Fear of death: the fear of being annihilated and ceasing to exist, comes from a primary feeling of all human beings for survival.
- Fear of loss of autonomy: the fear of being immobilized, paralyzed, restricted, subjected, trapped, imprisoned or controlled by circumstances that are beyond our control. The fear of freedom of our movements is common to almost all of us.
- Fear to loneliness: totally opposed to the previous one, this fear is related to the panic of abandonment, rejection or feeling despised. The loss of connection with the world generates feelings of anguish at the possibility of becoming an unloved person whom nobody respects or values.
- Fear of mutilation: It is about the fear of losing any part of our body structure, the idea of having limits on the mobility of our body or losing the integrity of any organ.
- Fear of damage to the ego: the fear of feeling humiliated, shame or any other situation of deep disapproval that threatens the loss of the integrity of being (also known as the death of the ego) (El Confidencial, 2016).
Unconsciously facing these fears results in breast cancer, a psychological embrittlement of the patient expressed in widespread fear and death, in uncertainty about her future life, in experiencing little hope of recovery, in knowing that she will face complicated treatments and painful, to think about a momentary prolongation of life and not knowing what will happen to his family (nuclear and extensive), friends, neighbors and their labor relations ?.
Second impact and the double crisis
In case the embrittlement was not small, then the patients with breast cancer go through a double crisis more.
- Exposure to surgical medical risk, as treatments and medications need to be provided, in addition to the practice of removing one or both breasts, and
- The consequences after mastectomy. The values in westernized cultures, highlight the importance of physical appearance and sexual attraction (hips and bust) exalted in advertising. There is a new conflict with the symbolism of the breasts (motherhood, food, attraction, self-esteem, pleasure).
Perceived consequences of mastectomy
As if this were not enough, a patient with breast cancer will have even more consequences, related to universal fears and other areas as you can see below:
- Related to the fear of death: Hopelessness for life and continuous thoughts related to death.
- Fear of loss of autonomy: Physical and occupational disability.
- Related to the fear of loneliness: Morbid feeling of being continuously observed by friends or family in the area of mastectomy, Feeling of rejection by your partner.
- Related to the fear of mutilation: Deformation and loss of the breast, Feeling half a woman, Loss of the aesthetic values of the body particularly of the bust, Mutilation of her self-image, Inability to function in the sexual field, Tendency to avoid mirrors or reflective surfaces.
- Related to fear for damages to the ego: Loss of sexual attraction and femininity, Loss of feminine freshness, Threat to integrity and identity, Not having the freedom to wear clothes before (necklines, tight clothes, sleeveless blouses), Having sex with the light off or covers from the waist up.
- Consequences derived from stress: Feeling of having aged prematurely or due to the impact of fighting cancer, Chronic stress (the expectation of recurrence of the disease or death), Sleep disorders: Insomnia.
- Related to communication and social interaction: Uncontrolled in the absence of information from medical staff and family members in the treatment of the patient, Alteration in relations with close people. Couple, children, family and acquaintances.
- Related to psycho-emotional processes: Duel: Denial, frustration, negotiation and acceptance, Low self-esteem, Depression with self-aggression (ideas of suicide) and aggression against others, Inability to learn to express their feelings and emotions, Decreased sexual arousal, difficult and painful relationships, and Orgasm disorders
- Related to medical treatments: Drug use (aromatase inhibitors) produce; Vaginal dryness and loss of libido
Therapeutic support: Cognitive Behavioral Therapy (CBT)
It is one of the most used therapeutic strategies. The most important assumption is that we act according to what we think. And, it has the ability to resignify the negative aspects of life, seeking its positive value in a short time.
- It is a way of understanding how one thinks about oneself, other people and the world around them, and how what one does affects their thoughts and feelings.
- CBT helps change the way you think ("cognitive") and how you act ("behavioral") and these changes help you feel better.
- It focuses on problems and difficulties of "here and now".
Suggestions for change
- The first thing is personal reflection, about the type of consequence that breast cancer has brought you.
- The immune system is strongly influenced by our thoughts: our words heal, but they also get sick.
- The value of a person is not outside (in the breasts) but inside, you are still a woman, the breasts do not define you as a person.
- Your sex life can continue, but it is your decision, only that it is important to have your doctor's support and surely some psychological support. The quality of sexuality will be strongly influenced by what you had before breast cancer. As well as your attitude to live life.
- The type of sexuality that can be lived on will depend on the adaptation process achieved by each person with their partner or individually.
- You will test your resilience and your ability to resignify your own sexuality and feel desired.
- It is important that the health personnel in charge of the treatment provide you with maximum information and maximum support.
- Every woman should consider whether she wants to continue an active sex life or not.
- Receive therapeutic support during the treatment and afterwards, since sometimes it simply does not pay any importance, for the doctor the only important thing is the medical attention and generally he does not know the psychosocial consequences that the patient will subsequently live.
- There are three fundamental aspects that go undetectable and have not been taken care of, which require immediate attention:
- Emotions related to fear and emotions matched to them (anxiety, sadness, anger).
- The social pain reflected in the insecurity to readjust his life again, either as a patient who has faced cancer or as a patient who will have this condition until the end of his days, and
- Individual, family or couple therapy, as the family is a system and if one part (patient with breast cancer) becomes ill, it affects the entire system.
"Cancer changed my life. I thank you for each day. It has helped me set priorities," Olivia Newton-John (actress diagnosed with breast cancer in 1992).
There are two ways to live your life: one as if nothing is a miracle, the other is as if everything is a miracle. Albert Einstein (1879-1955) German nationalized German scientist.
I don't run from a challenge because I'm afraid. On the contrary, I run towards the challenge because the only way to escape fear is to overwhelm it with your feet. Nadia Comaneci, former Romanian gymnast, winner of nine Olympic medals.
- APA (2009) Concise Dictionary of Psychology, Editorial Moderno, Mexico.
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- Dahlke R. (2006) The disease as a symbol (Manual of psychosomatic symptoms, their symbolism, interpretation and treatment), Editorial Lectorum, Mexico.
- From the source J. R. & Heinze G. (2014) Mental health and psychological medicine, Editorial McGraw Hill, Mexico.
- Affective-sexual education (s.f.) Concept of sexuality, accessed April 28, 2017, online: //educacionafectivosexual.wordpress.com/informacion-educacion-afectivo-sexual/
- The confidential (2016) The five fears that all human beings share, accessed on May 1, 2017, online: //psicologiaymente.net/psicologia/para-que-sirve-miedo
- ePsicología (2011) Social pain is experienced as a physical pain, accessed on May 1, 2017, online: //www.epsicologia.eu/el-dolor-social-se-vive-como-un-dolor-fisico / #
- Glaser & Kiecolt (2012) Psychoneuroimmunology accessed April 27, 2017, online: //www.youtube.com/watch?v=ISfpHSLtFuI
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