Not long ago, my sister went to the doctor with a sore back. She came home with stage IV lung cancer that had metastasised to her pleura and brain. Her oncologist talks a promising game of novel gene therapy and clinical trials, but the stats are less optimistic. Most people with her diagnosis don’t survive the first year, and only four per cent are still kicking five years later. You see, you generally don’t ‘beat’ lung cancer; you just shush it for a bit by lobbing nerf-ball medications at it, until your arms and body get too tired to keep tossing. My sister is 45 and has no idea what the future holds, but she’s almost the same person she was a few weeks ago, before her bad back became a terminal illness. She remains composed, sociable, and witty. She finds moments of humour and happiness within the onslaught of symptoms and side effects. And she responds to each new piece of cancer-related information with an astonishing mix of dignity, acceptance and courage. She has managed, somehow, to embrace life in the face of impending death, and find meaning in her illness.
Finding meaning in suffering
In his extraordinary book Man’s Search for Meaning, psychiatrist and holocaust survivor Viktor Frankl documented the atrocities and degradation suffered by Jewish prisoners of war during his three years in Nazi concentration camps. Frankl’s experiences led him to develop the concept of ‘tragic optimism’: an explanation for why some people sink into depression or simply ‘give up’ when faced with a bleak or uncertain future, while others are able to carry on with equanimity and hope. Like any trauma, a cancer diagnosis threatens a person’s assumptive world, challenging their underlying belief systems, their understanding of why things happen, and forcing them to rethink the purpose of their existence. When a person is faced with something as substantial as the reality of their own death, it’s not enough to tell them to ‘cheer up’ and think more positively about their situation (let’s face it – that’s not enough for most situations). The key to coping with and growing from trauma, Frankl claimed, is the ability to adopt a kind of tragic optimism and find ‘meaning’ in the midst of suffering. He believed that to have certain people, moments, and values that bring meaning to your life is to possess a talisman against the most insufferable situation, and to find new reasons to go on living. Even when the nerf balls run out.
Meaning making through expressive writing
There are horses for courses and strokes for folks, and everyone’s idea of what’s meaningful in life differs. In fact, not only is meaning specific and unique to every person, but it differs individually, from day to day, hour to hour, and situation to situation. This article from Psychology Today talks about five ways people find meaning in life, and how people might tap into these to increase meaningful pursuits. Importantly, what’s meaningful to someone before they suffer a traumatic experience or serious illness, may not be meaningful afterwards, and people often need to find new sources of meaning if they are to cope with traumatic events and find renewed wellbeing.
One of the ways that people can find meaning in traumatic experiences is through expressive writing; that is, writing about their innermost thoughts and emotions to better understand traumatic events and integrate them into their broader life story. Since humans first wielded a pen, writing about their physical and emotional experiences has been a way for people to cope with difficulty and make sense of their lives. Let’s be clear. Expressive writing cannot cure cancer and will not change the course of a person’s disease. But there’s emerging evidence from meta-analyses and systematic reviews (here, here, and here) that it can help cancer patients better adjust to their illness, improve quality of life, and relieve symptoms like insomnia and pain. It can also decrease stress, and help people to better process their illness and its significance in their life. Most importantly, expressive writing can help a person discover what brings true meaning to their life, where their values lie, and what things they might draw on in times of difficulty and suffering.
Writing specifically about cancer
Like any health intervention, expressive writing tasks shouldn’t be administered carte blanche to all cancer patients, indiscriminate of the type, stage, or trajectory of their illness. For instance, some research shows that writing interventions aimed at regulating, expressing, and processing emotions are more effective at helping people deal with the initial tremor of diagnosis and treatment, while those aimed at meaning-making are better employed when people have dealt with the initial shock and are ready to explore new ways of coping. Also, studies into the cognitive processes involved in trauma indicates that the usual writing time of 20 minutes might be extended for cancer patients, to allow ample time for people to regulate distressing emotions as well as explore positive change. Finally, positive psychology 2.0 researchers recognise that functional and lasting recovery from trauma can occur only if people acknowledge, accept, and find meaning in both the positive and negative aspects of their experience. To do so, they must explore the gamut of their thoughts and feelings, not just those bits that are positive and easy, or pervasive or conspicuous. This is where guided writing exercises with a trained positive psychology practitioner can be of most benefit.
Top left: Photo by Pixabay from Pexels; Top right: Photo by nappy from Pexels; Bottom right: Photo by Dean Moriarty from Pixabay;
Bottom middle: Photo by Negative Space from Pexels; Bottom left: Photo by Pexels from Pixabay
Expressive writing task
For those new to expressive writing, the website PositivePsychology.com has a collection of expressive writing worksheets, including this one to encourage healing from trauma through writing. The instructions are based on James Pennebaker’s original writing exercise, documented in the book Expressive Writing: Words that Heal. For most people, just 20 minutes of writing a day, for four consecutive days, can begin the healing process.
To focus more specifically on meaning-making in your writing, try further writing exercises that incorporate the following prompts.
– What are the most important values in my life and why?
– Who are the people who have affected me the most?
– What events and memories stand out for me in my life and why?
– What do I feel most proud of accomplishing?
– How would I like to be remembered?
The next step: Finding the ‘gifts’ in trauma
It’s a big ask and not everyone can do it, but for some people tragic optimism can eventually lead to joy, and acknowledgement of the benefits or ‘gifts’ that trauma can bring. The following very moving TED talk by Stacey Kramer offers a completely different perspective on suffering, and reflects Viktor Frankl’s own observations that small joys – like the beauty of a sunset framed by the Bavarian woods – were found even in the grim reality of a concentration camp. In my own experience, cancer has already afforded my sister and my family many of the gifts Stacey talks about. And for these we are incredibly grateful.
Not ‘the end’
At the end of Man’s Search for Meaning, Frankl uses the analogy of a movie to explain the complexity and interconnectedness of meaning in life. He reminds us that a movie has several dozens of scenes, and many thousands of individual images, every one with its own sense of cohesion and meaning. Yet the overarching meaning of any film can’t be fathomed until the very final sequence; neither can this overall meaning be understood without comprehension of each individual scene that precedes it. To find meaning in everyday moments is to find meaning in a life. My family and I don’t yet know when or how my sister’s film is destined to end – or any of our films, for that matter. All we can do is enjoy, engage with, and appreciate the scenes we have left.
Man’s Search for Meaning, Viktor Frankl
Expressive Writing: Words That Heal, James Pennebaker & John Evans
Opening Up by Writing it Down, James Pennebaker & Joshua Smyth
How do I overcome adversity?, Paul T Wong