Everyone who is born holds a dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. —Susan Sontag, Illness as Metaphor
On what might be considered a tourist visa, I visited a mindfulness workshop for cancer patients at The Bendheim Integrative Medicine Center at Memorial Sloan-Kettering Cancer Center (MSKCC) in Manhattan. These group members were citizens who were not holding what Sontag would call the “good passport” instead they were “at least for a spell,” obliged to identify themselves as “citizens of that other place.” As a psychotherapist, I visited the group wanting to understand more about illness, treatment, and the application of the ubiquitous concept of “mindfulness,” of mind-body cancer care. Though I had been granted permission to attend, I was mindful of my discomfort in hailing from “the kingdom of the well.”
After I briefly introduced myself, a voice emanating from the semi-reclining “Princess Chair” summoned me. In a playful, yet direct voice, she (whom I will call P. for Princess) inquired, “Can you tell us a secret?” I thought, How interesting . . . here I am in this group’s private, if not secret world, it only seemed fair that I present a “secret” worthy of admission. Instead, I fumphered, saying, “I need to think about that, as I am not sure what secret might be interesting or appropriate.” Despite this overly judicious response, somehow P. granted me a reprieve, she said, “That’s okay, you don’t know us.”
To echo the words of P., is there such a thing as a “kind of fun” ending—a final send-off that reflects the wishes and spirit of a life well-lived?
At the moment, being a member of “the kingdom of the well” did not feel so great, though I was glad to be let off the hook. Robert Schmehr, LCSW, Manager of Mind-Body Therapy at the Integrative Medicine Service of Memorial Sloan-Kettering Cancer Center, navigated the group discussion with great sensitivity and focus. Initially, hopeful news about treatment prospects dominated, then from the Princess Chair a voice was raised, not so playfully this time. P. asked if the group might help her discuss something difficult. She shared her unhopeful news of fearing that she was at the end of her medical treatments . . . she expressed a need to get her affairs in order and a fear of dying. After some concerned responses and silence a member asked, “What do you want from the group?” P. said, “Well, if I have to go, I guess, I would hope . . . that it could be kind of fun.” She said this quietly as though the idea of a somewhat uplifting death were taboo.
To echo the words of P., is there such a thing as a “kind of fun” ending—a final send-off that reflects the wishes and spirit of a life well-lived? While there was not a “cure” for P.’s cancer, there was “curiosity” about exploring a joyous farewell that seemed a part of her healing. As Epicurus said, “The art of living well and dying well are one.” The spirit of mindfulness that informs integrative medicine invites us to hold both the kingdom of the well and the kingdom of the unwell. In the language of Jon Kabat-Zinn, the creator of the MBSR (Mind Body Stress Reduction) program, there was “awareness-ing” going on within the group—a process that does not have a distinct pronoun or object. Or more simply put, there was a natural “attention” given to what was at hand in a moment-to-moment way. (For more information see: umassmed.edu.)
With Robert’s artful attention the group could shift almost seamlessly between holding feelings of hopefulness to attending to more anxious places such as fear of death. Even endings could have a sense of possibility.
Psychedelics, Energy Treatments & The Spa
One of the most radical explorations of end-of-life issues for cancer patients, appeared in The New Yorker article by Michael Pollan, “The Trip Treatment.” The article accelerated mind-body therapy to the next level, quite possibly out of body. It reported how New York University and Johns Hopkins led clinical trials with psilocybin to explore its treatment for depression, anxiety, and alcoholism. Stephen Ross, an associate professor of psychiatry at NYU, and a substance abuse specialist, explained how “cancer patients receiving just one single dose of psilocybin experienced immediate and dramatic reductions in anxiety and depression, improvements that were sustained for at least six months.”
Ross said “People who had been palpably scared of death—lost their fear. The fact that a drug given once can have such an effect for so long is an unprecedented finding. We have never had anything like it in the psychiatric field.”For many cancer patients seeking to shift their energy, a foray into Reiki and a touch of hypnosis may be just enough transcendence. For others, a psychedelic spa experience could be just what the doctor ordered. It just depends.
As Susan Sontag, in Illness As Metaphor said, “Cancer is not so much a disease of time, as it is a disease or pathology of space.” The Zodiac-like Cancer the Crab illustrated on the book cover of The Emperor of All Maladies: A Biography of Cancer by Siddhartha Mukherjee shows the all-encompassing crab claws. Their reach, like a cancer, seems intent on gobbling up space. Such an image embodies the fear of cancer’s physical and psychological impingement on one’s internal space. Fear of such encroachment almost demands the counterpoint of a more serene, open external space. The focus on creating such healing, or even sacred, spaces is evident in such stunning edifices as Memorial Sloan-Kettering’s Laurance S. Rockefeller Outpatient Pavilion (1999) inspired by the Zen-like architectural designer Clodagh.
Hospitals Discover Their Inner Spa
In an inaugural article, a New York Times headline read: “Hospitals Are Discovering Their Inner Spa.” This East-meets-West approach was heralded as the new pavilion was created with a mission statement that it would “stand as a symbol of our belief in the healing energy between medicine, science, and the power of each individual’s and patient’s mind.” Barrie R. Cassileth, PhD, incumbent of the Laurance S. Rockefeller Chair in Integrative Medicine and Chief of the Integrative Medicine Service at MSKCC has been key to articulating and advancing the mission of complementary medicine. She has published over 80 articles on the role of complementary medicine in treating stress, anxiety, depression, and the difficult symptoms related to cancer and its medical treatments (For Cassileth’s complete roster of articles, go to PubMed nvbi.nlm.nih.gov In addition, she has done an investigation of botanicals for potential anti-tumor effects. See the Integrative Medicine Service’s website, About Herbs.)
In multiple sources, repeatedly Cassileth has stated that complementary medicine is not an alternative to mainstream medical care. Of all the evidence-based integrative medicine treatments: massage and mind-body therapies such as meditation, hypnosis, Reiki, acupuncture, Qigong, and yoga, Cassileth states “exercise is the one that actually has a survival advantage . . . improving patients response to treatment by up to sixty percent.(movingforlife.org) However, getting patients who are traumatized by their illness to engage in movement or adjunct treatments can be a challenge.
Despite the mainstreaming of Integrated Medicine, there appears to be a missing link. Perhaps, it is the personal/professional touch. Professionally, it can be easy to focus on all that Western medicine can do, and to overlook what the patient may need to do to care for him or herself. In the midst of intrusive surgery, radiation, chemo, and various medical treatments, a patient is naturally overwhelmed. Transitioning to a new or unknown adjunctive complementary treatment can feel oddly intrusive, too “woo-woo” to a patient who is hardly feeling him or herself. Yet complementary care is precisely the kind of engagement that can help restore a patient’s sense of self.
Transitioning to a new adjunctive complementary treatment can feel oddly intrusive to a patient who is hardly feeling him or herself. Yet complementary care is precisely the kind of engagement that can help restore a patient’s sense of self.
The Power of Integrative Relationship
I was struck by the story of Fran Dillon, LCSW, a psychoanalyst in New York who was diagnosed with bladder cancer in 2012. She was undergoing the various medical treatments at the Urology Oncology Department at New York-Presbyterian Hospital, Weill Cornell Medical Center, but was not immune to the many difficult feelings (i.e. fear and shame), as well as the debilitating symptoms attending her cancer treatment. In the mecca of New York City’s Integrative Medicine scene, it was only by chance that Fran stumbled upon a posting near the elevator about Complementary Care classes. As it turned out the group was lead by her urology oncology nurse whose name just happened to be Fran, too.
Fran Conway RN, CYT, Director of Urology Holistic Health Center at Weill Cornell Medical Center, describes herself as turning to yoga after 9/11, “hating it,” and ultimately being so responsive to it that she became an instructor. This meeting of the Frans has an east-meets-west feeling and is a beautiful story about the power of “integrative” relationship, as well as medicine. This June, Fran Dillon, LCSW, presented a professional paper at the International Association of Relational Psychoanalysis and Psychotherapy conference called “Finding the Relational Pulse in a Medical Oncology Dyad.”
In the words of Fran Dillon, LCSW, “My attuned, compassionate nurse [Fran Conway, RN] recognized the diagnosis of cancer and treatment set me free. She understands that once you hear the words, ‘you have cancer,’ you are changed, you are never the same person that you were. My nurse emphasized that it took courage to change. Those who have been diagnosed with cancer feel as if their bodies have betrayed them. A relationship can be a powerful catalyst for physical and spiritual healing and psychological growth, if one chooses to use it. It’s an approach in which you learn about yourself by being present to the sensations, emotions, and thoughts that are constantly flowing through you. She helped me embrace many different parts of myself, accompanied by tears and humor. Together, we exposed life’s brevity and restored life’s flavors. Cancer cured the dance of hesitation.”
While Fran Dillon notes that every person’s complementary-care program is different, I am going to discuss hers to give you an idea of what it might look like. Fran’s work involved Iyengar yoga, during which she was offered yoga poses (asanas), breathing exercises (pranayama), chanting, yoga nidra (progressive relaxation), and meditation. Fran learned that the goal of yoga was to create what her teacher would call “an opening in the body which will create an opening in the psyche/spirit, eventually allowing one to experience an open-minded approach in practicing meditation.” Fran was instructed to facilitate an opening in the neck/lungs/chest/heart/abdomen and pelvis, allowing more blood flow, oxygen, and nutrients to the anatomy being worked on. Fran notes, “There is a sense of being stretched, but it goes far deeper than just plain stretching. ‘I experienced an openness; a letting go and a feeling of peace and equanimity.'” (Trungpa, 2009).
Wellness for Cancer
With the 2015 Mandatory Outpatient Screening for Cancer patients happening at major US cancer centers, patients will be strongly encouraged to receive complementary care. A distress rating of 4 or higher—out of 10 is considered cause for action. There is a widespread recognition that cancer patients need more help than they may realize or initially be comfortable with. A range of evidence based mind-body treatments (yoga, Reiki, massage, meditation, hypnosis, exercise) suggest that going beyond your comfort zone can help you reap many psychological and health benefits. Toward this end, Julie Bach, Founder of Wellness for Cancer, is rolling out a program for Cancer Awareness certifications for spas and wellness centers and practitioners. (For Cancer Aware Basic and Cancer Aware Comprehensive facilities go to: spafinder.com/wfc).
Many major hospitals train practitioners in an array of Complementary Care practices, so get curious. Like Fran, let cancer cure your dance of hesitation. Move, breath, laugh, cry, stretch, pause. You don’t have to do it alone. And remember, we can always return to the breath. Until we do not. And that is also a part of life.
Helpful Links & Resources
- Bendheim Integrative Medical Center at Memorial Sloan-Kettering Cancer Center (MKCC) 1429 First Avenue (At 74th Street) mskcc.org
- New York-Presbyterian Hospital, Weill Cornell Medical Center: The Department of Urology, Holistic Medical Center led by Fran Conway RN. See treatments such as Peggy Huddleston’s “Prepare for Surgery, Heal Faster,” Reiki, yoga, meditation, and more.
- Outpatient Nutrition at New York-Presbyterian Hospital, Weill Cornell Medical Center: 520 East 70th St., Starr Building, phone: 212-746-0838.