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How a Prognosis Can Precipitate an Existential Crisis

Existential suffering at the end of life.

Karolina Grabowska/Pexels
Source: Karolina Grabowska/Pexels

"Ivan Ilyich saw that he was dying, and he was in continual despair. In the depths of his soul Ivan Ilyich knew that he was dying, but not only was he not accustomed to it, he simply did not, he could not possibly understand it. The example of a syllogism he had studied...Caius is a man, men are mortal, therefore Caius is mortal...and Caius is indeed mortal, and it's right that he die, but for me, Vanya, Ivan Ilyich, with all my feelings and thoughts - for me it's another matter. And it cannot be that I should die. It would be too terrible." —"The Death of Ivan Ilyich"

How do you process an oncologist carefully, but authoritatively telling you that “you have a 30% chance at a 5-year survival?” That information came at the tail end of a year-long grind with chemotherapy, and radiation followed by two surgeries to remove rectal cancer.

No one in this life can avoid struggle, but we will all have a moment when we engage in a confrontation with an untimely glimpse of our own mortality. Our innate reaction is to isolate ourselves while our psyche twists in agony between the recent experience of normalcy and the current angst of the unknown. This immersion in the experience of cognitive dissonance between the wish for the past and the new reality represented by the nearness of death leads us to an existential crisis or existential suffering.

In an existential crisis, we are immersed in unbearable loneliness that isolates us from those whom we still define as healthy. We experience a state of isolation based on a perceived difference between who we were and who we think we are now or will become. We descend into an abyss of isolation apart from our normal social connectivity. Other states of experience include a feeling of utter hopelessness, helplessness, and fear of losing our identity based on our body appearance, function, and health. We engage in obsessive thoughts focusing on living and dying, which overtakes the mind's ability to escape from this vortex of self-possessed thoughts. We face the possibility of annihilation, a lack of existence which is by definition an unknowable state beyond experience and beyond the unbridled pursuit and drive for life. If left unprocessed, this state of mind will lead to a much-reduced quality of life, severe depression and anxiety, and even possibly a wish for a reprieve by way of suicide.

Existential suffering induced by a serious illness can move one into despair, especially right after receiving an ominous prognosis, but what one has to understand is that the angst shall pass in time. Although no one technique or method will work as a blueprint to navigate out of the suffering, there are lifelines that you can grab onto that are just within reach for all of us. The most important is to allow ourselves to be vulnerable and lean on our closest relationships. Some may choose family or best friends, but others will choose people from their religious or spiritual community. Others have work colleagues with whom they have developed a close connection. It’s the depth of the relationship and the chemistry between people that matter most. For some, this is the time to put aside one’s fierce attachment to individuality and allow oneself to be nourished by the closeness and emotional support of a loved companion.

For others who are empowered to manage the inevitable struggles of life on their own, this time allows for intense and valuable introspection to sort out what is most important and to focus energy on that rather than continue to engage with the mundane. For some, immersion in philosophy, meditation, going on a spiritual retreat, or finding a clinic that specializes in psychedelic-assisted psychotherapy allows for the needed self-reflection and insight.

Yet for others, distancing themselves from the constant mental distress is what is needed. Instead of spending time obsessing about uncertainty, they go back to work. They seek out the routine that was once taken for granted which now becomes their path into life again. A focus on performing work and a focus on one’s societal role allows a distraction from the current emotional plight allowing the mind to both continue to process the crisis on an unconscious level and allow life to be lived. Distraction becomes a very useful psychological tool.

Additionally, seeking help from a grief or bereavement therapist can be extremely helpful. These counselors have gone into this field out of a calling to help people, especially in times of severe distress. The deep irony of it is that as most people remain unaware and avoid the intense struggle of the human condition and only come upon it when befallen by an illness, grief counselors spend their time immersed in others’ suffering and angst. This gifts them an understanding of the human condition that is typically deeper than one normally attains. Their professional role is to navigate the existential dilemmas in life and allow their skills to help people reclaim themselves from the madness of the mental breakdown they heretofore were in.

In time, an existential crisis is transformed. Eventually, psychological strength develops. We allow ourselves to integrate our new reality into our world and through that integration, we attain a certain resilience and fortitude that possesses gumption. What was once fear, turns into a strength. Whereas an existential plight turns our world upside down, the strength won over-delivers our lives back to us. The new perspective is “marked by personal growth, a new or a renewed appreciation of daily life, new meaning, increased fulfillment, a sense of connectedness to others, and improved well-being.”1 Although the new reframe does not remove the struggle, it does allow for joy to enter once more. And that joy, that new growth, that new perspective on life allows one to peek past the darkness of their breakdown and see that once again, hope and meaning are attainable.

References

1. Mount BM, Boston PH, Cohen SR. Healing connections: on moving from suffering to a sense of well-being. J Pain Symptom Manage 2007;33:372-88.

Beyond prognosis communication: Exploring the existential dimensions of palliative care conversations with adults with advanced cancer. Elise C. Tarbi

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