By Ger Murphy
Diagnosis is of the present, prognosis is of the future, it is important not to confuse the two.
The arrival of a diagnosis into a life is a frightening happening. In this brief article I want to chart my own journey through coming to terms with a diagnosis, with its power and possibilities. I further want to explore these issues with the use of poetry which was a medium and a medicine of great use to me. I have worked closely with some clients who have faced threatening illnesses and the challenge of healing and the arrival, in some instances, of death. I therefore want to offer some thoughts that may be of use to others as they navigate their way following a powerful happening of this kind, regardless of the ultimate outcome of cure, maintenance or death.
In 2002 I was diagnosed with a serious illness, and it filled me with fear and other strong feelings. It was the first time I had experienced a crisis which was inside my body. Previously, crises had been typically external to my being and could be responded to with strategizing, planning and other mental and emotional responses.
But this was different. The vulnerability was breathtaking and it brought a response of shock and numbness and was difficult for my mind to compute. These feelings gave way to anger, self-pity and a sense of isolation. It was difficult to move beyond this reaction for some time, and in these dark, grief–filled times, poetry was a particular resource for me. The soothing quality of poetry as well as the spaciousness it offered was a medicine to me. The following lines, (Mary Oliver, 2004) from her poem Wild Geese, were a special comfort.
“Speak to me of despair, yours, and I will tell you mine, Meanwhile the world goes on
No matter how lonely you are, The world continues to offer itself to your imagination, Announcing, over and over, Your place in the family of things”.
Mary Oliver (2004)
It became apparent that there was a real discernment needed in dealing with despair. I began to know the importance of lingering with and opening to despair and began learning not to blindly rush away from it – in fear of becoming transfixed – like Lots wife looking behind and being changed to a pillar of salt! An image of bitterness and regret. Yet it was important not to be swallowed by regret and despair but to open through it, and a way began to appear of using intense feeling as a gateway to greater depth and presence in myself.
In this I was and am reminded of Brendan Kennelly’s exhortation to remain in contact with despair so as to be able to hear the many voices to be heard there. Yet it also became clear that the despair of a diagnosis could become a paradoxically comforting state in which to reside. There can be a certainty, or assumed certainty “at least now I know the worst has happened” and the journey to hope can be fraught with risk – as if returning to hope is akin to opening to love again. A line of my own comes to mind:
“There is a satisfied completion in black, No grey, no hope, no danger, Then emerging to the arms of uncertainty and possible”.
Ger Murphy …..(2004)
We can become comfortable in despair and remain there when the visit might best be ended. The words of (Anais Nin 1992) seem relevant here. “And the day came when the risk to remain tight in a bud, was more painful than the risk it took to blossom”
It became clear to me that the first task I faced was to find better ways to manage fear. The fear that a diagnosis brings is often tangible. It brings us into the future, “what if”, and pictures of future scenarios of illness come crowding in. In this way a diagnosis can become confused with a prognosis, in which our sense of personal agency or power can feel gravely diminished, and we give our healing over to the professionals who have given us the diagnosis.
Compulsive checking of symptoms, along with feelings of unfairness, crowd the present moment from view. We can feel that our trust in our bodies is gone and we can even become angry with our body, and full of self-doubt, making us turn outside of ourselves for any answers. Here also can emerge a frantic or manic rush for health, which has strong elements of fear or panic in it, until we have taken the time to work through the trauma of diagnosis. A diagnosis is a trauma, and needs to be met as one.
As Ogden, (2001:page 126) says in Trauma and The Body
“When we suffer from unresolved trauma, we report un-regulated body experience, an uncontrollable cascade of strong emotions and physical sensations, triggered by reminders of the trauma, replaying endlessly in the body.”
Pat Ogden (2001)
People often mention to me how they continue to repeat in their minds what they “should” have said to the Consultant, or memories of being given the diagnosis are alive “as though yesterday”.
In this place mindfulness meditation practice, remaining with what is, rather than what might be, was a lifesaver. The books of Eckhart Tolle “The Power of Now” and “A New Earth” along with those by Pema Chodron “When Things Fall Apart” were close companions.
In these situations and faced with these type of difficulties we tend to turn away and run from fear. However, I found that facing the fear was more useful. What do I mean by facing it? Not the bracing warrior stance we all heard about in “Feel the Fear and Do It Anyway” but rather a softening and opening to the feeling, allowing the shaking, shivering response to emerge and pass through us. I began to find out what had been said was true – fear does not last long and running away from it tends to give it more power and paradoxically keeps it more present in our lives. Fear makes us tremble, if we can allow it, and trembling can be a very healthy body-practice, akin to the shaking encouraged by Alexander Lowen in “BioEnergetics” (1979).
These inner tools were complimented by support from those close to me who loved me. Compulsive thinking felt like a constant for a while so it was really important to be able to be vulnerable, sad, frightened and angry. Allowing those feelings expression was most important to me to break the isolation that can ensue from a diagnosis when one feels alone and different, and afraid of pity. The words of an old Tibetan prayer translated by Sogal Rimposhe come to mind:
“Rest in great natural peace this exhausted mind, Battered by karma and neurotic thought, Like the ceaseless fury of the pounding waves, On the infinite ocean of samsara”
Time and a space for quiet reflection was then necessary before some purposeful action emerged. I realized that a diagnosis could become a number of things, not just one. Might it not be only a life sentence? Might it also be a beginning? The line in Marie Howe’s poem “What the Living Do”:
“I never knew that the doorway I was passing through Was in the shape of my brother’s dead body…”
These lines allowed me to face the possibility that tragedy can also offer a moment of possibility, of change, if we can meet it fully, surrender to it and embrace the future with openness. The experience of a diagnosis is a sort of death, a death of one view of us, but it may also be a beginning. Again poetry spoke to me here, especially the lines by Downa Markova “I will not Die an Unlived life”:
“I will not die an unlived life, nor live in fear of falling or catching fire, I choose to inhabit my days, so that my living opens me, makes me less afraid, I choose to risk my significance so that what came as seed, goes to the next as blossom And what came as blossom goes on as fruit”
I returned to one-to-one psychotherapy, which I found invaluable in dealing with the strong emotions rolling through me, and thereby allowing me to think more clearly. I found a therapeutic approach, which focused on the somatic/body as well as cognitions most useful. I began to think about the diagnosis and to revisit past experience to clear myself of old psychic wounds, so as to be freer of `baggage` for the journey ahead.
I found myself exploring many pursuits, which I had not previously done so fully. I felt a new compassion for my body and began to study and practice Yoga. I found homeopathy resonated with me, in its approach to health that fostered a view of supporting the healing powers of the body though particular individually chosen remedies, seeing the illness as a multi-level phenomenon with a spiritual, mental as well as physical dimension.
The stress levels caused by the diagnosis were also helped greatly by sessions of acupuncture and through yoga I discovered dance, realizing first hand the brevity of life for the first time, and finding an urge to live more fully in my body and to enjoy it. Mary Oliver`s (2004) line came to mind “And what will you do with this one wild and precious life”…
It became clear to me that I wanted to enjoy or take joy in being in my body, no longer caught in the hypnosis of believing that I would live forever. That is another effect of a diagnosis, to allow us to see our frailty and time-limitedness, and to focus us on what we really want. Again the lines from Raymond Carvers (1997) poem All of Us resonated
“And did you get what you wanted in this life, even so? I did. And what did you want? To call myself beloved, and to walk as beloved on this earth”.
The journey goes on, other challenges arise, other opportunities emerge to develop, and perhaps it is not about curing or fixing but about, as David Whyte’s (1997) poem Faces at Braga says: “Giving ourselves to the blows of the carvers hand”
So a diagnosis can be an opening into a new appreciation of life, and a new way to meet our unfolding lives. Perhaps a diagnosis does not have to become a prognosis, but it is here that the disciplines and supports and practices, which help us to stay centered and present, and not become overwhelmed by fear, are vital. Here we can both surrender with humility and stay strong and centered as we open ourselves to the meanings of the diagnosis. Perhaps a diagnosis can then transform from an enemy to being a teacher, and in this can reveal its message and meaning.
The renowned Jewish Psychiatrist Victor Frankl (2004;Page 214) who had survived the Concentration camps said: “The level of despair we feel is related to our experience of suffering minus our capacity to make meaning of that suffering” By surrendering to ‘the carver’s blow’ perhaps we can allow meaning to be shown to us, which can give us more, more than feeling a victim, more than seeing our state as only an ending or a life-sentence, more…As Rilke’s(1978) poem “God Speaks“ states
“Let everything into you, the beauty and the terror, Just keep going, remember no feeling lasts forever…. Take hold of my hand”.
Perhaps now I can look back and see a little of the gift of a diagnosis. The gift I see is the gift of an increase of kindness, for myself, and for others. The lines of Naomi Shihab Nye (2008)poem “Kindness” come to mind..
“Before you know what kindness really I you must lose things, Feel the future dissolve in a moment like salt in a weakened broth, What you held in your hand, What you counted and carefully saved, All this must go so you know how desolate the landscape can be between the regions of kindness.”
Naomi Shihab Nye (2008)
However, I am writing this eight years after receiving a diagnosis, which probably goes to show that it may take a good deal of time, and integration before the gifts of such a happening will become apparent. However it may offer some hope to know that meaning can emerge from darkness, even when we are still in that darkness, hope can fortify us for the journey.
The other gift that diagnosis may offer is the ability to face despair. As David Whyte (2007) in his poem Self Portrait says..
“It does not interest me if there is one god or many gods , I want to know if you belong or feel abandoned, If you know despair or can see it in others…”
David Whyte (2007)
I suppose after a diagnosis of a serious illness our task is to see how we can be generative again. This is on many levels, physical, but also relational and spiritual, and a diagnosis can become an important part of the challenge and the opportunity to remain open to life and I want to finish again with the lines from Mary Oliver (2004) When Death Comes:
“When it is over, I want to say: all my life I was a bride married to amazement I was the bridegroom, taking the world in my arms. When it’s over, I don’t want to wonder if I have made of my life something particular and real. I don’t want to find myself sighing and frightened, or full of argument. I don’t want to end up simply having visited this world”.
Mary Oliver (2004)
So we can know that a diagnosis is not a prognosis by managing ourselves when the diagnosis arrives with kindness and clarity, so we can stay open and present to the journey that awaits, healing into health or into death. The more present we can be to this journey and to ourselves in it the more we can remain active participants in this journey and not merely patients, or victims. A life –long journey!!!
Ger Murphy is an accredited psychotherapist and trainer with IAHIP, he is Director of Institute of Creative Counseling and Psychotherapy. He also is a founder of IAHIP, ICP and Inside Out journal.He can be contacted on firstname.lastname@example.org
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