Previous chapter: 4.1 Adaptation by the social environment
4.2 Adaptation by the patient
For the cases in which attempts to change external influences are unsuccessful the second of the two possibilities remains: The possibility of the adaptation by the patient to the external circumstances. At first, this appears to be the significantly more difficult approach, as it demands an inner psychological change by the patient himself, which may need to be more or less radical. However, as the patient’s efforts now become crucial, control over success or failure of these efforts is transferred to the patient. This offers the advantage for the patient that, in the best case, he becomes completely independent of external influences which he cannot control.
The disadvantage is the unfavourable starting position of the cancer patient with respect to the available resources, energy and strength for applying this approach. In practice, the following problems are encountered:
- The patient knows next to nothing about himself and about unconscious dangers and psychological entanglements.
- Often he does not acknowledge, even at an intellectual level, that it is necessary to be dealing himself with the connections between his psychological characteristics and his suffering. This knowledge however would be the decisive motivation for action to improve the situation.
- Even if he is aware of this connection, the patient can so greatly doubt the value and chance for success of the specific treatment method that he does not make any progress.
- The patient generally does not have the strength or peace of mind for self-reflection, in order to recognise and overcome these dangers and entanglements.
- The patient usually lives in surroundings which hinder rather than encourage such self-reflection.
- The patient is often - particularly if he is older - mentally inflexible. Needs, aversions, self-acceptance or self-ignorance are too thoroughly ingrained.
Nevertheless, when faced with death, the patient (with the help of those around him, including psychologists and doctors) may have no alternative but to set out along the stony path of adaptation, despite all of these problems. In the following, we aim to show some options that are available. Above all, the nature of deeply rooted modes of behaviour will be considered.
Next chapter: 5. Psychotherapeutic approaches