Brenda: Emotional impact and Support for Cancer Patients

When people hear the word ‘cancer’, all negative thoughts will always flow into their minds.  To most people, it signifies terminal illness despite increasing numbers of real cures as well as meaningful remissions.  For many cancer patients and their families, the cancer journey is always an intensely stressful moment.  It can be rather difficult to identify and honor the feelings.  Therefore, emotional support is always important for most cancer patients during their cancer journey.  Not to be forgotten, different supports from various organizations, people and services may improve cancer patients’ mental and physical health.

Fear, sadness, anger and other emotions, with vulnerability, anxiety and even depression will surface during the cancer journey for cancer patients and their family members.  The distressed feelings of uncertainty, questions, and concerns about responsiveness to cancer treatments, life changes within family, friends, work and routines, worries about mortality as well as confusion about meaning and purpose in life can fill up cancer patients’ mind.

The mind-body connection with unresolved, painful thoughts and feelings can cultivate disconnect internally and externally.  Without the capacity to identify, and express the mental and emotional reactions, cancer patients can reject themselves and others.  Any suppressed emotions can become toxic to the physical body too.  Ongoing perceived loneliness with a sense of isolation also supports detachment, dissociation, and disconnect.

Similar to Kubler-Ross model, the five commonly recognized stages of cancer grief are denial, anger, bargaining, depression and acceptance.  However, not everyone experiences all stages or goes through them in a certain order.  Denial is a coping mechanism to help an individual survive news that is difficult to handle.  During the anger stage, people always start questioning ‘Why did this happen to me?’ or ‘What did I do to deserve this?’.  Next, people will try to bargain to prevent future losses by changing their lifestyle of even promising God that they will change their behaviour in exchange for good health.  However, sadness or depression will always attack cancer patients upon diagnosis and affecting their mood, energy levels, motivation, and daily lifestyle.  Finally, when cancer patients accept their cancer diagnosis, it may not necessary mean that they have completely let go of their grief.  They may revert to other stages again.
This is where a social worker, counsellor and doctors can help cancer patients to wade through all information and make decisions during this distressing moment.  Information is a powerful antidote to fear and anxiety. Hence, open communication serves important role between patients and caregivers during the cancer journey. 
Doctors share different available options to patients and the pros and cons of the treatments options.  This helps patients to have a better understanding of what they will go through and make a decision that best fit in to their situations.  Emotional support creates connection and kindness to cancer patients is medicine.  Talking to other cancer patients and survivors often help to alleviate stress and depression.  There are a lot of cancer support groups available these days, be it in the hospital or other welfare organizations that provide a safe place for cancer patients to share experiences with others who are dealing with or have experienced cancer.  Social workers often are the people who will work closely with patients and the family members.  They often help to collaborate and identify solutions to their problems, ranging from financial difficulties to family issues.

Learning about available resources is also needful.  Community resources provide support and assistance in order that individuals and families may better cope in the long run.  Other than community hospitals, family service centres (counselling support) and social service office (financial support), there are other organizations aim to provide support for cancer patients in various aspects.  They are:

  • Singapore Cancer Society (home care, financial, psychosocial and bereavement support, rehabilitation programme, cancer support groups, family, and youth engagement)
  • Children Cancer Foundation (back-to-school service, caregiver support, emotional and financial support, palliative and bereavement support, academic and learning support)
  • Breast Cancer Foundation (mammogram sponsorship, education, and empowerment programme, befriender, enrichment programme, wig loan, talks, prostheses and bras sponsorship)
  • 365 Cancer Prevention Society (day activity centre, emotional and financial support, nutrition assistance, gatherings and outings, lymphatic detox exercise and detox dance, health education)
  • Leukaemia and Lymphoma Foundation (treatment cost subsidy, befrienders, and emotional support)
  • Brain Tumour Society Singapore (financial and emotional support, support group, befriender) 
  • AINS Society (emotional support, financial support, enrichment programmes for patients and families)
  • Assisi Home and Hospice (in-patient care, home care, day care)
  • Bright Vision Hospital (in-patient care, rehabilitation centre, TCM clinic)
  • Dover Park Hospice (in-patient care)
  • Hospice Care Association (home care, day care)
  • Methodist Hospice Fellowship (home care, spiritual and emotional support)
  • Metta Hospice Care (home care, spiritual care, medical equipment loan)
  • St Joseph’s Home (In-patient care, spiritual support)
  • HCA Hospice Care (home care, day care) (psychosocial, bereavement support, palliative and young caregivers programme, home care equipment loan)

 To sum it up, it is challenging for cancer patients to walk through the cancer journey alone.  Many times, the diagnosis of cancer brutally reminds us of our own finality.  It may sometimes a blessing to use the time of illness to think about death and dying in terms of ourselves, regardless of whether the patient will have to meet death or get an extension of life.  Families, friends, and health professionals play different roles to support cancer patients.  As sociologist Margaret Mead once said: “A small group of thoughtful people could change the world.’’  The more we support the family as a unit or the people who support the patient, the better we are at helping the patient throughout the whole process.

Challenges in the Social Work Field

Note: This is an invited post by May (pseudonym), an experienced social worker in the field.

Social workers are primarily concerned about the well-being and functioning of individuals and families, and work to empower the individuals to be better equipped to handle their issues.  In Singapore, social workers are employed in various settings, which include youth, family, prisons, hospitals, and special needs.  At the same time, they are also employed to look at shaping larger level policies, and how these policies are implemented to the ground level.  Social workers are very often associated with being volunteers - as being people with huge hearts and "give people a fish".

Societal views of the work as a social worker
However, how our society views this profession is an important perspective to think about, which is something that isn't always talked about, even in school.  Why is this so?  The people who will end up studying and aspiring to be social workers are from, well, that same society.  Acceptance of the society's views is a mindset that will challenge the student's perspective as well.

Being the "quick fix" to clients' issues
On a day-to-day basis, social workers face unreasonable demands  -  as there is an expectation that they are the "quick fix" solutions.  "Quick fix"'solutions administered for clients are almost always finite, with a stringent assessment process, and an interim solution to tie over a period of time where they are expected to still work on being more self-reliant, which inevitably frustrates people who view 'help' as an instant solution.

What social workers really do
What social workers actually do is to look at how various systems in the environment affect people, help people navigate these systems, as well as look into how systems can be improved.  This is done with a core value of empathetic and intentional listening, in a non-judgmental and objective way.  Advocacy for clients that are vulnerable or unable to access resources and systems is also an integral part of the work.  As with any other job, social workers deal with disagreements, emotional upheavals, expectations from various people, and have to always be mindful of their clinical interventions.

Staying motivated at work
Having to deal with so many concurrent issues is virtually impossible to do alone, and the concepts of individual and group supervisions and team work help to provide support to the social worker in managing dynamics, clinical interventions, and the emotions evoked when dealing with a multitude of issues.  This support from peers and supervisors is very helpful in motivating the growth of the social worker, regardless of years of seniority and experience.  It is important for social workers to keep up with positive attitudes and work hand in hand with different parties to build up a better community  -  and to constantly keep themselves motivated and purpose driven, to maintain themselves in this profession.

Jerry O.: Effect of Social Media on Suicides

The number of suicides that occur worldwide stands at almost 800,000 yearly, making it the 17th leading cause of death in 2015 (World Health Organisation, 2015) and with the increase in the publicity of suicides, it is now a major global health issue.  The relationship between suicide and the internet and in particular social media is very complex and various researchers have tried to find out if social media hinders or encourages death by suicide.  Studies have shown that even though there is no direct link between social media and suicide, there is some degree of interaction between them.

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The social media is a hub of information and one can easily find information on any subject simply by typing the search words and suicide is not an exception.  There is a huge repository of information on suicide on the internet and there are many pro-suicide chat rooms and forums which provide very detailed information about suicide and even the methods that can be used.  There are so many ways by which social media can contribute to an increase in the tendency to commit suicide.

The nature of human interactions is such that the chunk of our deductions and understanding of people’s behaviour comes from things they do not say.  That is to say human communication relies more on nonverbal communication that the actual exchange of words.  The heart and soul of our interactions are the gestures, eye contact, tone of voice, facial expressions, body language, and posture and so on.  We are able to fully understand what a person is saying by comparing the words they use with the nonverbal signs that we observe, we can tell if a person is excited, sad, hiding something or if they are relaxed.

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On social media however, these nonverbal signs are replaced by smileys and emoticons so they may as well be absent because you cannot actually tell that the person sending you a grinning smiley is actually grinning, for all you know they may be wearing a scowl on their face.  Social media gives people the opportunity to be anything they want to be; they may be depressed in real life and be very chatty online, they may be crying and be using all the happy emoticons and smiley.  So, unless a person opens up to you and shares their pain you will not know they have any unlike in face-to-face interactions where you can pick up that someone is being bothered by something and they are more likely to open up if someone asks them.  Likewise, there is no way to tell if a person is contemplating suicide via social media interactions unless they tell you because online interactions are grossly lacking in the nonverbal cues we already mentioned.

Social Media Influencing Suicides

Another problem with social media that can increase suicidal behaviour is cyber harassment and cyber bullying.  When various internet media are used to intentionally and continuously harass or threaten a child or teenager or even an adult, it is termed cyber bullying, cyber harassment or cyber stalking and it is a very serious problem.  The media used to perpetrate these acts include text messaging, instant messaging, e-mail and social networking sites where people get “trolled” maliciously.  These acts place negative pressure on the recipients thereby intensifying their lonely feelings, hopelessness, instability and isolation which is made worse in people who are already under intense psychological or emotional stressors and increases their risk to commit suicide.  A study by Hinduja and Patchin (2010) showed that middle school children who had been cyber bullied were two times more likely to attempt suicide that others who were not.  It also showed that offenders of cyber bullying were 1.5 times more likely to attempt suicide than those who were neither targets of nor offenders of cyber bullying.

Furthermore, there have been reports of strangers who met on bulletin boards and chat rooms or forums deciding to commit suicide on the same day.  This is called "Cybersuicide pact" and the first documented case was reported in 2000 in Japan where the suicide rate is still on the increase.  This problem is a major topic for discussion on the internet and it is suspected that its impact in precipitating or encouraging suicides lie in the fact that people of like minds are able to share their stories and then push each other in the direction they want. These boards also provide information on the various methods that people can use to commit suicide thus making it much easier for people to kill themselves.

Another point worthy of note is the media contagion effect.  Suicide contagion refers to a state in which suicidal behaviour spontaneously sweeps across a particular group of people and this affects people who are less than 25 years old more than other ages.  When certain people are exposed to information about suicide through any means, this may influence their decision to kill themselves.  In some cases, chat rooms and bulletin boards create memorial pages for those who die by suicide and for the impressionable minds;  this may push them towards committing suicide.  The reason being that users also want to be idolized by those who had already committed suicide and so they get a few minutes of fame even if they are dead.  This problem has more deep seated psychological problems that are merely augmented by the social media.

Contrariwise, social media also contributes in some ways to the prevention of suicide.  There are social networking pages that provide interactions between people with similar stories to help prevent suicides, provide help lines and provide awareness about suicide prevention.  Some of these pages include the American Foundation of Suicide Prevention and the National Suicide Prevention Lifeline which can both be found on Facebook.  There are also several groups on Twitter and even blogs that are dedicated to providing information vital in preventing suicides.  Also, Google and Yahoo also have features that serve as proactive suicide prevention links; when a person uses a search word that indicates suicidal intent, links are displayed at the top of the result page about the National Suicide Prevention Lifeline.  These features can provide help to a person who is contemplating suicide.
In Singapore, Samaritans of Singapore (SOS) is the main suicide prevention centre which helps people in crisis, thinking of suicide or affected by suicide. Their number is 1800-221 4444 (24 hours).

World Suicide Prevention Day 2017 (by Samaritans of Singapore)

The research into the role of social media in pro-suicide behavior does not have enough data to draw a clear-cut relationship although evidence suggests there is a link and the whole world is beginning to sit up and take notice.  Therefore, it should be the responsibility of every user of social media to ensure that they do what they can to prevent suicide by sharing information on suicide prevention help lines on their time lines and when people post contents that  may suggest that they are contemplating suicide, it should be taken seriously.

For more posts on Social Media on SG Psych Stuff:
SGPsychStud:  Networking on Social Media
Jerry O.:  The Influence of Social Media on Behaviour
Jerry O.:  Why People Are Into Social Media