Table Of ContentPsychotherapy and the
Treatment of Cancer Patients
Psychotherapya nd the Treatmento f Cancer Patients addressesth e needf or a
more integratedc are of cancerp atientsw ithin hospitals,w hich pays attentiont o
the mental anguisha s well as physical distressc ausedb y the disease.T his book
is basedo n LawrenceG oldie's own researchw ith cancerp atients,w hich has
shownt hat psychoanalyticp sychotherapyto getherw ith generalm edical carec an
significantly help dying patientsc opew ith the pain and suffering associatedw ith
the disease.
Drawing on this research,t he book advocatesa more holistic approacht o the
cancer patient and suggestsw ays in which more expert attention might be
provided through awarenesst,r aining and resources.T he book describest he
innovativea pproacho f applying the psychoanalyticp sychotherapeutiac pproach
within the hospital context to help individuals cope with cancer.A s well as an
overview of cancera nd the therapeutica pproach,t opics coveredi nclude:
The impact of cancero n hospital relationships
Canceri n different areaso f the body and mind
'Mind-bendingp ain'
Dread and trauma- on being told the truth
Psychoanalyticp sychotherapyin the NHS 'general'h ospital
Examiningg roup processesin hospital
PsychotherapJ!a nd the Treatmento f Cancer Patients chaIlengest he existing
orthodoxiesa boutp aIliative care and points to ways in which the principles and
methodso f psychoanalysisc an be applieds uccessfuIlyt o cancerc are within the
hospital context.
Lawrence Goldie is a consultantp sychiatrista nd psychoanalyticp sychotherapist.
He has publishedw idely on a variety oftopicsi ncluding hypnosis,e pilepsy,s leep
patterns in infants, intracranial bruits and on the subject of 'attention and
inattention'.H is psychiatrict raining was at the Institute of Psychiatryi n London
andw hile at the Institute of Psychoanalysihs e·wass upervisedb y Dr Wilfred Bion,
who inspiredh is work.
Jane Desmaraist eachesin the departmenot f English & ComparativeL iterature
at GoldsmithsC ollege, University of London. She has publishedi n the fields of
literature, the visual arts, and psychoanalysis.
Psychotherapy and the
Treatment of Cancer
Patients
Bearing cancer in mind
Lawrence Goldie
with Jane Desmarais
~~o~;~~n~~~up
I~
LONDON AND NEW YORK
First published 2005
by Routledge
27 Church Road, Hove, East SussexB N3 2FA
Simultaneouslyp ublished in the USA and Canada
by Routledge
270 Madison Avenue, New York, NY 10016
Routledgei s on imprint of the Taylor & Francis Group
© 2005 Lawrence Goldie and Jane Desmarais
Typeseti n Times by Keystroke,J acarandaL odge, Wolverhampton
Printed and bound in Great Britain by MPG Books Ltd, Bodmin
Paperbackc over design by Lisa Dynan
All rights reserved.N o part of this book may be reprinted or
reproducedo r utilised in any form or by any electronic,
mechanical,o r other means,n ow known or hereafteri nvented,
including photocopyinga nd recording, or in any information
storageo r retrieval system,w ithout permissioni n writing from
the publishers.
This publication has been producedw ith paper manufacturedt o
strict environmentals tandardsa nd with pulp derived from
sustainablef orests.
British Library Cataloguingi n Publication Dota
A cataloguer ecord for this book is available from the British Library
Library of CongressC ataloging in Publication Data
Goldie, Lawrence, 1923-
Psychotherapya nd the treatmento f cancerp atients:b earing
canceri n mind / LawrenceG oldie with Jane Desmarais.
p. ; cm.
Includes bibliographical referencesa nd index.
ISBN 1-58391-857-4( pbk) - ISBN 1-58391-856-6( hbk)
I. Cancer-Psychologicaal spects.2 . Cancer-Palliative
treatment.3 . Psychoanalyticp sychotherapy.4 . Terminal
care. 5. Cancer-Patients-Hospitacla re.
[DNLM: I. Neoplasms-therapy2.. Hospitals. 3. Palliative
Care-organization& administration.4 . Psychoanalytic
Therapy.1 I. Desmarais,J ane Haville. II. Title.
RC271.P79G652 005
616.99'406-dc22
2005001709
ISBN 1-58391-857-4( pbk)
ISBN 1-58391-856-6( hbk)
The art of living well and dying well are one.
(Epicurus)
Contents
Preface IX
Acknowledgements xix
Introduction 1
1 In the front line with cancer 9
2 Cancera nd the psychotherapeutiec ndeavour 26
3 The impact of cancero n hospital relationships 46
4 Canceri n different areaso f the body and mind 62
5 Mind-bendingp ain 87
6 Dreada ndt rauma- on being told the truth 102
7 Psychoanalyticp sychotherapyin the NHS
'general'h ospital 119
8 Examiningg roup processesin hospital 135
Bibliography 147
Index 150
Preface
Therew ere many threadst hat drew me to the work that I did at the Royal
MarsdenH ospital in 1972. At the time I lived neart he Sutton brancho f
the hospitala nd a relative of my wife was admittedt o this hospital. I knew
Mr W quite well and I rather admiredh im. He was originally born in
Czechoslovakiab ut subsequentlye scapeda nd volunteeredf or the British
Army. He was admittedt o the Royal MarsdenH ospital at Suttonb ecause
he had developedc ancero f the lung.
When I visited him, the Sistero n the ward askedm e what I did and I
told her I was a psychiatrista nd this led her to tell me aboutt he pain and
emotionald ifficulties that she had witnessedin patients.T o her distress,
their emotional pain was not considered.I becamei nterestedi n the
problemst hat she told me about and this resultedi n my introduction to
an eminentr adiologist, Dr S. He askedm e to join him when he was on
the ward discussingp atients.H e was impressivew hen demonstratingh is
franknessw ith his patients.O n one occasionh e broughti n a 50-year-old
man. He had this patient'sX -rays on the viewing box and he pointedo ut
to the patient the canceri n his lungs. At that time patientsc ame to the
hospitala t Suttonf or radiological investigationsa nd also for radiotherapy,
but, as Dr S told me, the radiotherapistsa nd radiologistsd id not take
chargeo f the patients.T hey merely conductedin vestigations.T he doctor
in chargeo f the patient was the doctor who originally saw and referred
the patient. As a radiologist, Dr S admitted that he was no more in a
position to carryon seeing a patient than a pathologist would be,
examiningb iopsy specimenso r the blood of a patient.
Still, I was struck at this first meetingw ith Dr S, with how he discussed
openly the cancerw ith the patient. There was no emotion but there was
no coldnesse ither. I recalledl ater that he had said that the lesion was very
slow growing, and although I cannot quote his exact words it was
somethingl ike 'Therei s nothing more that can be done'.W hen the patient
x Preface
left the room I askedD r S 'What is the outlook for this patient?'H e replied
'WeIl, it is very slow growing, and it will probablyb e somethingli ke two
yearso r more beforet his patienth asa ny symptomso r difficulties.' This
was very reasonableb, ut what madem e review his words to the patient
was the discovery later that the patient had died of a heart attack the
foIlowing weekend.I thought that this was becausew hent he radiologist
saidt herew asn othing more to be done,t he patienth adt akent his to mean
that he was a hopelessc ase.I n films andb ooks,t his is what is usually said
when there is no hope for a patient, when they are aboutt o die.
On reflection, I thoughtt hat the discussionw ith the patient was very
limited. No one knew what the patient thought about what was being
shown or said to him. I was struck by the fact that the cancerw as no
immediatet hreatt o his life, and was unlikely to be so for a considerable
length of time. But he died of a hearta ttack.
After diagnosisb y the radiologist, my wife's relative, Mr W, was
referred to his original doctor, and he was then transferredf rom the
Marsden.T he X-rays had shownt hat the cancerw as in his lung and that
therew as no treatmentf or it at present.H e then revertedt o the careo fthe
surgeonh e had originaIly consulted.T his surgeond id not know wheret o
place him so he put him in a generalw ard in anotherh ospital.
I discoveredw here Mr W had beent ransferreda nd went to visit him.
The ward seemedt o contain a mixture of senile patients and mental
patients.I spoket o him and he was, as usual, polite and seeminglyq uite
acceptingo f the diagnosis, without complaining about being in that
particularw ard. As I was leaving, I was approachedb y the young House
Surgeonw ho askedt o speakt o me, becauses he said Mr W had been
asking her to provide him with enought abletsf or him to be able to take
his own life. Shew as quite confuseda nd did not know what to say to Mr
W or what to do abouth is request.I was shockeda nd realisedt his other
side of him. He was in despair,f eeling himselfa bandoneda nd relegated
to this ward, wheren o treatmentw as taking place.F rom his point of view,
the ward was fuIl of peoplew ho were hopeless andm entaIly disturbed.
When I first startedw orking at the Marsden,t herew as alwayst he issue
of who was ultimately responsiblef or the patient, especiallyw hen there
were severald ifferent teamsi nvolved. Often the responsibility for the
patient was disavowed,a nd it feIl upon the doctor who had originally
referredt he patient. The doctor or surgeon,a s in the caseo fMr W, often
no longerh ada n interest,o r any meanso f treatingt he patient.I t was quite
ridiculous really, as with Mr W, to refer the patientb ack to a doctor who
had no further interest or treatmentr esources.H e did eventuallyr eturn
home,b ut he was very depresseda nd miserable,a nd he developeda heart
Preface xi
condition, dying of a coronaryt hrombosis.H e seemedto me to be very
miserable,d epresseda nd unhappy.I never forgot what I thought was
really quite tragic: that sucha bravem an,w ho fought in anotherc ountry's
army, shouldf eel so hopelessa, bandoneda nd uselessth at he would want
to commit suicide.
I was askedb y Dr S to comeo n to the wardst o look roundt he hospital,
and to make any observationsth at I caredt o about what was happening.
I spoket o the sisterso n the wards.A t that time, I hada friend, Mr C, who
was a surgeona t the hospital. He specialisedin surgeryo f the abdomen
and large bowel. He told me how he was spendinga lot of his time with
his outpatientsd iscussingt heir emotionala nd sexuald ifficulties. He said
that thesed iscussionsw ere becomingi ncreasinglyc ommonplacet,h at he
was discussingt he issueso f sex and sexuality more than their surgical
condition. Patientsf earedt hat they hadc ancero f the bowel becauseth ey
felt somethingin truding in their rectum.M r C would seet hem in the clinic
and perform a rectal examination,o nly to discover in the majority of
cases,t hat these men had enlarged prostates. He would then have
discussionsw ith thesep atientsa boutt heir 'sex life' and discovert hat they
had ceasedto haves exuali ntercourse.H e thoughtt hat this was the main
reasonf or the prostatic enlargement.A s a consequenceh, e approached
me to take over from him the discussiono fthe sexualp roblemso f patients
who camet o his clinic.
After a while, along with anotherr adiotherapist,M r C recommended
to the MarsdenH ospital Committeet hat a survey was required of the
psychiatric needso f the hospital. Knowing me quite well, they both
suggestedth at I shouldc onducta surveyo ftheir psychiatricn eeds.I t was
agreed,a nd moneyw as seta sidef or one yearw hen I would do the survey
and submit a report at the end of that time. The House Governora sked
me if, whilst I was doing this survey, I would also undertaket o seea ny
casest hat might be referred,w hich I agreedt o. I had no intention at that
time of having a permanenat ppointmenwt ith the hospitala nd it was with
considerabled ifficulty that I managedt o fit in time to see patients,a s I
was alreadyf ully occupiedw ith treatingp atientse lsewhere.
After it was agreedt hat I shouldd o this survey,I receivedl ettersf rom
individual memberso f the Committeee xpressingc onsiderablefe ars and
doubts about the plan. One letter askedm e not to go round the hospital
telling patientst hat they were going to die! I was also told by someo f the
Committeet hat there had beenv ery strong oppositiont o the idea of a
psychiatristi n the hospital,l et aloneo ne inclined towardsp sychoanalytic
psychotherapyS. omet houghtt hat it was completelyu nnecessartyo have
a psychiatrist,a s the patientsn everr equiredo ne. In any eventt hey thought
xii Preface
that their handlingo f patientsw as quite adequateA. notherp hysicians aid
that he had worked for a time in a psychiatrich ospital, so he knew quite
a lot aboutp sychiatry.H e, alongw ith anotherp hysicianw ho was violently
opposedto psychiatry,j oineda choruso f prejudicea gainstp sychiatrya nd
psychiatrists.T heset wo physicians,t he latter one in particular,r emained
very cool towardsm e when I subsequentlyb ecamea membero f staffa nd
a membero f the Committee.B oth of them had occasiont o refer patients
to me only when they had got into difficulties with them, and whent hey
had no alternativeb ut to ask for my help. This madem e a witnesst o their
failings, which they disliked.
I knew, therefore,w hen I startedt he survey that there were all kinds
of oppositionf rom thosea t the top. It was as if many fearedt he intrusion
of a psychiatristw ho would be looking at their behaviour,p erhapss eeing
problemst hat were not being attendedto . They also felt, it seemedto me,
that their 'patch' and their authority were being underminedb y a psy-
chiatrist. They seemedt o feel that their relationship to patients was
adequateT. hey felt confidenta nd god-like with regardt o them, and feared
that this position was going to be threatenedb y my presence.
One radiotherapisst aid to the Chairmano f the Committeet hat he did
not think there was ever any necessityt o have a psychiatrist see his
patients.T o his amazementt,h e Chairmant old him that there were more
complaintsf rom his patientsa bouth is callousa nd cruel handlingo fthem
than the rest of the hospital put together.T o his credit, this very eminent
radiotherapistw as astonisheda nd chastenedS. ubsequentlyh e referred
patientst o me, including his best friend. He obviously had no idea how
he cameo ver to his patients.
After three monthso f going round the hospital, I was askedt o give a
short talk and have somed iscussionw ith senior nursing staff and social
workers about what I had observed.T here was great general hostility
towardsm e, and up to that point I think that I would not have beena ble
to carry on without the supporto f the Matron at that time. Shew as a very
passionatea nd caring person who was fully aware of the pain and
suffering of the patients.A heatede xchangee nsueda fter I had given my
talk. Some of the religious social workers objecteda nd said that the
patients did not require a psychiatrist. All they neededw as spiritual
supporta ndr eligion; and if the patientsh ad this religious conviction they
would not be so afraid. The Matron, to their dismay,t otally disagreedw ith
thema nds aidt hat they had two nuns in the hospitala s patients,t hey were
seriously ill, and were the most frightened of all the patients in the
hospital. Neverthelesst here remaineds ome others who were deeply
suspiciousa nd opposedt o my intervention. One was a Senior Sister on
