Holiday season is upon us. We will be gathering with family and friends we haven’t seen in a while. Someone will have had a crisis since you have last been together. If you have been diagnosed with breast cancer recently, that person in crisis is you. You may not know what to say about your illness. Your family and friends may be worried about saying the wrong thing.
Every cancer patient has a story about some of the horrible things people said to her. It’s easy to be judgmental about these insensitive people until we remember a remark we wish we could take back.
Before I had cancer, I didn’t know what to say, and I cringe when I remember some of the comments I made. I meant well, but I had never been a cancer patient, so sometimes I made a mistake.
I recently read an article that gives one way of thinking about how to help someone in crisis, whether it is a job loss, an illness, or a bereavement. Susan Silk and Barry Goldman say to draw a set of concentric rings in your mind. The "aggrieved or afflicted" person goes in the middle. Next come the closest family members–the spouse, the parents, and so forth. Then imagine close friends in the next circle with colleagues and acquaintances in the outer circles.
The governing principle of the circles is "comfort in; dump out." The person with the crisis gets to complain and whine as much as she needs to. The people in the next circle–the caregivers, the family members also need someone to dump on, but they can’t dump on the person in the center.
Everyone in all the circles needs to be providing comfort to all those in the smaller circles. Here is how Silk and Goldman describe the process:
"When you are talking to a person in a ring smaller than yours, someone closer to the center of the crisis, the goal is to help. Listening is often more helpful than talking. But if you’re going to open your mouth, ask yourself if what you are about to say is likely to provide comfort and support. If it isn’t, don’t say it. Don’t, for example, give advice. People who are suffering from trauma don’t need advice. They need comfort and support. So say, ‘I’m sorry’ or ‘This must really be hard for you’ or ‘Can I bring you a pot roast?’ Don’t say, ‘You should hear what happened to me’ or ‘Here’s what I would do if I were you.’ And don’t say, ‘This is really bringing me down.’
"If you want to scream or cry or complain, if you want to tell someone how shocked you are or how icky you feel, or whine about how it reminds you of all the terrible things that have happened to you lately, that’s fine. It’s a perfectly normal response. Just do it to someone in a bigger ring.
"Comfort IN, dump OUT."
If you think about this circle, you won’t describe everything that went wrong with your aunt’s cancer treatment to your newly diagnosed coworker. You will offer to cover for her when she goes for her chemo, or you will call her husband and ask if you can take the children to the park on a Saturday morning so that they can rest.
However, it seems to me that one aspect of helping a sick friend is missing from this circle: listening for the cues the person in crisis gives. When I was in treatment, sometimes I wanted to talk about cancer, and there were times when I wanted to talk about anything BUT cancer. Sometimes I would suddenly change the subject and ask my friend or acquaintance about what was going on in her life. I might be physically tired and wanted to keep the conversation going to distract me from my own problems even though I was too out of breath to talk much myself. I might just want to hear about something happy. My friends were not being insensitive to talk about a success in their life when I had given them the cues that I needed to hear something cheerful.
Sometimes I needed to hear about possible problems I would encounter in treatment. My friends who were cancer survivors were not being cruel when they described what went wrong for them because I had given them the cues that I needed a realistic account of what I faced.
The other issue I have with the circles is that they oversimplify who is in crisis. Although I was the one who was exhausted from radiation, my husband was also exhausted from taking care of me. More importantly, he and I were equally scared about what would happen if the treatments didn’t work. With the ring theory, it was his job to comfort me and dump out to people in bigger circles. I learned later that he did do that. He was able to talk about how frightened he was to quite a few people when I wasn’t present. However, we also had times when we cried together and comforted each other. If he had never shown me that he was worried, I might have interpreted that as not caring or being in denial about how dangerous my illness was.
My sisters and I were all in the middle of that circle when our mother died. When the middle of the circle gets crowded, figuring out who gets comforted and who gets dumped on is more complicated.
Still the ring theory may help you as either patient, relative, or friend. With the holidays coming up, there will be plenty of social gatherings where keeping it in mind could be useful. If this will be the first time you see your cousin since her cancer diagnosis, offer your support and then take your cues from her.
If you are in treatment for your breast cancer, you are in the middle of the circle. You are not being selfish if you can’t host the big family gathering this year. You are taking care of yourself. It is the responsibility of everyone else to comfort you. They get to bring the pies while you rest.
Silk, S. and B. Goldman. "How Not to Say the Wrong Thing." Hospice Matters, Fall 2013 Montgomery Hospice Newsletter. Originally published in the LA Times April 7, 2013. Accessed Nov. 10, 2013. http://www.latimes.com/news/opinion/opinionla/la-oe-0407-silk-ring-theory-20130407,0,5036964.story#axzz2kF8iBw9U
Phyllis Johnson is an inflammatory breast cancer (IBC) survivor diagnosed in 1998. She has written about cancer for HealthCentral since 2007. She serves on the Board of Directors for the Inflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group at www.ibcsupport.org. Phyllis attends conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. She tweets at @mrsphjohnson.