|Year : 2016 | Volume
| Issue : 3 | Page : 1207-1208
The Unquiet Mind Cancer: The Metaethical Quandary of Therapies
Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
|Date of Web Publication||4-Jan-2017|
Department of Biosciences and Bioengineering, Indian Institute of Technology Bombay, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Manchanda R. The Unquiet Mind Cancer: The Metaethical Quandary of Therapies. J Can Res Ther 2016;12:1207-8
Authors : Varsha Dutta
Publisher : Narosa Publishing House Pvt. Ltd.
ISBN : 978-81-8487-570-6
Price : 1000rs/-
Year of Publication : 2016
Pages : 108 pp
Among the diseases that afflict the mind, depression is one of the most forbidding, a scourge that ranks very much on a par with Alzheimer's disease or with fulminant schizophrenia for its calamitous effects. It can at times descend on its victim altogether out of the void, not infrequently in the prime of their life, and in one fell stroke can leave blighted and scarred an existence that had thus far been wheeling along steadily enough. Among the maladies that afflict the somatic half of ourselves, on the other hand, the palm is taken, perhaps incontestably, by cancer. Very much like its mental counterpart, it can creep up on one unawares, the subtlest of its symptoms starting to disclose themselves only when it is already too late to arrest its often inexorable march. This particular state of affairs, however, makes arguably for a merciful one, as the interregnum before death is sharply delimited and the suffering commensurately contained. Often enough, though, neoplasm can make itself felt while still in a youthful phase, and render life a smaller or a greater hell for its victim for years together, with gut-wrenching anxieties tainting each waking day – anxieties over the carcinoma's progression, over its therapy, over the unsavoury fall-outs of the therapy, to say nothing of the ceaseless disquiet over the ever-present possibility of recurrence.
Plant these emissaries of nemesis –depression and cancer – together into the same ill-starred individual, and we have on hand a coalition that's just about too dreadful to contemplate. As if the simple sum of the infirmities visited by the two in tandem had fallen short of the mark in slaking their malice, they take to acting in concert – so that rather than merely adding to each other's corporeal and mental depredations, they multiply and amplify them, two hydra-headed goblins laying to pitiful waste the body and the mind alike.
What adds a particularly minatory dimension to the bleak vista is the possibility that one of the ailments can predispose to the other. It has been established beyond question that the diagnosis of cancer – the visceral shock that it packs, the ceaseless wracking of nerves in its wake – form a perfect breeding ground for the germs, as it were, of depression. The evidence for the converse that is, whether or not chronic depression foretells the onset of cancer is considerably more equivocal; cancer may supervene on depression more likely just as a matter of unhappy happenstance. What is unequivocal is that once the two have yoked themselves together, their conjoined maraudings can be just as perplexing for the clinical profession as they are for their victims or caregivers. For medical science scarcely has answers to either of the malaises on their own, leave aside the debilities spawned by the two of them commingled.
The depressed cancer patient, then, is a Gordian knot the key to whose unraveling is as yet unavailable to humankind. But while we await a miraculous catholicon to drop from the sky, can nothing be done to mitigate the suffering of those so beleaguered? “The Unquiet Mind,” a highly timely monograph that addresses this much-overlooked question, makes the assertion that as a matter of fact a great deal can be done or attempted toward allaying the distress of sufferers – and it argues its contention with just as much passion as it does with cogency and force. Edited by clinical psychologist Varsha Dutta, the volume makes a muscular case for psychological intervention to be charted out and put in place posthaste once a diagnosis of cancer has been pronounced, so as to limit the potential damage brought on by the collateral onset of depression.
The essays in the volume (nine in all) each treat of a particular facet of how to alleviate the psychologically assailed cancer patient's distress. With such titles as “The Newly Diagnosed Patient. What we say, how we say it, and what they Expect,” “Psychedelics in the Palliative Care of Terminally Ill Cancer Patients” and “Living Through The Grind of Therapy Depression and the Situational Crisis in Cancer and the Role of Meaning Centered Psychotherapy,” the chapters severally and together constitute a compelling manifesto for the underexplored field of psycho-oncology, and for considerably greater weight being accorded to it than is presently the case.
Chapter IV for instance, a trenchant essay penned by the editor, considers how personal catharsis may form an essential ingredient in palliating the distress associated with cancer diagnosis and therapy. Studies have shown, Dutta avers, how meaning-oriented psychotherapies can assuage the depressed cancer patient at any stage of the disease, helping them cope with and adjust better to the menacing new normal. “The protean nature of depressive disorders too complicates the decision-making process in cancer,” Dutta notes, rounding it off persuasively with: “Encouraging benefits of meaning-oriented psychotherapies seen in end-stage cancer patients can be emulated as a personal and meaning-directed therapeutic approach for patients at any stage of the disease who seek it. It seems appropriate then to set the tone for these reflective, meaning-centric therapies at the early stage of the disease itself, since this will warrant a more successful response to the aggressive cancer therapy.”
One of the most captivating chapters bears the title “Psychedelics in the Palliative Care of Terminally Ill Cancer Patients.” Psychedelic drugs, the chapter's author Ido Hartogsohn affirms, will assume a unique role in the psycho-oncology of the future. The use of psychedelics as an emollient measure has, unsurprisingly, fuelled much controversy whenever it has been advocated. Their use was widespread in ancient cultures, with their mystical healing powers invoked in communal rituals including death, which was construed as “a form of transcending reality.” The use of psychedelics was relatively unknown to allopathy till the mid 20th century – a prominent landmark being the discovery of lysergic acid diethylamide (LSD) in 1943 – following which the notion of psychedelic therapy was advanced, accepted and rolled out into practice. Alongside, the field of research on psychedelic adjuvants to therapy experienced galloping growth until its abrupt ban in the 60s. The ban was rooted more in public sentiment and muddled thinking on the ethical import of the practice, however, since the evidence for risks in the use of psychedelics in therapy was scant.
Banned in the 1960s, the use of psychedelics was resumed in the 2000s in a guarded fashion, for the terminally ill patient. Such agents as Psilocybin, Mescaline and LSD, have mind-altering properties capable of inducing powerful psychological and spiritual experiences. Hartogsohn affirms: “For some terminal patients, psychedelics can bring about a profound psychological process opening the path to reconciliation with significant others, with themselves, and finally with dying itself. It temporarily enables them to move their attention from the fear of the future to the joy of the moment…(giving) their last months of life a new and positive life-affirming perspective.” In the chapters “Strategies and Structures to enhance Psycho-oncology's impact in Clinical Cancer Treatments” and “Can we have a Directive or a Consensus on 'End of Life issues'? Are we Actually Listening and can we reach out?” “The Convalescent's Diary - Art and its Possibilities in Psycho-oncological Health” further instructive insights are presented on the realm of psychological ministering to the cancer patient.
All in all, The Unquiet Mind covers hitherto little-trodden terrain, and Dutta in her capacity as editor succeeds admirably in espousing the cause of a field of endeavor, psycho-oncology, that has thus far received regrettably short shrift and laying down a blueprint for its near future. The production quality of the volume is fine though its proofing leaves a good bit to be desired, for which the publisher should take care to make amends once a reprint is due. Once the reader gets past its infelicities, however, the book offers a stimulating and rewarding read and is to be commended to medical and bioscience practitioners alike, of all hues, for its eclectic blend of subjects of both specialist and general interest.