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Query

I am a 52-year-old banker who was diagnosed with breast cancer six months ago. At my doctor's suggestion, I will have to undergo chemotherapy, as well as remove one of my breasts to stop the cancer from spreading. My doctor tells me that I will survive, but I feel sad and hopeless. Somehow, I have no enthusiasm to undergo treatment and get better. Lately, I have been avoiding my friends, family and well-wishers. Is this normal? -A confused patient

Answer by Rishav Koirala, Psychiatrist and Researcher

For most cancer patients, it is very difficult to accept the fact that they have cancer. It is normal to feel frustrated in a situation like yours. The reluctance to undergo treatment is also fairly common, as the news of cancer can make patients emotionally vulnerable. 

Chemotherapy has many kinds of mental and physical effects on the human body. It can result in loss of hair and weight, which is directly connected to the individual’s appearance. For most cancer patients, the thought of this can be very stressful. They are unable to come to terms with the fact that they will undergo physical changes. After all, our appearance is part of our identity.  

I want to assure you that feeling this way is normal. But letting this escalate will worsen your stress. As a cancer patient, you need enough rest and a positive outlook, which is not possible if you focus on the negative and keep imagining bad scenarios for yourself. 

One thing you can do to stop overthinking negative thoughts is give them a positive spin. For instance, if you are worried about losing your hair, focus on the long-term outcome and not the temporary effects of therapy. The hair will grow back once the treatment is over. More importantly, you will be cancer-free and healthy again.

Yes, it is difficult to stay positive when you have been diagnosed with cancer. But positivity is something you practice and it is a gradual process.

You should also remember that you cannot tackle this situation on your own. You need people to talk to. So, rather than avoiding interactions, I suggest you find someone whom you are comfortable sharing your thoughts, someone who will listen to you and give you the right suggestion. Doing this can improve your depressive symptoms. 

If these suggestions do not work, you can always consult a psychiatrist or a psychologist, who can help you navigate this difficult process. 

I am a 26-year-old student with anger issues. I have no control whatsoever over my anger. Minor inconveniences irritate me and on a bad day, this irritation morphs into a full-blown violent episode: I bang doors and throw stuff. Sometimes, I don’t remember what I did in a fit of rage. I feel extremely guilty after my outburst, but I cannot help myself. How can I prevent something like this from happening in the future when I cannot even remember what I did? My behavior is pushing my friends and well-wishers away. Please help. —An annoyed fellow

Answered by Alisha Humagain, Psychological Counselor, Happy Minds 

Anger is a built-in part of the body’s “fight, flight, or freeze” system, which helps protect us from threats or dangers. Everyone occasionally feels angry, which is common. But if you are unable to control your anger, it can create issues in your relationship with family and peers.

It is important to know that anger and aggression are different things. Anger is an emotion but aggression is related to how a person behaves. Not everyone with anger will show aggression, and not everyone who acts aggressively is angry.

Everyone experiences anger, but there are ways to control it so that it doesn’t spiral out of control. Being aware of the changes in your body, emotions, and behaviors caused by anger can help you decide how you want to react to a situation before you act. Walking away or even pausing for a minute before saying something or reacting can help you get a hold of yourself. 

When you feel like you’re starting to get mad, start counting to 10 slowly. It will help you reduce the intensity of the anger. Releasing tension from your body also helps you calm down. To release tension, drop your shoulders, unclench your jaws, and stretch your body. 

When you are angry it is also common to jump to conclusions. If you find yourself in an argument with someone, take some time to listen and pause before responding. You also have to remember that sometimes when our emotions are running high a situation might seem much worse than it really is. Writing down all your negative thoughts and feelings in a journal can also help you release the anger you might be holding inside. You can also look for other distractions such as listening to music, taking a walk, or even just taking a shower. Diverting your negative thoughts will help you realize that the thing making you angry is not a big deal. 

You can also try using relaxation techniques, such as deep breathing and progressive muscle relaxation to mitigate anger. If you are unable to control your aggressive tendencies even after trying these strategies, it is best to seek professional help. And remember, addressing the problem is the first step towards healing. 

I am a 21-year-old student with a terrible case of insomnia. I have tried everything possible to get a good night’s sleep, from exercising till exhaustion to using sleeping pills–all to no avail. I feel tired and sleepy but I can barely get myself to sleep for two hours. Some days, I am up all night and asleep all day. This has been going on for six months now. I started having this problem in my teenage and it's only gotten worse. What should I do? —An insomniac

Answered by Rishav Koirala, Psychiatrist and Researcher

Most of the time when a patient claims to have a sleeping disorder or insomnia, it is usually a secondary problem. Mostly, it is a symptom of other mental health issues like anxiety and depression. My professional experience tells me that it is only about 10 percent of the time when sleeping disorder is a primary issue. So, to figure this out, you will have to go through a proper assessment with a professional to identify the root cause of your sleeping disorder. Only then can we move towards treatment. 

You also mentioned the activities you have tried to sleep better. You should know that some of those activities do more harm than good. For instance, tiring yourself out through exercise is not good, for excessive workout has a bad effect on your sleep, causing distress and sleep disorder. On the sleeping pills, did you take them after professional consultation? If not, I suggest you get off those pills immediately. If a professional prescribed it, then chances are those pills do not suit you. If that medication does not work, another might. 

Concerning your sleep pattern, sleeping all day and being awake at night is the worst enemy of your mental health. I suggest you look up ‘sleep hygiene’ on the internet and try some of the tips to improve your sleep schedule. Some things included with ‘sleep hygiene’ are: going to bed and waking up at the same time every day, including weekends; ensuring your bedroom is quiet, dark, relaxing and at a comfortable temperature; and avoiding large meals, caffeine and alcohol before bed.

Further, there are times when we feel like we have not fallen asleep, while our body is actually getting enough sleep. We wake up thinking we got minimal rest but in reality, our body will have had an adequate amount of sleep to support us throughout the day. You getting only two hours of sleep a night for the past six months also suggests this. If a human body gets only two hours of sleep a day, it will not function after a week or even less. So your body might be getting adequate sleep but you feel sleep-deprived because of stress. 

My first suggestion for you would be to go through some techniques to maintain sleep hygiene, which you will find on the internet. Second, it is good to seek professional help, if you haven’t, to identify the root cause of your sleep disorder. Only then can you proceed to the solution. 

Question

I am a 33-year-old working woman. I am not married but in a relationship. I tend to give more time to my work rather than to my loved ones or myself. This has affected my relationships with my partner, friends and family members. Consequently, I find myself lonely and to cope with this, I give myself even more work. I absolutely love my work and enjoy that part of my life very much. But at the same time, I feel I’m missing out in my personal life. Please help. -A workaholic 

Answered by Kapil Sharma, Counseling Psychologist, Hudec Nepal

You seem to be aware of the reason for your predicament. You admit that you have turned into a workaholic as a part of coping mechanism. But it also seems that your work-related stress has invaded your personal life and relationships.

You need to learn to balance your work and life. For this, the first thing you can do is setting goals, limits and boundaries at work. This will help you get more organized. Right now, you are unable to organize and set a boundary between your personal and professional life. The second thing is to focus on self-care, by allocating time for yourself.

Doing these things can get confusing, so what you can do is list out all your tasks, prioritize them and assign times to do them. You don’t have to give equal time and energy for each task. Focus where to invest your time based on urgency and importance. Also, learn to say ‘no’ to tasks that you cannot make time for. Many of us have the habit of saying yes to everything, only to later be racked with guilt and regret not being able to say no. Remember, it’s important to make time for oneself and prioritize self-care. 

A healthy lifestyle is essential to cope with stress and to find work-life balance. Eat well, get enough sleep, listen to uplifting music, include physical activity in your routine, and have some self-relaxation time. Try making your hobbies a part of your routine, be assertive, and develop a support system at work and home.

If your life feels too chaotic to manage and you still feel trapped in a vicious cycle of work-guilt-work, we are here to help you. Talk to professionals and take advantage of available services.