The Blame Game

Some cancer patients end up feeling, or are made to feel, that getting cancer is their fault—maybe they worked too hard or weren’t positive enough in their attitude. Whether they’re looking at their life through their own critical lens or because of suggestions made by friends or relatives, they can’t help but indulge in self-blame.

Survivors speak out

After she found out she had breast cancer Robyn Levy remembers reading a book that explored the way people’s life circumstances can influence their state of health. Simply put, it professed that people are responsible for bringing illness into their lives. It wasn’t what the writer and mother needed to hear after receiving such a shocking and frightening diagnosis.

“It made me feel really crappy,” Levy says. “I just remember thinking, this is such a crock. I don’t buy into that.

“That’s the last thing that’s going to help anybody in a situation like that,” adds the author of Most of Me: Surviving My Medical Meltdown (Greystone, 2011). Levy also has young onset Parkinson’s disease. “I can honestly say I never intended to get cancer. And if you do think ‘I could have caused this,’ what point is that going to serve? The point is to deal with the circumstances.”

Many people with cancer describe the disease as a gift, a wake-up call that motivates them to focus on what really matters and give up unhealthy habits, jobs, or relationships. However, there’s a flip side to finding out you have what New York doctor Siddhartha Mukherjee calls the “emperor of all maladies.” Call it the blame game: the distressing self-blame experienced by some people diagnosed with cancer.

Cancer survivor Dennis Hamilton says some of his family members questioned whether stress from years spent working in finance brought on his blood cancer. He didn’t accept that theory, and the implication bothered him.

“When you start saying someone essentially caused their own cancer, you’re discounting all the other factors that come into play, like genetics and the environment,” he says. “It’s a very slippery slope.”

Health professionals agree

Health professionals who work with cancer patients are familiar with the notion of personal accountability that some people take on.

“Guilt, a sense of being responsible for the cancer, is something our team of counsellors and social workers see a great deal at the BC Cancer Agency,” says Nancy Payeur, regional clinical coordinator of patient and family counselling services on Vancouver Island.

“Very often, comments from well-meaning friends and family can worsen this sense of guilt or responsibility, including the pressure to think positive, which seems to have become a part of the cancer-care culture. I’m not against positive thinking, but it does put a great constraint on patients and makes them feel that it’s not okay to have a down day or go to the dark place, which really, for most of us, would be an inevitable part of the cancer experience.

“This comes up almost every day, things like ‘I know my toxic work environment caused my cancer’ or ‘My divorce caused my cancer’ or ‘I’ve got to learn how to deal with my anger or my cancer’s going to come back,’” Payeur adds.

“There’s all this talk about how stress causes cancer, but it’s just not a straight line or a simplistic relationship. Cancer is so complex and so multilayered that we cannot say there is one single cause: in some cases it’s genetic; in some cases people have been exposed to environmental toxins like asbestos. Yes, it’s a good thing to actively manage your stress, but it’s normal to feel like you’re on an emotional rollercoaster, and crying is good.”

The search for control

“My theory is that this sense of responsibility comes from the need to feel an inner locus of control,” says Payeur. “There’s a positive side to feeling you have control over your life and make conscious choices; it gives people a sense of competence and mastery in their world. Where it all falls apart is when something like cancer comes along. I help people accept the reality that there are things in life you don’t have control over.”

Deborah McLeod, clinician scientist and member of the psychosocial oncology team at Halifax’s QEII Cancer Care Program, also sees the desire for control as an underlying factor in people blaming themselves for getting sick.

“The idea that one has done something in particular to cause their cancer stems from a very simplistic view of cancer and an idea that there is a single cause and the idea, the wish, that we can control it,” McLeod says.

“Not having control is very difficult,” she notes. “Almost every single cancer arises from a multitude of factors. To say, ‘This causes that and therefore you’re at fault’ is a child’s version of cancer. It’s almost magical thinking, and it stems from fear. These are cancer mythologies.”

Moving forward

At InspireHealth, an integrated cancer care centre in Vancouver, patients are encouraged to move forward rather than scrutinize every detail of their past.

“We frame ideas in a way that excludes the conception of blame,” says Hal Gunn, InspireHealth’s CEO. “I can see how that would raise anxiety. We encourage people to look forward by asking, ‘How can I optimally support my health going forward? How can I fully love myself and take care of myself in a meaningful way?’ We can all learn to take better care of ourselves and to learn more about nurturing our mind, body, spirit.

“Looking back and wondering maybe I worked too hard or didn’t eat the right foods in a judging way isn’t really valuable or important. It isn’t helpful to look backward.”

Helping loved ones cope with cancer

• Give loved ones a break from “cancer land” by giving them books, movies, or articles that are not cancer-related.
• Avoid giving health advice.
• Instead of saying, “Let me know if you need anything,” try concrete offers of help, such as child care, rides to and from doctors’ appointments, housecleaning, laundry, meals, taking dogs for a walk, or shopping for groceries.
• Keep up regular communication via weekly cards, emails, or phone calls.
• Follow their lead. Listen to them. If they’re crying, let them.
• Consider practical yet comforting gifts such as new pillowcases, a blanket or duvet cover, or cozy pyjamas (ones with buttons for those with breast cancer).
• Ask if they’d like a foot, hand, scalp, or neck massage.