CALIFORNIA STATE UNIVERSITY 1 NORTHRIOOE
BREAST
CANCERa THE RELATIONSHIP
,,
BETWEEN PSYCHE AND DISEASE
A thesis submitted in partial satisfaction
of the requirements for the degree of
Master of Arts in
Education
Educational Psychology
Counselling and Guidance
by
Carrie Lee Schucker
----·
January, 1978
The Thesis of Carrie Lee Schucker is approved:
..
California State University, Northridge
ii
ACKNONLEIX:;EfvlENTS
To thank all the dear people who helped and
encouraged me throughout this process would be endless.
I cannot express my gratitude enough.
I'll mention
a few by name.
To Jed and Lois for love, inspiration and endless
support.
To Beth for her magical fingers at the typewriter
and helpful sugges·tions.
To my friends at Plato's for laughs, understanding
and, of course, nourishmentl
And finally to Joe, who held the candle as I found
m~
path through the darkness.
iii
Table of Contents
. .. .. . . .. . ...... . . . . . .. .. .....i
......................... . • ii
Approval Page.
Acknowledgements • . .. . . . . . . . .. . . .. . . . . . . . . . . • iii
Abstract •• ................. . . . . . . . .. . . . . . .. . • v
CHAPTER 1 - INTRODUCTION •• .. . ............. . .1
Title Page ••..
Facts About Cancer ••..
Chances of Recovery.
How It Is Treated •..
Re-entry to Society.
.... ..
..
. .••• 3
. ... 4
. ..... 4
• •••• 5
....... .7
Research. on Cancer Profile.
. ....7
The Hastectomy Experience and
Recovery ••.... .. . . . . . . . . . . . . .
.14
3 - METHODOLOGY. .... . . . . . . . . .. . . ....21
CHAPrER 2 - REVIEW OF LITERATURE ••
CHAPTER
Subject Population •..........•••••• 21
Questionnaire •...................•• 21
Guidelines of Intervie1ving Process. 23
Content of Interviews and the
Differences •..............
..25
My Role as an Interviewer ••••
..26
.....
CHAPTER 4 - TRANSCRIPTS • .. . . . . . . . . . . .. . . ...
. .. ... ..
Laura •••
. .. ..... . .. .. • • • ...
Anne •.
.. ... ....... .• .• .• • • 71
Joan •.
Diane •• . ..
• • 73
~
• 30
•
CHAPTER 5 - CONCLUSIONS.
• • 30
• 49
................. ... .79
List of Traits and Experiences ••••• 79
Questionnaire Findings . . . . . . . . . • • 80
Conclusions About the Study •••••••• 101
Topics for Further Research •••••••• 101
Personal Reflections...
• ••••• 103
Refere!1ces . . . . . . . . . . . . . . . . .
..105
Appendix A- Questionnaire ••
··111
...............
.....
iv
•.
ABSTRACT
BREAST CANCER: THE RELATIONSHIP
BETWEEN PSYCHE AND DISEASE
by
Carrie Schucker
Master of Arts in Education,
Educational Psychology,
Counselling and Guidance
This paper is the end product of a study on eight
women who have had mastectomies.
The study consisted
of interviewing these ladies in a series of three to f'our
sessions using a questionnaire I had created.
The purpose
of the study was to explore the possibility that there
might be common themes in these women's personalities
\
and life experiences.
Five sections made up the question-
\
\ nairea self description, relationships, family background,
somatic history - sexual development and the cancer
experience.
The paper begins with my personal reasons for conducting this study.
The second component within the
v
.
,,
Introduction, Chapter 1, is some current facts on breast
cancer.
In the Review of Literature, Chapter 2, I
present the research that has been conducted up to this
point.
I describe my data gathering process, developing
the questionnaire, finding subjects and the interviewing
in Chapter 3.
and 5.
The essence of the study is in Chapters 4
In Chapter 4, I present edited transcripts of
the interviews.
I conclude the paper in Chapter 5 with
reporting on my findings and stating my personal' relationship to cancer as it is today.
The common themes among these women I studied are
briefly as follows.
These women describe themselves
as "caring" and "good".
around their families.
Their value systems center
They consistently put their
families' needs above their individual needs.
Anger is
usually invisible among these ladies, both sadness and
anger being rarely expressed.
In friendships outside
of the family, the relationships rarely include self
disclosure, and there was a fear of betrayal.
These
women did not receive affection from their mothers and
'\
their parents often had unhappy marriages.
There was
an extensive somatic history including other abnormal
growths.
vi
Chapter 1 - INTRODUCTION
This study starts with and comes from me.
I became
involved with the relationship between psyche and disease
as the result of my own experience.
About one year ago I
became aware of an ovarian tumour, which proved to be
benign and was removed.
In the process, I felt the loss
of an ovary and a fallopian tube.
I also had a strong
sense that in some way I had participated in the creation
of the tumour.
Initially I felt victimized, unlucky and
angry at this unknown source of the growth.
shock, I felt unrelated to the tumour.
It was a
I moved from that
place to the attit.ude of wanting to understand my contribution and the more complex explanation for the tumour •
.
My immediate response to taking responsibility for the
gro\';•th was through tremendous guilt - "what have I done
to myself now? l ''.
Through a long process, I stopped
blaming myself and used the tumour as another means to
understand myself.
I took a look at what was happening
in my life - where the stress was, why I needed a tumour
at that point, where my energy flow for the happiness
in life was blocked.
I came up with information.
The
information helped me to feel more in control of my recovery and general health.
It also helped me to change
my lifestyle.
The causes of cancer are as of yet undetermined.
1
I
2
see them as multifactorial, complex and interrelated.
Is it environment, a virus, nutrition or psychological?
Whatever it is, we need to look at cancer and other
diseases from more than an external body view.
The
internal and larger picture of the whole person is begging
to be looked at and incorporated into our theories of
cause and cure.
I have accepted the premise that person-
ality, lifestyle and cancer have a relationship.
not prove it.
I can
I am not interested in doing so now.
This
study is an attempt to study eight cancer patients intensively and see if any common veins of experience and
attitude arise.
est for me.
It's a_beginning of a far reaching inter-
I would hope my readers ·would approach this
paper with both an open mind and heart.
be kept to a minimum.
Conclusions will
I will be presenting much data
without interpretation.
I am not conducting a typical research project with
a set hypothesis, seasoned respected tool, many subjects
and set results.
I have developed my own tool, a
questionnaire, and interviewing style.
I have kept the
number of my subjects down, choosing to explore each one
more intensively.
My conclusions will be limited, leaving
plenty of space for further research.
Tl1ey are also
unavoidably subjective as who I am partially determines
my questions and my interpretation of the answers.
In
order to avoid unnecessary subjectivity, I will set forth
3
the answers·to a great deal of my questions in a transscript style before I theorize with conclusions.
What I have done is developed a questionnaire and
interviewed eight women who have had breast cancer.
will tell you their stories.
I
I chose breast cancer be-
cause of its growing prevalence in our culture.
I chose
interviewing as a means of obtaining information for two
reasons.
I wanted close contact with my subjects and can
use the interviewing experience for my development as a
counselor.
Facts About Cancer
For additional facts and information please refer to
the bibliography.
The 1976 American Cancer Society Facts
and Figures booklet s·tates the following information.
One out of fifteen to sixteen women will contract\breast
cancer in the United States during the next year.
out of four will die from it.
Three
Cancer of the breast is the
number one cancer killer in women.
Cancer of the stomach,
colon and rectum are the most common in men and \vomen.
Lung cancer is the equivalent of breast cancer in men.
Breast cancer seems to be more common in affluent groups,
very common in the Jewish population of the United States.
Women who have few children and at a later age (over
twenty-five) are more prone to the disease.
It is also
said that most women who contract breast cancer menstruate at an early age and/or have late menopause.
•
d
The age
4
group of thirty-nine to fifty-four is when most cases
occur although there have been plenty of cases at younger
and older aqes.
There is a hereditary factor; if a
woman's sister or mother has had breast cancer,.her
chances of getting it move to one out of ten.
Chances of Recovery
The best prognosis is for women whose breast cancer
has not spread to the regional lymph nodes.
There is a
survival period of five years after the mastectomy which
indicates whether or not the cancer is going to metastasize.
If lymph nodes '\·Tere involved, the five year pref
diction of survival rate move down from eighty to eightyfive percent to forty-five percent or less.
The.r·e is
little pain involveci in canc:c1.·; detection occurs usually
as a result of self examination, in a doctor's office or
from a mammography and/or a thermography.
Early diagnosis
is imperative; the less metastasis and the smaller the
area of cancer confinement, the better the chances for
a continued life.
How It Is Treated
\
Treatment (there is no such word as cure yet) is
surgery and/or radiation and chemotherapy.
There are
three types of surgical proceduresa
1.
simple mastectomy - developed by Dr. George Crile -
involves removal of the breast and not much else.
This
treatment does not include pectoral muscles and only
5
occasionally axillary lymph nodes.
2.
classical radical - developed by Professor
William Halsted - includes removal of the pectoralis
major (muscle on chest wall immediately beneath the
breast) and regional axillary lymph nodes as well as the
breast.
This method often results in a caving in of the
chest wall, occasionally some loss of the use of the arm
and swelling.
3.
super radical also includes the removal of the
supraclavicular nodes, internal mammary nodes in addition
to axillary nodes and breast.
Re-entry to Society For the Mastectomy Patient
Changes and improvements are being made.
In previous
years a. '\voman signed a consent form for a biopsy and
immediate removal of the breast if there was a malignancy.
She would know if she had cancer by whether or not she
woke up with the breast.
Now a woman can choose to have
the biopsy and the actual mastectomy at two separate
times, allowing for integration of the news and some
•
assuage of the shock of the removal of the breast.
The
extent of the scar depends of course on the type of
mastectomy performed.
less primitive.
Prostheses are becoming less and
Mastectomy groups are forming around
the country, books are being written, and daring ladies
are unadorning their chests at neighborhood gyms.
It is
becoming more common and more acceptable to have had a
6
breast removed.
Frequently women experience some loss of the use of
one arm depending on the extent of surgery and itching
on the missing breast•s side.
Exercises, information on
dressing styles and introduction to the prosthesis are
usually provided for the breast cancer patient in the
hospital by an American Cancer Society volunteer.
This
. "Reach to Recovery" volunteer is a woman who has herself
had a mastectomy.
Requested to visit the patient by the
I
doctor, these ladies can offer information and support.
They do not, however, function effectively as a true
intimate or a counselor might.
Most importantly, they are
visible proof of the chances for survival.
Chapter 2 - REVIEW OF LITERATURE
There has not been much written about the personality
of the cancer patient nor the emotional aspects of many
diseases.
Going back in time, the Greek philosopher,
Galen, noted a correlation between melancholy and ladies
with breast cancer.
Around the same time, Hippocrates
was citing the uterus as the main generator of hysteria
in women.
During the nineteenth century, ovarectomies
(removal of the ovaries) and hysterectomies were performed
to cure untreatable, prolonged hysteria.
After World
War II and in the early 1950's there was a brief upsurge
of interest in the relationship between cancer and
psychosexual problems.
All o£ these beginnings were short
lived and unfortunately did not develop further.
Now
seems to be the time when we are truly exploring the
relationship be·tween the mind and body in the concept of
holistic health.
Holistic healing incorporates both
physical and emotional causes and cures for diseases.
As in most movements, the holistic health movement is full
\
\
of repetition, false propaganda and easy remedies.
Research on Cancer Personality Profile
Lawrence LeShan (1966) has done a commendable bulk
of research and counseling with cancer patients.
Over a
period of twelve years, LeShan studied two hundred and
fifty cancer
patient~
at the Institute of Applied Biology
7
8
in New York.
He used three tools from which he observed
and drew conclusions•
the Worthington Personal History
Test, a series of interviews, and individual psychotherapy.
He found the following personality traits among
his patientsa
poor self image
trouble forming and keeping long lasting relationships
passive attitude toward disease
unforgiving; holds grudges
poor self expression with feelings - especially anger
rigid value system
low tolerance for stress
usually internally compliant, decent, pleasant
avoids self revelation
LeShan (1966) outlined three main stages in the cancer
patient's life.
The first stage (approximately age 1 - 7
years) includes the loss of a parent's emotional response.
Child either loses significant other's attention by death,
moving or emotional withdrawal-rejection.
This process
ever}~hing
is very subtle.
From the outside looking in,
appears normal.
However, the child learns to equate
intimacy with pain and begins to avoid close contact.
He/she also feels guilty and condemns himself/herself.
The second stage is characterized by success, either
in a primary relationship or work interest.
The person,
during adulthood, has thrown all his/her energies and
9
much of his/her self image into one kettle.
He/she is
also avoiding or compensating for his/her fear of intimacy.
The person can be seen as having much energy and
being very happy.
Inside the individual lurks an under-
current of despair and loneliness.
The third stage precedes the onset of the cancer
symptoms.
The individual experiences a loss of a loved
one, of a job, of an expected promotion - something
essential to his ego and role in life.
Widows have been
found to have a high incidence of breast cancer.
The
earlier feeling of self condemnation and guilt surfaces
with the conclusion, uyes, there is something wrong with
me after all, this was bound to occur''.
The cancer
symptoms follow the loss by six months to eight years.
The person reacts with helplessness and hopelessness, not
always conscious.
Nothing can bring the person satis-
faction or ease his/her loneliness.
Life has no meaning.
...
He/she is doomed.
He/she does not mobilize
hisr~er
rage and maintains the same activity level •
LeShan (1966) also found his patients to not be able
to accept the idea of the possibility of conforming to
society and also remaining an unique individual.
They
felt you could do one or the other, not both, reflecting
their rigidity in thinking and lack of a mobile value
system.
They could not make minor changes easily.
In
addition, these patients put others 0 wishes above their
10
own and usually received their acceptance by people
through compliance.
Beginning in 1957, Renneker and Cutler (1963} conducted a study on forty women who had had breast cancer$
Over a six year period at the Chicago Tumour Institute,
they chose five women out of sixty-seven to observe
extensivelye
With the five, they examined personality,
development and the content of these women's psychotherapy.
They concluded that malignancy can be affected by particular sexual malfunctions and disturbances in the maternal
drive.
The forty women all exhibited the following
character traits and experiences:
1.
masochism - self sacrificing
2.
inhibited sexuality
3.
inhibited motherhood
4.
facade of pleasantness covering an inability to
deal with hostility and/or aggressiveness
5.
unresolved conflicts with mother
6.
delay in securing treatment
7.
acute or chronic depression with self condemna-
tion and criticism
The conflicts with mother revolved around the parent being
cold and the child having unresolved anger and guilt
towards her.
Also in the parental relationships, there
existed a seductiveness on the father's part and incestuous feelings.
'
il
!,
According to Renneker and Cutler (1963) the breast
cancer patient acted caring and nurturing to others in
her family often doing much for the household, to cover
up inner hostility.
Hostility existed as the result of
not being taken care of and being deprived of oraldependent gratifications.
The patient, as an adult,
wotlld continue to be self-sacrificing and compliant to
reap the benefits.
They would usually choose a poor mate
and thus have additional rage to turn inward and to cause
depression.
When eventually the husband dies, left or
withdrew, the woman having no object relationship to take
care of would eventually develop cancer.
Cancer could be
seen as passive suicides in these cases.
Renneker and Bacon (1952) had earlier found an
unusually high amount of virgins upon marriage among their
ladies.
These women often had had no sexual information
from their parents and were often non-orgasmic.
They
were having suffering, unpleasant sexual relationships
with their husbands.
\
The husband was either cold and
demanding or passive and compliant, often alcoholic.
\
Few consciously desired pregnancy and they often put an
excessive amount of energy into mothering, becoming
dependent on the child.
Reznikoff (1955), in using a w-ritten questionnaire
(the TAT and sentence completions), found the following
psychological fac-tors in breast cancer.
It was his
11
12
discovery that the cancer patient is usually the middle
child in a large family, rarely an only child.
He also
found his subjects to be exceptionally compliant with
their spouses and overly domestic in their marriages.
These women had few interests outside of the home.
During
discussions, Reznikoff (1955) noticed a pervading sense
of.negativism surrounding the subjects of menstruation,
pregnancy and childbirth.
Tarlau and Smalheiser (1951) compared eleven women
with cervical cancer and eleven women with breast cancer
at the New York City Cancer Institute on Welfare Island
in 1951.
Each woman was given a personal interview for
one to two hours, a Rorschach test and '\'las asked to draw
the human figure.
In their findings the mother was the
dominant figure in the family histories of both groups.
The breast cancer patients denied their sexuality and
were less willing to accept ·their inner sexual d.ri ves
compared to the cervix group.
.
The cervical cancer.
patients demonstrated more contact with self and more
emotionality.
In a journal article titled, "A Possible Relationship
between Psychological Factors and Human Cancer", Blumberg
and Ellis (1954) concluded that cancer results from prolonged inner stress.
Using the MMPI, the Rorschach, TAT
and the vlechsler-Bellevue Intelligence Test 1 cancer
patients were noted to bea serious,
ovE~rly
cooperative,
13
overly nice, overly anxious, painfully sensitive, passive,
apologetic and lacking in self expression and self
realization.
Those patients who were successful in re-
sisting their malignancies were observed to have continued
in normal outward activity, begun psychopathic and/or
psychotic activity or been successful in reducing anxiety
through activities such as conversion hysteria.
Booth. (1964) came up with an. interesting discovery.
He found breast cancer to occur in women whose autonomy
needs inhibited or blocked the intimate interaction
between mother and child during nursing.
In ladies with
cervical cancer, he found an inability to achieve orgasm
but a motivation for sexual activity due to a need for
autonomy.
Lockhart (1976) speaks of cancer as a block in a
person's process of individuation.
Individuation is
Jung's term for the development of an individual's
consciousness.
Cancer evolves as a result of some part
of the self being denied, undernourished or cut down.
Lockhart stressed the value of using dreams as indicators
of cancer grovdng and also indicators of ways to heal
the individual.
With awesome brillance, Lockhart also
discusses the relevance of cancer growing in this century
and relates cancer back in history through mythology.
The preceding summary of journal articles was oriented
towards research conducted on the personality profile of
14
the cancer patient.
There are plenty of holes in each
report's conclusions.
Terms are not defined at. all or
inadequately, for example "psychopathic and psychotic
activity" used by Blumberg and Ellis.
What psychotic
activity represents to those researchers could be seen
quite differently by you and I.
Nevertheless, these are
the most conclusive studies I found and the ones from
which I chose to work.
The following section concerns
literature on the psychological aspects of the problem
brought out by the patient's recovery.
The Mastectomy Experience and Recovery
In Post Mastectomy, Win Ann Winkler (1976} describes
her experience after surgery of resentment against the
doctor.
Along with being in the "why me" syndrome, she
felt guilt and resentment towards her family and friends.
First, for being healthy in contrast to her and, second,
for overindulging her and pitying her.
It is a common
occurrence to want support and nurturing at this time,
but to resent getting it.
A double bind occurs of want-
ing to maintain independence and needing demonstration
of love and acceptance concurrently.
The "why me"
syndrome is characterized by disbelief and usually some
anger and despair.
Denial is another defense mechanism which came up in
Win Ann's experience.
This manifested itself in not
wanting to look at herself in the mirror or be without a
15
prosthesis.
In the "Psychological Impact of Cancer''
published by the American Cancer Society, it points out
that, the faster a woman gets up after surgery, the more
she denies her experience and ignores her grief; the
harder it will be in the long run to accept her new body
image and herself as a person who has had cancer.
They
also found a correlation between a strong fear of
anathesia and a denial concerning the loss of the breast.
Part of recovery includes the acceptance of having had
cancer and learning to live with the possibility of
reoccurrence.
In On Death and Dying, Elizabeth Kubler-Ross (1969)
outlines five stages a patient goes through from the time
of diagnosis to death.
They are denial, anger, bargain-
ing, depression, acceptance and hope.
I would imagine
that those stages are also part of a cancer patient's
experience and necessary for a full, healthy integration
of the problem and development of new coping mechanisms
for the future.
Possibly a standstill in one of those
stages without further movement to the next stage could
prevent the full circle from being completed and thus
thwart health and recovery.
Bronner-Huszar (1971) recorded the following reactions
in breast cancer patients.
Upon diagnosis and previous
to surgery, these patients had nightmares and dreams of
dead parents returning to offer support.
Following
16
surgery the women responded with anxiety, depression,
wi thdra'\'lal, loss of self esteem, feelings of rejection,
denial, regression, hypochondria, and either exaggerated
dependency on doctor and family or resentment and rage
directed towards them.
She suggests tranquilizers such
as thorazine, stelazine, mellaril or anti-depressants
like Tofranil and Elavil.
I believe tranquilizers would
just delay and coat over necessary incorporation of the
five stages involved in recovery.
In "A Crisis to Grow On", Roberta Klein (1971)
describes the mastectomy from the point of view of a
crisis counselor.
A crisis is defined as "an insoluble
problem precipitated by stressful or hazardous events
and causing a loss of equilJbrium for the individual".
The crisis begins immediately following surgery and lasts
four to six weeJ{s.
It calls forth old feelings and
unresolved conflicts.
In order for resolutions to new
and old conflicts to occur, the patient must actively
work on her problem rather than avoid it.
is extremely important.
Family reaction
A certain amount of tension and
anxiety is imperative to move the patient t.oward a quick
solution of her crisis.
Roberta Klein describes three main steps a patient
must take to reestablish a hold on her world.
The first
is to accept the loss by fully grieving with the inclusion of dealing with fears of losing husband/lover and
17
life.
The second is to reintegrate a self image ready
and willing to live life fully.
Thirdly, to make peace
with the albatross of possible reoccurrence which is
very possible for the initial five to ten years following
surgery.
Family and friends can help the mastectomy
patient by helping her to express her feelings, help
her make distinctions between what is real and unreal,
not giving false reassurances, helping her imagine and
anticipate her future, and help her to decide what and
how to tell others about her surgery.
The family itself
also needs help to understand the patient's feelings
and encouragement to express their own.
A month or two of depression following surgery is a
common occurrence.
The intensity and length of the de-
pression depends on how important the breast is to the
woman and her family.
It also depends on how startled
and shocked the patient is by reflecting on her own
mortality.
For example, if the breast is not considered
her sexiest physical attribute and the woman has dealt
with her dying before, she will recover faster from the
initial depression.
If that is not the case, it will take
her longer.
Asken (1975) relates that many women experience a
loss of feeling feminine following surgery and have
trouble overcoming the sensation of being mutilated.
is these women who make their remaining breast non-
'
6
It
"18
functionable in sexplay, and I would venture, in general,
have trouble incorporating the experience fully into
their self image.
I will point out the dangers of this
approach later in the paper.
After surgery there are quite a few adjustments to be
made, some of these involve simple physical maintenance.
Patients are encouraged to do exercises to reestablish
strength in the affected arm.
necessary.
Physiotherapy is sometimes
Many patients suffer from arm swelling with
varying degrees of severity and discomfort.
be helpful in these cases.
Massage can
A major part of recovery,
as far as body image is concerned, is becoming familiar
with a prosthesis and how to use it.
This is a difficult
problem as comfort, having it be the right weight
shape, is as important as external looks.
an~
Many women
also experience itching and phantom pain in the area of
the missing breast.
Post Mastectomy by Win Ann
~inkler
(1976) is an excellent "how to" book as far as recovery.
...
It gives information on what to expect and many helpful
hints on how to deal with physical recovery and a new
body.
The book hesitates to investigate fully the emo-
tional aspects of recovery, however, and is disappointing
in that respect.
Previous to surgery, Rose Kushner's
book, Breast Cancer, An Investigative Report is good for
learning the various alternatives in surgery and the myths
and procedures many surgeons operate on.
This book is also
.19
lacking in the emotional sphere of the experience and
should be updated as the medical profession is being
forced to change many of their approaches with women
and is doing so.
Betty Rollins (1976) gives a true personal account
of how her mastectomy affected her in First You Cry.
She taJ(eS the reader through her diagnosis, operation
and recovery with tenderness and a sense of humour.
It is the only autobiographical account I have read which
describes extensively how the experience affected relationships, goals, attitudes and self image.
Holistic healing is becoming very popular.
The most
commendable is happening in Texas with a married couple
by the name of Simonton.
In
a joint program of oncology
and psychotherapy, this couple is attempting to activate
the psyche in addition to using the tools of our modern
medicine to combat cancer.
In an intensive
prog~am,
including psychotherapy and meditation, patients take
responsibility for their disease and begin a battle against
it or an acceptance, depending on the individual person.
The Simontons are publishing articles, doing numerous
workshops and beginning to teach their methods to doctors,
nurses, paraprofessionals and counselors.
Here in
Los Angeles, the Center for the Healing Arts has a
similar program, but it is more oriented tow·ards the
spiritual nature of each patient, in addition to using
....
20
the basic tenets of the Simontons• work.
Chapter 3 - METHODOLOGY
Subject
Po~J.lat.ion
There were eight women in my sampling.
Four women
were referred to me by my supervisor at Southern
California Counselling Center.
agreed to be interviewed.
T"vo of the four referrals
My first interviewee then gave
me a list of nine women whom she knew had had mastectomies.
Of these, five agreed to be interviewed.
Also, one lady
was referred to me from the organization Reach to Recovery.
Six of the eight ladies I interviewed w·ere of the
higher socio-economic level.
was
blacl~.
Seven were white and one
six of the eight women were Jewish.
ranged from 48 to 70.
The ages
The time of the mastectomy varied
from a year previous to 18 years previous.
Questionnaire
In designing the questionnaire, (Appendix A), I began
with checking out the results and conclusions of the
studies cited in Chapter 2 1 Review of Literature.
Many
of the questions I used are based on those conclusions.
For exampie, "Did you experience anger directed towards
your doctor?" comes from "Adaptation to Radical Mastectomy';
Jh~_Psychological
Ir~act
of Cancer.
I also read the
Firo B, the Minnesota Hultiphasic Personality Inventory
and designed questions based on those tests.
21
In addition,
·22
I used questions I usually ask in an initial interview
·with a new client.
There are five major sections to the questionnaire•
self description, family background, relationships,
significant life experiences, and the cancer experience.
The first, self description, was the easiest for me to
create and give.
I've always enjoyed hearing people
describe themselves and how they think others see them.
I started off each interview asking the woman to describe
herself with five adjectives.
This gave me an immediate
clear insight to some of the basic tenets of the personality of the woman I was interviewing.
Bringing in a
description of herself that she would imagine a friend
would give gave me an indication of how she viewed her
impact on others.
The second major section of the questionnaire, family
background, is also a necessary part of any
profile and could not be ignored.
pers~nality
In this section.I
sought information on how the women felt towards their
•
parents and how they remembered their childhoods.
The relationship section holds the crux of the study
for me.
I focused much of my energy in this area,
particularly in how these women would view intimacy and
conduct relationships.
LeShan (1966) touched upon this
issue in his studies, mentioning that his subjects
seemed to avoid intimacy and self disclosing.
He saw
23
the origin of this behavior in his subjects' childhood,
where they experienced some profound hurt from a parental
figure or a sibling.
I had a general, vague impression
of this reluctance and uncomfortableness with self disclosing during my first few initial sessions with my
interviewees.
I devised the questions in this section
to·try to explore the possibility of that attitude and
to bring it out to focus.
I
use~
sentence completions
in the rela·tionship section because of their usefulness
in obtaining undercurrent attitudes and feelings which are
often difficult to draw out in question-answer conversations.
Sentence completions cancel out much of the
censoring existent in a conversational response and can
also open a door to the unconscious.
Which life experiences held significance for each of
the vmmen I interviewed gave me insight into her history,
her view of it and how much control she exercised over
her life.
The cancer experience part of the questionnaire
could make up three or four studies.
How the women
reassimilated into the world and whether or not she used
the experience as a means of transformation and growth,
were the crucial focuses in that section.
Guidelines of Interviewing Process
My first contact with each lady was by telephone;
I called up and introduced myself, mentioning how I got
their name and what I was doing.
I explained that I was
24
doing a study on ladies who had had mastectomies for my
masters project.
I would need to do four one hour
interviews; I'd be using a tape recorder and could come
to their homes.
I also stressed that I would be asking
personal questions or mentioned that the interview would
be "intensive",
All the informa,tion would be confidential.
The questions I was asked were usually;
'~hat
kind of
student are you?" "What are you looking for?" ••what does
!
your population consist of?" "Why do you want to ask
personal questions?".
The latter question could progress
to .. What does this have to do with the mastectomy?••.
I was also asked how old I was, and what was a young girl
like me doing a study on something like this for?
Out of
14 women that I contacted three refused to be interviewed;
others could not coordinate times with me, etc.
Reasons for refusal were metastasis of the cancer,
writing own book on experience and "I just don't want to''.
At the onset of the first interview I would reiterate that
I would be doing a series of four interviews, the information would be taped and confidential.
I also indicated
the subject area of the questions - self description,
family background, attitude and value relationships and
the cancer experience,
As a safety valve I would state
that if at any time the questions felt too personal or
uncomfortable in any way to state that to me and I would
25
go on to something else.
The response to that varied
from, "Too personal, what could be too personal?" to "Oh,
no, dearie, I'm happy to do this for you" to "Okay".
I
ended the introduction by asking if they had any thing
they would like to ask me.
With a direct question on what
my hypothesis was or what I was looking for, I would state
that I would influence my results if I gave that information.
I would say that I was studying personality.
Content of Intervie'tvs and the Differences
It was interesting to note how each individual
approached the interviewing process.
It went from wanting
to help me and thus feeding me information as if I was a
computer programmer'· to taking the questions in and using
them as a means to know oneself better.
I could usually
tell how self disclosing a woman was going to be by how
long she took to answer the first section on self description.
The longer she took usually meant the more infor-
mation I was getting.
..
This was not true in cases where
the woman has spent quite a bit of time on self awareness •
If I felt a woman would feel more at ease or be
more willing to share herself if she had some idea of
who I was, I would answer one of my own questions.
For
example, I would use five adjectives to describe myself.
Occasionally I would interject some encouragement or
clarification if the woman seemed to be struggling with
whether or not she was responding correctly.
Women who
26
were eager to talk however were eager to talka they took
the questions and were off and running.
I would feed
the questions, be attentive and caring and occasionally
feed back what they had said.
These women needed very
little from me, I only set the environment; they acted
out the play.
Other ladies would require more pulling
on·part; they would be caught up on answering correctly
. or at times startled by my questions.
I would then speak
more, restate questions, feedback their words, ask for
clarification, give examples and'note where they were
stuck.
I would also ask them how they were feeling if
it appeared to me that the questions were making them
uncomfortable.
I would also state hmv they seemed to me,
repeating that some of these questions were difficult and
that they could take their time or we could go on to
something else.
Actually consid'ering the hypothetical na-
ture of many of my questions, especially in the cancer
section, I received few "I don't knows".
Where as some
women would not elaborate on their sex lives or relationships, I got absolutely no "I don't want to discuss that"
responses.
My Role as an Interviewer
As an interviewer, I see myself as being interested,
warm, encouraging and flexible.
My approach with each
woman varied depending on how I felt I was most likely
to get information.
Some women needed to almost separate
27
me from the questions in order to respond.
One woman
rarely kept eye contact with me although she did take the
questions very seriously and answered each one diligently
and with great thought.
questions and more.
With this lady, I asked all my
Two women treated me as their
counselors, revealing and often trying to get feedback.
My·responses were important, I was supportive and accepting but actually gave little feedback and turned their
questions back to them to answer.
I was on a few occa-
sions asked for direct feedback at the end of the sessions.
Feedback on how they compared to other women in the depth
of their responses and also if there had been commonality
of experience.
I answered these questions minimally.
I
basically tried to go along with what each woman was
comfortable with, always getting each question answered.
In a couple of cases the interviews were more like free
flowing conversations, where my questions would function
as an ending summary of what had been said rather than a
beginning inquiry.
In others it was strictly question
and answer with little elaboration and a definite inter- .
\
\
viewer-interviewee attitude.
In a few cases, it felt
like having cake and coffee with a close friend who was
telling me what had happened since I last saw her.
I tried to be a vibrant, or alive interviewer; hating
the idea of being seen as a robot with tape recorded
programmed questions.
I approached each lady with
28
·.·:,
enthusiasm and genuinely enjoyed getting to know them.
Being a young w·oman, I learned quite a bit from hearing
these ladies talk about their lives.
It was interesting
to me to hear a perspective on what had been, the choices
they had made, regretted and were proud of.
Fantasizing
about what I would like to say about myself at their age
helps me to focus more clearly on what I need to do at
this age.
It has occurred to me that some women might
feel uncomfortable or competitive talking to me as a
young woman with two breasts.
My age was often
co~mented
on, I would listen and we would then continue w'ithout
further comment.
In two instances the size of my breasts
(I am small chested) vras commented on, in relationship
to describing the loss of
t~eir
breast.
In these in-
stances, the ladies were describing hmv full breasted
they had been and the difference in body balance after
the mastectomy.
They commented on how it \vouldn 't have
been such a big deal for a small breasted woman.
I did
not get involved personally in these comments, I kept to
understanding and feeding it back to them for further
\
clarification.
I encouraged each lady to use the sessions for her
own awareness and growth.
a professional.
I was in general treated as
I was asked for advice.
I was also
·1ooJ{ed upon vrith envy for pursuing a career in this field.
29
Quite a few of the women expressed an interest in seeing
the study and continuing a relationship with me.
Chapter 4 - TRANSCRIPTS
I have chosen the following four edited transcripts
because I think they best typify the overall personality
of the breast cancer patient.
Laura
Personal Data& Married, two sons, Christian backgrouna
Age at Mastectomy: 48
Present Age: 58
Ca
Use five adjectives to describe yourself; your
personality.
La
Well I am an introvert, I am happy.
lately of myself as middle aged.
I am thinJdng
Lately I've arrived at
the stage where I feel I have arrived, my last son was
married three '\veeks ago.
I have arrived.
Stable.
Ca
What are you proud of?
La
My family.
Ca
What would you like to change about yourself?
La
Oh, I've never had as much energy as I'd like, I just
never have.
Cr
Hmv would a close friend describe you?
L&
Reliable, lasting, dependable.
Cs
What do you think people think of you initially?
La
Sometimes I think people think I am dull because I am
introverted.
'
I am quiet, it takes me a while to blossom.
Ca
Do you express anger and sadness?
La
No, I just get depressed.
0
30
31
Ca
When someone does something you don't like how do you
usually respond?
Do you tell them right away, do you
wait, do you keep it to yourself?
La
I keep it to myself.
Ca
What is most important to you in life, what are your
values?
La
My husband, he is what is most import.ant to me in life.
Cs
How do you usually spend your time?
La
My life has been spent raising a family and volunteer
work.
Ca
When you die what would you like to be said about you?
La
Very little.
Ca
How would you like to be remembered?
La
I guess that I was a good person.
Ca
Name five significant life experiences that have had
an impact on you.
La
Well, my husband,
Ca
Meeting your husband?
La
Marrying him and then having our children and my
surgeries and being a Christian.
\r
Cc
I guess my education.
Describe yourself physically into the tape recorder
as if it was a camera.
La
Well, I am average, I am an average, typical,
American mother, homemaker.
Ca
Are you an attractive woman?
La
Average
Ca
Are you sexy?
La
Um Eh; •••
Ca
Would you describe yourself as a private person?
La
Yes
Ca
Do you confide in your friends?
La
No
Ca· How close are you to your friends?
La
Not terribly close, I am pretty private.
C1
Do you share your successes, problems and failures
with your friends?
La
No, No.
Ca
Do you think your friends truly know how you are in
the world and how you see yourself?
La
No, but you see all this is between my husband end
myself so I
don't really need this outside relationship.
We are very close and I
can remain aloof because I
don't
need outside support.
Ca
..
What does it take for you to let your hair down and
let people see you as you truly are inside?
La
I
Cc
Are these questions you've thought about before.
L:
No 1 Oh 1 No.
C:
What is your fantasy about my reaction?
La
I think I am just another woman.
C&
Whose needs come first; your needs or those of your
don't do that.
family?
33
Lt
My family.
Ca
Do you attach more importance to your husband's needs
than your own?
La
I thought that was coming.
I guess it's probably
fifty-fifty.
C1
Would you describe yourself as compliant with your
husband, more often than not, yielding to his needs rather
than pursuing your own?
La
Well, when he's around I yield to his wishes.·
But
when I am on my own in the day time than I do my own thing.
Ca
Do you spend alot of time doing for others?
La
I
Cs
Do you use a lot of energy taking care of people?
La
Yeah I do.
Ca
Did you originally want to have children?
La
Yes
Cc
What were your feelings during pregnancy?
La
I didn't enjoy it.
do.
I really didn't.
like being pregnant, I didn't.
was doing to me.
\
Some people
I objected to what that
I wanted the baby, but I didn't enjoy
\
having them.
Ca
Where are you in the family.constellation?
La
Well, you'll be sorry you asked.
My mother died when
I was six months old, my brother is four years older, he
was adopted by one of her sisters, I was adopted by
another one of her sisters.
34
La
The family that I was adopted into had a girl ·already
who was nine and a half years older.
I haven't seen him,
oh, my, three or four times ever.
Ca
How was your relationship with your adopted mother?
La
Well, I always think she resented me.
She took me
because her sister asked her to, she was not loving.
Ca.
And the father?
La
We were never close, we were closer after I was
married than we ever were before.
He was always kind and
good to me but we were never close.
Cc
Describe each one of your adopted parents carefully.
La
I think she was very unstable herself, very unsure
of herself.
Consequently she was the matriarch of the
family, she was the boss and nobody crossed her.
Not
until was I married did I learn to be independent.
Well,
I was independent but I learned·to do my own thing and
then tell her rather than ask her advice.
She was not a homemaker she was a housekeeper.
was immaculate.
house.
The house
I could never bring my friends into the
Never, to play.
My toys were not kept in my
room, they were kept in a corner of the dining room,
and the bedrooms were practically sacred; free from
germs.
It was her house, it was never a horne.
He was more outgoing, they were not congenial; I never
understood why they married.
When he was at horne in the
evening he was working, desk work.
35
Cs
Which'events stand out most in your mind about your
childhood?
What stands out in my childhood is going to
a new school, because the old one was very uncomfortable
for me.
L&
Things like that.
I had alot of headaches.
a well child.
So many headaches.
I wasn't
I don't know whay my mother died from.
One relative says tuberculosis, others say different
things.
I don't know why she died.
But I was not well,
and one thing I think mother resented was well, I had
many spasms, dozens of spasms and I couldn't keep anything in my stomach and meantime Daddy was on the road
and she really had a rough time, I'll say that.
I've always had headaches, as a matter of fact I wake up
every morning and I have a headache but this is menopause
kind of thing.
every month.
Ca
Until I had a hysterectomy I had migraines
Awful menstrual headaches.
What '\vould you have liked to have been different
about your childhood?
La
•
I
Ca
I guess I would have liked to have had more strength,
never had enough stamina to keep up with other kids.
Would you consider your household duties as a child
excessive compared to other children?
La
Yes
I could never, ((laughter) my husband and I were talking
about this recently) I could never go to the show with
36
other kids on Saturday afternoon because I had to stay
home and clean the basement.
This is how she was, so help
me, she did this to keep me home.
I had to clean this
dumb basement, it was a room where she did her laundry.
Ca
Do you remember hmv you felt as a child?
When you
had to stay home on Saturday afternoons?
La
Oh yeah when she thought I was down there working,
I was dancing.
I
just danced and danced and danced,
produced musical numbers.
I wasn't working, well, I did.
I did what I '\vas suppose to and she knew I wasn't working.
She knew I '\vasn ' t working down there all that time and
there wasn't thatmuch to do, but it was her way of
keeping me out of her way and yet keeping her thumb on me.
Ca
Why do you think she wanted to keep her thumb on you?
La
She cleaned house on Saturday$ come hell or high water
she cleaned house.
I couldn't; do it because I didn't do
it right, but she had to do it but yet she didn't want
me in her house.
Isn't that weird?
I wasn't suffering,
I was fed, I '\vas clothed, in fact my sister and I were
probably the best dressed kids in school.
Ca
Did you feel safe as a child?
La
I guess so but she beat me, she whipped me.
got out of line, she whipped me with a ruler.
When I
She had a
terrible temper, put me over the kitchen table and whammo!
Ca
Did that happen alot?
L:
Seemed like alot.
37
C&
Did you feel loved?
La
No
Ca
What was the general atmosphere of the household?
La
It just wasn't a very happy place, dull.
Ca
Did you have difficult periods? (menstrual)
La
Oh, yes
Ca· How were they difficult, tell about them.
La
Before I had babies I had cramps like crazy, and after"'"
wards, oh I always had a terrible time.
One of the nicest
things that ever happened to me was my hysterectomy and
nobody can believe that, but that is true.
terrible a third to half of the time, I
ble as if I had the flu.
I just felt
just felt terri-
And even the doctor didn't
believe me, but it just made a new woman out of me w:1en I
had the hysterectomy
Laura's Cancer Experience
..
•
\l
Ca
What did contracting breast cancer mean ·to y.ou?
La
Well, you see I had had cancer twice before.
Ca
Okay, "\vhen did you have those cancers?
L:
1950, 1954 and I had my breast cancer in 1967.
Ca
How old were you in '67?
Lr
48
Ca
The first time you had cancer it was where?
La
Thyroid
Ca
And the second time?
La
On my back
38
Ca
Okay, so when you got cancer, you said here it is
again, what was your reaction?
La
Oh, it was depression.
So you've had it before, so
you know what to expect, but it doesn't get any easier.
I guess mostly depression.
C&
Why do you think you got breast cancer, do you have
any theories or fantasies?
La
No
Ca
Do you feel stress was a factor in the creation of
your disease?
Lc
I don't know, it could have been, but who knows,
nobody knows.
Ca
What was happening one or two years prior to your
mastectomy?
La
What was happening in your life?
Okay, my father-in-law was very ill and I took him
for radiation for months and months, for eight months.
And he died a year before I had my breast cancer.
sister died three weeks before I found it.
..
My
But there is
no relation there because cells don't grow that fast, I
already had it before that happened.
That Fall, my
husband and I had a wonderful trip east, we left the boys,
I don't know how I did that but we did.
One of them was
in college then.
Cs
Do you remember feeling overloaded or depressed?
La
I was very tired, this I know.
The second and third
times I had it, I was very very tired before I found I had
39
it.
Whether or not I was tired because I had it or I
was tired and I got it, I don't know.
Cl
Were you depressed?
L&
The third t.ime, after ,.,e came back from that trip,
even before my sister died, yes, I was depressed.
Ca
Do you remember what was bothering you?
La
No
Ca
How long did the depression last?
La
~·lell,
·
I would say it started a couple of months be-
fore I found it and it must have lasted a year or a year
and a half or two years.
Ca
Describe to me the sequence of events surrounding
the mastectomy; discovery of symptoms, going to the doctor,
diagnosis, surgery and recovery.
La
Okay, I was lying on the bed resting one afternoon
and I just happened to feel it and I knew right away,
oh no.
That night we were going someplace so I didn't
tell my husband, I think that was on a Monday.
Well, I
don't know maybe I did tell him, seems like I didn't but
that doesn't add up right.
\
\
Anyway I told him that night
or the next night and the next day went to the doctor,
\
but I told my husband first.
The doctor sent me in for a
mamogram that afternoon, and he wanted to put me in the
hospital that night.
I didn't want to go.
Yeah I think
I didn't tell my husband that first night, because it
wasn't a good time to tell him.
I told him on Tuesday
40
night, went to the doctor on Wednesday.
He wanted to
put me in the hospital, I begged him not to, because
Christmas was the next Monday and I wasn't ready for
Christmas.
I mean I didn't have gifts wrapped and stuff.
So I begged him to let me stay out, I said I -.;.,rould go the
day after Christmas, on Tuesday, I would go in.
He had
surgery scheduled for Thursday morning, so I went in on
Wednesday and he operated on me on Thursday.
And he told
me if he had to go all the way, (in those days, everybody
had radical surgery and every woman signed her life away,
that was the way they did it), he told me if they had
to go all the way, I would know when I -.;.,roke up.
did, I knew.
bed and I
Hell, I
Cause my arm was tied up to the head of the
just knew.
And then I went horne on Monday; I
quit draining and Monday was New Year's and I figured
if I went horne that day, then my husband wouldn't have to
be away from work on Tuesday to come and take me horne.
So then on Tuesday, everybody -.;.,rent to school and w9rk and
I stayed alone.
I was up maybe not that day, but the
next day, vacuuming Christmas tree needles off the floor
because my husband had taken the tree down but he hadn't
gotten it cleaned up
af~erwards.
Ca
What were your concerns prior to the operation?
La
Oh, losing my breast.
Ca
What about afterwards?
La
I was always concerned.
I had a lymph involvement,
41
I was concerned whether or not I was going to make it.
Afterwards?
Oh, I was just crushed to the bone that I
had to lose my breast.
In those days it wasn't talked
about as it is now and I ran around in sweaters, jackets,
stoles, coverups for months.
Really crushed.
Ca
Did you have a prosthesis?
La
Not really.
I had seen advertised in the Sears
Catalog some prostheses so while I was still in the
hospital my husband ordered some of those.
So I had
a little soft styrofoam kind of a thing that I wore for
a year cause I didn't know any different and I figured
out how to anchor it down and I wore sweaters and looked
fine, really did.
C'
What a.re your concerns now, not having a breast?
La
Oh, it's still not easy, it's harder all the time to
look right.
Due to, I had radiation and my ribs haven't
collapsed but they've sunken and it's harder all the time
to fill in my hollows.
I've tried all brands and I buy
things and cut on them and work on them and it's real
..
hard, I just can't get fitted right and it gets harder
all the time, due to my individual, physical make-up.
Ca
How was it in your relationships at that time?
La
I didn't have anyone to cry to.
My mother was gone,
my sister was gone, and my mother-in-law was always most
unsympathetic about any illness I had.
operations.
I had a lot of
I had a precious husband but you can only
.42
burden a husband with so much.
So, I really didn't have
anybody to cry to.
Ca
Did you tell your friends?
L1
No
C:
Describe your recovery period.
La
Physically I snapped right back, emotionally, it took
a long time.
C•
Did you get support from your family at that time?
L&
Well, the boys '\vere teenagers at that time and I
didn't talk to them about it, no use burdening them with
Mom's problems and my husband 1vas great.
He always has
said, still says that the whole thing bothered me more
than it bothered him, but I never did cry to him.
C1
Why didn't you?
Ls
Well, no use burdening him.
Cs
Did you experience any anger?
L:
Yeah,
Ca
How was that directed?
La
I just, why does this have to happen to me?
I know
so many people who are well, why me?
Cs
How did you grieve the loss of your breast?
Lt
How did I grieve, I guess I was just depressed, but I
went about my normal life.
I can remember being places,
urn, w·hen you have radiation they put purple marks on you,
so they have their marks the next day, where to put the
machine and you are not suppose to wash them off and I
43
can remember various places I was ·when I had those marks.
It was hard to cover them.
I
had it in four different
areas, one of which was up here (pointing to neck) and
it is hard to cover that purple x.
been there knows, I
And anybody who had
can remember being in a store, a man,
a salesman, after he took care of what we were doing, he
said "God-bless you" and I knew he knew.
That's all
that was said, but I knew that he knew.
Ca
How has having had cancer changed your life?
La
Well, I wouldn't have been involved with the American
Cancer Society.
That was a big part of my life for eight
years, very large.
I
I
hurt alot.
am a hurter and my doctors never had another one like
me.
And the only way to stop hurting is to take off my
clothes and go to bed and then I
pressure on me, I
my back but I
stop.
Without any
quit hurting. · I went through this w·i th
do think it is getting better.
Ca
So you did experience pain?
La
Oh, yes, my yes.
Ca
Did you experience pain in the breast area?
La
Yes
Ca
What kind of pain?
La
Well if l didn't have to wear a bra, then I wouldn't
hurt.
Ca
It's that pressure which I can't get used to.
How has the experience of having had cancer left you
in general?
• 0
I hurt most of the time.
44
!,
La
I used to, every time I read in the paper that some-
one else had died of cancer it would throw me and I was
depressed for another day or two.
But I've gotten over
that and years ago, every time I'd feel someplace I'd
real quick feel the other side to see if it felt alike.
Well, I still do that in my neck, feel the other side;
is that the way it's suppose to feel?
There is still
that fear of its returning.
Ca
How do you see the remainder of your life?
La
I really feel that I've arrived, my obligations have
lessened and I'm learning to say no and I'm trying to
do what I want to and the heck with what someone else
wants me to, and let up and I'm just really getting
there.
Ca
I have time to do what I want to do, it's great.
Do you see yourself as a two breasted woman or a one
breasted?
La
Well, you see my back on the other side is as deformed
if not more so, as I am in the front on the right side.
I make alot of my clothes and buy clothes I work over.
I just work and work on them to make them fit.
\
I'm
getting increasingly hard to fit and so I am well aware
of my deformities.
Ca
When you initially had the breast removed and during
the following six months to a year, could you look at
yourself in the mirror?
La
• 0
Yeah I did •
45
Ct
How long did it take before you could look.
Ls
I looked, this was a big step for a patient, some
women don't look for a long time.
I looked, well, the
day I came home from the hospital I got in the shower,
I wanted to really get cleaned up, because they had had
me doing my own bed baths in the hospital and that's for
the birds, so I looked in the shower that day.
Ca
Did you show your husband?
La
Urn hum, and it didn't phase him and I didn't know
then what a big help he was being.
phased him he did not show it.
a great guy he was at the time.
You know, if it
But I didn't realize what
I better tell him.
C&
Did your primary relationship with him change then?
La
No, well it did on my part.
C1
How did it change as far as your view of it?
La
Well, I kept covered up and turned by back and that
sort of thing.
•
Cs
Do you still do that now?
L&
Yeah I do.
He thinks I'm sflly but there is really
no need ••• Keep life as beautiful as possible, I mean I
turn my back when I'm dressing.
C&
Did you tell your friends?
La
Well, you see I only told one friend and I didn't
know at that time that was all it took.
I didn't know
that everyone else knew •••
It probably made it easier for me when I didn't know that
46
!,
everyone else knew that I had had my breast off.
Cc
Did you share with others the experience besides your
husband?
La
No
Cc
Just that one friend?
La
Well, I really didn't share it with her, all I told
her.was they had to go all the way and then all that
Spring 1 she was great, once a week we w·ent out to lunch
always all that Spring, and we went shopping and we never
did discuss it.
When I went into the fitting room to try
something on she didn't go with me.
it.
We never discussed
I have never discussed it with her to this day.
But
she knows what I do for ACS but I didn't tell anybody
about that for years.
Ca
How do you feel about possible reoccurrence?
Do you
consider that as a possibility?
La
Yeah, as I have said this is something we have to
learn to live with.
Most people I've known who have had
it, it came back and I've had it come back, so I suppose
it will one day.
\
\
C1
How do you deal with that on a daily basis?
La
Well, I suppose I put it out of my mind.
Ca
What is different about you now after the experiences
with cancer?
L1
Well, I hurt all the time.
, like to.
I don't live the life I'd
It tends to slmv you dmm, but you learn to live
.
47
:,
"
with it.
Do you feel resentful about that or do you feel you've
Ca
accepted it?
Well, I'm a little resentful over the fact that the
La
doctor did such radical surgery.
However, ten years ago,
he did the best he knew how and I am here.
he.tells me be thankful you're here.
This is what
I am but I truly
feel if he hadn't done such radical surgery, I wouldn't
hurt so much.
Ca
Have you ever expressed that to your doctor?
L:
No, he's a dear elderly man and he's taken care of us
thirty years •••
Me as your interviewer and writing a study, \vhat•s
Ca
important for me to know about you?
What would you like to be included in my description of
you?
La
I would just hope that I've said something that you
can use.
I would hope that you can find a denominator
betw·een all eight of us that you can work with, that can
be valuable.
\
~I
I want to help.
C:
So your main reaction is that you want to be helpful?
La
Um hum Yes, that is it, believe me it doesn't do a
thing for me to sit and tell my story.
I don't get any
satisfaction of that as some people do.
Ca
How do you feel about the questions I have asked you?
La
Well, I had a really rough time the first day with
48
those ''how do you feel about. , •: because I had never considered those things before.
I wanted to help you but I
really didn't knmv ho"t<r I did feel about alot of things.
Ca
'Here you uncomfortable?
La
Kind of.
But nobody is interested in me, you are going to erase
the tape, except as far as your paper is concerned.
Right?
Ca
There is also me reacting to you.
If you meet a
I
different person and open yourself up and meet them and
talk to them, you remember them; there is something that
you share.
La
Well, now, we see patients all the time in hospitals
and you know it gets so that I can't remember them.
When we visit the lady, we give our telephone number and
in a week or ten days, I call·her back and she can call
me if she is depressed or I can help her in any way, and
somebody calls up that I've seen three weeks before I
just can't visualize that woman.
I see hundreds of
women and now it's gotten to the point where I can't even
remember them individually unless she has some outstanding problem, then I will remember that.
I can't picture
their faces but yet when I go to see her, not all the
time, but usually, we are on the same wave length.
'·
Anne
Personal Dataa Married, one daughter, Jewish background
Age at Mastectomya
59
Present Age: 62
Cs
Use five adjectives to describe yourself.
As
May I preface it by saying something?
Cs
Go ahead.
As
It tool{. me a long time but I've learned to love my-
self,
This is not an egotistical comment because I am not
an egotist, as a matter of fact, alot of times, I have
a tremendous inferiority complex.
want to be honest with you.
worked very hard on this.
You've asked me and I
I am a good human.
I've
I think I have an anticipatory
approach to people's needs, I try to be there.
I think I
have a healthy mind, a good outlook on life and I know
I'm considerate and I'm very loving.
That's it.
Ca
What do you most like about yourself?
A1
Being loving and Jdnd because that is what I most
wanted to be al"'l·rays.
\
Ca
Are you satisfied with yourself?
A:
Yes, as a person.
We are not talking cerebrally, I
could have done alot more ·with my head.
\
Yes as people
: come and go, because I know I am decent.
Cc
What is your realistic self image?
Aa
I do pretty well.
I paint myself into corners,
willingly, open-heartedly, and then I find that I resent
being put in the corner, which I do to myself.
49
·so
C:
How do you paint yourself into corners?
AI
By alw·ays being the first one to offer, by ••• I"'ve
heard this from other people that I make myself into a
doormat which I really don't feel that I do.
But some-
times I feel an entrapment which I know I've done, people
don't ask me to do it.
I don't think that it is wanting
to.be a good guy all the time, I really feel that it
is an earnest desire to try to help.
I often project
and think, if I was in her position, oh, God, how I would
want someone to lend a hand.
I think that has a lot to
do with it, maybe fear is at the base of it, I don't know.
C1
l'ihat do you think people think of you initially, what
do you think I think of you?
AI
Well, I feel this very keenly in people, I get a
tremendous chemical reaction with people and I make it my
business for people to like me, it's very important to me.
I love people, I said at the onset that I like people to
like me and if you are pleasant to people and you
at them and you're gracious, what's to dislike?
~mile
I don't
think I offend people, I've been told, I come on very
strong but that's my personality.
Cr
Would you describe yourself as a happy person, sad,
angry or all three?
Aa
I'm very sad for the world.
I consider myself very lucky.
I can tell you that.
Yes I have alot of anger
and the main reason I have anger is the people who are
• 0
·51
I
most, my closest, I cannot communicate with.
Because
they are people whose good intentions cannot stand· to
be impuned.
I cannot point
a
finger at my daughter or
husband because they are both very volatile so I swallow
alot which makes me angry.
C1
You said you swallmv alot, do you express any of your
anQer?
AI
Occasionally, oh, no, not the anger part.
I'm afraid
to take a chance, I'm afraid of an argument, I don't like
them.
They physically malce me ill.
C1
What is most important to you in life?
AI
Love, and I don't mean physical love, I mean just
love.
C:
vlhen you die what 1-rould you like to be said about you?
A1
That I \vas a good person and that I was loved.
C1
Are you responsible for your life?
Do you think you
are inner directed or do you think •••
AI
..
I think alot, it's the thing about painting oneself
into a corner.
I think in many areas we are victimized
or we become part of a stream that carries us away, but
I guess I'm partly responsible.
Ca
Name five significant life experiences that had a
significant impact on you.
A:
You mean such things as my parents, how my parents
go along?
Ca
Okay, if that is what feels significant to you •••
52
..·,·,
Aa
Well I think that had a very significant •••
Ca
What was it like?
Aa
It was horrifying.
Ca
Horrifying.
As
And at age three I crawled out of the crib to separate
the two of them, they were in such a violent argument
on New Year's Eve.
My mother had put on some lipstick
which ladies didn't do then, and I was made to feel very
responsible for keeping the family ship on an even keel.
Which I
resented terribly, always, I felt much more the
parent than the child.
My divorce had a tremendous impact
on me 1 not that I was any longer in love with my husband,
but I had a very deep sense of guilt about the failure.
It was a failure, a divorce is a failure.
Two pretty
horrible surgeries made a tremendous impact - I had a
tubal pregnancy and I was lying in bed for twelve weeks in
pain and profuse bleeding and I really thought when I went
to the hospital for that surgery that I ·v1as dying of cancer.
And I say significant because I remember I was
waking up saying ''God, if I live through this, I will
\
make every moment count".
\
I remember that very vividly
and I think that had a great deal to do 'vi th whatever
degree of maturity I've now obtained, I mean it changed
my values like you wouldn't believe.
Ca
How old were you when that happened?
A'
'I' hi r.t y-one.
53
Ca
So you started looking at things differently then.
Aa
Very differently because I J<:now when I was pregnant,
I didn't feel that I was pregnant, I felt that I '\'Tas an
instrument carrying a new life and I think that was one
of the biggest changes in my life.
I value myself but
only in reference to how I relate to the lives of other
people.
I ·mean I really, Carrie, do not remember getting
up any morning and asking
11
"\vhat "\vould please you today?"
And I'm not saying this to impress you or me, this is a
fact.
I do not ever say "this is your day", because I
don't think that's important.
I think it's much more
important, look, maybe it's a form of escapism, I don't
know, but I know this is the fact of my life.
So I feel
that that surgery and then when I had the mastectomy
three years ago, out loud, I said "If I make it this time
God, I will be such a good human, like you wouldn't
believe" and I have really tried and it's import.ant to
me.
Because there must be some reason why you get. that
close and then it all just opens up again.
There has to
be a reason.
I guess my marriage to my husband is significant
because we are very different in many ways, this present
husband.
And learning to uh, it's been a great struggle
since I came out here in 1941 financially.
Learning
really at the gut level to live very simply and to live
54
i
with much less than anybody else that I Jcnow or anybody
else in my family.
To,really get my values straight.
Ca
Describe yourself physically.
A:
Glad you didn't ask me that a month ago, I
off 18 pounds.
just took
You mean I'm tall, reasonably slim, got
a good smile, that's it.
C1
Hmv do you feel about your body?
Aa
My body is all scarred, I have one that goes from my
navel down to my pelvic bone '\vhich is \vhere they did the
exploratory for the tubal pregnancy and my mastectomy
scar is half way into the breast that is left, because
my cancer was in the center, so they had to go both ways.
It's the strangest thing, I have accepted the whole thing
but somehow I don't relate it to me.
I can't even explain
to you what I mean Carrie.
C:
The scars, the whole experience?
A1
I can't explain '\vhat I mean to you, honey, it doesn't
affect me.
I find that once in a great while I'll think
"Oh dear God, don't let me get cancer again", but I don't
think about it that much.
to take a bath or a shower.
I mean it doesn't horrify me
Nmv this is something that
I'd like to tell you since we are talking about mastectomies.
I would like to be able to do some exercises, and
I have some arthritis so I have to be careful what I do,
but I have been really almost pushed into it by my
daughter and a couple of friends who have said why don't
i
. 55
you go to the gym?
In that area I am very very self
conscious about offending other people.
I know as a child
I was friends with a girl who had lost her arm in a car
accident and when I sa1v the reaction of the other children to her, when we had to get dressed for gym or go
swimming, I thought, at that age, if anything like that
ev~r
happened to me, I wouldn't ever want to put it on
anyone else.
I knO'\v there alot of women who do go to
these clubs, who get undressed and take their showers,
I wouldn't give a damn for myself, it would not embarrass
me one iota for me, but I would be terribly afraid of
having those '-romen horrified for their own point of view -
Oh, my God, suppose that happened to me.
I know this
sounds like a pollyanna which I am not by any means but
I would really hate to have anybody shy away, because it
was a bad experience for them.
I wouldn't like that
Carrie.
•
Ca
When you are by yourself, can you look at yourself •••
AI
I walk around nude most of the time.
When I am alone •
It doesn't bother me.
Ca
Do you feel you are an attractive vroman?
AI
Yeah
Ca
How did you feel about your sex life up until the time
of your mastectomy?
Aa
That's not an easy one to answer, because things went
so bad in my former marriage.
My present husband, and I
56
hope my last husband, is a work alcoholic, that's his
whole life.
You know.
So the mastectomy didn't make
that much of a difference because it doesn't preoccupy
his mind particularly. :And I have learned.to live with
-v;hat ever is.
Ca
Is your sex life satisfactory?
A:
Ites practically nil because six months before my
surgery my husband had a bladder, cancerous bladder
tumour and while he was in the hospital there were all
kinds of things that happened, and he had to have his
prostrate removed.
I think that has made a difference.
But you see it's always been my contention, I \vould
settle anything for a good hug.
I mean to be affectionate
is more important to me than the act of sexual intercourse.:
Ca
Do you feel that you get that from him?
A:
No.
C:
What about w·hen he is here?
A:
Well, he \vorks whether he is here or in his studio,
He is too busy.
there is no difference •
...
Ca
What are your fears in developing friendships?
Aa
I guess being hurt.
C:
Would you describe yourself as a private person?
AI
No.
C:
Would you describe yourself as a family person?
A:
Very much so.
C;
Do you confide in
a
selected few?
57
AI
Yes, I guess so.
Cc
How could a friend hurt you?
Aa
Well, I've had that experience, I was being used
whether it was to drive them or do their bidding or
something of that nature.
That's a very hurtful thing
when you really put your heart into a friendship.
And
I've learned not to take it any ·more, friendship has got
to be a two way thing.
C:
Does that influence your present relationships?
AI
Oh, I think so.
Ca
Do you think that you held yourself back from getting
I think I am a little guarded now.
involved with people?
Aa
No, I w·ish I could learn to.
Ca
Are you satisfied with your friendships now?
AI
Well, as I told you, I have very few friends.
Ca
If you're asked but if
so~ething
is bothering you and
a friend is here would you discuss it or would you? •••
A&
Sometimes, most of the time I would try to work it
out by myself.
Ca
Most of the time you would try to work it out •••
A&
Yes, I am terribly afraid of becoming dependent on
anybody and that includes a therapist.
. v
Ca
Have you been in therapy?
AI
On and off.
Ca
Are you afraid of intimacy?
I'm afraid of dependency.
. 58
i
AI
No, dependency.
Ca
If you are under stress would you share it with a
friend, like before the mastectomy did you tell your
friends •••
No, honey, not a soul, not my husband, nobody.
Aa
I kept quiet which was damn foolish of me.
ho~e
When he came
I told him I was going to the doctor.
C:
How important is what people think?
Aa
Very important unfortunately.
Ca
Are these questions you've thought about before?
Aa
Some of them.
Ca
How do you feel right now?
AI
Talking to you?
C1
In talking about relationships and being '\'lith people,
Wonderful.
what do you consider your role to be? . If you were in a
group of people that were close to you.
..
AI
I guess more or less, guess the mother.
C1
Is that true with all people or is that germaine to
close people?
Aa
I guess mostly to people I'm close to, but it all
depends on their response when you meet new people.
guess it is always more or less offered to them.
I
If they
choose to take advantage of it, that's the role I would
assume.
C1
\'Vould you say that you trust people?
Aa
Yeah, I guess so.
59
C:
Do you trust first and then get support or hurt or
do you hesitate, judge first and then trust?
At
I trust and then get hurt.
Ca
Can you tell me a little bit more about this?
A:
Hell, how I get hurt is ultimately being taken for
granted and I think used in many instances, and it beco~es
a very one-sided relationship which nobody likes.
C:
How is it one-sided?
A:
The input comes from me.
C1
And you don't feel like you're receiving?
AI
No, very little.
C:
Hhat kind of input are you putting in?
AI
Affection, time, interest, energy, you know, service;
driving them where they have to go, marketing for them,
things of that nature.
C:
Taking care of them.
AI
Yeah.
C:
Do you make your needs known when you feel that you're
not getting what you need?
A:
No uh un.
Ct
No, you don't
A:
Because that would put one in the position, me in the
\\
)
position of asking and that is hard for me to do.
Ca
It's hard for you to ask.
Aa
Terribly hard.
, C:
After a1vhile do you find yourself resentful?
!,
A&
Yes
Ca
What happens to the resentment?
AI
It goes inside.
I get headaches.
i
C1
Anythin~~
AI
No uh un.
C:
What other kinds of somatic problems have you had?
A&
Tubal pregnancy and mastectomy.
C&
Do you remember your mother ever talking about her
else somatic?
pregnancy with you?
Aa
Yes I remember very foolishly, she told me when I was
a little kid, that I had had a twin sister and I had
killed her.
And what happened I suppose you know, kick-
ing, I must have pierced her lungs, I don't know.
affected me I felt quite guilty for a time.
It
I was eleven
years old andmvited to a birthday party and one of the
games we played was we stood on the top of the hill and
then there was a gulley and another hill, and I remember
the mother saying if you call out, your twin sister will
answer you and I called "Anne''
and this voice came back
I
and I was horrified not realizing it was an echo.
\
No, I
have no feelings about that, uh un.
C&
So your mother told you that you had had a twin sister
and she was dead on birth.
As
She was born dead.
And she was the beautiful one,
all pink and white and I was dark and had a big long
strand of black hair and that was it.
60
. 61
C:
Is there anything in your family background that tells
you that you shouldn't be proud of yourself, that ·you
shouldn't be aggressive or assertive?
AI
Have a strong ego.
No, well, I don't know there is something almost
immodest about a s·trong ego.
And as far as, there were
too many people in my family that had to be center stage.
I find the responsibility absolutely overwhelming.
I
don't want to be center stage.
Ca
So you took that information and incorporated it,
decided that •.•
A:
Yeah I had a father that had to be center stage and a
mother and a husband who has to be.
Ca
Describe your friendships to me, how you see
the~
how
they've changed over the years, usual duration, what part
of your life they play.
A:
Well, I don't have all that many friends, I have alot
of acquaintances, very few friends.
My
friends~ips
and
the 'ivay I related to people and they in turn to me.,
...
changed greatly when I married Herman because he is very
much of a loner, he's a work alcoholic and when we
married 14 years ago, I gave up most of my friends.
So
the friends I have now are all my little sparrows with
broken wings that I can help or sit and listen to on the
phone or whatever.
C:
Define the word intimacy.
A:
I t.hink the most important aspects of the word intimacy
, 62
is no barriers, a complete denuding of one's innermost
self and I don't.
Ca
So that definition wouldn't fit your marriage.
AI
No
Ca
What's missing in the marriage?
Aa
A free flmving communication, divergent interests,
my.husband is not a thoughtful, affectionate, loving kind
of a man.
C:
His life is his work.
So you find yourself kind of going along with what
he wants to do, how he sees the relationship?
Aa
Yeah, once in a1v-hile I'll open up my mouth, but it is
not worth it.
Ca
What happens to your need for intimacy?
Aa
l'lell it had been pretty :much submerged for a lon;s time.
Ca
Did you get the affection and caring you needed from
your mother as a child?
Aa
No from my grandmother.
I "'.vas the mother and she
the child because my parents did not get along and. that
little burden was always put on me, you know, to be the
arbitrator.
Ca
As far as your father goes, did you feel alot of
caring from him?
Aa
No
Ca
Did you ever feel any seduction from your father?
Aa
Very much so.
I told you I think that when my father died there was a
63
letter left for me in the safe which I tore up, I didn't
even open it.
I didn't want to know vihat was in it.
Ca
No, you didn't tell me that.
A:
I thought I had, I didn't w·ant to knm-r what ,.,as in
l
the letter.
C1
What 1-ras your fantasy about what was in the letter?
A1
I don't think it was a fantasy.
I think it ,.,as some-
thing very real; having something to do with what we just
spoke of, the seduction thing.
alot more from me,
I think my father expected
He used to say "You know you're the
oldest, you should this and you should that",
Burdens
and responsibility that had no right to be put on my
head as far as the family getting along and being the
peace maker, things that I didn't want any part of.
Anne - Cancer ExEerience
C:
v/hat did contracting breast cancer mean to you?
At
Well, the first thing that it meant to me was that I
wanted to have the surgery over as quickly as possible
so that my body 'vould be cancer free.
That was my first
reaction.
\
Ca
Why did you develop breast cancer?
AI
I haven't the vaguest idea, because as I told you the
other day, cancer is something that in the history of our
family, never cropped up before and my sister was stricken
with this eight or nine years before I was.
C:
. v
Your sister had one breast removed?
.64
AI
Uh Hun.
C1
What are your theories of why you developed breast
cancer?
As
I
I
have no idea, because the theories keep changing.
did nurse my baby.
I
did sustain a terrible bump
right in the center of my chest about four months before
I
developed breast cancer.
A cabinet door was open with
a very sharp point and I was running into the kitchen
and I
ran right into it and that was the exact same spot
where I
developed breast cancer although the doctors
all say, "no, that's not the way you get breast cancer ...
C1
How old were you when you had your child?
AI
Nearly 37.
C1
Do you feel stress was a factor in the creation of
your disease?
•
AI
Yes, I
do.
Ca
Where was the stress coming from?
AI
Well, I always had alot of stress, I had stress at
home as a chiJ.d.
There \vas terrible stress in my former
marriage; there was alot of family stress about the upbringing of my ex-husband's little girl.
I
developed
a spastic colitis which I had for five or six years
couldn't eat, it was just dreadful.
financial stress and after I
my present husband.
And there was always
got my divorce, I
married
He was a marine corps sargeant
and has never gotten over it and my daughter was then
• 6
65
eleven and a half, and the tension between the two of
them was not to be believed.
Horrifying.
And then ivhen
my daughter was not quite 14, he said either she goes orI go, which is something I will never forgive or forget.
And she found an apartment about a block away and she
lived there with her father and it was the beginning of
all her really bad problems as far as I am concerned.
It was just a dreadful, dreadful thing that I will never
get over.
And then when she carne back to live with us a
couple of months later, the tension between them •..
Ca
How long "\vas that before the mastectomy?
Aa
That was right up until, well, she got married in
June, six months before I had my surgery.
And for the
first six months of her marriage, I didn't see her or
hear from her.
C:
Did you experience that as a· loss?
AI
Terrible, it was the worst time of my life and simul-
taneously my husband was away working and I knew I had
this lump and I
thinJ~
I told you I didn't want to indulge
in the Jewish mother syndrome and call her, and apparently
she thought she was going through some kind of nervous
breakdown and apparently their marriage was very bad,
and it was just a horrifying time.
Cs
Do you think your tumour \vas telling you something?
As
Hell, I think any illness tell us something.
I
think -.;v-e do a lot to cause disease in our own body, with
66
venom and nervousness and our own adrenalins, and T think
we put out alot of poisonous substances.
I
didn't relate
the breast cancer to all the the tension and stress and
everything, it's only in the last couple years that
they seem to feel that this is possible.
I
always felt it
was because I had hit myself so hard.
Ca
How long of a period was it before you discovered
the lump and called the doctor?
Aa
Between the time that I
doctor?
Ca
I
discovered it and called the
Close to six months.
thought you said that you went to one doctor and he
suggested seeing a surgeon.
A:
Oh, that \vas about a year before, but that wasn't
because of the lump that was because the shape of the
breast had changed so radically, it was so ugly.
nipple was inverted.
I
imagi~e
The
about a year before, I
really can't relate to the time.
Ca
What were your main concerns before the surgery?
AI
Well, I was anxious not to die.
I
was anxious that
they get the whole thing so that it wouldn't be one of
these long drawn out things for my family and well as for
me.
Ca
What ,.,ere your concerns after the surgery?
Aa
Mostly I didn't want it destroying the people that I
loved because I knew I
could handle it and I
backwards to protect them.
As I
think I bent
look back now and other
.
67
,,
women tell me how supportive their families were and
their husbands, uhm, the strength came from me not from
them.
i
Cr
You feel you held it all together, the way you re-
sponded led the way for them?
Aa
Yes, I think so.
Yes, definitely.
Ca.
So, where did your needs get taken care of?
A:
I don't really think about them too much, Carrie.
I've explained that to you.
I'm involved with a·lot of
egocentric people who are very dependent and not too
demonstrative, I think my daughter gets more so as time
goes on 'ivith her tenderness and warmth.
I think if I had
gone under they all would have and why should I go under,
I mean the main thing 1-ras tn get rid of the cancer.
going under but getting some support for yourself.
Not
They
are not those sort of people, they bring presents.
Cr
You came right out of the hospital pretty quickly ••• ?
Aa
I was home on the fourth day, the doctor couldn't even
believe it.
\
Ca
How was having had cancer changed your life?
A:
I don't know if it has, it's intensified my caring
about other people and wanting to be I hate the phrase
a do gooder, but it has given me tremendous emphasis,
you know?
,
Cr
In general, how has the experience left you?
Ar
Well, I told you the first day, I still don't relate
68
l,
it to myself, even though I have this terrible itching
and, I am not too comfortable with the prosthesis, but
the cancer thing was never in my consciousness, strangely
enough.
C&
When you think of yourself as Anne, do you think of
yourself as Anne with two breasts or Anne with one?
Aa
When you put it that "\vay I'd obviously have to say
Anne with one.
Ca
So you feel you have accepted it?
AI
Yeah.
C&
Has your attitude towards life changed?
Aa
Hy attitude towards life, I think life is a very
precious gift and I think it is very difficult.
I don't
feel very much differently than I ever did, I really
don't.
I think I can accept pretty well and cope.
I
don't expect a bed of roses, I never have.
Ca
So you don't think that the cancer experience had a
significant impact on your life?
\
A:
I didn't let it.
C&
Hmv do you see your future?
A:
Well, I venture to say that I will continue to get
older every day and hopefully will not have a malingering
kind of terrible illness when the end comes.
I think alot
about that, and uh, hopefully I will always have people
around me, because I make them feel very much at home
and it will follow the same pattern as every one else
69
I guess.
Ca
What is important for me to know about you?
A1
Honey, I think by now you know it all.
what's left.
C:
I don't know.
(Laughter) I really don't.
When I write up a description of you, what would you
most like to be included?
Aa
I think that you found a warm and giving person who
has taken life on its terms.
Whatever has been dealt to
me, I've tried to take in stride and that I'm still trying to grow and learn and expand, and that I'm someone
you w·ill remember and hopefully that I will see you again.
Ca
In general, hmv do you feel about being intervievred?
A:
Well again I'm very fond of you and therefore it's
very easy for me to expound my views and theories.
And
I don't know what this is going to be used for but if it
is ever helpful to someone else,- I \vould be delighted.
As far as the mastectomy, I would love to be able to help
other women but I also explained to you at the outset that
I could not look a young woman in the face, a 25 year
old young girl and say it's nothing, because I think if
my husband was more of a sexual being, it probably would
be something even to me at this stage of my life, but the
fact that he could care less most of the time, it's of
relatively no importance, except that I had a disease
which I hope to God that I'm rid of.
I
thin~
to be able
to look someone in the eye and have a genuine smile that
70
comes from way deep inside is more important than what's
underneath your clothes.
I believe that.
!,
Joan
Personal Data: Married, three sons, Jewish background
Age at Mastectomy:
48
Present Age:
53
Joan's Cancer Experience
C1
What did contracting breast cancer mean to you?
J:
Well, it meant that my body had betrayed me.
C:
Why do you think you developed breast cancer?
J:· I don't know.
I don't know if the emotional back-
ground variables which I've discussed '\vi th you have any
thing to do in the world to do with it.
I don't know
whether it was the exhaustion of all these things in my
life at the time, structural things plus selling the
house, papering the bathroom and doing alot of physical
stuff w·here maybe I banged myself and didn't remember.
Urn whether it was a hormonal thing and I was getting to
be 49 and maybe there was a change in the hormones or
interacted with these other things.
I
just don't know,
it was very small, it '\vas very self contained.
It was
incapsulated in a piece of fat so that my doctors didn't
think it was malignant.
It was a very little cancer,
I don't think there is any way, you know as well as I
\
know that nobody knows what causes cancer.
C1
Do you feel you were a victim?
J:
I don't think I ever felt that way.
it.
I got angry about
I am really hung up on physical attractiveness so it
was very hard for me to for a long time to look at myself,
' totally.
' 6
I didn't look at it my husband looked at it, I
71
72
didn't make him look.
I can remember about a week out of
the hospital I felt my arm was swelled up so my husband
looked and he "ivas fine.
He was fine.
I didn't feel that
he was repulsed by it or rejecting or anything but I felt
repulsed.
Because I know he doesn't take these things
the way I do, he's not hung up on that stuff and I am.
C:
How long did it take before you looked?
J:
Eight or nine months.
C:
So the variables as you see them were the "ivay you
were living your life, what "ivas happening at the time,
moving out of the house and possibly the hypochondriac
stuff that was going on and "ivhat else?
J:
I would think that someone "ivho was for most of their
life in an anxious state, needing to please everybody
in order to be loved and validated, that that takes alot
of energy.
That was a chronic condition.
That anxious
state lasted throughout my life so that when these other
things carne up, it happened.
\
\
\
73
.,,
Diane
Personal Data:
Married, two daughters, one son.
Jewish background
Age at Hastectomy:
48
Present Age:
57
Diane's Cancer Experience
D&
I think that my therapy and my illnesses have given
me a sort of a strength, an inner strength that I didn't,
just didn't have before.
I was just too vulnerable.
I
mean I was naive, and stupid,vulnerable and too self
sacrificing.
Alot of things that I
I mean now I come first.
just wouldn't be now.
I feel that I am very important
and my health is very important.
I've had a terrible
experience, practically could have died.
It was such a
threat that I certainly don't want anything like that to
happen and so that I'm pretty good to myself.
Not that I
didn't think I was before but the truth of the matter was
there were too many demands on me.
It's very hard, say,
in a new marriage for your husband to just step in and
start being a father to your children.
It may sound good
on paper but it just doesn't work out that way.
In 1941, I had a lump in my breast which was benign.
\
\
I had the lump removed.
In 1951 I had a lump in the other
breast which was benign so apparently I grow both types
of tumours.
tumours.
I had a hysterectomy in 1947, I had had
I was immediately put on estrogen so that I
didn't have any hot flashes.
six months later I developed
the malignancy and I was immediately taken off the
'74
estrogen.
So my tumours were or my malignancy in my
.
breast was hormone induced.
I had cobalt treatments.
six months later I had a malignant thyroid.
The next
month they felt that this breast, even though it might
not be malignant, had a granular type feel ·to it, like
~andy
granules which could become cancer.
If I left it
it. could be precancerous and it was left up to me whether
I wanted to have the other breast removed, as a precautionary measure.
I decided to let them remove the other
breast and it '\vas much less traumatic for me than the
first one.
Ca
So in ans1v-ering the question, '\vhy did you develop
breast cancer? Would you say environmental factors?
Da
I VJ'OUld say that that was definitely a factor however
the fact that I am tumour-prone; breast tumours, uterine
tumours, as some of the members of my family are also.
So that it 1vasn 't entirely environmental, I think a person
has to have a susceptibility to that sort of thing.•
..
Ca
So you think stress was a factor?
D:
Oh yes, I am really a believer of the fact that many
illnesses are caused by stress.
Ca
What was your stress at that time?
D1
Well, I think mainly my first husband's death was
very much a contributing factor.
I was under tremendous
stress after that, really '\vent through a tremendous amount
of changes and that was ten years before.
It takes eight
75
years for you to be able to feel a tumour that is one
milligram, so it's been growing for eight years, anyway.
C:
Describe to me the sequence of events of your mastec!
tomy; discovery of symptoms, diagnosis, surgery and
recovery.
D:
I remember coming out of the anathestic and having
my. anathesiologist standing over me and the first thing
I did was to put my hand over my breast to see if it was
there.
I said "Did they take my breast?"
That ·was the
first thing that I said.
C:
Did he answer you?
D:
He said, ''Yes, they did."
so I st.ar-ted to cry and I
remember doing a lot of crying in the hospital.
almost like I \vas in mourn:ing.
It was
It's strange, I thinJ..: I
did more crying than the average woman that I visit.
(Reach to Recovery volunteer)
Cs
So you feel that you really mourned for your breast?
D:
Yes I really did, however I 1-.rill say that when I came
out of the hospital that \vas just about it, I don't
remember crying anymore.
But we did a funny thing, uh,
\
\
I don't like Las Vegas, nor does my husband particularly,
we decided to go away for the weekend and we did.
Of
course there are a lot of bare breasted women in Las Vegas
in floor shows and it \vas almost as if I was kind of
testing my husband at time.
You knmv I was kind of
noticing his reaction to the women and then noticing his
.
'•
reaction to me.
I was sort of very convinced when he
came home, that he really loved me just as much as he did
before and that one breast. gone didn't make that much of
difference,' but it was curious hmv we ended up in Las
Vegas.
I think it was my idea, not his.
C:
Were you able to looJ( at yourself nude in the mirror?
D:
Yes.
I '\vas very curious to see, so that when the
doctor was changing the bandage once I looked.
C:
You said you experienced a period of mourning after-
wards and I am wondering if you felt any resentment?
Da
I resented the doctor.
about my ••• surgeon.
my life.
I had very ambivalent feelings
On the one hand I felt that he saved
On the other hand, I resented him for taking
my breast. off.
I had very mixed feelings about him, 'vhen
I would go for a visit I would try not to show any resentment but there was resentment.
I was really angry at him.
I had very mixed feelings.
C&
How '\vould you have liked people's reactions to you to
have been different?
D1
\
Not really any different, I really felt, even with my
husband and he did get over that, after he was a little
\
over solicitious and over protective.
'\vas really fine, he
bacl~ed
When he saw that I
off from that and I felt better.
Because I feel that if someone is hovering over you and
protecting you it is more apt to make you feel that you
are dependent and I really didn't want to feel like that.
76
77
I wanted to go out and do things as soon as I could.
Ca
Did your husband's concern worry you?
Da
Yes at first it did, at first I thought he knew some-
thing that maybe I didn't know.
Maybe I was more ill than
I thought I 1vas or I 1vas informed of.
about that.
He reassurred me that he didn't knmv any-
thing that I didn't know.
from me.
I did question him
He wasn't keeping anything
So after awhile, the fear just sort of wore off
and of course as long as I felt well, I
just thought I
was going to be all right, I didn't worry about it.
Ca
Do you feel you 1vere spreading yourself thin prior
to the mastectomy?
Da
Yes, definitely, there were many times when I felt that
way.
Ca
Do you feel you \vere taking care of others more than
you 1vere taking care of
D:
yours~lf.?
Well, I would say that as a result of taking care of
others, it put me under a burden or too much stress at
times.
More than I could handle.
Cz
Did you feel that you were self-sacrificing?
D:
Yes, sometimes I did.
C:
Do you think you w·ere getting validation by being
,
self-sacrificing 1 is that a 1vay for you to feel important?
D:
No, really not.
I just felt that it was my duty,
particularly 1vhen I became a widow and I had to be bvo
parents, 1vhich is no easy matter.
' u
"
If I had to do it over,
78
I don't think I would try so hard.
I think it was harm-
ful to me to be that 1.vay.
C:
What did you learn from the cancer experience that
you "imuldn 't have learned otherwise?
Dr
Well, I guess that a person can go through a lot of·
trauma and stress, and go through a life-threatening
experience and come out with a very good attitude.
C:
Hm-r do you feel about recurrence?
D:
Well, I feel certainly that I hope I don't g"et a
recurrence.
rence I
On the other hand if I should get a recur-
just feel that it would be something that I could
handle, in other words it wouldn't be something that I
would die from.
But I feel good about myself, I feel "\vell,
I feel healthy, I don't feel that I will get a recurrence.
C&
Do you see yourself dying from natural causes?
D:
Oh ••• that I'm not sure of, I've thought about it but
I haven't thought what it "ivould be.
causes more than cancer.
\
\
I would say natural
Chapter 5 - CONCLUSIONS
In this chapter I will list the traits and experiences the eight women had in common.
I will then des-
cribe the eight 1-romen 1vi thin the framev-rork of my
questionnaire:
self description, relationship, family
background, somatic history and sexual development and
the cancer experience.
I will end this paper 1vith
conclusions about the study, further research possibilities and my new personal relationship to cancer.
List o.f Traits and Experiences
'I'he follow-ing is an overall list of the traits and
experiences these eight women had in common.
:.
They describe themselves as "good", "caring"
and "decent".
2.
anger.
They rarely expressed'sadness and even less
They had a tendency to ignore a conflict rather
than risk being in an argument.
3.
They were self sacrificing in terms of their
families.
They '\vould forfeit their individual !leeds
in order to answer the needs of their family.
4.
They often had a poor body image and little
relationship to their sexuality.
5.
They did not generally self disclose.
6.
In friendships, they feared betrayal and did not
usually share personal fears or problems.
79
80
7.
They i·rould more often then not choose the role
of the mother or nuturer within relationships.
Their
value systems centered around caring for others, most
specifically, their families.
8.
They all had extensive somatic histories includ-
ing other benign and/or malignant grmvths.
9.
In some cases there was a pervasive bacJ(ground
of depression and anAiety.
10.
These women • s mothers had not supplied 'them
with nurturing and affection as children.
The parents'
marriages were tumultuous.
11.
Stress was seen as a factor in the creation of
their disease.
12.
Denial was a common reaction to losing a breast
along with anger directed against the doctor.
Questionnaire Findings
The following section describes the eight 1-romen ivi thin
the frame1vork of my questionnaire: self description,
relationships, family background, somatic history and
sexual development and the cancer experience.
\
Self description.
Host adjectives used by these
eight women to describe themselves centered around two
themes:
to be "caring", to be ''good" and "decent".
They
used adjectives which indicated how they were 1vith people
within relationships•
"consi.derat.e", "loving", "caring"
and "reliableH, "decent", "dependable".
A good example
81
·.;
:~
'
is Anne 1-then she states, "I think I have an anticipatory
approach to people's needs; I try to be there."
When
asked w·hat she most liked about herself she stated,
"Being loving and kind because that is what I most 1vanted
to be always."
In response to, ''Are you satisfied with
yourself?'' she replied, "Yes, as people come and go,
because I know· I am decent."
Laura answered, "Very
little" to "'Hhen you die what would you
about you?"
liJ~e
to be said
In response to, "How vmuld you like to be
remembered?" she said, "I guess that I 1-tas a good person''.
Two women described themselves as introverted.
Two
others said they had experienced deep anxiety throughout
their lives.
One of these two, Joan, in discussing
emotional background variables to her contraction of
breast cancer, said "I would think that someone who \vas
for most of their life in an anxious state, needing to
please everybody in order to be loved and validated,
that takes alot of energy, that was a chronic condition,
that anxious state lasted throughout my life so that when
these other things came up it. happened. ''
\
The other
woman attributed her anxiety to her family experience
\
as a child w·ith an unavailable mother and a harsh,
Victorian type father.
Her definition of Victorian IWuld
be critical and highly demanding.
One of the most striking and pervasive characteristics
which I found among these women was voiced by Diane
telling the story of her life prior to her mastectomy.
She states, "I mean I was naive, and stupid and too self
sacrificing."
Diane 1vas the· only woman who independently
described herself as self sacrificing although most of
these women responded in the affirmative to the questions
asking if they thought they had this characteristic.
In answering the question "What are you most proud
of?" the \vCmen responded with answers like "my children,"
"my family," ''my husband".
In one case, a woman replied
"my ability to accept and mediate with people.
Tolerance."
In discussing values and \vhat is of the most importance in their lives, these women said again "my
children," "my family," "my relationships" and "involvement in other people's lives."
six women stated they had
put most of their energy into their families when asked
the question; "Where have you,put most of your energyfamily,
\>TorJ~,
self education, t.ravelling?"
One woman
stated she had put her energy into her work; but it was
she who replied, "Involvement is one of the major values,
involvement with people" to the question ''What is most
important to you in life?
What are your values?"
In discussing one 1voman's involvement w'ith her family,
I asked her ,.Do you feel yourself to be assertive?,.
replied "Oh yes, un. that's a good question.
She
I can do it,
I can be assertive.
It's no problem for me to be asser-
tive.
What I am, \vhat I want, I'm able
I can do it.
83
,,
'•'
to turn myself off when others are involved sort of.
There can be the best T.V. show I've been dying to watch,
dying to w·atch.
But if the
J~ids
are over and they don't
1vant to 1v-atch it, if they '\vant to go someplace else, I
can turn that desire off like that.
to me, I can turn it off.
I
~on't
It doesn't matter
In that way I'm not assertive.
do what I want to do all the time.
I do what's
best for the group all the time".
'When responding to such questions as "Do you express
anger and sadness?" these women revealed difficulty in
expressing anger or little relationship to that emotion.
Anger 1-ras either repressed, denied or expressed in a
minimal 1-ray usually a delayed reaction or in a diluted
fashion.
Sadness was expressed some1-rhat but usually
in private.
This attitude against expressing sadness
and anger \vas very apparent to me; it was blatantly
obvious among these lvomen.
angry?"
I asked Peggy ''Do you get
She replied "I don't get angry, I had a long
conversation with a friend of mine who's into all this
stuff, y'knmv, and I don't get angry.
\
\
of anger.
I don't get feelings
According to her it's normal to be angry.
urn, I don't usually get angry at people,"
her "What happens to your anger?"
feel it."
But
I then asked
She responded ''I don't
Another version of the anger avoidance among
these vTOmen is exemplified by Anne.
I asked Anne "Would
you describe yourself as a happy person, sad or all
84
.j'
three?"
.. I'm very sad for the world, I can tell you that.
I consider myself very lucky.
Yes, I have alot of anger
and the main reason I have anger is the people who are
most, my closest, I cannot communicate with.
Because
they are people 'lvhose good intentions cannot stand to be
impuned.
hu~band
I cannot point a finger at my daughter or my
because they are both very volatile so I swallow
alot which
ma1~es
me angry."
I then asked "You said you
S\·Tallow alot, do you express any of your
anger?'~
She
replied "Occasionally, Oh, no, not the anger part.
I'm
afraid to take a chance, I'm afraid of an argument,
I don't like them.
They physically make me ill.''
I asked one of the other women "Do you express anger
and sadness?"
She answered, "Sadness, not anger.''
Then
I inquired "Hhen someone does something you don't like,
hmv do you usually handle the situation?"
'\vas "Ignore it."
said "No, I
Her answer
In ans'\vering the same question Laura
just get depressed."
To "1-Jhen someone does
something you don't like, ho"\v do you usually respond?
Do you tell them right a"lvay, do you wait, do you keep
\
it to yourself?" she replied "I keep it to myself."
\
These have been examples of denial, unawareness,
repression, and ignoring of angry feelings.
Two results
were stated as depression and physical illness.
Three out of eight of these women had negative self
concepts about their bodies and sexuality.
I am not
85
speaking relative specifically to having had a breast
removed but also prior to that experience and throughout
their lives.
Laura, after describing herself as "an
average 1 typical, American mother 1 homemaker" answ·ers
the question "Are you an attractive woman?'' "Average"
To "Are you sexy?" she didn't really reply but kind of
shrugged her shoulders and looked be·w"ildered.
One of
the other 1-romen replied "I can be, it takes alot of time
and effort to be.
,,
To the question, ''Are you a sexy
I
w-oman?" the same woman answered, "No it is very hard for
me to tell if I
am sexy or not because I have no way
of knm-ring, I have only had intercourse 1-rith one man in
my life.
I was a virgin when 1-re vTere married and I have
never had intercourse 1-rith anyone else so it is difficult
to determine whether I am sexier than other
~oromen
really."
I then asked, "Do you feel you are a sexually attractive
1-roman?"
She responded, "No, I do not.
Although my sex
drives are very strong at this time, they 1-rere not when
I vras younger."
Finally I inquired, "Hmv did you feel
about your sex life up until the time of your operation?
Was it satisfactory, fulfilling?
it?"
Hm.; would you describe
She anm·Tered, "I think it was satisfactory, just
about that, I urn ••. there has al1vays been a slight problem
incur sex lives.
I have only one person to say from so
I have no idea who is responsible, we delved into that
in group therapy, my husband seems to have a sexual
• 6
.86
problem and of course you can't discuss sex individually
for me at least, it had always been a partnership with
him.
I was always satisfied with it, I had an orgasm,
it might not be in the
~ashion
that most people dream of,
I still do, it just is not very frequent."
The same
woman described herself physically as, "I am five foot
six and weigh 147 pounds.
overweight.
I am about fifteen pounds
I have bad posture, I am at this time in my
life rather flat chested although I was very buxom, I
now have wide hips and a big stomach also of recent, at
least before they were camouflaged by alot of breasts so
that I hardly noticed them.
I have nice legs.
hair mostly bleached, natural and unnatural.
without make-up, rather plain looking.
I have
I am usually
Also as I men-
tioned before often squinting or frowning.
My nose is
rather large, mouth small, eyes rather nondescript." These
women described themselves as rather plain and their sex
lives as problematic. They came across to me as lacking an
inner confidence of their attractiveness and having
little interest in sex and their ovm sexuality.
Out of
the remaining five women, four said they had satisfying
sex lives and one didn't really answer the questions
fully.
I felt that if I had had more time I could have
gotten more data in this area.
It felt to me that I would
have to develop a closer, ongoing relationship with these
women to have them open up and discuss their sex lives
l,
extensively.
Ego appeared to be involved, "Oh, yes,
everything is fine," answering quicl<:ly and wanting to
get on to another subject 1vas a typical response.
I tend
to doubt th3.t everything \vas fine although I have little
evidence of that and might be biased w·i th my own hypothesis in examining this area.
To summarize the salient
points of this part of the questionnaire, these women
described themselves as "caring 11 ,
"good'' and "decent".
Their value systems centered around their
in some cases giving to others.
famili~s
and
Over and over again,
the att.i tude of the family coming first as opposed to
their individual needs or goals 1.vould come up.
The
majority had put most of their energy into their families
as opposed to a career.
They rarely expressed sadness
and even less frequently anger.
There appeared a tendency
to deny anger and to ignore a conflict rather than to
deal with it and risk an argument.
In a fe\v cases there
was a poor body image and little relationship to their
sexuality.
.
h'lf>S.
RelatJ_ons_
\
First, I 1-rill discuss friendships and
then I ' l l explore marriages and family relationships.
In answering the question, ''How would a close friend
describe you?" one 1-roman answered, "A close friend \vould
describe me as w·i thdrawn..
I've had many close friends
describe me in the same 1vay, that I am not as involved
with them on a day to day personal -.;-ray as t.hey are 1vi th me.
.8;7
. 88
I
Whatever that means whatever 1vord would describe that.
They 1vould describe me as loving and concerned, interested
and interesting.
Available and uh, available."
I later
I
asked this same lady "What do you imagine people think
of you initially?"
She replied, "Uh, initially I think
people think I am rather dull and withdrawn to people
du!ing the initial meeting."
In talking about the closeness within friendships
all of these women revealed a reluctance to disclose
intimate information to friends.
In as1vering the question
"Do you share successes, problems and failures with your
friends?" three ans1vered affirmatively, stating they were
very selective; they shared with one special friend.
Two others said they never shared problems, one stating
she discussed those kinds of things vith her husband and
therefore didn't need outside relationships.
The remain-
ing four said they usually chose not to and al "ivays preferred to work out problems privately.
..
Four said they had
not thought about these typesof questions before.
Four
said they had thought about some of them previously but
not to intensely.
This gives us an indication of how
much self insight existed among these ladies.
In telling me a story about their friendships three
related strong themes of taking care of their friends
within the relationships.
Anne is a good example of this
describing her friends as "my little sparrows "i·ri th
89
broken w·ings that I can help."
friends vras that of the mother.
Anne said her role 'ivi th
Most of the 'ivomen des-
cribed their friendships as mostly social with except.ions
occasionally and excluding those three who felt they did
share failures, successes and problems with one designated
friend.
A fe'iv ans1vered in the affirmative the question, "Are
you invested in keeping up a certain image?"
One lady
completed t.he sentence "One of the 'ivays I'm phony
.
lS • • ,
"
I butter up people and have my country club 'ivays and
throw out compliments and give strokes."
Anne talked
about being gracious and nice so people would like her.
Fl. ve women answ·ered in the affirmative to "Do you find
yourself putting alot of energy into being pleasant and
agreeable?"
One other answered in the negative going on
to explain it was spontaneous she didn't need to put
energy into it.
The same five women answered in the
affirmative to "Do you use alot of energy taJdng care of
others?''
Four women told me a story of having had the experience of being betrayed by a friend; that person having
broken a confidence and there resulting a growing fear
of sharing information.
Two of these women stressed the
importance of a friend being dependable and reliable, it
almost sounded like a fear of being left,
In talking about their husbands and families, five
90
women described their relationships as being very close.
Three ·women stated there w·ere large parts of themselves
they could not share 1vith their husbands, but that they
did receive the emotional visibility they had in their
lives from their families.
It is important to remember
that all of these ladies had trouble expressing sadness
an? anger so how much they are actually sharing 1vith their
families might be very different from ·their picture of the
intimacy involved.
To the questions, "Do you attach more importance to
your husband's/boyfriend's needs than your own?" and
"l'lould you describe yourself as compliant "rith your
husband/boyfriend more often than not yielding to his
wishes rather than pursuing your own?'' four 1vomen replied
yes to the first question, seven replied yes to the
second.
In a discussion with Diane regarding her life
.style previous to the mastectomy, I asked her "Do you
feel you w·ere taking care of others more than you w·ere
taking care of yourself?"
She replied, "Hell, I "\<rould
say that as a result to taking care of others, it put
\
me under a burden of too much stress at times.
I could handle."
I then asJ(ed, "Did you feel that you
'i·rere too self sacrificing?"
times I did."
More than
She answered, "Yes, some-
I folb1ved 1vith, "Do you think you were
getting validation by being self sacrificing, is that a
way for you to feel important.?"
Diane said ,.No, really,
91
not, I
just felt that it 1vas my duty, particularly w·hen I
became a 1vidm\T and I had to be two parents, which is no
easy matter.
If I had to do it over, I don't think I
would try so hard, I think it was harmful for me to be
that way."
To summarize, I \vould like to point out four characteristics of these women's relationships.
1.
The friendships did not 0sually include self
disclosure.
2.
There was much importance and energy put into the
family relationships.
3.
A tendency to be self sacrificing and ignore in-
dividual needs existed "\vhen it came to the family.
4.
There \vas a high value attached to helping and
taking care of others.
Fami.ly background.
Six of these "romen answered in
the negative to "Did you get the affection and caring you
needed from your mother as a child?"
The mothers were
presented as being domineering, cold, unaffectionate or
unavailable.
The fathers 1vere described by four "\vomen
as being very charming and strong unusual characters but
rather separate from or above most of the family activities.
Two women described their fathers as being very
passive, sweet but inconsequential.
T1vo 1vomen felt their
fathers lfere overly seductive tm·rards them.
Six of these
vmmen described their parents as being poorly matched and
!,
having a highly strained, unhappy marriage.
The house-
holds of these -vmmen as children \vere described as uncomfortable in four cases.
Three described themselves as
being mediators in family arguments and experiencing that
as an unwanted burden,
Three stated they had been lonely
as children.
· Somatic history and sexual_ development.
Most of these
women had quite extensive somatic histories.
had hysterectomies prior to the mastectomy.
Four had
T-.;m of these
women attributed their breast cancer to the estrogen they
had been given follovdng their hysterectomies.
Tw·o of
these same w·omen also had cancer in the thyroid 1 one of
the two had had a malignant grmvth on her bade in addition.
Two described chronic problems -.;vi th headaches.
Two had had cancer in their families; one of these
\YO-
men's sister had had breast cancer.
Four of these w-omen stated that they had cyst.ic
breasts and at least one benign growth biopsied in their
breast previous to the malignancy.
\
Tvro had their second
breast removed as a precautionary measure against develop\
\
ment of more cancer.
On lady when asked, "Did you grieve
the loss of your breast?" told the following tale.
"Maybe it was because from the time I -.;v-as fourteen I had
lumps in my breasts and I hated them, I 'vas always being
frightened by a doctor who came to my breasts, because
he v1as alviays going to feel a lump.
. v
I was on the verge
. 92
93
of biopsies many times so that I was just happy to.get
rid of them.
It didn't occur to me not to have· them off.
Maybe most women care, I would like to see the day when
breasts are removed like tonsils.
That after a woman
gives birth and is not in the child rearing business any
longer, she gets rid of her breasts.
a hazard.
I felt it at the time.
They are really
The fact that they
have been made a sex symbol is ridiculous.
You know I
i
had the other breast removed five· months ago.
was nothing wrong with it, I
was too full of lumps."
wan~ed
There
it off, because it
Asked again, "Did you grieve the
loss of your breast?" she quickly replied, "No I guess
comparatively I didn't have love for that breast and I
couldn't wait to get rid of the other one."
Cancer experience.
This section will be divided up
into three major parts; 1)
causa~
explanations on life
previous; 2) actual mastectomy experience, and; 3) effect
of breast cancer including discussion of reentry in'
life's routine and transformation.
CAUSAL EXPLANATIONS
Four women felt stress had been a factor in the
development of their breast cancer.
Two described their
lives previous to the onset as being tense and highly
pressurized.
Two mentioned being depressed prior to the
onset of cancer.
T1vo \vere not sure stress had been a
factor and t1vo felt there was no relationship between
94
stress and their disease.
Two women had had major losses
prior to their malignancy being discovered.
death of a husband.
One was the
The other loss was of a daughter
marrying and. cutting off contact with her mother for a
period of six months.
l-vhen asked,
'Why did you· develop breast cancer?"
1
three of these ladies mentioned feeling they· were ''tumour
prone .. or "my body just grows things".
One lady had a
great fear of developing cancer and was not
surp~ised
when it happened; it was as if an unconscious expectation
had been fulfilled.
Two women attributed their cancer to the fact of having bumped themselves a few months before.
They held on
to these accidents as being possible causes although their
doctors discounted the possibilities and dispelled the
myth.
ACTUAL MASTECTOMY EXPERIENCE
Two women delayed calling the doctor; denying the lump
and fearing the possibility of cancer.
One of these
delays was for a period of six months.
\
Most responses to "What were your concerns prior to
\
\
the operation?" revolved around a fear of dying.
One
woman was more concerned with losing her breast for
cosmetic reasons, one other with how her illness would
affect her family.
Two expressed an unusually strong
fear of going under general anathesiat fear of not
95
waJdng up.
Tw·o others stated having much trouble with
anathesia and pain killers and as a result using the
minimum while hospitalized.
Elizabeth Kubler-Ross'
(1969) stages of denial, anger,
bargaining, depression and acceptance in people with
terminal illnesses seem to fit these women's experiences
to. a great degree.
As I w·as not in contact 1vi th the
ladies during the time period surrounding their mastectomies, I cannot state this 1vi th certainty.
In telling
their stories, my intervie1vees related their memory of .
1vhat had happened.
A tendency toward denial could be seen in five of
these ladies.
Denial of the horror of having a breast
removed and the magnitude of their mortality sla@ning
them in their faces.
This took shape in the reaction of
getting up quickly out of
bed~
going right back to what
they had been doing and not experiencing grief or a period
of mourning.
Another very important form of denial 1vas
a delay and, in b:vo cases, a complete refusal to lool-c at
oneself nude.
This denial or self reflection would often
be pro j ect.ed on to the husband and/or family.
In quite
a few cases, the woman could look at herself but would
hide her chest from her husband.
Laura exemplifies
this syndrome by saying, "Keep life as beautiful as
possible, I mean I turn my back lvhen I'm dressing."
96.
~-
'•
One of these ladies goes through an elaborate ritual
while showering and dressing not to be confronted with
her missing breast.
lovemaking.
She also now wears nightgowns during
One only of the eight ladies used their
remaining breast during sex; liking to be fondled.
Anger against the doctor occurred in four of the
women.
Anger for removing the breast, slow diagnosis and
false assurrances that the growth was bound to be benign.
This was coupled with immense gratitude and
adoration.
god-~ike
Diane described this ambivalence beautifully
in her transcript (refer to Chapter 4).
Bargaining was a big issue for Anne.
She told of
making a deal with God to be a better, giving person if
she lived through the experience.
She believes today
that is why she is still alive.
Depression was experienced in varying degrees by each
one of these ladies.
The range of time went from a few
days in the hospital to a year and a half afterwards.
Three women experienced a period of mourning or grief
for the loss of their breast.
\
Acceptance was an evolving, slow process for these
\
women~
Initially quite a few of them experienced a type
of hypochondria after the operation; every little ailment
felt like another form of cancer activating their fear of
recurrence.
To develop a relationship to the possibil-
ity of recurrence and death took time.
I asked one
97
lady, "How did you deal with the fear of dying?f!
She
answ·ered, "\'lell, after I said to myself even if yo.u are
going to die, are you going to make yourself miserable
for the year or the two years or the four years?
Whatever ••• I mean isn't that silly?
my old routine. 11
So I went back to
All of these women expressed a closer
relationship to their own mortality.
One woman answered
the question, "What's different about you now aft.er this
experience?" by stating, "I think the experience of kno\'Ting you're going to die, not knowing when you are going
to die had come with this and therefore you have to live
while living.
death.
There is no such thing as preparing for
It's there.
the time.
It's part of you:
It's with you all
There is no preparation for it, that is the
one thing that you don't have to train for."
I asked
her, ''Are you more aware of your mortality?"
She re-
sponded, "I think I am less fearful of death than I was
before.''
Three women felt they would eventually die of
cancer; two felt relatively certain they would die of
•
something unrelated to cancer.
Recurrence seemed to
be a scary subject to talk about, but most of these
women had developed some type of coping mechanism to
deal with that possibility over a period of time.
EFFECI' OF BREAST CANCER
In asJ{ing the question, "Hm..r was having had cancer
changed your life?"
I received three types of responses.
. ;.98
'
I
The f1rst'one was a statement that there had been no
change and a determination to have that situation continue.
T~c
second w·as consisted of some change, being
more aw·are of death and living life more fully, and in
I
two cases experiencing physical pain and developing
more of a religious faith.
fascinat.ed me.
The third type of response
There were two women \vho used this trage-
dy to change their lives and grmv from the experience.
They experienced transformation in that they started to
take more care of themselves and began· putting their
individual needs and health first above everything else.
They described themselves as becoming less self sacrificihg with their families.
These two ladies had had their
mastectomies ten or· more years ago and so \vere obviously
V8ry good examples of what a survivor looks like.
Diane
expresses this change in her statement, "I meant I was
naive, and stupid, vulnerable and too self sacrificing.
Alot of things that I
I come first.
I
just \•rouldn' t be now.
I mean nm>r
feel that. I am very important and my
health is very important.
I've had a terrible experience,
practically could have died.
It was such a threat that
I certainly don't \vant anything like that to happen and
so that I'm pretty good t.o myself.,.
The other lady
ans1-rered the question "Hhat is different about you after
having had cancer" in this way "Hell, I think I have a
better outlook on life.
' 6
I don't knmv if I would have
99
arrived at this maturity without that.
aware of living."
resentful.
I am very vitally
Another lady said, ''I don't feel
I feel sadness because I probably won't get
to live until a hundred and ten which is what I always
thought I would.
I had added a whole other dimension,
as I have said, it does get you past the muck and the
mire of everyday life.
I became relatively selfish after
my first surgery for a period of time.
went back into my own business."
That's when I
I responded, "It helped
you focus on what was important to you."
and it made me less motivated by guilt.
back, I've retrogressed.
want me to do.''
gressed?"
She said "Yeah
Now I've gone
I do more or less what people
I asked, "Hhy do you feel you've retro-
She said, "Because I think it's easier to go
back to established patterns, doing what you've spent
your lifetime doing which is not
fighting for vlhat you want.
~hanging
things, not
It seems to me that I bmv
quite a bit."
I would venture to theorize that these two women's
process of transformation (in these cases, changing out
of self sacrificial patterns) had a direct relationship
to their not experiencing a recurrence of cancer.
Further research is needed to explore this possibility.
It must also be pointed out that these two women had
more than breast cancer to scare them.
One had had
benign growths in her uterus and in her thyroid.
The
100
other had a malignant grOivth on her thyroid and several
benign growths in her breast and uterus.
Reassimilation into society is an intricate, involved
process.
Four \vomen chose to ignore their new· unique-
ness, not discuss it, bring attention to it or let it
effect the structure of their lives.
They experienced
depression, fear and grief but did not use the experience
as a motivator to create change.
Two seemed to now
identify themselves as cancer patients, both experiencing
quite a bit of physical pain w·hich is unusual for a cancer
patient,
Cancer is supposed to be painless.
Five were
very concerned 1vi th people's reactions to their new
physical make-up.
They protected people; their husbands
by not undressing and dressing in front of them and in one
case not attending the local gym for fear of frightening
the other women in the locl';:er room.
Diane tested her
husband by taking him to Las Vegas and being among bare
breasted women in nightclubs.
Four women expressed· a fear of having information
being kept secret from them.
They felt this way in
response to over protection performed by the1r husbands
and families.
One woman seemed entrenched in shock and
the uwhy me" syndrome aggravating those feelings by
refusing to incorporate the loss into her body image.
Ano·L:her' s sex life greatly deteriorated along with her
intc-?.resi: in her appearance.
This woman did not. attribute
101
·:,-,
these changes to her mastect.omy.
The various reactions
and approaches to reassimilation I saw could maJ<::e up an
entirely separate study.
I have chosen to try to present
more of a picture of these ladies' personality.
Conclusions About the Study
Now with the completed study in front of me, I feel
overcome 1vi th a sense of pride and relief.
I think the
study is successful in accomplishing my main purpose:
to present an overall picture of who these ladie-s are
to the reader.
I have outlined the similarities in
personality, values, relationships and family bad<ground.
I have also given a fe\v different versions of the actual
removal of the breast and how that was integrated into
their lives.
The intervie·w·ing experience has helped me
to develop my vocabulary as a counselor and to gain more
expertise in devising questions vhich \vill elicit personal,
not easily disclosed, information.
Topics For Further Research
1'-lhat I would liked to have investigated more extensively were ·the follow-ing aspects:
1.
\
\
In the area of sexuality I would be interested
in knowing more details about how these women viewed
their sexuality and expressed it previous to t.heir
mastectomies.
2.
I \'rould have liked to go more intensively into a
few of the ladies' fear of betrayal and emphasis on
102
\
dependability in friendships.
3.
I would have
liJ~ed
to have investigated more
in detail with all the w·omen how- lonely their childhoods
w-ere and hov-r they related to loneliness no-v.r.
4.
My strongest fantasy in doing further research
is to compare \¥omen who had had a reoccurrence to women
who have not.
I would like to examine t.horoughly their
initial reactions to having had breast cancer and see if
there is a correllation between change aftenvards and not
further development of cancer.
5.
My other ideas for further research include
interview·ing the families and a close friend t.o see "ivhat
changes they observed, if any, in the breast cancer patient.
I
6.
I "ivould like to investigate each part of the
questionnaire more deeply adding questions, extra sessions
and perhaps other tools of observing body image and personali ty.
For example, I could
asJ~
"i·TOmen to draw· their
bodies and use various personality tests to collect more
..
detailed data •
Having a larger subject population and other researchers would be more along the lines of an actual research
design.
I could enjoy doing that nm..r.
My immediate plans
are t:o continue doing my own individual research and
gradually branch out into counselling cancer patients.
I am making the relationship between personality and
psyche my specialty in.the field of counselling.
103
Personal Reflections
In making a full circle, I would like to end this
study 1vhere I began, discussing my personal reaction
to an abnormal grm.,rth.
I 1..ras reminded of my or5.£"ina1
experience and the changes I've been through recently.
I w-as sitting in a friend's office talking to a 1voman
1-Jho had just had a mastectomy five
1veeJ~s
earlier.
It
was dusk, the office "\vas getting dimmer and dimmer.
We
sat on the couch sharing quietly 1-.rhat our lives had been
liJ{e prior to the growths.
She talked a long time about
the pressures in her life and the changes she was trying
to make.
as1~ed
I listened, commented on what she was saying,
questions and shared some of my experience.
In
discussing change and pressure I felt as if we had turned
on a light in the room.
I remember feeling as this
woman did, so anxious, so fright.ened and most of all
incredible pressure.
vent, to cure.
I
felt frustration and then guilt,
blossoming into blame.
year.
Pressure to do something - to pre-
Something happened to me last
I 1..-ras exposed to the idea of trans format. ion, of
using the experience as a gentle push forward or maybe
within rather than a slap in the face.
myself again in a totally different way.
I started liking
·I named
pressure, drive, ambition and my endless critical judge
as
sideJ~icJ~:s.
I began to reclaim my spirituality, my
love of solitude and the need to be lvith my body.
I also
104
gave up a relationship which required endless
me and 1-rasn 't ansvrering my needs.
large part of me.
~;rork
for
Pressure is still a
My judge and I locked horns again in
doing this study but I have a space within me nmv \vhere
I can go, visit and regenerate.
If cancer were to be
part of my self again, I would take it, hold it, dra'-r it,
si~g
it, dance it and then show it to the world.
1vith it can be the only ans1-rer.
Rising
105
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111
Appendix A
QUESTIONNAIRE
Self Description
Use five adjectives to describe yourself, your
personality.
. What do you most like about yourself?
What are you
proud of?
Are you satisfied with yourself?What aren't you
sat.isfied w·ith?
Describe to me your ideal self image, realistic self
image and now negative self image.
How would a close friend describe you?
What would
you like to be different in that description?
What do you imagine people think of you initially?
Use me as an example, what do you imagine I'm thinking of
you now?
What's incorrect or missing in that interpre-
tation?
...
Would you describe yourself as a happy person, sad,
angry or all three?
Do you express anger and sadness?
When someone does something you don't like how do you
respond?
Give me an example.
Who is usually at fault
in the disagreement?
Have you ever had depressions?
Have you spent time alone?
that?
long ones?
How did you feel about
Do you enjoy 1>::ing alone or do you avoid it?
112
What do you do when you are alone?
What is most important to you in life?
value system?
What is your
How do you like to spend time?
Where have
you put most of your energy - family, work, self education,
travelling, etc.?
Are you happy with that?
been your goals?
What have
Are you happy ""i th what you • ve done
up to this point?
When you die what would you like to
be said about you?
What would you like to have accom-
plished?
Do you consider yourself an individual?
Is it possi-
ble to conform to society and still maintain individuality?
Are you responsible for your life?
Is what happens
to you outside of your control?
Name five significant life experiences that have had
an important impact on you.
Describe yourself physicallY.•
your body?
How do you feel about
Are you an attractive woman?
Are you sexy?
How did you feel about your sex life up to the time of
the mastectomy?
satisfactory?
Has that changed?
Are you appreciated?
Is your sex life
Do you feel you are
in touch w·ith your sexuality?
RelationshiE§.
Do you belong to social organizations?
group functions?
and the like?
activities?
• d
Do you enjoy
Do you like to be invited to parties
Do you like to be included in friend's
Do you include others in your plans?
How
'·
113
important is being with people in your lifestyle?
you make time to be with people?
Do
Do you initiate get-
togethers?
What do you like to do with your friends?
involved in activities together?
topic of conversation?
Are you
What is usually the
What do you like to talk about?
How do you like people to be when you meet for the
first time?
person?
How would you describe yourself with a new
What is your external demeanor - reserved, aloof,
curious, friendly, shy?
How do you behave?
As you get
to know the person and feel more comfortable, how does
your manner change?
What is your role with people?
For example, are you
the friendly clown, reserved intellectual, gracious host?
How do you want to come across to a new person?
different from how you do come across?
difference.
Is that
Describe the
What's behind the role?
Are you actively seeking new friends?
If you're
interested in speaking to a person at a party or class,
do you wait until they approach you or do you walk up
\
to them?
Do you meet the people you're interested in?
How important is meeting new people?
people?
Where do you meet
Where do most of your friends come from, where
did you meet?
What do you want from friendship?
What kind of
character traits do you look for in a friend?
How
!,
.'f;
important are common interest?
What, if anything, holds
you back from developing friendships?
yourself as a private person?
friends?
Would you describe
Do you confide in your
Do you confide in a selected few?
a friend hurt you?
How could
Has that happened before?
experience influence your friendships now?
satisfied with your current friendships?
you say they have been?
Does that
Are you
How close would
Do you share your successes,
problems and failures with your friends?
Do you. feel
your friends truly know how you are in the world and how
you see yourself?
Pick a close friend and imagine her/him
describing you to me.
What is he/she saying?
Is there
a difference between how you see yourself and how they
see you?
Nha·t's missing in their description?
Why was
that left out?
Do you have impact on your friends?
they like most about you? least?
in you?
What do you think
Do your friends confide
Is that important to you?
Do you feel you know
your friends well?
Would you say you trust people?
Do you trust first
and then get support or hurt or do you hesitate, judge
the person and then trust?
Do you generally assume
people will like you and act from there or do you start
off trying to impress them?
What does it take for you
to let your hair down and let someone see you as you
truly feel inside at the moment?
How important is what
114
1rs ,
people think?
image?
way?
Are you invested in keeping up a certain
Do you want people to think of you in a certain
What is that image?
image or incomplete?
What's unreal about that
Have you shared that with people?
Do you dominate others?
Do people dominate you?
like to be close and personal with people?
achieve that?
Do you
How do you
Are you successful?
Did your friendships change after the mastectomy?
In what way?
Did you start looking at your friendships
differently?
Describe your
frie~dships
with three ad-
jectives.
Tell me - describe your friendships to mea how you
see them, how they have changed over the years, usual
duration and what part of ·your life they play.
Tell me
a story about one of your friendships.
Are these questions you have thought about before?
How do you feel answering these sort of questions?
is your fantasy of my reaction to your answers?
Complete the following sentencesa
I am a person who •••
Being close means •••
The scary thing about getting close is •••
I avoid •••
One of the ways I protect myself is •••
It's hard for me to admit that I •••
If I didn't have to worry about my image •••
What
116
One of the ways I'm phony is •••
What I need and never received from another person is •••
If I were free to say anything I might tell you •••
The worst thing I could tell you about myself is •••
I want you to think that I •••
The last thing I want to admit is •••
If you and I were friends I might tell you •••
Doing these sentence completions has left me feeling •••
Use four words to describe your marriage.
word intimacy.
Define the
Does that definition fit your marriage?
What's missing?
How do you feel about your relationship
with your husband now?
How has it changed over the years?
Are you satisfied with your relationship?
like to be different?
What would
How have you compromised?
okay with you or are you uncomfortable with it?
emotional needs taken care of?
husband as your best friend?
Is that
Are your
Would you describe your
Do you confide in him?
Is
he aware of your fears, desires, successes and failures?
Does your marriage excel in companionship, intimacy or
neither?
\
What does it excel in?
What are the negative aspects?
\
your husband?
What are the good points?
Do you feel close to
What do you hold back from him?
Complete these sentencess
The best thing about my love relationship is •••
I stay married because •••
The bad thing about my marriage is •••
117
What I want and don't get from it is •••
I do get a lot of •••
It's hard for me to •••
I would like to •••
Do you find yourself putting a lot of energy into
being pleasant and agreeable?
yo~r
Whose needs come first,
needs or the needs of your family?
Do you attach
more importance to your husband's needs than your own?
Would you describe yourself as compliant with your
husband more often than not yielding to his wishes rather
than pursuing your own?
needs?
Do you feel you sacrifice your
Do you spend a lot of tirne doing for others?
Do you use a lot of energy taking care of other people?
Do you have interests outside of your family and home?
How important are they?
Where do they fit into your
lifestyle?
Would you describe yourself as more domestically
inclined than other mothers and wives you know?
does that feel to you?
How
Do you do that out of choice?
What are the benefits? the repercussions?
Did you originally want to have children?
your
feelings during pregnancy?
first pregnancy?
What were
How old were you during
How important is being a mother to you?
Do you feel you are overly involved with your children?
Are you over protective?
your children?
Are you anxious often about
What would you like your children to have
·118
\
which you didn't have as a child?
Family Background
Where are you in the family constellation?
How would
you describe your relationship with your mother as a child
and adolescent?
With your father? Siblings?
each one of your parents carefully.
pi~ture
Describe
I want to be able to
them and have a sense of their personalities.
Who were you the closest to?
or both of them?
Could you confide in one
Did you?
Which events stand out the
most about your childhood?
Tell me how it was for you
as a child - tell me a story.
have been different?
What would you like to
What is especially clear to you?
What was the family's religious orientation, socioeconomic level?
Would you consider your childhood duties
either in taking care of siblings or the house excessive
compared to other children?
Who were you closest to?
Did you feel safe? Loved?
What was the general atmosphere
of the household?
Did you get the affection and caring you needed from
•
your mother as a child?
Do you consider your mother cold,
undemonstrative with affection?
Did you feel competitive
with her for your father's attention?
your father's attention?
attention to you?
How important was
How important was your father's
Was he ever seductive towards you?
Do you think they had a good relationship?
affect you and the rest of the family?
.
il
How did that
119
Somatic History - Sexual Development
Do you remember getting your first period?
tell me about it?
How did you feel about it?
your family"s reaction?
Can you
What was
What kind of things were said
to you?
When you first began developing breasts, what was
yo-ur reaction?
What Jdnd of feedback did you get from
family and others?
Starting from childhood list all diseases, ailergies,
operations, accidents or physical problems you have had
in your life up to this point.
Cancer Experience
What did contracting breast cancer mean to you?
did you develop breast cancer?
Were you a victim?
Why
Do
you feel stress was a factor in the creation of your
w~at
disease?
was happening one or two years prior to
the onset of cancer?
Why breast cancer opposed to another
type, in a different location of your body?
Describe to me the sequence of events surrounding
the mastectomy.
\\
and recovery.
doctor?
Discovery of symptoms, diagnosis, surgery,
How long did you wait before consulting a
What were your concerns prior to the operation,
after and now?
anathesia?
Did you have an unusually great fear of
Did you have any dreams during that time
period that you can recall now?
How was it in your
relationships at the time of the operation?
Did you tell
. 120
your
•
I
?
fr~ends.
Describe your recovery perioda depression,
resentment and rate of recovery.
Did you experience
anger directed towards your doctor?
Did you grieve the
loss of your breast?
How has having had cancer changed your life?
has the experience left you?
life changed?
Values?
Has your attitude towards
How you look at each day, the
remainder of your life?
How have you incorporated the
loss of a breast into your body image?
about your body now?
How
How do you feel
When you visualize yourself nude,
do you see yourself as a two breasted or one breasted
lady?
Do you feel you have accepted the loss of your
breast?
Have your primary relationships changed?
feel about that?
How do you
•
How do you feel people saw you during
this experience?
Were they caring, judging, horrified,
embarrassed?
Did you share with others your experience?
Who took care of you?
..
Did you receive the nurturing and
support you needed prior to the operation and during
recovery?
How do you see your future?
Possible reoccurrences?
Whatis different about you now after this experience?
How does that feel to you?
Do you feel you've accepted
what's happened or is it still hard to believe?
Have you experienced therapy during this experience
or at any other time? ·Did it alter your attitude towards
the disease?
121
'
How has having had cancer benefitted you and opened
your scope of experience?
What is important for me to know about you?
What
would you like to be included in my description of you
when I write up this thesis?
•