Cancer and Guilt

Hester Hill Schnipper, LICSW, OSW-C Program Manager Emeritus, Oncology Social Work

JANUARY 02, 2019

Do you worry that you brought on your cancer?

Of all the useless and soul-sapping feelings we sometimes have, guilt must be near the top. Many times, when I meet someone with a new cancer diagnosis, she is struggling with the question, "What did I do to bring this on?' or "What did I not do to bring this on?" The answer, of course, is almost always nothing. We do know that there are cancers that can be related to lifestyle choices like tobacco or alcohol use, but those habits surely do not guarantee cancer, and many people develop those illnesses without that history.

Some years ago, I worked with a delightful woman who had lung cancer. She had smoked for a few years in her 20s, but had stopped decades ago. Nevertheless, it haunted her, and she tortured herself with guilt and self-criticism. It was finally relieved when another women in our support group made this suggestion for a response when someone asked, "Did you smoke?" Her perfect response was, "Only after sex."

We often look for a reason because, if we could find one, we think we could then change our habits, take more control of an out-of-control situation and prevent more troubles.I have heard all sorts of quirky possibilities: the dog stepped on my breast; I didn’t eat enough cauliflower; my crazy father predicted I would get cancer. Then there are the reasons that are more haunting: I was promiscuous in my youth; I drank too much; I don’t handle stress or anger well. None of these things caused the cancer. If anyone knew the answers, we would be much further along in cancer research than we are! Don’t you think that we would be told what to embrace or what to avoid if there were actually evidence that those things could prevent or cause cancer?

Instead, we are left with a few soft lifestyle recommendations: don’t smoke; drink alcohol in moderation; maintain a healthy weight;and exercise regularly. All of these behaviors are surely good for our health in general, and they may impact our risk of cancer or even recurrence, but they certainly are not promises or absolutes.

There are many theories about environmental causes, and good reasons to worry about pollution and contaminated water. There is probably less reason to worry about drycleaning our clothes or wrapping our left-overs in plastic wrap. As far as I understand it, the best guess is that sometimes something in the environment—the water we drink, the food we eat, the air we breathe—trips up a vulnerability in a cell and begins on a malignant process. But no one can indicate what or why or how. The body actually does a magnificent job of fighting cancer, and it takes many steps for a cell to become malignant. Most stay healthy.

A number of popular books have proposed psychological reasons for cancer. Remember the best seller some decades ago that asked: “Why did you need this cancer?” Supposedly, the diagnosis was in response to an unresolved issue or a unloved childhood or some other human problem that actually has plenty to do with sadness and nothing to do with cancer. It distresses me when I talk with people who are struggling with thoughts like this and blaming themselves.

Perhaps because breast cancer is the most common cancer for women, it is especially associated with crackpot theories. Wearing underwire bras and using an antiperspirant come up regularly. Here is the truth about breast cancer: Except for those women who have inherited one of the BRCA gene mutations, we have no idea of the cause. It just happens.

It is tough to accept that cancer is just bad luck, but that seems to be the truth. Since cancer is more common in older people, as we live longer, our bodies have more opportunity to make mistakes. None of us would prefer to return to the less cancer-prone days before antibiotics or other medicines when so many children died and so many women died in childbirth.

You are not responsible for your cancer diagnosis, and the sooner that you can let go of this worry or guilt, the better you will feel.

Have you worried that you brought on the cancer? Have you had theories about why this happened? Please share your story in the BIDMC Cancer Community.