BIANCA BAGNARELLI

Editor's Note: Every Monday, Lori Gottlieb answers questions from readers about their problems, big and small. Have a question? Email her at dear.therapist@theatlantic.com.

Dear Therapist,

My closest friend of many years is battling a very deadly diagnosis of Stage 4 breast cancer. She is single, childless, and not super close to her family.

She is generally a very private person, and I’ve always been the one who knows her best. About four months ago, I traveled out of the country; around the same time, she decided that she needed to disconnect from our friendship in order to stay focused on her own situation. There was no issue between us that caused this, and she’s confirmed that. She has told me that she just needs to deal with this stuff on her own and that it’s too difficult for her to talk about.

I suspect that she’s had more bad news, because that tends to cause her to retreat from others, and I worry that things are going downhill. I miss her deeply, and I’m also kind of angry with her. She has apologized to me for “it having to be this way,” but asks that I don’t contact her at all, and says that she’ll connect when she is ready. Although I know her so well, I can’t relate to this state of mind. I am so sad that we may not have much time left to spend together. I have respected her wishes, apart from a couple of texts to let her know I’m thinking of her. She has asked that I not even do that.

I feel like I'm already mourning my friend. I also feel like it’s so selfish of her to retreat in this way, as if a friendship only goes one way. I'm hurt that she doesn't have space for me, or seem concerned about my life, which has had a major event in these past months. I’m also sad that she isn’t really “living” while she still can. Mostly, I really miss her, but I don’t even know how I would react if she reached out tomorrow. I’m trying to figure out how to process this in the meantime.

Thanks for any thoughts and advice.

Anonymous


Dear Anonymous,

I’m so sorry that your dear friend is seriously ill. She must be swirling in a whole slew of emotions right now—fear, anger, sadness, helplessness, hope, and despair. And though you’re not in her position, you’re probably feeling a very similar set of emotions, just from a different angle.

When two people are experiencing a lot of the same feelings, and with great intensity, their relationship can get complicated. But if you can separate your feelings from hers and deepen your appreciation of her experience, you might be able to view the situation with greater understanding, and that, in turn, may help to quell your anger and ease some of your suffering.

First, it’s common for people with late-stage cancer to withdraw from the world in ways big and small. Each person is different, but in general, the sicker people get, the more they close in on themselves. Hospice workers educate family and friends about this phenomenon so that a person’s loved ones don’t take this behavior personally. Disconnecting from the people and things one enjoys can be a natural part of the dying process. And just as you’re already grieving the loss of your friend, she’s grieving for herself, too.

I don’t know what her grief looks like (grief is so personal), but I can share with you what cancer patients have told me about their reasons for taking a step back from friendships during this time.

The most frequent explanation I hear is that the way the friend is trying to help isn’t very helpful. Everyone reacts differently to a cancer diagnosis, and there’s no right or wrong way to handle the news, but often a person’s friends have strong opinions about what their sick friend should be doing. Well-meaning advice on treatment options, self-care, mind-set, support groups, and what to eat can feel overwhelming and intrusive. Many people want to do their own research and consult their own doctors, and make their own decisions accordingly. They don’t want to be told that they aren’t doing “enough” (for instance, if they’re choosing an Eastern medicine approach over a Western medicine approach, or if they’ve chosen to cease treatment altogether despite the possibility of prolonging life); or, alternatively, that they’re doing too much (continuing a treatment with little chance of success) or need to “relax more.” (As one patient said to me, “My life is on the line and I’m supposed to relax more?”)

In your case, you’re sad that your friend isn’t really “living,” but imagine how that might sound to her when, in fact, she’s living in exactly the way that makes sense to her right now. Would you do it differently? Maybe. But you can’t know for sure unless you find yourself in the same situation. More important, the way you’d choose to spend your time doesn’t have to be the way she does.

Many people with cancer have told me that they were, in fact, bothered by something a friend said or did or felt, but didn’t have the emotional bandwidth to confront the friend and instead simply withdrew. Others brought up the unhelpful behavior to the friend, but ended up soothing the friend and taking care of the friend’s feelings instead of the other way around, and left the interaction with a sense of resentment. Very sick people don’t want to have to make others feel better about the fact that they’re dying.

All of that said, your friend has told you that there was no issue between you; assuming that is the case, she may nevertheless feel a need for distance. Some people with late-stage cancer have told me that even when their friends are there in ways that feel supportive and nonjudgmental, they just don’t want to face healthy people. You mention a major life event that you want to share with your friend, but she may not have room for anyone else’s concerns given how profound hers are. If the change in your life was a positive one, she may struggle to feel happy for you, and that in turn may cause her to feel guilt and shame. If the change was a tough one, that too could be hard for her, in that it may make her wish to have smaller problems. It’s not that there’s a pain contest—it’s simply that people who are dying often envy those who get to live, in the same way that people who want a child or partner and don’t have one may have trouble listening to friends’ concerns about their own children or partners. Terminally ill people still love and care for their friends, but their friends’ concerns can be too painful to bear.

Finally, your friend may feel self-conscious about her physical decline. Many people don’t want to be remembered as emaciated, bald, frail, in pain, and perhaps bedridden or unable to get to the bathroom on their own. Sometimes the fear they read on their friends’ faces when these friends see these physical changes triggers their own already tremendous fear. You say that your friend is a very private person; as close as you are, letting you see her this way may make her feel too exposed and vulnerable.

Of course, I understand your heartbreak, not only because you miss your friend’s presence in your daily life right now, but because you don’t have the opportunity to grieve this tremendous loss with her in a way that you would find meaningful. You may also feel frustrated that you can’t help your friend in this terrible time, but remember, she’s telling you what the best way is to help her—and you’re doing it. The task is to figure out what would help you while also respecting her wishes.

Here are some ways that you can help yourself: Remember that her choices aren’t a comment on how much she cares about you. Contact her family (though they aren’t “super close,” they’re likely helping out) to get updates on her condition so you aren’t left wondering. Let them know that you’re thinking about her and miss her, and that they should feel free to pass that along if they desire. If your friend chafes at this, she or her family will let you know, but it’s also possible that she’ll appreciate your loving concern from afar. Write her one warm and candid letter in which you let her know how important she is to you, what you love and admire about her, and how her friendship has affected you. Don’t share your anger with her, or the fact that you’ve had something major happen in your life. Do share fond and funny memories from your friendship, and let her know that should she be up for it, you’d love to be there for her right now—whether that’s taking her to appointments or to an escapist movie or to a bar for a stiff drink. Tell her that you’re thinking about her, and that as hard as it is to stay away from her at a time like this, you love her enough to take her cue but are here for her if she changes her mind.. Tell her that you miss her deeply.

Yes, you’re crossing her boundary, but in this case, because you may never have the opportunity to share with her something she may want to know before she dies, it’s a onetime risk that might be beneficial—not just for you, but also for her. She can choose not to read the letter, to read it and throw it away, to feel grateful for it but still not want to be in contact, or to send you a note letting you know where she is in her process at this point. Whatever she does is up to her. Send her that letter, take a deep breath, and then keep living your life the way you know how while she keeps living hers the way she knows how.


Dear Therapist is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental-health professional, or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.

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