Men Don't Want to Talk About Cancer

Editor’s note: In our lifetime, one in eight men will be confronted with the challenges presented by prostate cancer. This is the final story in a series of six articles where Jackson Rainer discusses the implications of prostate cancer diagnosis, treatment and the impact on quality of life.

I was stoic, assertive and goal-directed during the prescription of treatment options when diagnosed with prostate cancer. One of the few friends to whom I disclosed the process said, "I know you can tough it out." My answer to him was, "Yeah, I can and I will." 

While factually acknowledging that I had cancer requiring aggressive treatment, I steered clear of all thoughts, feelings and beliefs that were exposing of any vulnerability or fragility. I kept my head down and stayed in motion.

I have to admit, though, I was stopped in my tracks and cringed when I heard the term "chemical castration." I made dark-humored jokes about becoming Mrs. Doubtfire, of going through manopause, and of processes imagined that would feminize me.

Throughout boyhood and into adult life in contemporary western society, we men are taught to narrow our range of emotions, restrict feelings and orient our approach to problem-solving by steeling ourselves toward outcomes and "keeping (your) eye on the prize." 

I learned the lessons early of what it means to be a 'real' man through great psychological pain and humiliation. As a youngster growing up in South Georgia who didn't take to traditional hypermasculine activities of hunting, fishing and organized sports, I aligned much of my growth and development as a budding musician with an eye for the arts and humanities, all of which were seen in my culture as feminine. As a result, I spent years feeling uncertain and insecure about what is means to be masculine. During adolescence, I was marginalized from the good-ole-boys' club.

Later, after years of psychotherapy and academic study, I gained a foundation and scaffolding for the examination of myself as a man. Now in my 60s, I understand adult life through the historic lens of a genuine, intimate 38-year marriage to a strong woman until her death some years ago. I work as a practicing psychotherapist moving toward retirement of a fully realized 40-year career and live happily as a member among a wide network of close and loving friends.

Before cancer, I lulled myself into believing I had a full range of feelings with broad access to my emotional life. I believed I earned a sense of mainstream masculinity and could defend and protect my unconventional appetite for what I had been taught in early life as more stereotypically feminine preferences.  

It was not until I began androgen deprivation treatment, which uses medication to reduce testosterone, and engaged in an extended course of proton radiation therapy that I realized a new meaning of vulnerability. I lived inside the metaphor of nakedness as the treatment process took me to a defenseless and raw place; I did not trust such a strange somatic and psychological place of frailty and exposure. 

Most of the treatment procedures involved uncomfortable physical compromises requiring disrobing, allowing various and repeated penetrations of my body, and navigating physical processes, like toileting, that most adults do not have to consider in a normative course of their day.  More alarming was the loss of emotional fluency and a feeling of being defenseless and unprotected.  The prescription from providers to "be patient…" was outside of my temperament and not reassuring.

Prostate cancer treatment has changed the way I live in my body. I was told to expect as much during treatment, but not what this might mean. I became a stranger in a strange land.

Most traditional forms of masculine expression are based on distancing from somatic reality. We are prone to say, "No, that doesn't hurt (when bleeding profusely)," or professing some variation of "If I don't feel better tomorrow, I'll do something about it," a refrain oft-repeated as physical distress escalates.  

We have a reluctance to seek or accept help when it is needed. Giving in to physical pain is seen as weak or incompetent. While I didn't go as far to define prostate cancer as a life failure, in no way did I ever imagine having to deal with an illness as far out of my control. I now attend to my physicality with new caution and immediacy.

Male psychological defenses extend into the realm of deep emotional experience. In the presence of alarm or distress, we are prone to suppress those softer qualities such as compassion, empathy, nurturance, tenderness and vulnerability because they are stereotypically perceived as something other than masculine.

The entirety of my medical providers is male, working in a patriarchal health care system. They are excellent for killing cancer and not so great at the psyche of illness. I am interviewed in detail regularly by researchers about my treatment response, via questionnaires prior to face-to-face appointments. Examinations are oriented entirely to physicality. Any psychic discussion at best yields a recommendation for an anti-depressant. I am left to my own devices to meet the demands of the "soul" of the illness. As one fine physician laughed, with tongue in cheek, when I disclosed my psychological vulnerability, "Jack, that is above my pay grade."

It is assumed that a man with prostate cancer accesses the full measure of medical care available to him. A cancer diagnosis does not get better on its own. Scientific research is sufficiently advanced to provide a patient multiple options and courses of care to meet the demands of the progressions of the disease.  

What is less well addressed in a discussion of prostate cancer is the private experience of emotional, intellectual and relational shock that sickness evokes. The physical demands of cancer resonate through mind and spirit, inviting examination of the impact that disease brings. The psychological demands of cancer persuade us to consider meaning outside the depth of the traditional male mantra to "tough it out."

The term psyche refers to the self-regulating system of our minds. It is the center of the field of consciousness containing our histories, beliefs, values, intuition and attitudes to the ways we move through the world. Cancer naturally takes most people into a private examination of personal assumptions, expectations and fantasies. 

For me, the loss of physical energy and stamina and a diminished sense of my psychological self requires ongoing attention to what is figural and important. The limits to what I can do, without a traditional masculine outlook on life, slams me into unknown territory. I profanely describe it to others as "taking a hard right turn into 'where-the-hell-am-I'?" 

I am fortunate to be willing to live in the unknown, the realm of the spirit defined as a mystery rather than a loss. The demanding crisis of health activates psyche, the self-regulating system of the mind, much like the endocrine system regulates the body. As the hormonal mechanisms of my physical body were altered, psyche became active to organize my thoughts, feelings and sensations.

Psyche speaks through the unconscious, the region of our mind containing memories, emotional conflicts, wishes and impulses that are not directly accessible to logical awareness but have dynamic effects on thought and behavior. The awareness of psyche comes through symbols and paradox in daydreams and night dreams, and in conscious awareness that things have changed.  Psyche is accessed through the gentle and curious observation of self. My grandmother defined this practically when she would say, "Well look here. I am just beside myself."

I am told many times how fortunate that such an aggressive cancer was caught early, so that treatments would yield favorable results, defined by longevity. I am surprised that, even with this reassurance, I consider my death more frequently than one might wish. 

As we age, ruminations of mortality are universal. In western society, we logically know, as Ram Dass poetically said, "We are all just walking each other home." Over time, I have come to realize that thoughts of life and death take me to the choice of accepting the cancer experience as an invitation rather than a catastrophe.

That said, traditional masculine thought keeps all physical frailties at arm's length. The harder I work at denial, the more profound my thoughts of the end of life become. With the courage required to take a deep breath, allow room for uncomfortable and unpleasant feelings, and explore this "hard right turn," I realize I have grown out of my youth into mature years. It is time to give up interests and pleasures that no longer bring meaning to life.

I continue to explore this new territory in an interesting and challenging fashion. I now live with the belief that much of life is a paradox, and peace is found more in questions than answers, and symbols coming as figures, patterns, rhythms and nuance are the path into mystery that provide understanding of the unknown.

Cancer is a lonely place for one to find himself. Reminders abound. It is a truth painfully realized: No one could be with me in a proton radiation machine reminiscent of "Star Wars," nor could they hold my hand as I was 'nuked.'  

Frequently waking at 3:00 am, ruminating over the meaning of life while needing to revise advance directives and a will is challenging and disconcerting. Fortunately, gratefully, I have a group of intimates who really know me. I have a partner who has been foundational and steadfast in the journey. As a group of good people, they get me.  

In my aloneness, there is an awareness bringing clarity to the truth that dealing with cancer unfolds with greater ease in the presence of a community. Medical providers direct the physical course of treatment. My intimates hold my imperfect and frightened soul. I intentionally move past the traditional masculine to let others see me, in psychological speak, for 'who I am'. To acknowledge the need to be seen is a significant change from the masculine practice of hiding out.

I have learned when others genuinely ask, "How are you?  What do you need?" to answer, "I'm moving through a tough time, and I need you to worry about me a little. Let me hear from you."

Jackson Rainer is a board certified clinical psychologist living and working in Atlanta, Georgia and Tryon, North Carolina.  He may be contacted  by [email protected].
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