A socially well-identified disease, cancer sometimes brings more understanding and empathy than mental illness. In women suffering from psychosis, certain female cancers also resonate in a singular way, as noted by the general practitioner, who tries to reflect to the most appropriate support, in a team and during a colloquium.
In the minds of some patients suffering from psychosis, cancer sounds like a morbid and nightmarish motherhood, at least that’s how they seem to understand it, and carry it.
Thus Madame U., affected in her female breast, confided to me during our first meeting that she no longer knows whether she had a tumor or a child, that this growing mass, she could have raised it, and instead it was taken away from him. Cancer is a small death of a few cells that we carry within us during gestation, which grows like a fetus until we give birth to our end, or to recovery.
Madame R. also carries this burden within her. Without knowing it completely surely, since it is difficult today to measure what she hears and understands of our words, and of her evils.
Madame R. has one child, a son. Their fusional relationship is partly explained by the violence that her late husband and father of her son showed with them. Until the day she took her child under her arm and fled with him to protect him.
Today, Mrs. R. lives in the long-term unit, where her son comes regularly to keep her company. She is blind, and cannot hear very well.
In moments of delirium, she rebels again against her husband whom she sees in a corner of the room. She shouts and insults him in Arabic, she doesn’t let it go.
With us, however, she seems reassured. She has “her darlings”, certain nurses who know her well and who speak her mother tongue, which helps a lot.
And with her son, she becomes a mother again.
However, the nurses observed repeated uterine bleeding. Pap smear, MRI…, we make the diagnosis of uterine cancer. It will take several multidisciplinary meetings with specialists to agree on palliative care, with the aim of sparing him major surgery – which, at his age and in his condition, would cause intense suffering –, in an attempt to limit the progression of a cancer that she does not understand.
It is with his son that the work of acceptance is the most difficult, but we are not getting there, step by step.
A disease that inspires compassion
Shortly after, at the congress of the National Association for the Promotion of Somatic Care in Mental Health (ANP3SM), where I heard two clinical stories that came to elaborate my thinking a little more in this direction.
The first is that of a patient suffering from schizophrenia, about to be operated on for cancer of the uterus, too. But she finally refuses, because in her delirium, this cancer that she carries in her uterus is the reincarnation of her brother who died a few years earlier, and who is now her guardian angel. A gestation that will have lasted the number of years that separates her from his death.
The second is the story of another patient, psychotic, also suffering from cancer of the uterus, and persuaded to be pregnant, announcing to her gynecologist: “I have a blood pregnancy tumor”. And who, after the gynecological examination, describes the consultation as follows: “I had a ventral nuptial visit”.
Yes, cancer sometimes appears as the gestation of suffering, or of bereavement. This image is all the more telling when it comes to neoplasia affecting the female genitalia or the breast.
This finding is not unique to mental illness. I rather think that psychosis comes to give substance to unconscious mechanisms housed in everyone. Because we are not that different.
And precisely, cancer is socially well identified, much more accepted and likely to arouse empathy and understanding from others than mental illness. It sometimes makes it possible to obtain the social support that a psychiatric patient did not have until then, excluded as he was by his pathology. It sometimes changes its host: when the body comes back to the fore, psychosis is sometimes silent. As we were able to observe with Madame C., who, seeing her burns, finally accepted treatment that she had always refused.
So we invest cancer as it is now: a new identity, an extension of oneself, a new life project, the certainty of being loved. We invest it like a newborn.