Receiving a terminal diagnosis represents a profound break with our idea of the future. In a matter of minutes, plans, priorities, and our perception of time can be radically altered. However, each person copes with this news differently.
Some need to talk immediately, others prefer to remain silent; some seek all the information possible, while others need time before they can assimilate it. None of these reactions is better or worse than the other; they are different ways of trying to adapt to a reality that challenges our expectations and severely tests our psychological resources.
The Stages of Grief: A Model for Understanding What We Feel
In 1969, psychiatrist Elisabeth Kübler-Ross published a revolutionary book for its time: “On Death and Dying.” After interviewing hundreds of patients with terminal illnesses, she described five common reactions: denial, anger, bargaining, depression, and acceptance.
Kübler-Ross sought to humanize the care of people in the final stage of their lives at a time when death remained a taboo subject, even in hospitals. This led to the development of the five-stage model of grief, which serves as a framework for understanding the emotional reactions that arise in the face of such a diagnosis and the prospect of death.
However, Kübler-Ross herself pointed out that these stages are not a rigid sequence or a universal rule. Reality is much more complex, so although these stages can serve as a “roadmap” or a compass, they do not always appear in that order, nor do all people experience them in the same way.
- Denial: When the Brain needs to buy Time
One of the first reactions after receiving a terminal diagnosis is often disbelief. Some people believe it is a mistake, seek second opinions, or continue acting as if nothing has changed. Far from being a problem, this response serves a protective function. Receiving news of this magnitude has an enormous emotional impact. Denial helps us process this information gradually, instead of having to immediately confront the full emotional burden it carries.
It is a perfectly normal reaction, as long as it doesn’t persist for too long, since in that case, it would prevent us from making important medical decisions or planning the necessary care, thus hindering our adaptation to reality.
- Anger: A Frequent Response to the Loss of Control
We often interpret anger as a lack of acceptance, but in reality, it is a common and perfectly understandable reaction to the feeling of injustice and loss of control. After all, it’s normal to get angry or frustrated when things go wrong.
When faced with a terminal illness diagnosis, this anger can be directed toward doctors, family members, one’s own body, or even toward circumstances completely unrelated to the illness. In reality, this anger is a reflection of the frustration that comes from realizing that there are fundamental aspects of life that are no longer within one’s control.
However, even though it is an understandable reaction, it is important to go through it and move on. Researchers from Harvard Medical School and Massachusetts General Hospital found that seeking emotional support and using acceptance coping strategies were associated with a better quality of life and improved mood in patients with incurable cancer, while denial, anger, and criticism were negatively correlated with these outcomes.
- Bargaining: Attempting to Regain a Sense of Control
When we begin to accept a diagnosis, we generally go through a negotiation phase in which we rethink our attitude toward the illness. We may become actively involved in treatments, redefine our priorities, or seek a new spiritual or existential dimension that gives meaning to our experience.
We engage, in a way, in a kind of intimate negotiation with fate, a natural attempt to regain some control in a situation that is slipping out of our hands. A terminal diagnosis not only implies facing death, but also the loss of autonomy, uncertainty, and the feeling that the most important decisions no longer depend entirely on us.
Seeking ways to influence the course of events is an understandable psychological response, since, in highly stressful situations, people try to reduce the emotional impact by regaining, even if only partially, a sense of control. In this context, negotiation can become an adaptive strategy, as long as it doesn’t lead to denying reality.
- Sadness: Not Always Equivalent to Depression
The five-stage model of grief indicates that it is common to go through a stage of profound sadness, although it’s not always synonymous with depression. In fact, a person may experience pain because they will not be able to continue living as they had imagined, fear in the face of uncertainty, or worry about the impact the illness will have on loved ones. These emotions are part of an adaptation process and, in themselves, do not constitute a mental disorder.
Distinguishing between sadness and depression is important because it avoids pathologizing completely normal reactions. While sadness tends to fluctuate and allows for continued moments of connection or enjoyment, major depression involves a much more persistent disturbance that affects daily functioning and may require specific treatment.
Research shows that many people alternate between moments of intense sadness and others of calm, humor, or even enjoyment. Positive emotions do not necessarily disappear after a terminal diagnosis; rather, they have a buffering and even adaptive effect.
- Acceptance: Does Not Mean Resignation
Accepting the diagnosis does not mean giving up or ceasing to fight, but simply recognizing the reality of the illness in order to decide how to live the remaining time. This allows us to stop wasting enormous amounts of energy trying to change what is beyond our control and instead direct it toward what still makes sense: which relationships to nurture, which personal matters to resolve, or what kind of care and attention we want to receive.
Acceptance doesn’t mean giving up hope, but rather transforming it. The focus shifts from healing to other equally valuable goals, such as managing pain, maintaining as much autonomy as possible, spending quality time with loved ones, tying up loose ends, or living in accordance with our own values.
Accepting the reality of the illness often allows us to have conversations and make decisions that were previously difficult. Some people take advantage of this time to hire a lawyer specializing in personal injury or inheritance law, either to pursue legal action or to resolve outstanding estate issues.
Addressing these matters not only provides greater financial security during treatment but also offers greater emotional peace of mind for both the patient and their family, as confirmed by the Lung Cancer Group, which has been helping people in this situation for decades.
Psychology confirms that acceptance brings great serenity and improves emotional well-being, although it also clarifies that it is not a permanent state. In some cases, the person may again feel overwhelmed, angry, or frustrated.
A Unique Path
More than going through a series of stages, facing a terminal diagnosis involves learning to live with changing emotions. Some will be painful, but others will also be unexpectedly serene. Understanding their existence and identifying them allows us to know where we are, normalize reactions that may be disconcerting, and remember that there is no “right” way to cope with an illness.
Some will never experience strong denial. Others will alternate between acceptance and sadness for months. Some maintain hope even with a very limited prognosis, while others need more time to process the information. And all of that is perfectly normal because everyone must build their own path.
References:
Nipp, R. D. et. Al. (2016) The relationship between coping strategies, quality of life, and mood in patients with incurable cancer. Cancer;122(13):2110-2116.
Folkman, S., & Moskowitz, J. T. (2000) Positive affect and the other side of coping. American Psychologist; 55(6): 647–654.
Leave a Reply