By Dr Joseph Hawkins, Consultant in Palliative Medicine, Clinical lead for End of Life Care, Ashford and St Peter’s NHS Foundation Trust. Twitter: @JoeHawk75825077

People are our sunrise and sunset and everything in between. Even if you’re not a morning person.
It has always been a peculiar and wonderful quirk that when reading of famous hermits one usually does so through the experiences of others interactions with the hermit in question. Truly great hermits are best known for their wise sociability. The hermit paradox is real and can only be found in company. Even the most anti-social personalities are defined by their interactions with other human beings. So it is then that when we imagine threats to our existence we see them through the lens of our sociability. The outwardly visible and familiar can be both succour and sinister. Perhaps this is why disease strikes so many as an incalculable threat and one that we are poorly psychologically adapted to face.

Catastrophic thinking is common-just consider how many of us have shared those horrible visions of bad things happening when watching a child swim or standing near a high place. These aberrant thoughts can be an adaptive psychological response to potentially worse case scenarios. So it is no surprise that these visions of a future that we wish to protect ourselves against are repeated in the media we indulge in. Disaster movies and Armageddon proliferate in our popular indulgences. We allow the stories of criminals and their path to murders to infiltrate our ears because we are fascinated with the worse case scenario. An instinct to understand that which we fear also causes us to seek out the moments of fantasy that send a thrill down our spine. Death abounds and we must know more in our pursuit to avoid it. A deep evolutional imperative that drives hobbies and even multi-million film budgets.

Yet when faced with the reality of disease we find ourselves in an entirely unprepared wilderness of sadness and shock. The apocalyptic twins that somehow were missed from the bible. It is addressing this shock and sense of uncertainty, that is often the first step in empathic support of those stricken by a diagnosis of life limiting disease. The things you thought you were prepared for have not come to pass and instead you find yourself struggling with an enemy within. The fact that it is not actually an enemy in the traditional sense, by which I mean that disease is not a conscious force. Indeed, organ failure has no mind that may be tricked. This lack of consciousness with which we might soar and in some way envisage a victory, however unlikely- will often make it worse for the bearer of the illness. It is reasonable to say that disease is both uncomprehending and incomprehensible.

The first step in healing this fracture of the mind that occurs following diagnosis is often in managing the turmoil of uncertainty that comes from such a scenario. To acknowledge uncertainty and that there is no fight, no winners or losers. Instead we must simply learn what is now normal, what may be achieved and what is unlikely and cannot be influenced by thought or hope and therefore will only cause distress if focused on to the exclusion of all else that might instead be achieved, however hard it is to consider.

I don’t have the answers as to how each person might face illness but I have observed many people and I find that at some point there comes a time where it is useful and can be a healing action to acknowledge all that I have spoken about here. Accepting the unknowable can be a powerful step forward in illness and life, alike.

Also by this author:

The palliative times special investigation in to predatory conferences
Make a wish
To palliate or not to palliate