(This is an Excerpt from Coping with the Emotional Impact of Cancer by Dr. Neil Fiore)

The inability to talk about your problems and feelings is a most serious obstacle to having a good relationship. Every relationship has its problems, but if you can talk about them you have a better chance of living through them, together. It makes sense, especially during times of serious illness, to be aware of barriers to open communications. In my work with cancer-stricken families I have seen two major barriers to communication: a conspiracy of silence and premature mourning.

A Conspiracy of Silence

With any serious illness and emotional topic, there is the danger of avoiding mentioning it for fear of saying the wrong thing and evoking strong feelings. This can lead to a conspiracy of silence in which the patient and the family avoid the topic in an attempt to protect each other, all the while creating feelings of alienation, misunderstanding, and barriers to direct and open communication.

Out of a sense of duty and a desire to protect a loved one, a vicious cycle of silence, misinterpretation, guesswork, and isolation gets started. Phrases like, "I don’t want to say anything because I’m afraid she’ll get upset," or "They haven’t brought it up so I assume they just don’t want to talk about it," are signs that a conspiracy of silence is taking place.

While you want to respect another’s timing, this doesn’t mean that you must sit silently with your own feelings and try to interpret clues as to when it’s okay to speak. You can still invite a conversation with phrases such as, "I don’t know what to say but I want you to know that I’d be glad to talk whenever you wish," or "Please let me know when you’d like to talk about what you’ve been through."

We cannot protect others from reality; they usually have some idea of what’s going on and often are imagining the worst. Even though our intentions are good, the desire to protect someone from hurt usually comes with an attempt to protect ourselves from our own upset. It generally makes sense to say something about what is troubling you, even if you choose to keep the details vague. For example, "I’ve been avoiding talking to you because I’ve been afraid I’d break down and cry. If you don’t mind me crying, I’d be glad to talk with you." Let them know that you can handle your own emotions and that you don’t need protection from their feelings. If the two of you are going to cry, at least you can cry together.

Premature Mourning

Learning that a loved one has cancer often causes family members to start a painful premature mourning process and to be less available to support the patient’s ongoing treatments. Anticipating that you’ll have to repeat the mourning process in the future can lead to avoidance of the patient, thereby depriving the patient of real, human contact. Patients and their families and friends have different timetables for grieving and adapting to how cancer has affected them.

Even when we know that many forms of cancer are curable, there remains the fear that a cancer diagnosis is a death sentence. This fear can lead us to mourn the loss of a loved one even though he or she may recover from cancer, may live with it for years, or may want to enhance the quality of the last months of life with frequent visits and support from family and friends.

Of course, the patient can be the one who’s doing the premature mourning, isolating himself from the family and depriving them of an opportunity to share feelings and to express their concern and desire to help.

Please remember that being diagnosed with cancer, having cancer, and dying of cancer are separate and different states, each requiring its own emotions and adjustments, each in its own time. Eventually, the premature mourner must cope with the present moment rather than the imagined future. The patient may want to tell the premature mourner what I told a friend:

Stop avoiding me and treating me as if I’m already dead. I’m still here. I’m still alive! I need you to be with me, now. Help me to make the most of whatever time is left. There’ll be plenty of time for grieving after I’m gone. But don’t be so sure I’m going that fast. In fact, I may hang around so long that you may be saying, "How can I miss you if you won’t go away?"

You most likely will find that, as you become more comfortable with these difficult feelings, you’ll worry less and will enjoy more fully the valuable time that you still have with each other.