1
St udy suppor t ed by t he Br azilian Coor dinat ion of I m pr ovem ent of Per sonnel of Super ior Level; 2 Psychologist , Doct oral St udent in Psychology, e- m ail: r odr igosanchesper [email protected] .br ; 3 Psy chologist , Pr ofessor, e- m ail: m asant os@ffclr p.usp.br. Depar t am ent of Psychology and Educat ion. Facult y of Philosophy, Sciences and Let t er s of Ribeir ão Pr et o, Univer sit y of São Paulo, Brazil
D isponible e n ca st e lla no/ D isponíve l e m língua por t ugue sa SciELO Br a sil w w w .scie lo.br / r la e
BREAST CAN CER, POVERTY AN D MEN TAL HEALTH: EMOTI ON AL RESPON SE TO THE
DI SEASE I N W OMEN FROM POPULAR CLASSES
1Rodr igo San ch es Per es2
Manoel Ant ônio dos Sant os3
Per es RS, Sant os MA. Br east cancer, pov er t y and m ent al healt h: em ot ional r esponse t o t he disease in w om en
fr om popu lar classes. Rev Lat in o- am En fer m agem 2 0 0 7 set em br o- ou t u br o; 1 5 ( n ú m er o especial) : 7 8 6 - 9 1 .
This st udy aim ed t o analyze t he em ot ional response of a low- incom e group of wom en t o t he breast cancer.
The sam ple w as com posed by 15 pat ient s fr om a m ast ect om ized w om en’s suppor t ent it y . Dat a w er e collect ed
t hrough individual face- t o- face sem i- st ruct ured int erview. The result s were appraised according t o a classificat ion
syst em t hat post ulat es t he exist ence of four cat egories m ut ually excluding: denial, st oicism , afflict ion and confront at ion.
The result s obt ained indicat e t hat st oicism was t he m ore frequent em ot ional response in t he evaluat ed group. The
scient ific lit erat ure shows t hat st oicism can cont ribut e t o t he t em porary reduct ion of st ress, but it gradually leads t o
a uselessness feeling which t ends t o m ake difficult t he psychosocial adj ust m ent t o t he disease and it s t reat m ent .
DESCRI PTORS: br east n eoplasm s; pov er t y ; m en t al h ealt h ; psy ch ological adapt at ion
CÁN CER DE MAMA, POBREZA Y SALUD MEN TAL: RESPUESTA EMOCI ON AL A LA
ENFERMEDAD EN MUJERES DE CAMADAS POPULARES
El pr esent e t r abaj o t iene com o obj et ivo analizar las r eacciones em ocionales al cáncer de m am a en un
gr upo de m uj er es de clases popular es. La m uest r a fue com puest a por 15 pacient es de una ent idad de apoy o
a las m uj er es m ast ect om izadas. Dat os obt enidos con una ent r evist a sem i- est r uct ur ada se apr eciar on de acuer do
con un sist em a de clasificación que post ula la ex ist encia de cuat r o cat egor ías que se ex cluy en m ut uam ent e:
r echazo, est oicism o, aflicción y confr ont ación. Los r esult ados indican que el est oicism o fue la r eacción em ocional
m ás fr ecuent e en el gr upo ev aluado. La lit er at ur a cient ífica m uest r a que el est oicism o puede cont r ibuir a la
r educción t em por al del st r ess, per o que llev a gr adualm ent e a un sent im ient o de inut ilidad qué t iende a cr ear
dificult ades par a el aj ust am ient o psico- social a la enfer m edad y el t r at am ient o.
DESCRI PTORES: neoplasias de la m am a; pobr eza; salud m ent al; adapt ación psicológica
CÂN CER DE MAMA, POBREZA E SAÚDE MEN TAL: RESPOSTA EMOCI ON AL À DOEN ÇA EM
MULHERES DE CAMADAS POPULARES
O obj et ivo do est udo foi analisar as r eações em ocionais ao câncer de m am a em um gr upo de m ulher es
de cam adas popu lar es. A am ost r a foi com post a por 1 5 pacien t es v in cu ladas a u m a en t idade assist en cial de
ap oio a m ast ect om izad as. Os d ad os f or am colet ad os m ed ian t e o em p r eg o d e r ot eir o sem i- est r u t u r ad o d e
ent r ev ist a indiv idual e apr eciados em confor m idade com um sist em a de classificação que post ula a ex ist ência
de qu at r o cat egor ias m u t u am en t e ex clu den t es: n egação, est oicism o, aflição e en fr en t am en t o. Os r esu lt ados
obt idos in dicam qu e o est oicism o f oi a r espost a em ocion al m ais f r eqü en t e en t r e as pacien t es an alisadas. A
lit er at u r a m ost r a q u e t al r eação p od e con t r ib u ir p ar a a r ed u ção t em p or ár ia d o est r esse, p or ém , con d u z
gr adat iv am ent e ao inv alidism o que t ende a dificult ar o aj ust am ent o psicossocial à doença e ao t r at am ent o.
I NTRODUCTI ON
B
r east can cer is basically ch ar act er ized by t h e occu r r en ce of m alig n an t t u m or s in on e of t h est r u ct u r es com posin g t h e or gan , f or m ed du e t o t h e
uncont rollable reproduct ion of cells t hat w ent t hrough
a com plex pr ocess of disor der ed t r ansfor m at ions and
m a y e v o l v e b y d i r e c t e x t e n s i o n o r m e t a s t a t i c
dissem inat ion. The m ain local sym pt om s ar e palpable
n o d e s a n d d e f o r m a t i o n s - e sp e ci a l l y ca m b e r s o r
r et r act ion s - in t h e b r east . How ev er, b lood y n ip p le
secret ion and nodes in t he arm pit s m ay be occasionally
seen . Con st it u t ion al sy m p t om s - su ch as ast h en ia,
f ev er an d w ei g h t l o ss - al so co m p o se t h e cl i n i cal
condit ion( 1).
Now aday s, t his disease is t he m ost com m on
t y pe of m alignant neoplasm in t he fem ale populat ion
in m any cou n t r ies. Addit ion ally, t h e in ciden ce r at es
in cr ease each y ear as a r ef lex of t h e g lob al t r en d
t ow ar ds t he pr edom inance of lifest y les t hat pr om ot e
ex posur e t o r isk fact or s. The m ost r ecent pr oj ect ions
of t he Minist r y of Healt h appoint t hat , only in Br azil,
a p p r o x i m a t e l y 5 0 , 0 0 0 n e w d i a g n o s e s w o u l d b e
confir m ed in 2006 and t hat t he r isk r anges fr om 38
cases in t he Cent ral-West t o 71 cases in t he Sout heast
f or ev er y 1 0 0 , 0 0 0 w om en . For t h is r eason , b r east
can cer con t r ol st an ds ou t as an in cr easin g con cer n
for nat ional public healt h ser v ices( 2).
I n r e c e n t y e a r s , a d e c r e a s e h a s b e e n
w it n essed of t h e m ean size of b r east t u m or s an d ,
con seq u en t ly, a d ecr ease of m or t alit y r at es cau sed
b y t h e d isease, in a g r ou p of d ev elop ed cou n t r ies.
Af t e r a l l , e a r l y d i a g n o si s i n cr e a se s t h e p o t e n t i a l
t reat m ent resolubilit y. Nevert heless, breast cancer st ill
r epr esen t s on e of t h e m aj or cau ses of deat h in t h e
f e m a l e p o p u l a t i o n , e s p e c i a l l y i n l e s s p r i v i l e g e d
eco n o m i ca l cl a sses. Th i s i s b eca u se - d u e t o t h e
co n v e r g e n ce o f a n u m b e r o f f a ct o r s su ch a s l o w
e d u ca t i o n a l b a ck g r o u n d , l a ck o f i n f o r m a t i o n a n d
rest rict ed access t o new t herapies - in t his populat ion
seg m en t , secon d ar y p r ev en t ion is in f r eq u en t , ev en
in t he r ichest nat ions( 3 ). Mor eov er, am on g people in t he sam e count r y, shar ing t he sam e cult ur e, im por t ant
regional differences are seen, due t o social class, age,
gen der an d at t it u des, belief s an d v alu es associat ed
t o healt h and disease.
I n r ecent scient ific lit er at ur e, it is seen t hat
st udies ar e ev er y t im e m or e or ient ed t o psy chosocial
f act or s t h at w ou ld be associat ed t o t h e dif f icu lt y of
est ablishing an ear ly diagnosis in br east cancer. Most
of t h ese st u d ies sh ow t h at , in d iv id u ally, b eh av ior al
b elief s associat ed t o t h e lack of in f or m at ion an d a
dist or t ed per cept ion of t he disease lead, in a higher
or low er degr ee, t o t he av oidance of t he br east
self-exam , and r est r ict t he r equest for m am m ogr am s and
clin ical b r east ex am in at ion am on g w om en liv in g in
pover t y( 4- 5). Such fact m ay be under st ood consider ing t hat , in spit e of current scient ific advances in oncology,
t h e w o r d can cer i s st i l l co m m o n l y v i ew ed , i n t h i s
p o p u l a t i o n , a s a s y n o n y m o f p a i n , s u f f e r i n g ,
hum iliat ion, m ut ilat ion and deat h( 6).
Th e b e h a v i o r a l b e l i e f s t h a t m a k e t h e
adher ence t o t he m et hods used in ear ly br east cancer
diagnosis difficult am ong w om en of low er pur chasing
pow er m ay also in f lu en ce t h e em ot ion al r eact ion t o
t h e d i sea se a n d , t h u s, m a r k ed l y co m p r o m i se t h e
effect iv eness of st r at egies pat ient s adopt in t he fight
t o m ain t ain t h eir ow n liv es( 7 ). Th er ef or e, get t in g t o k n o w su ch b el i ef s i s i n d i sp en sa b l e f o r h ea l t h ca r e
p r o f e ssi o n a l s t o a v o i d t h e d i sq u a l i f i ca t i o n o f t h e
popular ex per ience of get t ing sick and, t hus, t o find
m eans t o m ax im ize t he r each of t heir int er v ent ions.
Based on t his pr inciple, t his st udy w as conduct ed t o
analy zing t he em ot ional r eact ions t o br east cancer in
a l o w - i n co m e g r o u p o f w o m e n . Su ch p u r p o se i s
w ar r ant ed due t o t he lack of r esear ch of t his nat ur e,
specifically dev eloped w it h t his populat ion.
METHOD
Ty pe of st udy
Th i s st u d y f o l l o w e d a d e scr i p t i v e , cr o
ss-sect ional and qualit at iv e design.
Th eor et ical- m et h od olog ical f r am ew or k
I n a classic st udy, a useful m et hodology w as
defined t o evaluat e t he psychological im pact of br east
cancer. The em ot ional r eact ions m oved by t he disease
in a sam ple of sixt y- nine pat ient s w er e evaluat ed t hr ee
m on t h s af t er su r gical t h er apy h ad been per f or m ed.
Fiv e y ear s lat er, t hese r esponses w er e r elat ed t o t he
t r eat m ent cour se. The r esult s obt ained show t hat t her e
w as a lar ger n u m ber of w om en f r ee of t h e disease
am ong t hose r eact ing t o br east cancer w it h denial or
show ing a fight ing spir it , t han am ong t hose r esponding
w i t h st o i c a cce p t a n ce o r f e e l i n g s o f d e st i t u t i o n .
m o b i l i z a t i o n e m e r g e s f r o m t h e co n t a ct w i t h t h e
d iag n osis r ealit y if b ased on a ser ies of b eh av ior al
b e l i e f s t h a t su p p o r t ce r t a i n b e h a v i o r s o f h e a l t h
sear ch( 8 ).
This m et hodology consist s in a classificat ion
sy st em t hat pr esum es t he ex ist ence of four m ut ually
ex clusiv e cat egor ies of em ot ional r eact ions t o br east
c a n c e r, n a m e l y : d e n i a l , s t o i c i s m , a f f l i c t i o n a n d
f i g h t i n g . Th e ca t eg o r y d e n i a l r ef er s t o r esp o n ses
show ing dissociat ion in t he psy chological ex per iences
em er ging fr om t he diagnosis, fr equent ly follow ed by
evasive or indiffer ent at t it udes. The cat egor y st oicism
com pr ehends em ot ional r eact ions based on t he belief
t hat t hey m ust st and t he suffer ing her oically. I n t his
case, t he disease m ay be seen as a t r ial t hat m ust be
passively accept ed or as a t est t o hum an lim it s, w it h
not hing left t o do, ex cept confor m at ion.
I n t h e ca t e g o r y a f f l i ct i o n , t h e r e sp o n se s
i n d i ca t e t h a t t h e e m o t i o n a l su f f e r i n g t h e w o m e n
ex p er ien ce d u e t o t h e d isease is v er y in t en se an d
surpasses t he adapt ive resour ces, so t hat she is unable
t o m o v e t o st o p i t . Fi n a l l y, t h e ca t e g o r y f i g h t i n g
cl a ssi f i e s t h o se b e h a v i o r s, f e e l i n g s a n d t h o u g h t s
show ing an at t it ude of fight ing t he sit uat ion dir ect ly.
I t is not ew or t hy t hat fight ing t he pr oblem is supposed
t o be a posit iv e adapt iv e r esour ce, cont r ar ily t o t he
fight ing cent ered on t he em ot ion, w hich charact erizes
t he t hr ee fir st cat egor ies of t he sy st em discussed.
Cau sal r elat ion
The st udy populat ion consist ed of 42 pat ient s
w h o, in t h e p er iod com p r eh en d ed b y t h e r esear ch
( Mar ch t o Decem ber 2 0 0 6 ) , w er e enr olled in a car e
en t it y f or social su p p or t t o m ast ect om ized w om en .
Th e sam ple w as com posed of 1 5 pat ien t s scr een ed
for m eet ing t he inclusion cr it er ia, i. e., w ho: a) w er e
3 0 t o 8 0 y ear s old ; b ) w er e d iag n osed f or b r east
cancer at least t hree m ont hs ear lier ; c) did not show
psychiat ric precedent s or suspect ed int ellect ual deficit ;
d) did not show evidence of r ecur r ence or m et ast asis,
an d e) h ad a f am ily in com e of u p t o t w o m in im u m
w ag es.
Th e m ean age of t h ese st u dy su bj ect s w as
57.5 year s old, ranging fr om 49 t o 72 year s old. Table
1 sy st em at izes a social- dem ogr aphic char act er izat ion
o f t h e s u b j e c t s a n d s h o w s , r e g a r d i n g c u r r e n t
o c c u p a t i o n , m a r i t a l s t a t u s a n d e d u c a t i o n a l
b ack g r ou n d , r esp ect iv ely, t h at eig h t of t h em w er e
h ou sew iv es, n in e w er e m ar r ied an d sev en d id n ot
f i n i sh el em en t ar y sch o o l . Ad d i t i o n a l l y, a m o n g t h e
sev en w om en w it h som e r em u n er at ed occu p at ion ,
occupat ions of low social pr est ige w er e pr edom inant ,
r e q u i r i n g l o w o r n o e d u ca t i o n a l b a ck g r o u n d a n d
pr of ession al qu alif icat ion .
Ta b l e 1 - So ci a l - d e m o g r a p h i c ch a r a ct e r i za t i o n o f
w om en w it h br east cancer. São Car los - SP, 2006
s t c e j b u
S Age EducationalBackground Current n o i t a p u c c O
l a t i r a M
s u t a t S
1 49y-o Incompleteelementaryschool Housekeeper Married 2 58y-o Incompletesecondaryschool Housewife Married 3 66y-o Incompleteelementaryschool Housewife Married 4 62y-o Incompleteelementaryschool Housewife Widow 5 52y-o Incompleteelementaryschool Artisan Cohabiitng 6 53y-o Incompletesecondaryschool Cook Single 7 60y-o Incompleteelementaryschool Housewife Cohabiitng 8 55y-o Incompleteelementaryschool Housewife Married 9 49y-o Incompleteelementaryschool Ironingwoman Married
0
1 57y-o Incompleteelementaryschool Housewife Single
1
1 64y-o Incompletesecondaryschool Dressmaker Married 2
1 69y-o Incompleteelementaryschool Housewife Widow 3
1 72y-o Completesecondaryschool Nursingaid Married 4
1 51y-o Completesecondaryschool Salespromoter Single 5
1 46y-o Incompleteelementaryschool Housewife Widow
I nst r um ent and Mat er ials
Fo r t h e d at a co l l ect i o n , a sem i - st r u ct u r ed
int er v iew scr ipt , a r ecor der and casset t e t apes w er e
u sed. Th e scr ipt em ph asized t h e su bj ect iv e aspect s
r elat ed t o how t he pat ient s evaluat e t heir healt h st at us
and t he em ot ional react ions unchained by t he disease.
The opt ion for t his k ind of inst r um ent w as based on
t h e pr in ciple t h at a sem i- st r u ct u r ed scr ipt w ou ld be
a b l e t o m a k e t h e e x a m i n a t i o n o f t h e e m o t i o n a l
r eact ion s cau sed b y b r east can cer v iab le, or ien t in g
t h e r e s e a r c h a c c o r d i n g t o c e r t a i n a s p e c t s t h e
r esear ch er s co n si d er ed m o r e r el ev an t an d , at t h e
sam e t im e, of f er in g t h e su bj ect s t h e oppor t u n it y t o
c o n f i g u r e t h e i n t e r v i e w f i e l d a c c o r d i n g t o t h e i r
indiv idual char act er ist ics, t hus helping t hem t o show ,
i n r e s p o n s e t o t h e q u e s t i o n s t h e y w e r e a s k e d ,
r esponses r epr esent ing t heir concept ions, v alues and
beliefs( 9 ).
Dat a collect ion pr ocedu r e
Th e in t er v iew s w er e per f or m ed in div idu ally,
f ace- t o- f ace an d au d io- r ecor d ed w it h t h e su b j ect s’
a g r e e m e n t . Th e e t h i c a l c o n d u c t s f o r r e s e a r c h
in v olv in g h u m an b ein g s w er e f u lly r esp ect ed . Th is
st u dy is par t of a br oader pr oj ect , appr ov ed by t h e
t h e i r f o r m a l a g r e e m e n t b y s i g n i n g a n i n f o r m e d
c o n s e n t f o r m , w h i c h e x p l a i n e d t h e i r r i g h t s a n d
em phasized t he volunt ar y nat ur e of t heir par t icipat ion.
I t is also im port ant t o highlight t hat t he invest igat ors
paid for t he t r anspor t at ion expenses of t he w om en t o
t he car e ent it y office, w her e t he dat a collect ion w as
p er f o r m ed .
Dat a an aly sis pr ocedu r e
The audio r ecor ds w er e t r anscr ibed fully and
l i t er al l y. Su b seq u en t l y, t h e em o t i o n al r eact i o n s t o
b r e a s t c a n c e r m e n t i o n e d b y t h e p a t i e n t s w e r e
classif ied in t o f ou r m u t u ally ex clu siv e cat eg or ies
-d en ial, st oicism , af f lict ion an -d f ig h t in g - u sin g t h e
sy st em alr eady m en t ion ed( 8 ). To av oid any ev en t u al con t am in at ion of t h e r esu lt s, t h e applicat ion of t h e
i n t e r v i e w a n a l y s i s p r o c e d u r e w a s p e r f o r m e d
i n d e p e n d e n t l y b y t w o e x p e r i e n ce d j u d g e s ( p o st
-g r a d u a t e d p sy ch o l o -g i st s) . Co n se n su a l l y cl a ssi f i e d
r e a c t i o n s w e r e a u t o m a t i c a l l y a c c e p t e d . Th e
r esea r ch er s d i scu ssed d i scr ep a n ci es ca se- b y - ca se
w it h t h e j u d g es u n t il a con sen su al ag r eem en t w as
r each ed .
RESULTS AND DI SCUSSI ON
The r esult s obt ained show t hat eight of t he
fift een subj ect s ( Subj ect s 1, 2, 3, 4, 6, 11, 12, and 15)
faced breast cancer as a fat alit y, in view of which t he
only at t it ude possible would be passive accept ance. I n
t h ese ca ses, ev en t h e a n a t o m i ca l l o sses i n cu r r ed
t hrough surgical t herapy caused conform ism . This kind
o f e m o t i o n a l r e a c t i o n , s u p p o r t e d b y a s p e c i f i c
beh av ior al belief adopt ed as a r esign at ion at t it u de,
m any t im es appeared as a way t o suffocat e pot ent ially
disrupt ing em ot ions, including indignat ion, rebellion and
anger about t he t hreat of a disease t hat could t ake her
life. Ther efor e, it is seen t hat st oicism w as t he m ost
frequent em ot ional react ion in t he st udy sam ple.
Th e n eed t o su f f ocat e t h e em ot ion s cau sed
b y t h e d i s e a s e b e c o m e s u n d e r s t a n d a b l e a s t h e
confir m at ion of a br east cancer diagnosis r epr esent s
a n i m p o r t a n t p sy ch o l o g i ca l t r a u m a i n m o st ca ses
b e c a u s e , a s s u p p o r t e d b y s p e c i a l i z e d s c i e n t i f i c
lit erat ure, t he disease involves t he m ain body sym bolic
su p p o r t o f w o m a n ’ s se n su a l i t y a n d se x u a l i t y( 1 0 ). Addit ionally, t he physical consequences and em ot ional
r eper cussions of t he t r eat m ent usually affect t he body
im age, n ot r ar ely leadin g t o r u pt u r es in t h e f em ale
i d e n t i t y. W i t h o u t t h e b r e a st , m a n y p a t i e n t s f e e l
r est r ained fr om w hat defines t heir nat ur e. Ther efor e,
accor ding t o a num ber of st udies, br east cancer m ay
be consider ed as one of t he m ost fear ed diseases by
w om en, independent ly of t he social lev el( 6).
The st at em ent show n below ex em plifies how
st oicism could be ident ified, in t he discourse of one of
t he subj ect s.
At t he t im e I was very scared. But t hen it was gone [ ...] Because our life is already writ t en, right ? I believe t hat everyt hing is fat e. So, w hat can w e do? Not hing, r ight ? ( Subj ect 6) .
The not ion of “ fat e” - w hich also appear ed in
t h e in t er v iew s as t h e ex pr ession “ div in e w ill” - w as
invoked in t hese cases t o j ust ify t hat , in view of w hat
w as supposedly designed for t hem ( “ w r it t en” in t heir
k ar m a) , n ot h in g cou ld b e d on e ex cep t accep t in g it
passiv ely. Som e pat ien t s ex pr essed t h is con for m ism
by saying t hat t hey put t hem selves in t he hands of a
su per ior bein g or ph y sician s, w h o cou ld su pposedly
w or k accor ding t o t he “ div ine w ill”.
Em ot ional r eact ions of t his nat ur e t end t o lead
t o a hesit at ing adher ence t o t he t r eat m ent indicat ed
b e c a u s e , e v e n i f t h e w o m a n c o n s e n t s t o f o l l o w
r ecom m en d ed con d u ct s, in h er in t im acy, t h er e w ill
alw ays be r oom for doubt and disbelief. I s it w or t h t o
go t h r ou gh all t h ese t r ials? I s t h is t r eat m en t r eally
t h e b est solu t ion ? Will ev er y t h in g b e alr ig h t in t h e
en d ? Qu est i o n i n g s si m i l ar t o t h ese m ay ar i se. As
ev er y t h in g is p r e- d ef in ed b y t h e d est in y t r aced f or
each , t h e ex ist en ce of ef f icien t m ean s t o in f lu en ce
t he appar ent ly ir r em ediable cour se of fact s w ould be
u n lik ely.
This incr edulit y also m anifest s it self in ot her
w ay s. Thr ee subj ect s ( Subj ect s 5, 9 and 13) show ed
t hat , w hen t he diagnosis w as confir m ed, t hey ignor ed
t h e se v e r i t y o f t h e d i se a se a n d , t h e r e f o r e , t h e y
d el ay ed t h e st ar t o f t r eat m en t . . Th at i s, i n t h ese
cases, t he disease led t o denial. I t is not ew or t hy t o
include t hat , as t he st at em ent below illust r at es, one
of t he subj ect s ex am ined m ent ioned t hat , ev en aft er
c o m p l e t i n g t h e t r e a t m e n t , s h e q u e s t i o n s t h e
m alignancy of her t um or.
I did t he chem o and t he lum p disappear ed. Then, I t hought it w as not cancer . So, I didn’t r et ur n t o t he doct or w hen t he sur ger y w as scheduled. I j ust w ent t hr ough t he sur ger y lat er because I not iced t hat t he lum p had r et ur ned. But , t o be honest , unt il now I have m y doubt s ( Subj ect 5) .
Th e d i scr e d i t o f sci e n t i f i c k n o w l e d g e a n d
Th e o c c u r r e n c e o f t h i s p h e n o m e n o n i s
pr obably associat ed t o t h e con dit ion of pov er t y t h e
st u dy su bj ect s liv e in as, for low - in com e people, t o
be sick m eans t o lose t he only r esour ce t hey have t o
liv e: t h e ab ilit y t o w or k( 1 1 ). Th is w ay, t o d eny t h e d i s e a s e m a y b e a w a y t o k e e p t h e r o u t i n e o f
h ou sek eepin g or pr of ession al act iv it ies an d t o f av or
t he pr ovision of basic needs, such as food and housing.
Mor eov er, it is f r eq u en t ly b eliev ed , in t h e p op u lar
cont ext , t hat a “ w om an cannot give her self t he luxur y
of being sick”, as t he essent ial r ole t o keep t he fam ily’s
w ell- being belongs t o w om en, w ho oft en leav e t heir
ow n w ell- being aside.
Only t w o pat ient s ( Subj ect s 8 and 10) r eact ed
t o br east cancer by fight ing, as t hey act iv ely sought
i n f o r m a t i o n a b o u t t h e i r o w n p r o g n o s i s , d i d n o t
su r r e n d e r b e f o r e t h e d i f f i cu l t i e s i n h e r e n t t o t h e
t r eat m ent , did not feel st igm at ized by t he disease and
did not feel r esent m ent by t he m ut ilat ion or oppr ession
by f eelin gs of sh am e. Th e r epor t below sh ow s h ow
t h is r eact ion cou ld be iden t if ied in t h e discou r se of
one of t he w om en.
I asked t he doct or w hat it w ould be like. I t w as t he fir st t hing I did. He explained ever yt hing. Then I did ever yt hing I had t o do. [ ...] Did you know t hat I knew a wom an at t he hospit al w ho did not accept t he t r eat m ent ? And she r eally didn’t do it ! So she died. Wow , t his never cr ossed m y m ind! ( Subj ect 8) .
Th e a c t i v e s e a r c h f o r i n f o r m a t i o n f r o m
healt hcar e pr ofessionals fr equent ly t r anslat es t he w ill
t o feel again in t he cont rol of t he fact s of t heir lives.
Th i s b a si c f e e l i n g i s p a r t i a l l y t a k e n a w a y b y t h e
ap p ear an ce of a sev er e d isease lik e b r east can cer.
Ther efor e, t o adopt a com bat ive and r ealist ic at t it ude
befor e t he disease m ay hav e a r epar at or y charact er,
i.e., it r epr esent s an at t em pt t o r egain self- dom inion
upon w hat happens t o you. To have t his kind of post ur e
t ow ar d s h er ow n d isease can m ak e t h e d if f er en ce,
pr obably dist in gu ish in g su r v iv or s f r om pat ien t s w h o
die becau se t h ey ign or ed t h e dan ger, as m en t ion ed
b ef or e in t h e ev alu at ion of t h e em ot ion al r eact ion
show n by Subj ect 8.
How ev er, it is em phasized t hat , t o fight t he
disease, a subj ect ive involvem ent w it h one’s ow n body
i s r e q u i r e d . Th e sci e n t i f i c l i t e r a t u r e sh o w s t h a t ,
g en er al l y, i n p o p u l ar l ev el s, t h e p er so n al p hy si cal
r esour ces ar e t oo used at w or k( 11). On t he ot her hand, lit t le at t en t ion is giv en t o body ex per ien ces ou t side
t his cont ex t . That is: a r eflex iv e r elat ion t o t he body
seem s t o be incom pat ible w it h it s ex plor at ion in t he
per f or m an ce of pr odu ct iv e act iv it ies. Th is r eason in g
w ould explain, at least par t ially, t he fact t hat t he fight ing
highlight ed as an em ot ional react ion t o t he disease is
uncom m on am ong t hese st udy subj ect s.
I n t w o cases ( Subj ect s 7 and 14) , a m ar ked
em ot ional m obilizat ion w as seen during t he int erview ,
j u s t i f y i n g t h e c l a s s i f i c a t i o n o f a f f l i c t i o n a s a
p r e d o m i n a n t e m o t i o n a l r e a c t i o n . Th i s p o s s i b l y
occur r ed because t he per spect iv e of r ecur r ence w as
liv ed as an im m in en t t h r eat , f r om t h e m et aph or ical
p o i n t o f v i e w , a n a l o g u e t o t h a t r e p r e s e n t e d i n
m y t hology by Dam ocles’ sw or d. Anguish and pur suit
rem ain in t hese subj ect s’ discourse, m onopolizing t heir
co n ce r n s w i t h a p o ssi b l e r e o ccu r r e n ce o f b r e a st
cancer, as m ay be seen in t he r epor t below.
Look, nobody knows what I ’ve been going t hrough. I ’m scar ed, desper at e! The doct or said t hat t he sur ger y is not a cer t aint y. I t hought t hat it w as j ust t o t ake out t he t um or and it w as done. But he said it m ay appear som ew her e else. Ther e is a lar ge r isk ( Subj ect 14) .
S o m e o f t h e r e a s o n s a s s o c i a t e d t o t h e
p r e v a l e n c e o f s t o i c i s m i n t h i s s t u d y a r e e a s i l y
assu m ed , con sid er in g t h at m an y st u d ies sh ow h ow
dist ur bing br east cancer m ay be. I n one of t hem , it
w as fou n d t h at on e- fou r t h of t h e w om en diagn osed
f or on e y ear m et t h e cr it er ia f or som e p sy ch iat r ic
disor der - especially an x iet y, depr ession an d sex u al
dysfunct ion - even if m ild( 12). Anot her r esear ch show ed t h a t f o u r i n f i v e p a t i en t s ex p er i en ce r ea ct i o n s o f
p sy ch olog ical su f f er in g in t h e f ace of t h e d iag n osis
and half of t hem int ensely enough t o be consider ed
as a psy chiat r ic disor der( 13).
How ever, t he r esult s of t his st udy suggest t hat ,
in low - incom e pat ient s t he elabor at ion of t he popular
ex p er ien ce of g et t in g sick is sp ecif ically in f lu en ced
by an au t om at ic associat ion bet w een br east can cer
and a pain fu l phy sical det er ior at ion pr ocess w it h n o
par allel in hum an ex ist ence. Such associat ion seem s
t o b e esp ecially m ar k ed in t h is p op u lat ion an d , as
already m ent ioned, in general, it is essent ially due t o
t he lack of infor m at ion and em ot ional appr ox im at ion
w it h can cer. Addit ion ally, it u su ally feeds beh av ior al
beliefs t hat m ak e adher ence t o secondar y pr ev ent ion
d i f f i cu l t a n d , co n se q u e n t l y, m a k e e a r l y d i a g n o si s
im p ossib le( 4 ). I t is ex act ly f or t h is r eason t h at t h e p a t i e n t ’ s so ci a l l e v e l i s co n si d e r e d a n i m p o r t a n t
pr ognosis fact or in br east cancer( 14).
Resear ch also show s t hat t he m ost fr equent
em ot ional react ion t o breast cancer in t his st udy sam ple
t ends t o pr om ot e, in pat ient s w it h t um or s in differ ent
t r an sact i o n s b et w een t h e su b j ect an d t h e co n t ex t
w ould be pot ent ially oppor t une for physical and m ent al
h e a l t h p r o m o t i o n . A l t h o u g h i t c o n t r i b u t e s t o a
t em por ar y decr ease in st r ess, t his pr ocess gr adually
leads t o in v alidism , ex t en din g bey on d t h e obj ect iv e
lim it at ions im posed by t he disease and, t hus, it m ay
com pr om ise t he dy nam ic adj ust m ent t o t he inher ent
dem ands of each of t he st eps t o com e, fr om diagnosis
t o t r eat m ent( 15- 16).
The act ual im plicat ions of t his inv alidism for
t he m ent al healt h of pat ient s fr om popular levels ar e
s t i l l u n k n o w n , a s t h e s t u d i e s s u p p o r t i n g t h e i r
a s s o c i a t i o n s t o s t o i c i s m w e r e n o t s p e c i f i c a l l y
d ev el o p ed f o r t h i s p o p u l a t i o n . Ho w ev er, i t seem s
r easonable t o t hink t hat t he phenom enon m ent ioned,
pr om ot ing a deficit in t he per for m ance of pr oduct iv e
a b i l i t y a n d i n t e n si f y i n g m a t e r i a l p r i v a t i o n , w o u l d
dram at ically affect t he sense of self- efficacy - i.e. t he
per cept ion of bein g com pet en t t o per f or m dif f er en t
daily act ivit ies - in w om en living in povert y. Aft er all,
t his w ould cause a cont inuous and pr ogr essive process
o f d i sa f f i l i a t i o n r e g a r d i n g t h e ca p i t a l i st m o d e o f
pr oduct ion cur r ent in t he globalized w or ld.
FI NAL CONSI DERATI ONS
I n s p i t e o f t h e p e r s p e c t i v e o b t a i n e d b y
h ear in g a r elat iv ely sm all n u m b er of p at ien t s, t h is
st u d y sh ow s t h at t h e em ot ion al r eact ion of w om en
f r om popu lar econ om ic lev els t o br east can cer m ay
b e r el at ed t o t h e u n f o l d i n g o f p o v er t y co n d i t i o n s,
w hich fr equent ly include lim it ed access t o infor m at ion
and t r eat m ent r esour ces. Mor eov er, it suggest s t hat ,
in t h is popu lat ion , poor adapt iv e st r at egies t en d t o
b e a d o p t e d i n t h e m a n a g e m e n t o f t h e e m o t i o n a l
r e p e r cu ssi o n s o f t h e d i se a se a n d t r e a t m e n t . Th e
f in din gs also cor r obor at e ev iden ce t h at , in pat ien t s
w it h br east can cer, cer t ain t r aces of per son alit y ar e
fr equent , such as t he t endency t o suppr ess em ot ions,
especially anger, and t o r espond t o st r ess by using a
r epr essiv e fight ing st y le( 12). New r esear ch is definit ely r equir ed, but t he r esult s r einfor ce t he not or ious need
f o r m u l t i d i s c i p l i n a r y h e a l t h c a r e e d u c a t i o n a l
pr ogr am s, com pat ible w it h t he cognit iv e and affect iv e
u n iv er se of low in com e w om en , w it h a v iew t o t h e
p o p u l a r i z a t i o n o f s e c o n d a r y b r e a s t c a n c e r
p r ev en t i o n .
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