To follow up on my January 25th column, "If Patients Feel Guilty....," here is another patient handout. May it support your efforts to help patients struggling with guilt about their possible-or likely-role in their cancer situation. Feel free to use it whatever way works well for you.

View from the Other Side of the Stethoscope

Dear Patient,

We want you to read this handout because you have expressed some concern about the role you may have played in your current health situation.

A natural reaction to a cancer diagnosis is asking, "Why did this happen to me?" While some people blame their disease on luck (or genes) and then don't give it another thought, others struggle with guilt and/or regret about their past actions.

It's important that you share any such concerns with us. We may be able to reassure you that your worries are unfounded-that you absolutely couldn't have done anything different to prevent your illness. Otherwise, we can help you deal with the past in healing ways.

Responding in Healthy Ways

Feeling guilty is not necessarily bad. We've seen patients whose regret has energized them to endure difficult therapies ("I got myself into this mess, and I'm going to get myself out of it"), motivated them to quit smoking cigarettes ("It took cancer, but now I know I can do it"), or sensitized them to the needs of loved ones ("It's the least I can do"). If a sense of guilt is serving a useful, healthy purpose, embrace those uncomfortable feelings and continue to use them positively.

Unfortunately, though, a sense of guilt (often mixed with shame, embarrassment, anger, or grief) just makes a bad situation worse for many patients by draining energy needed to cope. We've seen patients hide discomforts or refuse support, feeling responsible and believing they deserved to hurt (often that belief is subconscious and they are unaware of it).

The problem is that if guilt and regret are not addressed, they may interfere with your getting good medical care. And they may ruin opportunities for meaningful interactions and moments of joy, which may exacerbate your sense of isolation and increase the risk of depression.

If thoughts and feelings about the past are dragging you down, even a little, your job becomes finding ways to let go of guilt and regret. The bottom line is that you can't change the past. Feeling bad about it won't help anyone in any way. You simply have to let it go.

Letting Go

Some patients have trouble letting go because they expect the thoughts and feelings to disappear naturally, without any effort. Actually, you have to choose to let go. Letting go is an active-and sometimes difficult-process, like letting go of a favorite flannel shirt, too frayed to give warmth, tattered beyond repair.

With this in mind, try to see "letting go of guilt" as evidence of your commitment to your healing: "I want and need to direct all my energy to dealing with what's happening now, so I am choosing to let go of the past."

If "letting go" isn't easy, it may help to consider new ways of thinking about the past. For example, you can focus on the fact that you did not make past choices with the intention of the creating trouble. It would be a different matter if you had hoped to get cancer with the intention of using your illness to hurt others. Rest assured, everyone knows you did not want this disease or intend to hurt anyone. So, really, it's okay to let it go.

Here's another way to think about letting go: All of us live life forward in time, not backward. When we face problems, it's true that it may help to reflect briefly on the past for insights that help us take proper action from now on. But this reflection is healthy if, and only if, we keep it brief. In contrast, ongoing regret about what's over and done only hurts us by tethering us to the past, keeping us from seeing-and embracing-all the good in front of us. To move forward and live our life, we must let go of guilt and regret.

Specialists in Letting Go

Please tell us if you would like to speed up the process of letting go, especially if you have already tried the approaches discussed above. We work with a variety of specialists who can provide additional, effective ideas and techniques to help you let go. For some patients, talking with a counselor or spiritual leader is essential. We will ask you a few questions to determine which particular professional would be best for you.

You may think you don't have the time, energy, or finances to deal with this now. From our perspective, addressing guilt and regret is no different than tending to nausea, insomnia, or pain. The good news is that we can refer you to professionals in settings where finances are never a barrier to obtaining counseling. So, please, keep us informed if worries have not resolved completely.

What Now?

After a cancer diagnosis, your job involves mustering all your resources to make wise decisions and cope with the unwanted changes, losses, stresses and pain. By addressing worries about the past with people who can help, you help set the stage for getting good care and living as fully as possible today, tomorrow, and every day.