Grief and/or Gratitude? Choosing Your Truth in the Cancer Experience

February 27, 2020
Wendy G. Lichtenthal, PhD, FT

Dr. Wendy G. Lichtenthal is a clinical psychologist and director of the Bereavement Clinic at Memorial Sloan Kettering Cancer Center. She specializes in helping people with cancer and their loved ones.

In his book, Existential Psychotherapy (p. 219), Dr. Irvin Yalom shared the following reflections:

“I was snorkeling alone in the warm, sunny, clear waters of a tropical lagoon and experienced, as I often do in the water, a deep sense of pleasure and coziness. I felt at home. The warmth of the water, the beauty of the coral bottom, the sparkling silver minnows, the neon-bright coral fish, the regal angel fish, the fleshy anemone fingers, the esthetic pleasure of gliding and carving through the water, all in concert created an underwater elysium. And then, for reasons I have never understood, I had a sudden radical shift in perspective. I suddenly realized that none of my watery companions shared my cozy experience. The regal angel fish did not know that it was beautiful, the minnows that they sparkled, the coral fish that they were brilliant. Nor for that matter did the black needle urchins or the bottom débris (which I tried not to see) know of their ugliness. The at-homeness, the coziness, the smiling hour, the beauty, the beckoning, the comfort—none of these really existed. I had created the entire experience! … It was as though I peered through a rent in the curtain of daily reality to a more fundamental and deeply unsettling reality.”

I often give this passage to individuals I work with and ask for their reactions. The idea that we create our reality—that in our worlds it can be true that there are both beautiful fish and ugly debris, and our experience depends on where we choose to look—can be a provocative one in the context of cancer and loss.

So, which of the following is true?

Cancer brings loss. Cancer brings grief. Cancer brings fear. You are a victim. You are suffering.

Or, cancer brings appreciation. Cancer brings change. Cancer brings connection. You are a survivor. You are resilient.

Or, can all of these things be true?

Living with multiple truths

However you may have been touched by cancer, chances are you’ve experienced grief, fear, and anger at some point. Why? Because for most people, cancer brings threat and loss in some form. The losses might be subtle or more extensive—physical losses, relationship losses, the loss of “who you were” before cancer entered your life.

And chances are, even if you haven’t experienced it personally, you’ve heard of people who describe how they’ve experienced growth, appreciation, and gratitude after cancer entered their lives.

The remarkable thing about our minds is that we construct our reality and can adopt an infinite number of perspectives about a given situation. What that means is there is an infinite number of “truths” about any given experience.

Are there parts of your experience from which you have grown? The answer can be yes.

If you could undo this entire experience, would you? The answer can also be yes.

Do you feel more vulnerable since the diagnosis? Do you simultaneously feel like you can handle more than you could before cancer?

It is important to allow the coexistence of these truths. Our minds are capable of creating almost any story we choose. This can be a blessing when we choose self-compassionate narratives that allow us to make healthy choices for ourselves. But this can also be a burden when we are self-critical or are focusing on the worst-case scenarios.

The bottom line is that how we think about things affects our experience of them.

Choosing “and” experiences instead of “or” experiences

For those who are experiencing a complex set of feelings about their cancer experience (which is basically everyone), it’s common to question why one set of feelings is dominating at a given time. I work with many people who, when feeling especially sad, ask themselves, “Why aren’t I grateful for what I do have?” They are hard on themselves. Similarly, I work with people who, when feeling especially joyful, ask themselves, “Why I am feeling happy when things are so off? Does it mean I’m ‘okay’ with this awful thing that happened?”

When people think they should be feeling differently than they do, they often get stuck.

So, the trick is giving yourself permission to experience these “multiple truths” and understanding that it is an “and” experience (sad and grateful) instead of an “or” experience (sad or grateful).

Once you give yourself that permission, you can then choose to portray certain feelings more often than others. I use the word “choose” carefully here with the understanding that there are many aspects of one’s appearance that one has no choice over. There are many visible signs of cancer that are beyond one’s control. But to the extent that someone with cancer can make choices, what narrative do you choose to portray? Remember, in all that is out of control, this is within your control.

The truth you choose to live

Another byproduct of living with multiple truths is that the people who know you may not understand the complexity of what you are experiencing. Your suffering, your symptoms, your grief, and your fear are often invisible. Your loved ones may not fully comprehend that, despite all you are going through, you can also have moments of feeling joyful and grateful. That doesn’t mean you’re “over it.”

It can help to gently share with others—especially those who might not be aware of the complexity of your experience—that you may be feeling one way at a given moment but that does not mean that you are not also experiencing other, seemingly opposite feelings.

Ultimately, you can decide what cancer means to you. You can decide at any time if you are allowed to feel grief—to crawl into bed and pull the covers over you. Or, you can decide to focus in the same moment on what matters most to you and step into life as fully as possible. This should not be an either/or. Sometimes you may need to pull the covers over your head, and sometimes you may be smelling the roses.

I am not suggesting that you can choose your feelings. But you can choose the meaning you make of them. There are multiple truths in the experience and in how we feel. There are multiple truths in who we are. There are multiple truths in what the cancer experience brings.

So what is the truth? Well, whatever you focus on can become your truth.

Remember, grief and gratitude can coexist. Give yourself permission to experience the entirety of what you’re feeling. Then, when you need respite from a given angle or perspective, nurture the alternative. You can amplify a perspective you value by sharing it, by journaling about it, or by working through it through self-talk. Be flexible when a certain perspective isn’t working for you.

You are the author of your story. You are the creator of your truth. You can be the voice of compassion. 

No one chooses cancer. But you can choose your “truth.”


Yalom, I. D. (1980). Existential psychotherapy. New York, NY: BasicBooks.

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