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29 October 2014
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Adjusting to the news

Dr Suzy Jordache

Finding out you're suffering from a terminal disease can provoke a wide range of reactions that can be difficult to predict or understand. We look at what they are and how you can get help to adjust to your situation.

Initial reactions

Most people live their lives as if somehow immune to life-threatening events. They tend to believe they're in absolute control of their time here. A diagnosis of cancer or other life-threatening disease shatters these assumptions.

The immediate reaction to such bad news tends to be a mixture of disbelief, confusion, shock and numbness. Most people find it hard to remember what's been said and it's often necessary to go back over the information at a later stage when the shock of the news has passed a little.

Adjustment styles

Once the initial confusion and panic settles it seems that people interpret the threat posed by the bad news in several ways. Greer and Watson (1987) identified these five common adjustment styles:

  • Fighting spirit: 'This is a challenge. I'll win.'
  • Avoidance or denial: 'It's not that serious.'
  • Fatalism: 'It's out of my hands. I've had a good life - what's left is a bonus.'
  • Helplessness and hopelessness: 'There's nothing I can do. What's the point of going on?'
  • Anxious preoccupation: 'I'm so worried about everything all the time.'

Many individuals can adopt all five styles

These summarise the patterns of thoughts, feelings and behaviours that an individual may display. It can take weeks or months for a pattern to develop. Many individuals can adopt all five styles at different times during the initial adjustment period - swinging from positive to hopeless, through fatalism to periods of dark depression or complete denial.

Offering support

It can be difficult and frustrating for those trying to support someone during this time. Conversations and behaviours can feel repetitive and circular and enormous patience is required to be alongside someone during this traumatic period. Relationships within the family and with friends can come under huge strain. Consistent support without judgement or criticism is vital.

It's important to remember that the vast majority of people do cope well with bad news and develop good emotional adjustments. Very few people need specialist intervention from psychologists or counsellors.

Many publications and the media often promote the 'fighting spirit' as the best possible response to the news of cancer. These claims are mostly unfounded and hugely damaging to those individuals who cannot react in this way. No one facing the bad news that they've a life-threatening disease should be made to feel guilty about their emotional response. Different reactions are a result of many life experiences prior to the cancer threat, and as such are neither predictable, nor right or wrong.

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