Befriending the Monster at the Door - By Rob Rutledge MD

Dr. Rutledge was a guest speaker at the Young Adult Cancer Conference on June 7th in Toronto. After hearing Travis Gobeil speak at the conference, Dr. Rutledge wrote this article:


Befriending the Monster at the Door

“It’s like there’s a huge monster at the door and he’s so scary that I don’t even know what he looks like”. Travis, a young man in his early thirties, tells a group of cancer survivors what it’s like to live with the anxiety and the panic attacks that he has suffered since his diagnosis of Hodgkin’s lymphoma, over eight years ago. 

“If the monster started knocking at the door, I would just cower in the basement, covering myself up with blankets, hoping he would go away.” He speaks figuratively about the first few years after the diagnosis when, at seemingly random times in his life, he would suddenly be overwhelmed with such a heart-pounding sense of dread, he thought he would die. Trying to ignore the feelings or escaping what was happening by distracting himself with video games simply wasn’t working. “It just felt like every time I didn’t acknowledge him, he would come back even stronger and uglier. His pounding just got worse and worse.”

The leader of the session explained the difference between a defensive mechanism and a conscious strategy of working with anxiety. A defense mechanism is a way for the psyche to simply suppress the overwhelming feelings so that we can continue to function – usually only just well enough to get by. Suppression happens mostly at a subconscious level, and does not allow the psyche to process, come to terms, or even potentially reframe or overcome the source of the anxiety. Developing a conscious strategy to work with the anxiety takes deliberate intention and work – and ultimately will allow the brain to rewire itself.

The first step is to acknowledge, and with time, accept that anxiety is a natural part of life. (Of note: anxiety significantly affects at least 20% of people affected by cancer). Our ancestors developed these deeply seated psychological mechanisms to learn from fearful situations so that we humans wouldn’t repeatedly expose ourselves to predictable/known risks. ‘Once bitten, twice shy’ stops us from re-provoking an aggressive dog and increases our chance of survival. Anxiety and panic attacks become problematic when they persist unnecessarily and cause us debilitating symptoms.

Travis then describes the classical desensitization process. “Finally, I got some help. I learned that if I heard the knocking at door, instead of running away, I would actually go to the front door. At first, I’d look through the peephole at the monster – even just for a moment. It helped me to see him as a large red bull -horned beast – it’s both visual and visceral – and it gave me a sense of control. Over time, I could open up the front door just a crack and I’d tell the monster to go away. We weren’t really friends. As the years went by, I’d hear the monster there, and kind of shout out to him ‘OK. I hear you. Thank you. You can go away now.’ And his knocking got a lot quieter.”

The work here is to accept whatever feelings and thoughts are knocking at our inner door. To stay with the most difficult feelings. Simply Stay. Acknowledge. Even befriend the monster at the door. Like the 15^th century Sufi mystic Rumi suggests in his poem The Guest House (translation Barkman Coles) the difficult emotions point us to something bigger in ourselves.

This being human is a guest house

Every morning is a new arrival

A joy, a depression, a meanness

Some momentary awareness arrives as an unexpected guest

Welcome and entertain them all!

Even if they’re a crowd of sorrows who violently

sweep your house empty of its furniture

Welcome and entertain them all

They may be clearing you out for some new delight

The dark thought, the shame, the malice

Meet them at the door laughing

and invite them in

Be grateful for whoever comes

For each has been sent

as a guide from beyond.

One of the many benefits of a meditation practice is that it can help to bring a sense of spaciousness and awareness that can hold whatever is coming up in the level of our mind. Brain science shows that meditation empowers the left prefrontal lobe which is responsible for dampening down over-exaggerated emotions. Our brains become wired to gently hold all of our experiences with a greater sense of equanimity and compassion for ourselves.

Travis’ final words to the group offer great wisdom. “I don’t think you want give the monster a big hug right away. It takes time. Lots of time. And I think the monster will be part of my life from now on.” Then Travis’ tone gets really serious as he looks directly at all the people in the room. “I can’t say how important it was for me to get some professional help. So if you have any issue I really think it’s best to see a councillor, or social worker or whoever. It makes all the difference in the world.”