Tina Morris

Psychological and social adjustment to mastectomy. A two‐year follow‐up study

A consecutive series of 160 women admitted to hospital for breast tumor biopsy was assessed prior to, and at 3, 12, and 24 months following operation for marital, sexual, interpersonal and work adjustment, depression, and personality characteristics by means of rating scales based on structured interviews and standard tests. By 2 years there were no significant differences in social adjustment between mastectomy patients and benign breast disease controls; 70% of cancer patients were no longer stressed by mastectomy at 1 year. Factors predicting poor adjustment to mastectomy were high preoperative scores on the Hamilton Rating Scale for Depression and the Neuroticism Scale of the Eysenck Personality Inventory; deterioration in sexual adjustment was associated with biological or chronological perimenopausal status. Significantly more cancer than benign disease patients were dissatisfied with the information they received about operation and diagnosis. Implications of these findings for the care of the mastectomy patient are discussed.

Psychological attributes of women who develop breast cancer: a controlled study.

As part of an interdisciplinary study of breast cancer, psychological investigation of a consecutive series 160 women admitted to hospital for breast tumour biopsy was carried out by means of detailed structured interviews and standard tests. Interviews and testing were conducted on the day before operation, without knowledge of the provisional diagnosis. Information obtained from patients was verified in almost all cases by separate interviews with husbands or close relatives. Present results are based on statistical comparisons between 69 patients found at operation to have breast cancer and a control group comprising the remaining 91 patients with benign breast disease. Our principal finding was a significant association between the diagnosis of breast cancer and a behaviour pattern, persisting throughout adult life, of abnormal release of emotions. This abnormality was, in most cases, extreme suppression of anger and, in patients over 40, extreme suppression of other feelings. Extreme expression of emotions, though much less common, also occurred in a higher proportion of cancer patients than controls. Previous reports of correlations between breast cancer and extraversion, previous stress and depression were not confirmed.

Patterns of expression of anger and their psychological correlates in women with breast cancer

Abstract Previous work from the Faith Courtauld Unit described an association between the diagnosis of breast cancer and an apparent tendency to suppression of anger, particularly in younger patients. A detailed study of this phenomenon has been carried out in 71 patients prior to breast biopsy, using structured interviews, the Eysenck Personality Questionnaire (EPQ) and the Spielberger State—Trait Anxiety Inventory (STAI). Taped transcripts of interviews, independently rated, using a revised anger rating scale, again demonstrated a significant difference between patients with benign breast disease and those with breast cancer in expression of anger. Mean EPQ ‘N’ score was significantly lower for cancer patients. STAI A-State and A-Trait anxiety scores were significantly higher than standard scores for all patients other than young cancer patients. The pattern of correlation between variables differed for the two diagnostic groups suggesting (a) that cancer patients are more stressed by impending biopsy and (b) that young cancer patients are more likely than other patients to use denial in the face of stress.

Development of a method for rating cognitive responses to a diagnosis of cancer

The development of a method for rating cognitive responses to the diagnosis of early breast cancer, lymphoma and Hodgkins disease is described in the context both of recent coping theory and a previous study by this Unit relating outcome to response to diagnosis. The ratings are defined in a manual using simple language and avoiding assumptions about the functions of responses; examples are given.

The study of psychological factors in breast cancer: problems of method.

Abstract Since Galens observation that “melancholic” women were more likely to develop cancer than “sanguine” women, a number of eminent clinicians have suggested that personality characteristics and stressful life experiences may contribute to the development, or influence the course, of breast cancer. Psychological examination of women with breast cancer has led some psychiatrists to similar conclusions. Previous reports, although based on uncontrolled observations and inadequately designed studies, provide a valuable source of testable hypotheses. However, attempts to verify these hypotheses in such a way as to meet the customary requirements of scientific evidence are beset by major obstacles. We review the literature, explore problems of methodology in detail, and describe our attempt to overcome these problems in a systematic controlled study. Although major sources of bias have been avoided in the present study, critical examination of our methods reveals several limitations. These are discussed. Further advances in this area depend upon still more stringent methods. We make certain recommendations in this regard.

Psychosocial aspects of breast cancer; a review☆

A fascinating new study [2] has explored these differences in perception. One finding throws much light on controversy about breast cancer; and, in the psychological sphere, does much to explain the peculiar blend of overconcern and inaction which afflicts us. While 59% of healthy men and 26% of healthy women think breast cancer is “the worst thing that can happen to a woman” only 6% of fiatients think this. It is without question men who determine the treatments available to women with breast cancer. It may therefore be these very differences in perception, between sufferer and non-sufferer, between men and women, which make for those controversies. There is still much ignorance of what women feel and many assumptions are made on their behalf by the clinicians treating them [S]. Clinicians dealing with breast cancer do not escape the cultural stereotypes that surround