The US defense secretary is facing scrutiny after failing to immediately disclose to the White House his recent diagnosis of prostate cancer and a related hospitalization, a breach of protocol for which he apologized.

But while Secretary Lloyd J. Austin III, as a Cabinet member, faces certain expectations about what and when he should publicly disclose about his health, mental health experts who work with patients with serious illnesses, such as cancer, say reluctance is common – even in the age of oversharing online.

“I see it all the time with my patients,” said Dr. Andrew Esch, senior education advisor at the Center to Advance Palliative Care, a national health care advocacy organization based in New York. “It’s very human not to want to get skinned in front of the whole world.”

There are many reasons why people might choose to keep their illness to themselves in certain settings, experts say, but some are more common than others. Privacy can be a coping strategy, Dr. Itai Danovitch, chair of the department of psychiatry and behavioral neuroscience at Cedars-Sinai in Los Angeles, particularly in the first days after a diagnosis, when patients are inundated with new information.

“We use different strategies to try to control things that are out of control,” he explained. “One of the common mechanisms we use is to compartmentalize. » Although compartmentalization, or separating certain thoughts and emotions, is often maligned, it is adaptive, Dr. Danovitch said. For example, it can help people stay focused on their work even when illness causes significant stress.

Dr Danovitch warned, however, that if the compartments become too “deep and separate” they could prevent people from receiving necessary treatment. I gave the example of a patient who doesn’t have follow-up testing for a suspicious mass because it’s too stressful.

Others may struggle with how vulnerable it is to reveal an illness, said Steven Meyers, professor and chair of the psychology department at Roosevelt University in Chicago. They may discover that their diagnosis is stigmatized and that they may expose themselves to pity.

“Some people view being healthy and physically capable as essential to their role or identity,” he said. “These people will have a much more difficult time admitting publicly that they feel diminished in their self-esteem. “These people will also be much more concerned about being a burden to others.”

Cultural and generational norms can also influence the decision to disclose, said Dr. Jesse Fann, medical director of psychiatry and psychology at the Fred Hutchinson Cancer Center in Seattle. He said he’s seen a general trend where young people who grew up on social media are more open about their diagnoses.

Mr. Austin, on the other hand, who is 70, is “fiercely private.”

Although experts were reluctant to prescribe circumstances under which anyone “should” share, they said certain factors could help influence the decision. Some powerful arguments for disclosing a health problem relate to protecting your own health.

“I always validate a person’s desire for privacy, regardless of their reasons,” Dr. Fann said. “But I also explain that keeping their diagnosis completely secret, or not being able to talk about it, can actually make it difficult for them to seek help when needed – very concretely, getting a ride to get treatment or getting a listening ear when necessary. “you’re stressed.”

Keeping a low profile can also lead to social isolation.

“Loneliness has a profound impact on a patient’s ability to live with the illness they are living with,” Dr. Esch said. “The burden of secrecy really contributes to a lot of stress, anxiety and depression.

But another consideration, besides how keeping an illness private can affect personal well-being, is the right of others to know, Dr. Meyers said, which is not absolute.

“Not everyone is required to know every detail of a person’s confidential medical condition,” he said. You can reveal an illness to a friend, but not go into detail about your treatment; or you could tell your employer about a life-changing diagnosis, but only after you’ve had time to discuss the long-term plan with your doctor. (In general, most employees are not required to share personal health information.)

Dr. Meyers recommends asking yourself: Is the person a “stakeholder” when it comes to your life and well-being or just a “bystander”? Spectators don’t really have a “right to know”, he said, while stakeholders will be affected, and this should be taken into account.

In other words, you may want to tell your immediate family about a diagnosis, but not your entire social network.

“For those who are fortunate enough to have others in their professional and personal lives who would provide support, assistance and care, disclosure could be a very positive thing,” Dr. Meyers said. “But each individual really needs to assess their psychological safety and the practicalities of being vulnerable.”

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