Embitterment pp 142-153 | Cite as

Cancer patients: Loss of meaning, demoralization and embitterment

  • Anja Mehnert
  • Sigrun Vehling


In the following chapter we outline the variety of psychosocial problems among patients during the course of cancer and provide a conceptual framework for the study of existential concerns in chronic illness. While referring to the newly proposed psychiatric syndrome of embitterment disorder, we shall introduce the concept of demoralization, a clinically relevant syndrome of existential distress and despair. Furthermore, we discuss psychotherapeutic interventions helping to sustain or enhance a sense of meaning and purpose in life. Despite some conceptual overlap, demoralization can be clinically differentiated from embitterment disorder characterized by intrusive memories, blame, dysphoria, and somatic complaints as reactions to a stressful life event, since demoralization refers to the human search for meaning in the face of serious illness including feelings of incompetence and failure, being unable to cope, helplessness, hopelessness, dysphoria, disheartenment and loss of meaning.


Cancer Survivor Autobiographical Memory Life Story Posttraumatic Growth Global Meaning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aapro M, Cull A (1999) Depression in breast cancer patients: the need for treatment. Ann Oncol 10:627–36PubMedCrossRefGoogle Scholar
  2. American Psychiatric Association (APA) (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association, WashingtonGoogle Scholar
  3. Baltes PB, Staudinger U (1996) Interactive minds in a life-span perspective. In: Baltes PB, Staudinger U (eds) Interactive minds: Life-span perspectives on the social foundation of cognition. Cambridge University Press, New York, pp 1–34Google Scholar
  4. Baumeister RF, Newman LS (1994) How stories make sense of personal experiences: Motives that shape autobiographical narratives. Pers Soc Psychol Bull 20:676–690CrossRefGoogle Scholar
  5. Bloom JR (2002) Surviving and thriving. Psycho-oncology 11:89–92PubMedCrossRefGoogle Scholar
  6. Bluck S, Levine LJ (1998) Reminiscence as autobiographical memory: A catalyst for reminiscence theory development. Ageing Soc 18:185–208CrossRefGoogle Scholar
  7. Breitbart W (2002) Spirituality and meaning in supportive care: spirituality-and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10:272–80PubMedCrossRefGoogle Scholar
  8. Breitbart W, Gibson C, Poppito SR, Berg A (2004) Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry 49:366–372PubMedGoogle Scholar
  9. Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Timm AK, Berg A, Jacobson C, Sorger B, Abbey J, Olden M (2009) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology doi:10.1002/pon.1556Google Scholar
  10. Brewer WF (1996) What is recollective memory? In: Rubin DC (ed) Remembering our past. Studies in autobiographical memory. Cambridge University Press, Cambridge, pp 19–65CrossRefGoogle Scholar
  11. Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A (2005) Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 330:702–06PubMedCrossRefGoogle Scholar
  12. Calhoun LG, Tedeschi RG (1998) Posttraumatic growth: future directions. In: Tedeschi RG, Park CL, Calhoun LG (eds) Posttraumatic Growth: Positive Changes in the Afermath of Crisis. Lawrence Erlbaum Associates Publishers, Mahwah, pp215–238Google Scholar
  13. Chang VT, Taler HT, Polyak TA, Kornblith AB, Lepore JM, Portenoy RK (2000) Quality of life and survival: the role of multidimensional symptom assessment. Cancer 83:173–179CrossRefGoogle Scholar
  14. Clarke DM, Kissane DW (2002) Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 36:733–42PubMedCrossRefGoogle Scholar
  15. Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P (2007) Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol 18:581–92PubMedCrossRefGoogle Scholar
  16. Folkman S (1997) Positive psychological states and coping with severe stress. Soc Sci Med 45:1207–1221PubMedCrossRefGoogle Scholar
  17. Folkman S, Greer S (2000) Promoting psychological well-being in the face of serious illness: when theory, research and practice inform each other. Psycho-oncology 9:11–19PubMedCrossRefGoogle Scholar
  18. Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55:647–654PubMedCrossRefGoogle Scholar
  19. Frankl VE (1955) Man’s search for meaning, 4th edn. Beacon Press, BostinGoogle Scholar
  20. Frankl VE (1969) The will to meaning. Foundations and applications of logotherapy, exp edn. Penguin, New YorkGoogle Scholar
  21. Frankl VE (2005) Ärztliche Seelsorge. Grundlagen der Logotherapie und Existenzanalyse.Zehn Tesen über die Person, 11th edn. Deuticke, WienGoogle Scholar
  22. Grassi L, Sabato S, Rossi E, Biancosino B, Marmai L (2005) Use of the diagnostic criteria for psychosomatic research in oncology. Psychother Psychosom 74:100–107PubMedCrossRefGoogle Scholar
  23. Habermas T, Bluck S (2000) Getting a life: the emergence of the life story in adolescence. Psychol Bull 126:748–69PubMedCrossRefGoogle Scholar
  24. Holland JC (2002) History of psycho-oncology: overcoming attitudinal and conceptual barriers. Psychosom Med 64:206–21PubMedGoogle Scholar
  25. Holland JC, Reznik I (2005) Pathways for psychosocial care of cancer survivors. Cancer 104:2624–2637PubMedCrossRefGoogle Scholar
  26. Janoff-Bulman R (1992) Shattered Assumptions: Toward a New Psychology of Trauma. Free Press, New YorkGoogle Scholar
  27. Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL (2006) Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychol 25:753–761PubMedCrossRefGoogle Scholar
  28. Jim HS, Andersen BL (2007) Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. Br J Health Psychol 12:363–381PubMedCrossRefGoogle Scholar
  29. Kangas M, Henry JL, Bryant RA (2002) Posttraumatic stress disorder following cancer. A conceptual and empirical review. Clin Psychol Rev 22:499–524PubMedCrossRefGoogle Scholar
  30. Kissane DW, Clarke DM, Street AF (2001) Demoralization syndrome — a relevant psychiatric diagnosis for palliative care. J Palliat Care 17:12–21PubMedGoogle Scholar
  31. Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, Love A, Ranieri N, McKenzie D (2003) Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psycho-oncology 12:532–546PubMedCrossRefGoogle Scholar
  32. Kissane DW, Yates P (2003) Psychological and existential distress. In: Aranda S, O’Connor M (eds) Palliative care nursing: A Guide to Practice. Ausmed, Melbourne, pp 229–244Google Scholar
  33. Kissane DW, Grabsch B, Love A, Clarke DM, Bloch S, Smith GC (2004) Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis. Aust N Z J Psychiatry 38:320–326PubMedGoogle Scholar
  34. Knobf MT (2007) Psychosocial responses in breast cancer survivors. Semin Oncol Nurs 23:71–3PubMedCrossRefGoogle Scholar
  35. Lee V (2008) The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer 16:779–785PubMedCrossRefGoogle Scholar
  36. Lethborg C, Aranda S, Cox S, Kissane DW (2007) To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliat Support Care 5:377–388PubMedCrossRefGoogle Scholar
  37. Linden M (2003) Posttraumatic embitterment disorder. Psychother Psychosom 72:195–202PubMedCrossRefGoogle Scholar
  38. Linden M, Baumann K, Rotter M, Schippan B (2008) Posttraumatic embitterment disorder in comparison to other mental disorders. Psychother Psychosom 77:50–56PubMedCrossRefGoogle Scholar
  39. McCormick TR, Conley BJ (1995) Patients’ perspectives on dying and on the care of dying patients. West J Med 163:236–243PubMedGoogle Scholar
  40. Mehnert A, Koch U (2007) Prevalence of acute and post-traumatic stress disorder and comorbid mental disorders in breast cancer patients during primary cancer care: a prospective study. Psycho-oncology 16:181–8PubMedCrossRefGoogle Scholar
  41. Mehnert A, Koch U (2008) Psychological comorbidity and health-related quality of life and its association with awareness, utilization and need for psychosocial support in a cancer register based sample of long-term breast cancer survivors. J Psychosom Res 64:383–391PubMedCrossRefGoogle Scholar
  42. Mullan F (1985) Seasons of survival: reflections of a physician with cancer. N Engl J Med 313:270–273PubMedCrossRefGoogle Scholar
  43. National Institutes of Health (NIH) (2006) ( Accessed 02.09.2010Google Scholar
  44. Palmer SC, Kagee A, Coyne JC, DeMichelle A (2004) Experience of trauma, distress, and post-traumatic stress disorder among breast cancer patients. Psychosom Med 66:258–264PubMedCrossRefGoogle Scholar
  45. Park CL, Folkman S (1997) Meaning in the context of stress and coping. Rev Gen Psychol 1:115–144CrossRefGoogle Scholar
  46. Park CL, Edmondson D, Fenster JR, Blank TO (2008) Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs. J Consult Clin Psychol 76:863–875PubMedCrossRefGoogle Scholar
  47. Reker GT, Peacock EJ, Wong PT (1987) Meaning and purpose in life and well-being: a life-span perspective. J Gerontol 42:44–49PubMedGoogle Scholar
  48. Reker GT, Wong PTP (1988) Aging as an individual process: Toward a theory of personal meaning. In: Birren J, Bengtson V (eds) Emergent theories of aging. Springer, New York, pp 214–246Google Scholar
  49. Reker GT (1996) Manual of the Sources of Meaning Profile — Revised. Students Psychologists Press, PeterboroughGoogle Scholar
  50. Reker GT (1997) Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly. Gerontologist 37:709–716PubMedGoogle Scholar
  51. Reker GT (2000) Teoretical Perspective, Dimensions and Measurement of existential meaning. In: Reker GT, Chamberlain K (eds) Exploring existential meaning. Optimizing human development across the life span. Sage Publications, Tousand Oaks, London, pp 39–55Google Scholar
  52. Robert Koch-Institut, Gesellschaf der epidemiologischen Krebsregister in Deutschland e. V. (Hrsg) (2008) Krebs in Deutschland 2003-2004. Häufigkeiten und Trends. BerlinGoogle Scholar
  53. Simonelli LE, Fowler J, Maxwell GL, Andersen BL (2008) Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator. Ann Behav Med 35:275–284PubMedCrossRefGoogle Scholar
  54. Tedeschi RG, Calhoun LG (1996) The Posttraumatic Growth Inventory: measuring the positive legacy of trauma. J Trauma Stress 9:455–471PubMedCrossRefGoogle Scholar
  55. Westman B, Bergenmar M, Andersson L (2006) Life, illness and death — Existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. Eur J Oncol Nurs 10:169–176PubMedCrossRefGoogle Scholar
  56. Xuereb MC, Dunlop R (2003) The experience of leukaemia and bone marrow transplant:searching for meaning and agency. Psycho-oncology 12:397–409PubMedCrossRefGoogle Scholar
  57. Yalom I (1980) Existential Psychotherapy, Basic Books, New YorkGoogle Scholar
  58. Zabora J, Brintzenhofeszoc K, Curbow B, Hooker C, Piantadosi S (2001) The prevalence of psychological distress by cancer site. Psychooncology 10:19–28PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2011

Authors and Affiliations

  • Anja Mehnert
    • 1
  • Sigrun Vehling
    • 1
  1. 1.Department of Medical Psychology Center of Psychosocial MedicineUniversityMedical Center Hamburg-EppendorfHamburgGermany

Personalised recommendations