"Whatever your conception of health is, a diagnosis of cancer changes that," said Beth Israel Deaconess Medical Center's Dr. Michael Miller, who is also editor-in-chief of the Harvard Mental Health Letter. "Cancer can be attacked with chemotherapy, radiation, or, as in Jerry Remy's case, a tumor can be physically removed from your body. But you may worry about having lost your own vitality. You worry about how others see you. You become self-conscious about a new identity as an ill person."
Hester Hill Schnipper is a licensed clinical social worker and chief of oncology social work in the cancer center at Beth Israel Deaconess Medical Center. For thirty years she has helped patients and caregivers cope with the mental and emotional stress that can come with cancer.
"About 25 percent of cancer patients will express feelings of depression at some point after their initial diagnosis," she explained. "But almost without exception, every one will experience a psychological or emotional struggle with feelings of anxiety, worry, despair."
Three decades of counseling cancer patients can give you a pretty good feel for the numbers, but Hester Hill Schnipper's experience goes beyond facts and figures. As a breast cancer survivor, she's well acquainted with the feelings.
"For anyone who has cancer -- regardless of prognosis or treatment outcome -- there is no such thing as a clean bill of health. We never get a promise," she noted. "You might say that nobody does, but as one of my patients once put it, 'While we all could get hit by a bus, I see it coming around the corner with my name on it.'"
Generally, there is a good deal of support for patients from friends and family. People can be very sympathetic, for a time.
"Talking about cancer is not as taboo as it was a generation or two ago," said Dr. Miller. "Soon after a cancer diagnosis and early treatment, people with cancer can usually talk to friends about their fears. They may find a confidant to talk about mortality, to take stock of life, consider their legacy and their worries about not having time to accomplish all they want. But some may feel there is a taboo about talking about depressed mood or a lack of motivation to stay engaged."
The most difficult time is often when cancer treatment ends, according to Schnipper. When that initial adrenaline rush has long since dissipated and patients no longer have to worry about coordinating four appointments a week, many turn inward with painful results. That's why Jerry Remy's decision to speak out about his depression, his therapy and medication was so significant.
"We have a number of good ways to treat depression, but the only way we are going to eliminate the stigma surrounding it and other mental illness is to talk about it," she said. "To have a very public person like Jerry Remy do it--it's fantastic. Especially for men, who are notoriously reluctant to seek support."
"When Jerry Remy speaks about this in a matter-of-fact way, it can only help," according to Dr. Miller. "If you have kidney disease there is no stigma, but there is stigma about psychiatric illness -- partly because the illness is located in the brain, and the brain is where we live. It's that overlap of biological function and identity that makes us confuse concepts of illness and morality. It's not about character. It's not a moral issue. It's a medical issue.
"Think of it this way: Hitting a baseball is difficult. When a player is in a slump, he's likely to talk to a hitting coach. Maybe they tweak his swing or his stance and they keep working until things get better. Well, life is difficult, too. Talking and medication can help. The important thing is to recognize you need help, to keep at the problem the way a player might keep working on his swing, and usually things improve." In other words, listen to the Rem Dawg and stay tuned in to yourself.
Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of the Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.