Although most of us have lived the truth of the statement “the only constant thing in life is change”, we don’t always feel ready for the changes that unfold in our lives. Some changes improve our daily living conditions but may require subtle, though significant, adjustments in self-image, daily routines, and relationships with others. For many new ostomates, the initial changes in lifestyle can feel emotionally daunting and possibly even overwhelming. Processing these changes and adapting to a new lifestyle requires support.

For new ostomates, the post-surgical sense of relief from imminent health threats can be quickly replaced by feelings of grief, embarrassment, awkwardness, loneliness and even shame. One can subconsciously grieve for the loss of “wholeness” of his/her physical form. There may be a change in self-image; for a period of time new ostomates may see themselves differently and struggle to form a new identity. Accompanying this sense of loss are the changes in one’s perception of individual freedom in lifestyle. They may continue to feel challenged by the uncertainty associated with their health prognosis.
Then there are the feelings of awkwardness and shame, leading to potential self-imposed social isolation. Learning to work with ostomy appliances requires patience and a new way of appreciating one’s physiological functioning. We in the western culture have a general discomfort with topics that involve the elimination of waste. This tendency contributes to new ostomates’ feeling of awkwardness; they can even feel that they have a “dark secret” which they should conceal. What follows may be social isolation. It is simply easier for someone to remain by him/herself and not risk any kind of ostomy-related accidents around friends, co-workers, or even family members. The social-isolation then becomes another part of losing one‘s pre-surgical lifestyle, to the detriment of one’s sense of adequacy in social relationships.

Recognizing the Symptoms

Understandably, this complex grief is often unacknowledged but manifests itself in depressed moods and seemingly inexplicable bouts of sadness. As well, it is common and human that when we grieve for a loss, we are reminded of and re-experience much of our unprocessed grief of losses from the past. Daily living can feel like heavy work. Although individuals experience depression differently, the common set of symptoms include the following:

• Feelings of helplessness and hopelessness
• Loss of interest in daily activities
• Appetite or weight changes
• Sleep changes
• Anger or irritability
• Loss of energy
• Self-loathing
• Reckless behaviour
• Concentration problems
• Unexplained aches and pains

The good news is that new ostomates need not suffer through the emotional ordeals described above. Obtaining necessary and accurate information from health service providers such as your doctors and ET nurses is crucial and takes the uncertainty out of the “how-to’s”. Taking part in a buddy-program or group therapy helps one develop helpful social connections in which the participants share experiences and useful tips from one another. Counselling therapy supports ostomates by providing a secure, supportive and confidential environment wherein they can begin to verbalize their thoughts and feelings. For many, it may be difficult to find the language to vocalize their sense of discomfort, awkwardness, shame, and grief. However, counselling therapists are attuned to the needs of their clients and will help the latter better comprehend their life experiences with clarity and strength. The process not only breaks the confinement of self-imposed social isolation, but helps ostomates build new and more positive perspective of their situation in life. Instead of seeing themselves as patients who need an appliance for survival, they can see how they have prevailed against a fatal disease.

Moreover, sharing the changes in one’s physiological functioning with the therapist helps new ostomates practice how to speak of the issue with intimate loved ones. Over time, the process becomes easier and their sense of awkwardness and embarrassment can diminish greatly. Shedding light on the issue dispels the hidden sense of shame, which thrives in silence. Other personal issues may also surface in new ostomates’ work with the therapist. It is up to the particular individual whether s/he wishes to explore emergent issues at that time.

Further along the therapy sessions, therapists and clients can begin exploring future possibilities. What are the client’s dreams and wishes? How can they be captured and made into personal goals? And how can they construct concrete steps to reach an individual goal? It is at this point that new ostomates realize what they had assumed previously as a loss of lifestyle and self-image need not be so. In fact, they may come through this change with more clearly defined goals and a more profound degree of motivation to live their lives as fully as they can.

By Christina Chen, M.Ed., R.C.C.

Christina has worked with youths and adults in the area of education and counseling therapy for the last sixteen years. She has lived in multiple cultures and worked with a diverse range of population and age groups. Christina holds two Masters of Education degrees, in language and literacy and in counselling psychology, in addition to completion of post-graduate-training in Adlerian Psychology. She is a member in good standing with the BC Association of Clinical Counsellors (#3745).