Between Two Worlds

Abstract

Disease-directed therapy near death is a growing trend among persons living with late-stage cancer. As a sociocultural phenomenon, cancer-directed therapy (e.g., chemotherapy) when given for very advanced disease is a process that offers questionable benefits and portends further suffering, but also suggests potential for growth and transcendence. Theories and concepts drawn from cultural anthropology, sociology, and existentialism illustrate how contextual factors contribute to the creation of a "liminal space"; the latter part of the cancer trajectory where living and dying can overlap. When applied to clinical practice, this theoretical framework gives the patient, family, and health care provider a way of "unmasking" a period of transition during terminal illness when aggressive disease-directed care continues to be provided. The liminal space may function as an existential plane; a gateway or threshold with inherent potential for psychospiritual development during the final stage of life.

“Living with Loss”: A qualitative exploration of existential fears among people with advanced lung cancer in online lung cancer support groups

“…Our findings demonstrate that encountering death in online support groups can pose a serious challenge. The tension arising from living in a liminal space and sharing life experiences with those who are dying can be overwhelming for some (Adorno 2015;Currin-McCulloch et al 2021). Significant literature has explored end-of-life and death experiences, such as those of AYA (Perez et al 2020;Pritchard et al 2011;Sansom-Daly et al 2020) and breast cancer survivors (Kenne Sarenmalm et al 2009).…”

A Theoretically Informed Critical Review of Research Applying the Concept of Liminality to Understand Experiences with Cancer: Implications for a New Oncological Agenda in Health Psychology

“…When McKenzie and Crouch [54] referred to how cancer survivors can live in a world of "dissonant interactions" where they cannot express how they really feel, they, and others, attributed this to society's emphasis on warding off the specter of death and focusing instead upon positivity, strength and uplifting cancer stories [52,[69][70][71][72]. In fact, this observation about the relevance to liminal experience of historical changes within society was an important theme in Little et al's seminal 1998 article [1].…”

“…Namely, experiences 'devised' by means of LATs can help people to make new sense of their experience as they go through crises and liminal becomings in their actual lives, and to work out escape routes from sticky liminal hotpots. Several recent studies have devised and utilized rituals as 'liminal technologies' during and after the disease experience [15,20,62,69]. Sleight [20], for example, developed a framework for the use of ritual as part of a psychosocial treatment approach to help cancer survivors move beyond 'prolonged liminality'.…”

“…Much of the recent liminality-theoretic literature in the oncology field agrees upon the broad notion that liminal experience is deeply paradoxical such that it escapes an Aristotelian identity logic of being categorically 'either' this 'or' that, and generates forms of experience that are not just 'both/and' but both/and as well as neither/nor [38]. One recurring observation here is that the uncertainty caused by the possibility of cancer recurrence (as a probable/uncertain occurrence) means that individuals feel trapped between two psychosocial dimensions: health and disease [1,14,16,51,[61][62][63][64][65][66][67][68][69][70][71]79]. Comparable characterizations regularly feature beyond cancer research in studies portraying people with chronic conditions, physical disability, schizophrenia and arthritis, who described feeling "neither sick nor healthy" [16,63,72,80].…”