Learning Emotional Judo

Andrew Roth is a psychiatrist who works with prostate cancer patients. Photo by Rick DeWitt

For the past 22 years, psychiatrist Andrew Roth has worked in medical oncologist Howard Scher’s genitourinary oncology clinic at Memorial Sloan Kettering Cancer Center in New York City. Being in the clinic gives Roth access to patients who might not otherwise consider psychiatric counseling to be a part of their cancer treatment.

Prostate cancer patients have different concerns depending on their disease stage and treatment, Roth says. They may be uncertain about their next treatment steps, worry about cancer recurrence or struggle with incontinence or sexual dysfunction. Almost all of these men grapple with new visions of their lives. “Just having to deal with cancer opens a window of mortality that I think a lot of men are uncomfortable with, a lot of people are uncomfortable with,” Roth says.

Roth recently distilled his advice for prostate cancer patients into a book, Managing Prostate Cancer: A Guide for Living Better.

CT: How did cancer come to play such a large role in your psychiatry career?

ROTH: Part of my introduction to oncology was personal. Both of my parents had lung cancer. They eventually both died of lung cancer. I think the writing was on the wall for everyone, except for me, that psycho-oncology would be the perfect thing for me to go into. A Memorial Sloan Kettering fellowship program had an opening and accepted me. When I finished my fellowship, our department chairwoman, Dr. Jimmie Holland, told me that there was a medical oncologist [Scher] at Memorial who wanted a psychiatrist on his team. He knew that the men he treated were distressed. He knew that their families were distressed. He wanted to get them expert help.

CT: How does your practice differ from the average psychiatry practice?

ROTH: Usually, I start off my sessions by asking about what’s going on medically. I might explain to patients that, whether they’re feeling anxiety or depression or sadness or irritability, in the context of cancer, there are many different reasons for men to feel those things.

CT: You talk in your book about teaching patients emotional judo. What is this?

ROTH: It’s trying to flip them back to the present. If you’ve ever done any meditation, you know that your brain doesn’t usually stay here and now all the time. It thinks about this or worries about that. I ask patients to have four or five things they can do that will get them distracted, so that when they start to worry or get depressed, they can turn down the volume on their anxiety and negative thoughts and flip back to the present. Some techniques could include listening to some music or doing a puzzle, calling their spouse or their partner, or calling one of their kids, as opposed to letting their brains fester with the worry and the sense of depression. Of course, sometimes it’s OK to validate aspects of sadness or fear. It’s OK to have these feelings.

CT: Why do you think invoking judo is useful?

ROTH: It’s active. It’s fighting back—with finesse. It’s not just pounding your fist against someone else. It’s being able to use techniques to overtake the opponent, in this case the anxiety or depression, and using the opponent’s strength with the correct techniques to put it down. That’s how I describe it to patients. That anxiety, that depression, can feel like a big, bad opponent. If you run away from it, chances are it will be there tomorrow. If you try to pound it, it might just beat you up. Let’s learn a technique where you might be able to use its strength, its presence, and flip it so you gain control over it.

CT: Do you ever see the partners of men with prostate cancer?

ROTH: Very often, when I go into my waiting room, I’ll call out the patient’s name and two people stand up, and I’ll be introduced to the partner. The consult was for one, and so I’ll always ask the patient if it’s OK for the partner to come in. He usually says, “Of course, that’s the reason I’m here. I’ve been more irritable, been more anxious. It’s really affecting us.”

CT: What advice do you have for patients dealing with sexual side effects in the context of a relationship?

ROTH: I think a lot of guys are more often thinking, if it’s sex, it’s going to be erection, then intercourse and then ejaculation. Part of the therapy is designed to help educate them about how being close physically is very important for the relationship. The couple is not going into intimacy trying to get an orgasm. They’re going in initially just to massage each other, nothing related to the genitalia, just to touch and rub each other’s feet or the head and neck, and to slowly become familiar with each other’s bodies again, to develop intimacy with the physical that is disengaged from intercourse.

CT: What further advice would you give to men with prostate cancer?

ROTH: I’d like them to stay active. If they can’t play 18 holes of golf after surgery, then maybe they can play nine holes. If they can’t do what they used to do, find some things they can do. Encouraging them to be more active will help on many levels, physical and emotional.

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