PTSD is defined as an anxiety disorder caused by a traumatic event, or stressor, such as a natural disaster. A life-threatening illness is only considered a stressor if it involves a ‘sudden, catastrophic event’ such as waking up during surgery.

In this article for Aeon Liza Gross explores an argument put forward by Phil Wolfson, a psychiatrist in Marin County, that hearing the words “You’ve got cancer” is a catastrophic event in itself, and even when the tumors retreat, “that kind of fear stays with you.” Wolfson is campaigning for a new diagnosis: PTSD-life-threatening illness (PTSD-LTI) — to increase support both for the survivors of life-threatening illnesses, and for their carers.

Although a diagnosis can bring benefits, Cole says, ‘you are in a state of anxiety at all times.’ He can’t shake the thought that any aches and pains, normal for his 67 years, might be new signs of his body’s betrayal. Today, he practises palliative care at a hospice. He knows the patients are probably floating in space, too, needing specialised care to manage their distress.

He believes no one should leave an oncologist’s office with a cancer diagnosis without a referral to someone trained to manage the anxiety and trauma that inevitably shadows the course of treatment. But that’s not what happens. ‘As medicine advances, we have more survivors,’ Cole says. ‘That’s a good thing. But those survivors carry trauma to their graves, and we haven’t recognised that it’s a disease process that needs treatment.’

Wolfson is also an advocate for using ketamine and MDMA in the treatment of those suffering from this form of PTSD.

Therapists have long known that MDMA, outlawed in 1985 as having no medical use and a high potential for abuse, melts defences and eases anxieties while boosting mood and trust – key ingredients for successful therapy. The drug works partly by dissipating the crippling fear that prevents people from revisiting a trauma, a necessary step in learning how to live with it. ‘It opens the doors of the heart and removes some of the blocks to feeling and suppression,’ Wolfson says, making it easier to tolerate deeply distressing memories and emotions.

Feeling unburdened, Wolfson’s patients were willing to plumb the depths of their psychic pain in profound ways, looking at how the disease disrupted their lives, self-worth, and personal and professional interactions. Their ability to confront their worst fears helped Wolfson chart a therapeutic path to ease their suffering and anxiety.