Professor Penny Hopwood has spoken and published widely on patients’ experience of living with breast cancer. As a psychiatrist, she has spent the last 25 years mainly counselling patients undergoing treatment of the disease. She is married to a medical research statistician who works in a similar field.
Penny has two sons, aged 24 and 29. She lives in Manchester and London.
I began by asking Penny to explain how the medical profession treats patients with cancer and how this might affect their happiness.
Oncologists treating patients with cancer generally have to prioritise care in terms of the cancer itself and its response to any treatment administered. As medical professionals we also need to think about how we deliver that care, including psychological aspects, and how we communicate with patients. And it’s also important to think about the medical care we provide to a patient in the context of his or her own life.
As a psychiatrist, I was mainly seeing patients because of problems they were experiencing related to their treatment for breast cancer – that’s the reason we were meeting. But there would be other aspects of their lives affecting them at the same time as their cancer, inevitably, whether it was related to their treatment or not. Other big issues – like their job, having to retire because of their health, money or family pressures – they all play an important part in life. In their day to day lives they perhaps saw these other issues as more important than their cancer.
I was trying to understand what cancer meant to them. When you’re treating a patient, the cancer isn’t the only thing you’ve got to pay attention to. Within the medical profession, the sociological and psychological implications of what patients are going through probably aren’t sufficiently well-recognised, in terms of what affects patients.
I asked Penny about how counselling patients with breast cancer affected her.
I never found my work depressing. Challenging, yes, and I was very conscious of the tough and sometimes upsetting consequences of cancer that patients were facing. But if you choose a job like mine, you have to expect to deal with some difficult situations.
I couldn’t have done it for 25 years with my emotions completely enclosed. As a psychiatrist you have to be able to explore not only your patients’ symptoms, but also their feelings of sadness and distress. But the process of psychotherapy with a patient – which is, potentially a worthwhile and positive process – can be really quite rewarding, especially when you see a change in someone. That’s been very satisfying. It’s a process you’re prepared for, as a therapist. You have to imagine an end point for the therapy and negotiate what you and the patient want to achieve. It requires a certain amount of objectivity, but also some personal reflection. You’re engaging in a very personal relationship for that time.
In addition to seeing patients I really enjoyed the research side of my role – writing papers, collaborating and giving presentations. It was a good balance for the more emotional clinical work. And handing over to younger colleagues – seeing them go on and develop – it’s like leaving a legacy for what I’ve done over the years and I get a sense of satisfaction and happiness from that.
Penny has recently retired from clinical practice, but continues to volunteer on a part-time basis in a research capacity.
While I was working full-time I was never really free of concern – sometimes for patients, or work pressures like staffing issues. I was carrying a lot of responsibility. Fair enough, I was expected to take those things on, but now I’m semi-retired I find I’ve discovered a certain lightness of spirit.
I suppose it takes a while to get out of a routine. I’ve got to work out a different pace of life and I’m not quite there yet. I wouldn’t say I’ve achieved an equilibrium, or a sense of complete relief. And happiness was not my ‘default state’ for some years – I didn’t see it as a permanent state anyway. But that’s changing….
Working so hard for so long, personal time became very precious to me. If things got shifted or put back in my personal life – for example delays on some work being done on the house – it would get to me and become an irritation. But I find now that irritations don’t seem to stress me like they used to. I don’t mind as much. Now I know I can put things off for a day or two. Before there was such a tight schedule.
I was walking to the tube station the other day. It was a nice day and I thought ‘I’m really enjoying this.’ Now I’m semi-retired I’m still working, but it doesn’t feel like work. It just hit me and I remember thinking that I liked the feeling, a feeling of happiness. It was there without a reason, whereas before, happiness usually came in response to something special happening, or receiving good news.
Penny’s mother recently passed away, after a long illness.
You can be happy at the same time as being unhappy or sad. Not in the same moment, of course. When Mum was ill it was, of course, very difficult, but I could still appreciate things and be relatively cheerful – with good company, friends. Happiness doesn’t get completely shut off.
The context in which we gathered at Mum’s funeral was very sad, but there were moments of happiness there too. I got to see my cousin, who lives overseas, which was really nice. And although we were sharing in grief, there was also a joyful celebration of life. It was good to spend more time with my brother and to be in closer contact with other members of the family over that period.
And that’s been true for my patients as well. They might be undergoing treatment for breast cancer – which can be very toxic and draining – but there are moments of happiness too, like a new grandchild or realising that they don’t have to worry about the trivialities of life any more.
I asked Penny to recall some happy memories and experiences outside of professional life.
The experience of having children is associated with a great deal of happiness for me. Not the actual birth, but seeing them grow up, and the fact that they’ve done well for themselves. There have been some huge moments of happiness along the way. There were some times of anxiety, of course, but no more than any parent experiences. I’m pleased that my kids have got on with life. I’m very proud of both of them and I’m very happy for them.
Friendship is also important to me. I’ve learned it’s something you have to pay attention to. I’m happy, now I’m not working so many hours, that I have more time for friends. I’ve started going out for lunch at least once a week and that’s been great!
I’ve always enjoyed travel, and fortunately my husband and I have had frequent opportunities to travel together – I think the boys have inherited some of the joy of that from me. There have been some great trips – for work and some brilliant holidays – but one stands out as particularly memorable. Nick, my eldest son, was living and studying in Ghana a few years ago and Richard and I went to visit him there. It was a very grounding experience and I have very happy memories of that trip. Meeting people there made me realise how little you need in life, in terms of material goods, and how little you need to be happy. It was inspirational to see people there really making something of their lives.
The Ghanaians are so warm and welcoming. They have so little to give and yet they give so much. When I came back I realised that material things aren’t that important for creating happiness and one could live a simpler lifestyle just as happily if one wanted. Nick and I are going back to Ghana in a few months to visit the schools where Nick worked as a volunteer teacher. Nick’s relationship with them makes me proud and happy.
I love being with my younger son Olly too and Richard and I had some very happy times in Berlin with him when he was living there for a year as a language student. He knew the city so well it made it very interesting and fun to explore it with him in all the seasons. For me the best part was staying in the former East Berlin, which is changing and lively, with quirky new shops and bars and all the history of the communist era around you.
Olly was teaching in a junior school and it was so nice to see him enjoying his independence in Berlin. I went along with him for the end of term school concert at Christmas. I could see how naturally he fitted in and how much the staff and children thought of him – that was special.
I’m very committed to my family, of whom I’m very proud, but I consider myself lucky to experience so much happiness from my children and my marriage – and now I’m looking forward to Richard’s retirement so that we can be free to vary our lifestyle or move in new directions.
I interviewed Penny in April 2009.