Heallist Podcast

Navigating cancer diagnosis shock and decision-making with Dr. Manuela Kogon

• Yuli Ziv • Episode 68

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In this episode of the Heallist Podcast, we explore how a cancer diagnosis can affect decision-making, emotional regulation, and the nervous system, with Dr. Manuela Kogon. The conversation centers on the immediate shock, fear, and urgency that often arise at diagnosis, and how those states can shape treatment choices in ways patients may not fully recognize at the time.

Drawing from clinical observation and patient experiences, Dr. Kogon discusses the importance of slowing down decision-making where possible, considering quality of life alongside length of life, and navigating conversations with both medical teams and family members. The episode examines how mind–body awareness and simple physiological practices may help individuals stay oriented during high-stress moments, without positioning them as treatments or replacements for medical care.

This episode is offered for educational and reflective purposes only. It does not provide medical advice or recommend specific treatments, but aims to add context to complex health decisions and highlight the value of informed, personalized care across medical paradigms.

Key takeaways include:

  • A cancer diagnosis often triggers shock that can influence early decisions
  • Urgency can narrow perceived options during treatment planning
  • Decision-making is affected by nervous system state, not just information
  • Quality of life and length of life can come into tension
  • Patients often navigate conflicting personal and family expectations
  • Holistic approaches are often used as supportive, not curative, care
  • Collaboration across medical paradigms can support individualized decisions

Dr. Kogon is also the author of When Cancer Visits, which explores how patients and caregivers experience distress and decision-making during cancer care. 

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Yuli:

Welcome to the Heallist Podcast, where we unpack the many layers of holistic health. I'm Yuli, founder of Heallist, your portal to holistic healers worldwide. Now let's go deep. Hello, dear friends, and welcome to the Heallist Podcast. We have a really important conversation for you today on the topic of holistic cancer care. And if this resonates, please hit subscribe, follow, or rate wherever you're listening. It's a small and simple way to support this type of independent and free content. And I really appreciate you. Today I'm speaking with Dr. Manuela Kogon, integrative medicine internist, clinical professor, and director of integrative psycho-oncology at a large academic institution. And she brings with her 30 years of experience across internal medicine, psychiatry, integrative medicine, and conscious work. She's the author of When Cancer Visits, a practical guide for reducing distress and stabilizing the nervous system during a cancer diagnosis, treatment, and beyond. And in this episode, we're gonna break down what holistic cancer care actually looks like and how mind and body interact during illness and the tools patients can use to navigate the cancer experience with more clarity and resilience. Very important conversation. I'm so grateful for you, Manuela, joining us today on this such an important topic. And so welcome officially.

Manuela:

Thank you very much.

Yuli:

And um, I like to dive right in because I I think the topic is just there's so much for us to share with our listeners today. And I know personally, for me, so many people around me battling this or going through this experience, and I know how lost they feel. So I would like to just acknowledge, uh, first of all, and I'm sure you're seeing it a lot in your work. What is usually happened in that moment of diagnosis? What do you see people come to you with, and what about their overall state of being?

Manuela:

Yeah, I mean, I always encourage everybody to look at the whole system. So it's not just the person who gets the diagnosis uh who is affected. It affects everybody around them and how everybody tries to navigate this incredibly challenging time. And for most, everybody comes as a shock. You know, sometimes people have a sense they might have cancer, they have a family history or had cancer previously, but in general, it's a shock. And that's how the body responds. It is in shock. And since you have to make very, very important decisions about treatment, this is about your life. It's not just longevity, it's also about quality of life, and to navigate those two sometimes challengings. You come from a place of shock, and you have to make wise choices with your family, with yourself, with a treating team, medication, what kind of treatment? And so I always advocate to start from a place of am I dialed down enough from my shock? Is my nervous system dialed down enough to actually make good choices? The mind tends to interfere in those choices. A mind is a storyteller that doesn't always act in our best interest. And to learn to navigate the shock of the body with the storytelling tendency of the mind is um task, it takes some work and awareness. But start knowing that you enter the task in a state of shock. So let's de-shock everybody first before they start making choices.

Yuli:

And what I see also that often people want to jump into a solution right away, right? There's this sense of urgency and you feel such a pressure to make a decision, like such an important big decision in a very short period of time, but like you said, when your system is completely shocked. So do you see that point as well? And what do you advise in terms of the timing and then taking the time to make that decision?

Manuela:

Yeah, thanks for mentioning that. You know, there's a technical term even for that, is is negative urgency. So the urge to act is often not motivated by making an intelligent choice. It's motivated by alleviating the discomfort everybody is in. And people tend to rush into choices that then have consequences that they later regret. So an important message is again, can you dial down the system? And I would love to have conversations about how to dial down the system so you don't act from a place of negative urgency. Just a discomfort, something horrible is happening to me, and let me just take an action. So this horrible sensation that I'm experiencing right now, the shock goes away. And that's true for other parts of. I'm very glad you mentioned that. The urgency of taking action is often not about the action itself, it's about alleviating the discomfort we have in this shocked state we're in. And the state by fear, it's about survival.

Yuli:

Yes. So how do we dial down? When we say dial down, what do we actually mean?

Manuela:

Yeah, so you know the nervous system is designed to alert us to danger. So when you uh have uh hear a cancer diagnosis, the system goes this is life-threatening and wants to get better, but then the the mind isn't very good acting on fear. So fear distorts our ability to think. And the mind wants something that's called cognitive closure. It wants to come to a solution of not just survival, but quality and survival, you know. And so it starts to tell us, hey, you know, do this treatment, or don't do this treatment, or do this little extra, or if I slept a little more. It it starts getting us into all these ideas that don't really help with calming the nervous system. And so I always tell people to enter the system in two ways. One is very simplistic, you know, slow your heart, expand your lung. We have a built-in lung, nervous system, heart coordination that slows everything down, and once that slows down, the mind slows down with it and becomes less of a frantic storyteller. And then in coordination of this kind of slower nervous system and a clearer mind, you can start contemplating is it radiation, is it chemotherapy, is it surgery, is it a combination of all of the above? And who are the people who are best equipped to help me with that choice?

Yuli:

Absolutely. And since we started talking about choices, I think the choices is where a lot of people get paralyzed, right? Because there's so much negative stigma about some of the things that you mentioned already, but there's also this craving, especially in the holistic community, to look for more holistic, more natural approaches. How do you even start considering, even if you kind of regulated your nervous system and you got yourself out of the state of shock and you're capable to make a decision, but I think the search itself for the solution is not really straightforward. Like what do you see in terms of those choices and what people should be exploring?

Manuela:

Yeah, so I pause with the word should because you know there's so so many choices where often there's no right and wrong. There's only your personal choice with how you feel comfortable in this complexity. You ultimately have to live with the choice. Sometimes the family or caregivers rebel against that choice. You might pick quality of life over quantity of life. It can be very distressing for this for other people in your system. So a basic rule is to acknowledge the complexity. And again, the mind's desire to create perfection, which doesn't exist. There's only upsides and downsides and advantages and disadvantages. So every time you make a choice, whether this is in the holistic world or what we call conventional world, which in itself is an interesting word, but for the sake of definition I'll use it. Whenever you make a choice, it has an upside and a downside. And when you don't make that same choice, it has an upside and a downside. If you choose a treatment that increases your risk of survival, you want to make that choice, but you don't want to pay the price for the choice. But if you don't make that same choice, you're lowering the probability of survival, but you might not have the downside of that choice. So every time, any again, this is not just applying to cancer. Every time you make a choice in your life, it has an upside and a downside, and not making that same choice has an upside and a downside. So imagine the complexity that we have to navigate, and the attempt at bringing clarity and simplicity is excruciating because every time we're playing with our own lives, and then it's not just the inside forces that guide us, it's the outside forces that sometimes push against it. So I don't know if that answers the question in terms of first acknowledge it's a very, very, very complex situation you're in. And again, if you think what I call in when cancer visits the four quadrant approach to choices. So think of chemo. I make the choice, it increases my risk of survival, but I pay a price for it. If I don't make that choice, it lowers my probability of survival, but I don't live with the downside. I mean, just think about that. And you want to do the right thing. You want to get the survival without the price. And so again, you have to slow down and get comfortable with the choice you make. I often tell people don't look at the upside of the choice. Look at the downside of the choice you're making. Can you live with the downside of the choice? And can you live with the downside of not making that same choice? You know, if someone forgoes the treatment and then they have a recurrence or it shortens their lifespan. And uh it's hard to live with yourself. So acknowledge the complexity and then try to be as clear with yourself as possible based on uh your core needs and desires you have in this process. If you choose quality, it might go against your partner's desire for survival and quantity of life, and then creates a conflict.

Yuli:

I I think this is a great uh framing for this, and I like how you approach this from a less of black and white perspective, right? And and I think, like you said, a lot of people in this situation go to the extremes sometimes. And do you also see people making decisions out of maybe their desire to please their family, or they make it not for their best interest? They have maybe their children or spouses in mind more than themselves?

Manuela:

Definitely again, thanks for mentioning that or bringing that up. Um, you know, many own brother was in that situation who chose quantity for the sake of his at the time very young child and went through excruciating suffering and pain just to provide longevity for this young child, and that's something I hear from a lot of parents that they do anything to be around for their children as long as possible, and they would never choose that if it just were for themselves, because it comes with a lot of suffering.

Yuli:

Do you have any framework for those kind of decisions?

Manuela:

Yeah, in when cancer visits in chapter eight, I describe an approach of dialing into your core needs and desires and wants, and then navigate that with not just your conflicting and opposing needs within yourself, but then in chapter nine to navigate that with the needs of the other. So everything is on a basically normal distribution. If I now decide I want quality of life as a patient, but my partner or my family wants quantity of life, they're on the other side of the normal distribution curve, and that distance creates conflict. So everybody first needs to dial into what matters to me? Am I approaching this question because you know I want to live longer or I want to still experience a particular thing or I want to live until retirement or whatever, all these desires everybody has, and then simply be honest, as honest and aware as we all can be, and then dial into the other person's need. And if you do quantity versus quality of life, it's mutually exclusive. It can really be reconciled often. And can we then be respectful about the respective choices? Or do we add stress into the system by well I want quality, but the partner wants or the family wants quality?

Yuli:

It's a very interesting situation. And just to add to that, also when people decide to take the non-conventional route, again, a lot of people in this holistic community and they would rather choose something that may be less proven but more aligned with their values to stay true to themselves, which also creates tension, uncertainty, all kinds of issues. What do you see from your perspective in those cases?

Manuela:

Yeah, that is also something important to explore, and I'm I'm not sure if I have good words for that space to not be in antagonism, but in collaboration if you now make choices that the conventional world will push against it, you know, it's irresponsible or it's not proven or it's not part of a study. Do you feel confident enough in your own belief system that you can have a conversation with someone who operates from a different belief system? And it can be very enriching when that's possible. That's part of my world where I am trained in this conventional academic scientific world. But from my clinical experiences, I've come to respect people's choices. Ultimately, at the end of the day, you know, it's we're all an N of one. Even if we make choices that are based on studies that help 60 or 70% of people, that still leaves 30% of people that need something else. So can you navigate me as an individual and I need this particular thing, with a world that has rules in place where we make choices based on studies that serve a majority and not an individual? How do you navigate the majority space with the space of the individual?

Yuli:

I'm curious how do you navigate being on kind of the both ends, someone who is clearly a proponent of holistic healing, but also works in a and operates mostly in the conventional industry?

Manuela:

Yeah, I mean, I'm not sure I have an answer for you. It's in part what motivated me to write when in cancer visits now live in a world that talks about targeted precision medicine. So conventional medicine advocates now to individualize, but it doesn't include all the individual choices that move outside of the research-approved boxes. And I'm afraid I don't have a good answer for you in terms of be as open as possible. I think I experienced both that sometimes I can relate to both worlds quite well. And I have a desire to bridge them. I can feel that's really part of why I wrote When Cancer Visits, it's like, can I bring this individual peace into something that at times can be experienced as quite dogmatic? Can I individualize and get confident enough in my choices that I can then also present them in a way that I find people who will collaborate with me in choices?

Yuli:

Well, I'm grateful that people like you exist who help us bridge those two worlds because I think it's about time that we stop dividing things into holistic and conventional.

Manuela:

Yeah, and I'm glad you bring up the word because when conventional medicine realized people spend billions of dollars on other modalities, you know, they wanted to start studying that world and first called it alternative. And that's a tricky word because it's not really an alternative to conventional treatments. Then they called it complementary, which is also a tricky word, and now we're moving towards calling it holistic, then we can really be respectful and uh about both worlds and take the best from both worlds.

Yuli:

Absolutely. This this is the emergence of where I live, and I love that, and I love to see more clinicians and traditional doctors using some of the holistic methods or getting certified, or at least becoming curious about some of those modalities that existed for centuries and finally getting the recognition they deserve.

Manuela:

So I I I love this kind of emerging trend of the blurring of the Yeah, I agree that there's more and more kind of curiosity also, particularly among younger physicians. I see that a lot, that they have that problem less than my generation, where if you just moved a little bit outside of that box, that would not tolerate it well. And so that that is nice to see. There's definitely curiosity on both sides.

Yuli:

In terms of holistic modalities, since we touched on that, do you see any of them in particular that people who go through a cancer experience gravitate towards or you're Find useful.

Manuela:

Yeah, I mean I always tell people be simple but not simplistic. So simple in terms of manageable units. So as we said in the beginning, cancer comes as a shock. And the day has 24 hours, and I always say divide them into eight hours of sleep, eight hours of what people in our world call work, and eight hours of something else. And when cancer enters your life, all of a sudden it adds kind of an eight hour segment to your life. It's a full time job, it can be a full-time job, but the day doesn't have, you know, what's now I can't do my own math of what's 24 plus 32 hours. And so you have to be realistic. What does fit in a 24 hour day? And most everybody I meet, including myself, is not realistic what fits in 24 hours. And so that's rule number one. And then rule number two, and it's on page 167 of when cancer visits, a simple approach to what matters to me what matters to the system around me and can it be reconciled? Because so much conflict and stress is in this unrealistic assessment of the day not having thirty-two hours. And then within that framework, nutrition, sleep, movement, relationship with others, and that in itself, each of them can't become a full-time job. People stress about oh I'm not sleeping enough and now the cancer will come back, or I'm eating the wrong stuff and the cancer will come back. Don't be simplistic with causalities, because people want what's called cognitive closure, they want an end, they want a successful end to their story, and they create a system that if I sleep enough, if I exercise enough, if I eat the right organic carrots, then the cancer won't come back or it won't progress, and then you're stuck in being unrealistic about what fits in the 24 hours. So pick something that's manageable from a simple menu. What manageably can I change in my diet? Like, am I willing to for a week not eat processed food and see what that feels like? Is that realistic the way I live? Most people don't have the finances to do that. Or is it realistic for me to not be stimulated by any devices in an eight hour period between nine and five? Again, for many people that's not realistic because they have to work a second job to survive. But maybe they can do it one day a week. Relationally, there's always room to grow. Barrel themselves into competing needs within themselves. I want this, but I want this other thing also, and it just doesn't fit. And then they do it with others, like I illustrated with longevity and quality and quantity of life is a big stressor for many people. Can you sit down, acknowledge your own needs, acknowledge the other person's needs without being at each other's throat? Can you do that for five minutes a day? So manageable units within this framework of nutrition, sleep, movement, for many cancer patients it's very, very hard to hear you should exercise. You know, you had Anthony Abagnana on your podcast and it was lovely to hear him say it's infuriating when people say you should meditate. You know, for a cancer patient to hear you should exercise is so stressful because they can barely get out of bed to make themselves a cup of tea. So the mind pressure of you should exercise can add more stress into the system, but can you find a manageable unit even if that means you are in bed and you lift your foot? That's movement, so pick something manageable from the simple menu of nutrition, sleep, movement, and relational experience and see if you can abide by the rule that the day only has 24 hours. And just because you have cancer, it's now no 32.

Yuli:

I love how you make it very accessible and you break it down into smaller chunks that people can actually see themselves maybe implementing from doing this work and talking to a lot of people on the healing journey and practitioners. I know some of the hardest things in this job is changing habits because any modality you take essentially is forcing you to do that.

Manuela:

Yeah, and also uh I want to add something. Also, a big reason why I wrote when cancer visits was that the people don't follow the laws of physiology. Physiology of the body is complicated, but some things are fairly straightforward. You asked in the beginning, how do you dial down? And we have a built-in system that the way you breathe or slowing your heart automatically signals to the brain, hey, now I can think better. And people, whoever listens right now can give it a try to just monitor what the brain is chattering. The mind has a tendency to chatter right now. So take a moment of what is it talking? And then notice if you have any access to your lung and the heart at the same time. And then just for a moment shift your attention from whatever the mind is commenting on or blabbering or talking. And see when you breathe in, can you feel the lung expand? Not just that there's something that presses from the inside to the outside. Some people can feel it, some people cannot feel it. And when you exhale, if you exhale through your mouth, can you kind of feel the little tickle on your lips? And just notice when you pay attention to that activity in the physiology that's already built in. Breathing, it happens. What happens to your thought content? This is a mechanism that the brain cannot process too much at any given time. And if you shift your focus on how your lung expands and maybe you feel your pulse and it slows down, you will notice that it breaks the brain's ability to think at the same time. It can't do it all. And so if I'm running a negative or shouldism commentary, you should eat this, you shouldn't eat that, you should exercise, you da da da. It's very stressful on the system. It dials the system. And then to notice that if I shift my focus on the simplicity of an expanding lung and a slowing heart, and it helps me have less of that commentary, I'm very intrigued at using those skills. And so there are numerous exercises that you can use that I describe in cancer visits how to use your mind, how to use your senses to follow simple physiological rules to dial down the system so the mind actually can think. Just by shifting your focus and what I say breaking the beh the brain's being the ability to process certain things at any given time.

Yuli:

Do you find that most people almost ignore sometimes this simple advice because they feel like to deal with something as big as cancer, there have to be more extreme measures than just breath?

Manuela:

Yeah, it makes me chuckle because I just had an interaction earlier, not today, but a few days ago, where I made a suggestion from the basket of manageability, and it was an immediate response, I need more. And I was a little stunned because I felt pretty good about the suggestion I had made because of the effects effectiveness of our physiology. Um and to your point, it's actually again I'm contemplating is that the is that the fallacy of the mind that unless it's complicated, it can't be have much worth. That that might that might easily be the product of the mind.

Yuli:

Unless it's not useful. My guess is there's also a little bit of a brainwashing there, right?

Manuela:

Yeah, I mean, I have to give that some thought. I mean, you you definitely hit on something important. See, the body, our system, you know, in the book I describe that we are a conglomerate of cells, and I purposely did that so people really connect to them from the physiology that we are a composite of cells. And so some cells think, and some cells have cancer, and some cells are hungry, and the mind, the brain that produces thought sometimes has really crazy ideas. I mean, I'm just thinking the association, it has to be complicated in order to be valuable. That would be uh uh an interesting mindset that's an obstacle. And whether it's brainwashing, I have to think about that. You know, it's like how do we come up with the idea that it has to be complicated in terms in in order to be effective? And that is definitely not true.

Yuli:

And it's also reliance on external forces to heal us, right?

Manuela:

Yeah, and that of course I can fully relate to because you don't have the skill set. So cells tend to be eliminated from the body when they don't belong there until the system gets overwhelmed. And cancer is something in our system gets out of whack that it can grow beyond our ability to eliminate it. And then we need help to eliminate it, as I call it in the book, the unwanted house guest. All of a sudden you have someone in your system that you don't want there, and we need help to have it eliminated because we don't have the skills to eliminate it. And then you enter a whole world where you yourself are ignorant and you gotta trust that you are in the hands of someone who knows how to eliminate those cells from your system. And that is, you know, in itself, from an emotional perspective and from a nervous system perspective, very stressful, particularly for people and who need a sense of control in their lives and also delegate that control. That is also very activating and stressful that you're now in a situation that you can't control yourself. Hmm.

Yuli:

Yeah, that's a heavy point. Aniwala, this is some really incredible and important messages to our listeners. And um, we're we're running almost out of time, and I would love to ask you for any last words of wisdom, any message to our listeners and anyone in particular who's navigating this cancer experience at the moment.

Manuela:

Yeah, show yourself some grace and generosity in a very, very difficult time. Be curious about the important things in your life and finding the best people possible to help you navigate it. And if you hear should, that's a red flag to explore what's effective and what works and what's manageable rather than what you believe is helpful is not always what's helpful. Pursue what works, not what doesn't.

Yuli:

And since you mentioned finding the right person to give you the right advice and something we didn't touch on in our conversation, any quick tips how to recognize which provider or practitioner that you're talking to is this person right for you or not?

Manuela:

There's something what I would call a collaborative mindset. So when you present yourself, say this is important to me, and it might sound not conventional, but you immediately will feel whether or not there's a wall going up that says, no, you know, your belief system doesn't fit here. And so it's trial and error. And ask friends, you know, people who know you can help you say, hey, I know somebody. I mean, that was always true in our family when someone had cancer, to ask friends, like, I know this particular person, do you think it's going to match the person with their needs? And ultimately it's about openness and tolerance. Trial and error, and don't be deterred when something doesn't work. Pursue what works, not what doesn't, and trust yourself that that you know what works for you when you also feel that resistance and judgment. You know, whenever you hear the word should, then uh tread lightly.

Yuli:

Solid advice. Thank you so much for this. And I hope um I think anyone who's gone through this experience should read your book.

Manuela:

Last thing is the cover is a painting by my brother who did die from cancer, and it's a tribute to him and you know, keeping him alive just by providing the art behind this. It's something that's very connecting to me every time I touch it. See him, I feel him, and I'm proud of him. He fought uh a tough fight.

Yuli:

What a beautiful story. And the way you preserve his memory is just um I I feel so pride there. Well, thank you for sharing your wisdom with us and all of our listeners. And I feel like this some episodes are really key episodes. I think this is one of them. So thank you again.

Manuela:

Thank you.

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Yuli

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