Why Do We Always Want to See a Zebra? Normalizing Emotional Coping in Serious Illness

When diagnosed with a serious illness, most people experience some form of distress. As palliative care clinicians who support the emotional health of patients, it is important to think about our expectations and what we consider a normal reaction—in addition to looking for the “zebra” (the anomaly). The coping and defense mechanisms people use can help protect their inner and outer selves from anxiety, fear, anger, and other emotions that come naturally. We cannot fix someone’s emotional pain. Our expectations of what is “normal” may prevent or even pathologize useful coping from patients.

This Interprofessional Grand Rounds session reviewed anticipated emotional reactions to diagnoses and life with a serious illness, and the essential role defense mechanisms play in mitigating harm. Speakers increased attendees’ capacity to recognize their own reactions that may cause them to rush to address and fix patients’ emotional reactions, and taught them how to witness, hold, and validate normal distress instead. Finally, the speakers provided a framework to better identify when it is necessary to refer to team members, specialists, or even emergency personnel. In this form, we can support healthy coping among our patients.