a woman brushes her teeth and falls into a rumination about her own death

How Ruminating Can Make You Suffer

I’m not sure what makes worry spike and then subside. It could be something I say to myself, or a few words that someone says to me, or just a tone of voice, or the natural ebb and flow of the worry wave.

Every spot causes worry

When I got my first squamous cell carcinoma in situ (on the skin), I was worried because it was all new to me. But after my dermatologist explained that it was on the skin and not a major health threat, I calmed down. I have had so many now that I lost count, and when my “squamous cell radar” senses that a flakey spot is going to need attention, I don’t get too worked up about it. I still get nervous when I need to have Mohs surgery, but I don’t go over the top with it.

Realizing that I am ruminating on skin cancer

Now a different kind of suspicious spot, on my wrist, is making me nervous. My dermatologist didn’t make much of it when I saw her a few weeks ago, but it looks different, maybe darker, to me. We’re supposed to be on the lookout for changes in a wart or a mole, right? It might have changed on its own, or it might have changed because I picked at it. But the latter possibility – that I did it myself – faded in the face of the scary one – that it might be a melanoma. Every time my dermatologist sees something, I say, “Not a melanoma, right?” She says I’m prone to squamous cell cancers, not melanoma.

Trying to listen to my rational thought

Rational thinking would lead to this: If it’s a melanoma, they will take care of it and I’ll be OK because I’m watched so closely that nothing would have the chance to progress. Irrational, fear-fueled thinking goes like so: It’s going to spread rapidly and I’m going to die. I suspect I’m not the only one prone to this kind of catastrophizing.

Thinking only about the catastrophes

Looking for a good definition of catastrophizing, I had to laugh when one of the first ones I found had to do with skin cancer. (

It was on the website of Headspace.com), the meditation site, and it started out with the writer going overboard on a suspected skin cancer: “I notice a dark brown spot on my forehead. I lean closer to the mirror and examine it closely. It is dark in color, with irregular borders. It’s melanoma, I’m thinking. As I brush my teeth, I imagine my final days. My friends visit, bring me flowers and sit by my bedside. My funeral takes place in a beautiful park by my house. People are huddled in small groups, speaking in hushed tones. What a shame, she was so young. I put away my toothbrush and my heart is flopping around like a fish on a pier. I reach up and touch the spot. And it rubs off. It was hair dye.1”Stop predicting the worstShe writes that by ruminating, we create our own suffering. “When we catastrophize, we actually do two things: first, we predict the worst possible outcome; second, we assume that if this outcome transpires, we won’t be able to cope and it will be an absolute disaster.1”This is what I was doing with the spot on my wrist. This is how I calmed down: After I sent my dermatologist a photo, and her nurse said that the doctor would look at it...and gave me an appointment a few weeks away, I realized she didn’t think I was in immediate danger.An embarrassing realizationAlso, I’m embarrassed to say that I picked at it and the dark crust came off and I realized it was a scab and not a death sentence after all.

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