[The cancer patient and his environment]

There are complex interacting factors at work both in the frequent social ostracism of cancer patients and in their self-imposed stigmatisation. Attribution of guilt and fantasies about the infectiousness of cancer are cited as examples of how the layman's concept of the disease often includes metaphorical elements. "Victimization" of the cancer patient on the part of a healthy person can often be interpreted as a defence mechanism in the process of the latter's coming to terms with his own fears and at the same time it may be due to unconscious justification of his tendency to keep distance. In view of the widespread tendency of people to behave insincerely and ambiguously towards cancer patients, it is shown how difficult it is for these patients to recognize any clear pattern in the reactions of others. This explains many of the conformist and defensive forms of behaviour adopted by cancer patients; however, such behaviour tends to reinforce isolation, rather than to dispel it. The feelings of cancer patients are frequently disregarded in medical institutions and this may take on the character of an "institutional defence"; this is a further reason why there are also many doctors (as well as laymen) who believe that they can do nothing to help overcome the psychosocial isolation of cancer patients.