Chemotherapy-related cognitive impairment as a crisis of the self: a Winnicottian psycho-oncological perspective

Objective Chemotherapy-related cognitive impairment (CRCI) is typically conceptualized as a neurocognitive side effect of cancer treatment, with emotional distress framed as a secondary or reactive consequence. This paper aimed to reconceptualize CRCI from a psycho-oncological perspective by examining how acquired cognitive unreliability disrupts self-experience, identity, and continuity of being, using Donald W. Winnicott’s theory of the self and environment. Methods This theoretical paper synthesized Winnicottian concepts—including the True Self, False Self, holding, and play—to develop a conceptual model of CRCI that links cognitive dysfunction to disruptions in selfhood and relational safety. Results CRCI is conceptualized as a potential disruption of the continuity of the True Self in a subset of survivors, particularly those whose premorbid identity was strongly organized around cognitive functioning. Within this framework, cognitive unreliability is interpreted as threatening self-continuity, with adaptive responses taking the form of intensified False Self functioning, including vigilance, over-adaptation, and concealment. While these strategies may preserve external functioning, they constrain spontaneity, vitality, and the capacity for play. Recovery is therefore reframed not as cognitive restoration alone, but as the re-establishment of a holding environment that supports the gradual re-emergence of authentic self-experience. Conclusion Within this framework, addressing CRCI is not limited to cognitive remediation, but extends to the relational conditions that support the continuity of the self and the possibility of authentic lived experience in a subset of survivors.