Heidi Waltos, MSN, CNS
Resilience (including those characteristics of people who ‘beat the odds’) has recently been subjected to the scrutiny of science. In the traditional medical model we’ve been pretty good at identifying what goes ‘wrong’ but are just beginning to identify what goes ‘right’. It turns out, in the realm of recovery that the concept of transformation is at the center of what goes right.
While we may wish to just eradicate illness and resume our lives as if nothing happened, if we simply do this, the same stress factors precipitating illness continue to exist. We will have missed an opportunity to stop and listen beneath the pain, where perhaps there are deeper essential truths.
Symptoms can enlighten us, and for those who choose to grow through their illness there appears to be a distinct route with recognizable signposts along the way. By recognizing these signposts, clinicians can become better prepared to understand and respond to people’s experiences and make suggestions which are supportive of growth and well-being. Marc Barasch’s work, The Healing Path, is an exceptional resource for anyone wishing to gain in-depth insight into the universality of transformational struggles. Barasch learned that most people who surpassed ‘medical’ expectations for recovery felt their attitudes and insights were central to their healing. In fact, “each person, (though some reluctantly), wound up doing the opposite of what sick people are supposed to do: Rather than simply trying to ‘get back to normal’, they embarked, at the most inauspicious time, on a voyage of self-discovery. They managed to cling instinctively to the circumnavigator’s faith that the only way home was forward, into the round, unknown world of the self. The quest for wellness was intimately entwined with their search for personal authenticity. Though virtually all had rediscovered the power of “good feelings and attitudes – joy, forgiveness, faith, trust, love…they had to draw them up deliberately, hand over hand, from their own deep and often dark wells.” (Barasch, 1993, p.290).
In every tale of success, individuals clearly stated, that early in the process, they had the belief they were going to get better. It went beyond the power of positive thinking; they did not ‘try’ to think positively, they just knew. Some marched assuredly and strongly to the rhythm of a different drummer while others did so tentatively and reluctantly, yet in each instance the application of internal strengths was a must.
Andersen et al, at the National Institute for Mental Health in England (2004), outlined four consecutive stages of recovery: dependent and unaware, dependent and aware, independent and aware and inter-dependent and aware. People seek care, initially just wanting to be cared for and fixed. There is little energy to grapple with the deeper issues in this early phase when discomfort and denial are high. It is vitally important as health care providers that we allow people to move through all stages of healing. If we foster continued dependency on our services, fail to prod awareness and deeper understandings and/or minimize the probability of full recovery we will have not served well.
In a study by Achterberg, Matthews and Simonton, cancer patients who outlived predicted life expectancies were found to be “highly creative” and scored high on indices like “non-conformity”. Other studies substantiate that it is not the compliant, cooperative patient who surpasses the diagnostic predictions and typical course of disease, but the more ‘uncooperative’ who refuse to fit obligingly into medical diagnoses. This permeates all instances of illness, from mental health issues to AIDS. The results of a UCLA study on AIDS indicated the following characteristics were most common among survivors: “a refusal to accept a poor prognosis (this has been referred to as positive denial); a stubborn, even ornery insistence on not following recommendations until they could make sense of them; and the direct expression of emotions like anger (Barasch, p.203) In the study of “Mental Health Recovery: What Helps and What Hinders? (A national research project for the development of recovery facilitating performance indicators, 2002), it was unanimous that a paternalistic approach by health care providers was detrimental to recovery, where as the promotion of self-agency, (even if it meant the patient taking more risks in their life), was more helpful.
Survivors tend to be feisty with an independent streak toward the outside world yet they also exhibit a growing ability to accept confusion and surrender within themselves. It is a delicate balance, where the journey is not completed alone but where there are times when it is vitally important to release reliance on external fixes and instead turn to oneself.
Not surprisingly, the path of recovery mirrors the progressive series of challenges illustrated in every classic heroic myth throughout history. In these archetypal tales of the human experience the main character moves from innocence, through crisis and loss, to hard won self knowledge. All mythic stories deal with transformation of one kind or another and usually contain the underlying theme of stripping away disguises to reveal the true being within.
In his interviews with recovered individuals, Barasch identified 19 themes encountered in these parables of transformation. He found that by steering through, rather than circumnavigating the scary stuff, the individual’s chances for complete recovery grew. These signposts can be grouped together into five sequential steps:
- Crisis: Life Crisis, Herald of the Journey, Health Crisis, Spiritual Crisis, Denial and Despair
- Sanctuary: Encounter with the psyche, Vision Quest, Identity Loss, Social Separation, Appearance of a Helper
- Discovery: Roots of Predicament are Revealed, Rediscovery of Aliveness, Confrontation with Death of Former Ways
- Transcendence: Turning Point, Change of Heart
- Return: Return to the World, Wounded Healer is Born
Crisis – The tale begins when the main character faces an external difficulty. “The catalyst is always something that happens to break up the even tenor of one’s life (Burnham, 1997, p259). Essentially, it is a ‘break-down’ which eventually allows the individual to ‘break-out’ of previous scripts. These early issues may not even enter our awareness until physical symptoms manifest themselves and gain our attention. Aryurveda teaches that a disease is already in its later stages by the time it shows itself at the level of the physical body. In psychiatry early signs may include difficulty sleeping, changes in mood, increased distractibility, changes in appetite, etc…we recognize ‘something is off’.
The ‘herald’ of the journey signals the journey is about to begin. Illness may first appear, not as a sign or symptom but, as an awareness that something is shifting. How many times have we ourselves known that if we continue on a certain path there will be consequences, yet we turn a deaf ear until our system screams in alarm? Sooner or later, characters in the heroic epics almost always suffer some physical malady. It is as if the loss of reliance on the physical self must proceed the development of the non-physical (emotional/spiritual) self. According to Joseph Campbell (The Hero with a Thousand Faces, third edition, 2008), in order to enter the deeper realms, the hero himself becomes a victim, often experiencing a wounding of some sort. The transformative experience almost always begins as a journey into despair, with a sick and longing soul, otherwise there would be no impetus for change.
Ultimately it is not the life crisis or the health crisis that need the real attention, but what is dormant within that individual’s core that seeks expression; perhaps overcoming old limitations in the way they view and portray themselves. In a more modern day version, Star Wars was famous for its archetypal journey, where each hero had a persona that was no longer working for them (even though at one point it was what they leaned most heavily on) – Luke Skywalker’s preoccupation with being a brave fighter, Han Solo’s quest for material wealth, Princess Leia’s angelic savior role. Not only does the hero eventually overcome limitations but for those who ultimately integrate and express their ‘deeper’ more genuine selves they become conscious of themselves as creative beings and the authors of their stories.
Crisis instigates fear and denial so it is not unusual to see last ditch efforts at this stage, to abort the mission. In the literature these hurdles are represented by entities guarding the way to the final goal, such as the monsters or clashing rocks, depicted in the famous story of Jason and the Golden Fleece. In real life, we ourselves create these obstacles; these guardians of the ‘status quo”. Change can be immensely difficult. When researchers asked a group of seriously ill patients which they would choose if both had the same outcome – an operation or a drastic re-orientation of life – fewer than one in five said they would opt for personal change. (Barasch, p.287). Many individuals choose to stick with known methods of interventions (even if of limited gain) and are not interested in a more comprehensive (and perhaps more permanent) healing experience if it takes moving out of their comfort zone. Other individuals, however, will not be able to ignore that voice within that continues to reiterate “there must be a better way”. “And herein is the crux of depression and mental illness. We are told the “truth” is one thing, and yet, we sense something very different is true. Somewhere deep inside, something is stirring. Something wants out. We may try covering it up with distractions, food, activity, over-work, drugs, etc. We think it is pain. And to be sure there is pain there. But there is something even deeper that will no longer be denied. This is the call of our very own soul.” (Whittle, Debrah, 2005). For those that heed this call, inevitably their journey will take them inward, and on to the next step.
Sanctuary – Here the individual’s focus of awareness shifts from the outer aspects to an encounter with the psyche; an exploration of inner sources. It is a coccooning phase – a retreat (sometimes unwilling) from taking care of life’s daily tasks. We are no longer in 'management mode' and though this may, at first, feel extremely uncomfortable it is a time to understand the illness more fully and what the monsters (symptoms) represent. If there is a door in the castle that the hero has been told not to enter that is the very one that needs exploration. Author Anne Lamott eloquently discussed the rush of liberation which occurs when these doors are finally opened, “If you bring forth what is inside you, what you bring forth will save you. If you don’t bring forth what is inside you, what you bring forth can destroy you” (Lamott, Bird by Bird, 1995, p.199).
According to the American Medical Association, 83% of all illness is lifestyle induced…this is the time to examine these issues. Not only does the individual gain understanding about the inception of their dis-ease, but they also begin to glimpse the dormant potentials within. People realize who they presented to the world or who they thought themselves to be was only one small aspect of their infinitely more “powerful” totality. Many even report direct, vivid and often startling connection with an ‘inner presence”. Sometimes appearing as a figure in a dream, other times as a symbol with all the earmarks of a “soul” experience: idiosyncrasy, complexity, and an unmistakable aura or power. Intuitive feelings re-assert themselves, unimpeded by the chattering of the ‘rational’ left brain. Jung hypothesized that these creative visions emanate from deep in the unconscious (which he called archetypes). Dealing with these deep structures and drawing on the unique forms of energy they possessed, is part of the transformation process. In a sense, the person now begins to realize that meaningful change is actually possible.
Unfortunately, this also creates a conflict of interests: the hard shell of the hero’s ego must be challenged in order to gain access to their core, essence or spirit. The potential identity loss during this time is symbolically filled with mazes and labyrinths and always represents a journey into the unknown. The images are a metaphor for our experience of letting go and finding ourselves in the midst of a twisting, winding road with no sense of its digressions. Only in the end, if we persevere, do the pieces fall into some kind of coherent whole. This time of “unknowing” requires a fair share of silent contemplation. As Campbell made clear, the hero’s journey includes temporary social separation from the world in order to access internal information and power. As energy is transferred to inner demands, less is devoted to external demands. Those close to the individual may pull back from the person they once knew, as well. Ultimately all involved must renegotiate relationships and roles, but these new connections will have a more genuine harmonious quality.
Despite the relatively solitary journey thus far, individual’s discover when they are ready a “teacher” or “helper” appears. It may be a fellow journeyer, a health professional, or even someone who unexpectedly just seems to resonate with the experience. In mythology, the teacher is often imbued with supernatural powers (i.e. Merlin) – demonstrating there is more than meets the eye but also knowing, full well, that their role is solely one of facilitator. The ideal helper (based on interviews by Barasch and Onken, Dumont, 2002) has the following qualities, they: empower the individual, challenge the individual to change from deterioration to creation, accept the uniqueness of the individual (not how they fit into a preconceived image or category), communicate in a way that rings true, empathize in a manner that indicates perhaps they too have traveled this path, protect – by providing sanctuary and permission to do what is needed, aren’t afraid to put a hand on the person’s shoulder if need be, base the relationship on more than the immediate alleviation of symptoms, are humble (recognizing that in the hierarchy of the psyche, the helper is allied less with the high and exalted than with the low, dark and small, undeveloped aspects of the self), and recognize the importance of transformation.
Discovery – Layers of understanding are peeled back and there is an increased awareness of the forces which shaped the current situation. In the epic tales, the hero often discovers hidden things about the past; Moses comes to know his true birth origin, Hercules finally understands his banishment from Olympus, Luke realizes Darth Vader is his father…It is often here in these dark corners that many report an awakening to the roots of their predicament. The issues reported most often included significant childhood losses and traumas, particularly if there was a deferral of their own authentic self. In hopes of gaining love and a sense of mattering, they often discover their earliest efforts were focused on hiding inner feelings (angers and hurts) and deferring to the needs, expectation and judgments of others.
In the process of these discoveries, the hero also reconnects with genuine strengths which have been denied as well. By revealing and facing head on what they have been frightened of they are no longer bound by that fear. The spell of replaying the same story over and over, hoping for a different ending, breaks. “The hero discovers and assimilates his own unsuspected self (their darker side) as well. One by one, resistances are broken, responsibility is taken and there is a subsequent dramatic change in outlook – a rediscovery of aliveness.
However, before the final death of old ways and rebirth of new ones, people frequently report an ultimate test of their new resolutions. Many refer to this as the dark night of the soul. It can be accompanied by emotional paralysis. In symbolic terms the hero is in suspended animation (Snow White sleeps, Hans Solo is frozen in his carbonite tomb, Hercules is stripped of his godly powers, Jonah is swallowed by the whale, winter freezes the earth and strips away the showy plumage of autumn). At this juncture the individual subconsciously determines if he or she is ready to face life without the “former outgrown self”. Things may seem temporarily worse – just as the individual is beginning to feel better it dawns on them that they really are giving up a way they used to be and this can be frightening. Sometimes the upsurge in symptoms is the necessary push which catapults them to once and for all release themselves from past patterns. Eventually, there is surrender. Roberts & Wolfson, (2004) found that a majority of patients reported the following, “Perhaps the most important thing was there came a time when it all “clicked”, when I realized that nobody was going to recover for me, that I was going to have to find a way to do it myself”.
Transcendence – Paradoxically, the moment of surrender is the turning point in the journey – when all conscious stratagems have failed and the ego finally abdicates its position of dominance, the doors to deeper life forces open. A new here-and-now orientation develops, where the experience in the moment trumps the illusive past and future. Consciousness becomes conscious of it self. This is the pivotal juncture of becoming whole (of healing). People who reach this leg of their journey describe it as a profound experience, often beyond words. Illness is no longer an enemy to be feared but is viewed impersonally (maybe even as a teacher of sorts) and only as a partial aspect of self.
Those who recover truly report a “change of heart”. Often there is a noticeable grace and a sparkle in their eyes which accompanies this. They sense a larger more universal self that is no longer bound by past history and conditioned responses. Throughout history there have been references to this state of being – Maslow refers to it as self-actualized, the Buddhists call it the no-self, Buber calls it the “thou” state. Once individuals experience this (if only momentarily), they are profoundly altered. Even if there is a slip back into mechanized ways, they are forever aware of the existence of a place where life can be created anew: at the very least hope and faith are restored.
Return – Every journeyer must make also make their pilgrimage home. Though transformation may have occurred, the individual still needs to embrace whatever interests or activities are needed to hold onto this renewed zest for life. They have become aware they have a right to personal joy, meanings and purpose, yet they also realize that they cannot remain aloof from the world and must somehow bridge the gap between internal and external experience.
Campbell cites that credibility is the most difficult part of the hero’s return to the world, as others may be reluctant to accept the changes as genuine. Words alone cannot convey the changes which have occurred; these will only become truly evident through new actions. The individuals, rather than being passive recipients of care or trying to control everything, apply their self-knowledge to the practical problems in every day life. They become partners in care, weighing recommendations from outside sources against their own internal recommendations. They begin educating themselves regarding their illness, studying treatment options, learning terminology with which to converse and assess their own healing capabilities. The crisis-activated psyche begins to see the world with more meaning and seeking information becomes a way to build upon this wisdom. By establishing a sense of internal control and being consciously aware of what they are choosing, they often empower the treatment intervention itself. They are no longer victims or passive observers of their situation…they take ownership.
Not only does the individual value their own inner workings more but there is also an increased empathy and understanding for others. Eugene Taylor writes, “To the extent that we lose our old self, to that extent, we find ourselves in others. The more deeply we penetrate within, the more deeply we penetrate into the fabric of all who have ever lived”. Though not all individuals travel this far in the journey, those who become ‘wounded healers’ are recognizable. They are the people you come across who are able to “facilitate our ability to feel ourselves, however briefly, as fully alive, vibrant, healthy and whole” (Dacher, 1991, p 195). People feel valued in their presence. There is a heightened sensitivity to other people and a tenacious commitment to something that inspires individuals to rise above their present circumstances. ‘Wounded-healers’ often attach themselves to causes far grander than any they dared to envision prior to their illness. Allan Luks, author of “The Healing Power of Doing Good”, surveyed thousands of volunteers and discovered those who help others consistently have better health than those who do not help others.
Recovered individuals tend to report a deepened awareness of the integration of mind, body and spirit, and the ability to take more action at earlier points if imbalance is noted…this has been referred to as “weller-than’well”. It was not a hyper-vigilance but a subtle change in paying attention to themselves and “knowing” what measures would promote or hinder their well-being. There were also fewer occasions where subconscious secondary gains were derived through illness; thus they were better able to harness the energy of their thoughts toward positive ends.
But most of all, those who saw the entire journey through, experienced a sense of wholeness and a new found ability to be present in the moment. Alan Watts writes that most of us live as if in a sort of hourglass, with a big bulb at one end (the past) and a big bulb at the other end (the future). We are at the little neck in between and ironically perceive we have no time. These individuals discovered an enormous present in which to live – our past and future only being abstract borders in which we don’t live.
In summary – the trials, tribulations and ultimate rewards of the hero’s journey dove tail with the characteristics of those who heal: these individuals reframe a ‘damage’ model into a quest for wholeness, they see bad times as temporary, they re-interpret past events to identify their strengths, they realize that struggle is part of life, they recognize that hurt and rebounding from hurt co-exists, they make sure to spend time with healthy people and establish boundaries with those who are harmful and they stop blaming themselves for what went ‘wrong’ but instead own what they manage to make ‘right’. The tools which continue to sustain them (according to the “What Helps and What Hinders?” study, in order of most to least important) were: Family and friends, social activism, exercise, one-to-one therapies, group affiliation and psychiatric drugs.
As healthcare providers, we do our best work when we are capable of following people along on their hero's journey, blending our science with the art of caring for the human condition.
Heidi Waltos, RN, MSN, CNS (2016)