Prior to opening my private practice, I worked for many years as an Oncology Social Worker. For a year I provided weekly therapy through an interpreter to an Iraqi woman, a refugee, with an aggressive breast cancer. She was terrified given language and cultural barriers. She initially hid her diagnosis from her six children by never removing the hijab from her bald head in their presence. In her view, she was permanently damaged with a death sentence. Most of our therapy involved acknowledging feelings, dispelling myths, and helping her navigate the confusing and often impersonal healthcare system.
After many months, I felt a bit stuck in our work together. At a loss, I described Joseph Campbell’s model of dealing with adversity. In A Hero With a Thousand Faces (1949), Campbell outlines commonalities found in stories cross-culturally and historically where the protagonist must venture out on an arduous journey of challenge and discovery. The hero receives a call and wishes he hadn’t. He tries to refuse the call but realizes he has little choice. The hero always leaves home (comfort, safety, familiarity) and heads out alone (even with a large support system, the cancer patient is, in a sense, on their own). As Campbell puts it, the hero receives The Call to Adventure. Stories, myths, and movies show us that the adventure could be anything - wandering the maze to kill the Minotaur, entering the belly of the whale, obtaining the ring from the underworld, or entering the Hunger Games arena. I like the motif of the dark forest. When we enter the forest, we cannot see; we do not know where we are going, it is disorienting. While the goal is to find the Holy Grail, exit the forest and return home, the hero must first face many tests, obstacles, challenges and dangers. This resonates for anyone dealing with illness.
While making his way, the hero is given a task: He must find the hidden treasure which may be easy or difficult to find; the treasure may be large or small; there may be one treasure or many. I have heard cancer patients say that they have discovered a renewed sense of compassion for self and others. I remember a perpetually busy man deciding to take his whole family on a long cruise. One woman came into support group and announced, “I did it! I bought a piano!” She had frugally denied herself something she had always wanted, and now she was taking piano lessons.
Not everyone finds the treasure and some don’t even look. Nor is finding the treasure necessarily contingent upon survival. I have known people to be cured from cancer who never allowed themselves to be introspective enough to dig for it while others cherish the treasures they find before they leave this world. The idea is to locate the treasure, exit the forest and return home to share it with the village. It is the community’s job to welcome the hero home. We might also say that he returns home to himself, changed, with an inner treasure, hard won and life altering.
So what is it that makes one person look for the treasure while others barrel through without contemplation? I have often wondered what the mechanism is in which one person cannot emerge from the maze of despair while another is able to transcend adversity, make meaning, and move on. Lawrence LeShan wrote about this idea in Cancer as a Turning Point (1990), which has sparked workshops and conferences around the country. He encourages patients to question the meaning of their illness and asks what might be emerging as a new life purpose given their circumstances. The literature on post-traumatic growth (PTG) may also give us some ideas about this. It is suggested that with PTG, one moves beyond simple recovery where we can see an enhancement of their psychological state. It involves “a process of revision and reconstruction of shattered beliefs that results in the development of new beliefs and assumptions that can accommodate the traumatic experience.” (Gerrish, N., Dyck, M., Marsh, A. Post-Traumatic Growth and Bereavement; Mortality, Vol 14, No. 3, August 2009). The assumptions that correlate with PTG include a belief that the world is benevolent, that the world is meaningful, and that the self is worthy. In other words, resiliency is linked to these internal schemas. Perhaps this is why someone with a history of significant trauma may have more difficulty in adjustment to illness, since their prior experience may very well have contributed to the development of different schemas.
Cancer patients often ask, Why me? This question may be rooted in grief related anger, or it may simply be an attempt to make sense of what seems so senseless. Perhaps the question people need to ponder is not so much Why?, but How? What? and Where? How has this illness changed me? What is my disease trying to tell me? Where in my life have I abandoned myself? These questions are less accusatory than the question Why? They are softer, include inquiry, curiosity, and multiple possible answers. They allow for compassion.
As I told her The Hero’s Journey story, my Iraqi patient looked at me with wide eyes. Through tears she said, “I know what the treasure is. The treasure is my life, and when I get through all of this, I am going to learn English. Maybe I will have American friends.” Touched, I reflected, “Now wouldn’t that be a great gift to the community?” She eventually felt ready to leave therapy. Occasionally I would get calls from other refugee patients that were sent to me by her. I was happy to know that she had come out of isolation to help others. One day, many years later, while at a local well filling large bottles with fresh water, I looked across the well and saw her. Wearing her beautiful abaya and hijab, she walked over and hugged me. I am still deeply moved by the vision of two women from very different worlds, surrounded by onlookers, embracing at the well. I smiled when she spoke to me in English. I thanked her for finding the treasure and bringing it back to the village.