as clay is worked upon before it must go through the fire, then we are both the artist and the work itself. We are a work in progress until the final touch. How we respond when we suffer shapes us, and what we do when we know we are dying makes a difference if we truly are spiritual beings on a human path.
Living in the Shadow of Death
One out of seven women will get cancer of the breast and one out of three people will get cancer in their lifetime. Often the diagnosis is made in prime adult years, way before it feels as if it is time to face the possibility of dying.
Appearances make the parallels to being in the midst of a holocaust graphic. Patients with either progressive disease or those in the throes of aggressive chemotherapy or radiation therapy often lose appetite and weight. They can begin to resemble inmates of concentration camps, where Viktor Frankl learned about choice and survival of spirit in the midst of pain, deprivation, malnourishment, and suffering. Between the illness itself and treatment, there is often pain and suffering. There are times when food cannot be kept down, or cannot be absorbed. Malnourishment is common. While there are no barbed fences, the necessity of being in a hospital linked to an intravenous bottle is as confining. In a hospital as in the concentration camps, people live in a valley of the shadow of death, susceptible to feeling powerless and in danger of giving up.
In radiation-therapy waiting areas in large medical centers, patients become aware that they are not alone in their suffering, that they are not the only one. Just as Frankl noted the way inmates responded, similar observations can be made in hospital settings. One such observer, Phil Head, a contributor to a series of essays in When the Worst That Can Happen Already Has, described what he saw. “You watch the ones who sadly give up. They don't walk into the room and say, ‘I give up, I have cancer,’ but in the way they accept the treatments and the way they relate to the other people, you know they've given up…. Then there are the people who try, to the best of their abilities, to spread a little fellowship and humor. From the very beginning, humor for me was a big help. As long as I was able to laugh at myself, the treatments, and my circumstances, there was hope.”4
Humor is an expression of spirit and fellowship in the midst of a descent into the underworld. It's a means of commenting on reality and getting through uncertain times of risk and pain. (Frankl described humor at Auschwitz and Dachau as among “the soul's weapons in the fight for self-preservation.”) When one has been stripped of the outer garments of dignity and there is no visible means of security, humor comes from the soul's perspective and laughter changes our biochemistry and psychology.
While humor may seem irreverent and far removed from a five-thousand-year-old goddess myth or the two-thousand-year-old Easter story, myth and humor have much in common in helping us through a period in the underworld. Both feed the spirit and are expressions of the unconquerable element in us. Humor and myth provide perspective on our suffering and make pain easier to bear. Each also is a commentary on there being something more to what is going on than meets the eye.
Entry to the Underworld: Ready or Not
There are many good reasons for an immediate admission to the hospital, such as traumatic injuries from accidents or violence, severe burns, a likely myocardial infarct, hemorrhaging, being unconscious, having a raging fever—any state in which immediate care could make the difference between life and death. At Los Angeles General County Hospital, where I interned, anyone who arrived in a critical condition was called a “red blanket.” The patient was immediately put on a gurney, a red blanket (in actuality, a bright red sheet) was thrown over him, and an attendant wheeled the gurney on a nonstop elevator to an admitting ward. When a red blanket arrived on the floor, that patient was seen immediately.
In contrast, many people go to a doctor's office with symptoms that have been present for a while, often after having had to wait for days or even weeks for this appointment, and are told that they must go from the office to the hospital immediately. In an atmosphere of fear and urgency, there is then no time to prepare others, or get some matters settled that might otherwise be major worries, or get a second opinion, or be able to inquire into alternatives, or become psychologically and spiritually supported and prepared for an undertaking that will tax the body and soul of the patient. Doctors who instill fear, don't discuss options, and take immediate charge under noncritical conditions usually render the patient helpless to chart his or her own course. Fear of malpractice suits, unfamiliarity with the patient as a person, and the economics of insurance coverage may make this course the prudent one for the physician and a very difficult situation for the patient to resist.
This is a critical moment. The decision to be immediately admitted to the hospital may be the right one, and you may be relieved that this is happening, because you have had a feeling that something quite serious was not being attended to, and now it is. You may intuitively trust the doctor and the decision. Or, as is sometimes the case, there may be an inner resistance, an intuition or feeling that you need more information, or need to sort out the situation, or need to take care of other matters before you can go in. For the soul, and quite possibly for the body, it matters whether you are ready or not. For you are not just being admitted to the hospital, you are on a soul journey that will take you into the underworld.
3
PSYCHE'S JOURNEY
A serious illness takes us into a time which is both strange and scary for almost everyone. It is a life-changing, major event that brings the possibility of death or disability close to us. “Biting the bullet”—that western-frontier expression to do with submitting to surgery that absolutely must be done with no available anesthesia, and biting down rather than crying out—is now what is called for metaphorically. It means having the courage to face the reality or possibility of having an illness that may kill you. It means suffering pain that goes with the disease or the apprehension of it. It means enduring the treatment. What ails the body is at the immediate forefront, but attending to what ails the soul and is not right with our lives is often not far behind. Any serious medical condition—a heart attack, a bleeding ulcer, malignant hypertension, a malignancy— may have an impact on the psyche by cutting through layers of denial. An illness may confront us with what we know in our bones about being unhappy or self-destructive and have thus far disregarded or denied. Biting the bullet then applies to more than the medical problem; it's facing what is wrong with other aspects of our lives and what must be done. Once we face a medical truth and submit to what must be done to survive, barriers to other truths often come down as well. When this is so, it is a harbinger of change that will come next on the soul level.
When an illness is life-threatening, we can usually recognize how insignificant and unimportant many of our everyday concerns are. We may find that we are, for this time, free of neurotic preoccupations; what matters, for a change, may be what really matters. “Cancer can be an instant cure for neurosis” was how several women at a conference for breast cancer survivors put it.
At this same meeting, women who had made major changes in their lives as a result of a cancer diagnosis and were not just surviving the cancer but thriving remarked how their illness was “the worst thing that had ever happened to them and the best thing that had ever happened to them.” Men who were work driven, aggressive, and ambitious until they were felled by heart attacks, who slowed down and refocused, say the same thing. Usually these women and men took a good, long look at what was wrong in their lives and acted decisively to end what was bad for them—at the body and soul level—and moved toward what sustained and nourished them, also at the body and soul level.
It may be that they (finally) ended dysfunctional, soul-draining relationships with narcissistic, controlling, needy, abusive, or chronically angry people, who responded in their characteristically
