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The Minotaur in the Labyrinth and the Beauty and the Beast in the Castle; different ways of reaction to a traumatic event

labyrinthThe Minotaur in the Labyrinth

The Minotaur is a Beast, half man, half bull, which eats the flesh of the youth, seven boys and seven girls, a given holocaust from Athens. The Minotaur is imprisoned in a Labyrinth, without any chance of escaping. This myth belongs to the Bronze Greek age, dated around  1500 BC, and calls into action a “Beauty”, Aradne, daughter of Minos,  King of Crete and a hero, Theseus, son of the King of Athens, Aegeus, who wish to cease this sacrifice of the best of youth of his city. Why this use the myth of the Minotaur as the Beast? In the setting of medical illness, the terms “Beast” or “Monster” or synonymous  are recurrently used in patients’ narratives in reference to their disease —as for example talking about their life with multiple sclerosis, cancer, psoriasis, and even in the fragility of the aging process. This occurs especially when the person exhibits poor coping strategies, the ability to master “something unwanted, disruptive, and unforeseeable”.  In a recent study on 123 patients with multiple sclerosis, the word “Beast” was mentioned at diagnosis in up to 7%, and increased up to 40% in patients who were not able to cope with the trauma brought by the disease on their life.

In fact, if there is no chance of creating and finding any possible solution to afford the change of life with the disease, the monster is always there, as a Minotaur that the patients will eventually encounter constrained in the Labyrinth. By analogy, the maze space regards the setting of care, that might be home, hospitals, nursing homes, and practices. All these locations of care change, according to where the patients are, at certain time of their illness. They might be in hospital beds, or at home, or ill but at their work place.

A so called patient’s journey start: this is the formal definition for the sequence of care events which a patient follows from an entry point into the system of care triggered by a certain illness, until the patient is discharged from hospital to his or her home, care home, hospice or due to death.

How is this patient’s journey? Is it linear? Is it circular? Does it have an exit point? Is it a Labyrinth?  Complexity increases. In these situations, the patient’s journey is so analogue to a maze,  that people and carers might get lost and this is often what they declare, both in the diagnostic phase, when it is difficult to give a name to their disease, and in finding the carer most suitable for the patient’s dreams and needs.

The architecture of the Labyrinth represents the “labor into”, the fatigue, in which every step, physical or metaphorical is taken to find the way out, because of two big dangers:  getting lost in the pathway of care and  being eaten by the Disease, the Minotaur. Here, there is no possibility to tame the Beast, but there is only one chance to get rid of it: being brave as Theseus who firstly  killed the Minotaur, through the help of the sword given by Ariadne, and then  found the way out from the Labyrinth through a ball of wool  to avoid him getting lost. This thread could be associated to the rational mind, which opposes itself to the naïve thoughts of the youth who are going to perish in sacrifice.

By analogy with the pathways of care, translated into algorithm of care- one patient may enter the branch where there are good carers and another patient might end up in the branch with an upper medicalization, due to an improper listening. Most of us experienced that after one simple diagnostic test, we are recommended to perform  other investigations, that, in the majority of cases, we will not perform. However, there are many people who torture themselves, also in a hypochondriac way, by the idea that they have to undergo, from test to test, from physicians to physicians.  They draw a Labyrinth as their patient’s journey, without giving themselves any possibility to get out from the maze with the “thread” of the rational mind. Theseus was able to overcome this Labyrinth only holding in his hand the thread given by the beautiful Ariadne, the Mistress of the Labyrinth and by being able not to be in panic in front of the Beast.  Insane passions, too strong emotions and fear among all,  are not the right attitudes to get out from the space of the Labyrinth, a space that is an archetype into the humankind realm[3]; it is able to represent the life of every person, as soon as launched in our earthly dimension, with its degree of unforeseeable events.  Theseus went to Crete, to kill the Minotaur, with the clear scope to eradicate the sacrifice of fourteen Athenienses; from the myth, it is not clear whether he even cheated Ariadne, letting her hoping in his love, leaving her alone abandoned in Naxos.  He will pay for being so superficial, forgetting to change the black sails of his ship with the white sails which would have been the signal for King Aegeus that the Minotaur was defeated. King Aegeus, looking the back sails, thought that his son was dead, suicides, throwing himself in the sea, that it will be named from this action the Aegean Sea.

Patients’ get lost not only when they are diagnosed a disease by a physician, but also when they self diagnose a disease through the Labyrinth of the web: they lose certainties, becoming fragile, with no clear map given. A savour, external, or internal, as Ariadne, is warranted not only to fight the disease but also to find good therapists.

Patients, as the innocent young people, after getting lost in the Labyrinth  are forced to live in a chaos attitude[4], with no possibility to escape from the end which might be caused by the Beast of by starving to death in a hidden branch of the maze. Even the hero Theseus, who is able to fight the monster with the thread is in a chaos, forgetting to change the sails of his ship. He kills the Beast, but he is not able to learn from the Disease anything if not the memory of a terrible trauma.  He is not able to perceive the true love of Ariadne and of his father Aegeus, lacking totally of empathy. He gets out from the Labyrinth however with the open scar of a war, even if he won. This is the opening scenario of the post traumatic stress disorders (PTSD). Past studies have shown evidence of PTSD symptoms among people who’ve been treated for cancer, heart attacks and stroke as well as organ transplant patients. But PTSD may go unrecognized in many patients and can sometimes slow recovery from a critical illness.

Here some evidence of coming back from the trauma of the Labyrinth:[5]

  • Heart attack. One in eight persons who had a heart attack or other acute coronary emergency develops PTSD symptoms, according to researchers who analyzed data from 24 PTSD studies that included 2,383 heart patients. The analysis, published in June 2012 by the journal PLOS One, noted that the risk of having a second heart attack or dying among heart patients with PTSD doubles within three years.
  • Eighteen percent of stroke and mini-stroke survivors reported symptoms of PTSD in a study published online in January 2013 by the British Journal of Health Psychology. Sixty-five percent of those patients with PTSD symptoms were less likely to follow their drug regimen—perhaps because it reminded them of their stroke—putting them at risk for another stroke.
  • Breast cancer. Nearly one in four women with breast cancer developed PTSD symptoms within the first two to three months after diagnosis, says a study published online in February 2013 by the Journal of the National Cancer Institute. Symptoms were most common in African American and Asian women and women under 50.
  • Spine surgery. In a study of 73 patients who underwent elective lumbar spinal fusion surgery—a procedure that fuses together two or more vertebrae—nearly one in five had PTSD symptoms within one year of surgery. Patients who had pre-surgery depression or anxiety were most likely to develop PTSD.
  • Hospitalization in an intensive care unit (ICU). One in three patients admitted to an ICU with an acute lung injury and placed on a ventilator to aid in breathing had PTSD symptoms up to two years after their stay, according to a recent meta-analysis conducted by Johns Hopkins and published online in March 2013 by Psychological Medicine. The Hopkins doctors suspect that PTSD is common among other ICU patients as well.

What do we learn from all this scientific literature? That if there is no change of attitude from Chaos to Quest, that is to say, what am I learning from this experience, and moreover, the opening to empathetic feelings toward the helpers, trauma will stay, and will be bigger that the disease itself. The Minotaur, which could have been only an animal, enters in the realm of threatening mythology of fears.

If trauma is not transformed, not metabolised, it will impact the outcome of the survivors in the future, despite any thread and sword received for killing the Beast.

The space of Labyrinth has a secret order however not acknowledgeable to human sense: it generates chaos, confusions, and when we are fragile during a disease, we need somewhat some few certainties, not only the eternal living in the idea to be lost.

 

The Beauty and the Beast

The Beauty and the Beast is a fairy tale, which probably has its roots in the Greek age, or earlier in Bronze Age, 4000 BC. Fairy stories, as mythologies, often have themes common to humankind throughout the world and through all ages, such as family, betrayal, violence and survival. However, fairy tales are characterized by a happy ending since they were and still are nourishment for positive thinking.
Also, the Beauty and the Beast fairy tale  has a positive happy ending, which shows that even scaring figures can be “tamed” and “transformed through love”. In this novel, another Beauty is a main character, the daughter of a merchant who gets in a forest during a storm. Seeking shelter, he enters a dazzling palace. A hidden figure opens the giant doors and silently invites him in. As the merchant is about to leave, he sees a rose garden and recalls that Beauty had desired a rose, before his leaving. Upon picking the rose, the merchant is confronted by a hideous “Beast” which tells him that for taking his most precious possession after accepting his hospitality, the merchant must die. The merchant begs to be set free, arguing that he had only picked the rose as a gift for his youngest daughter. The Beast agrees to let him give the rose to Beauty, but only if the merchant or one of his daughters will return.

The merchant accepts this condition. Beauty accepts responsibility for her actions and willingly goes to the Beast’s Castle. The Beast receives her graciously and informs her that she is now mistress of the Castle. He gives her lavish clothing and food and carries on lengthy conversations with her. For several months, Beauty lives a life of luxury at the Beast’s palace, with no end of riches to amuse her and an endless supply of exquisite finery to wear. Eventually, she becomes homesick and begs the Beast to allow her to go see her family. He allows it on the condition that she returns exactly a week later. However Beauty stays at her father’s home longer than a week, and while staying there she begins to feel guilty about breaking her promise to the Beast, and decide to go back to the Castle. She is horrified to discover that the Beast is lying half-dead from heartbreak and the Beauty weeps over the Beast. Only by finding true love, despite his ugliness, could the curse be broken. He was transformed in a beautiful prince and married happily Beauty.

As the analogy of “the Beauty and the Beast” is put into the context of illness, who or what does the “Beauty” embody? Is there a way to induce a metamorphosis of a “Beast-disease” into a less threatening situation? The “Beauty” could be the care, as well as the patient’s coping factors as agreeableness, extroversion, openness, optimism and consciousness inborn to humankind, which might lead to the acceptance of the “Beast”. It is nice to consider that even in the ancient time, this optimistic view on surviving the most cumbersome situation was there.

When someone has to face a disease, a new space-temporal condition is there. Time might seems longer and unbearable as ever, looking forward to receiving the results of the test, or the access to a  new cure or an innovative treatment. The mental space of a patient is invaded by the Beast, which takes the control of the whole body or of the whole context in which the ill person lives. However, in this tale, if at the beginning, the Beauty is shocked by the Beast and his ugliness, as time goes by, she discovers that he has some kind manners: even if he looks scaring, he does everything to try to calm down the Beauty, going from nice presents up to talking with her, being capable to create a dialogue.

Ariadne is used by a man, and then left abandoned on a desert island: on the contrary, the Beauty is able to find her inner resources to go back on her own willingness to the Castle and to stay with the monster. Culture helped her. The fact that she is a woman with empathetic skills, not falling immediately in  a passionate love for a hero, but discovering on a more intimate ordinary life, a way to cope with the Beast, even reaching the “absurd” position of loving the Beast itself. The fact that the Castle is not a Labyrinth, with only one way of getting in and out, but it is an easier place to go in and to get out represent a wider Freedom.

The Beast is scaring at the beginning, but gave to Bella all the entertainment she wanted and also the ultimate chance; freedom to go back to her relatives and to her beloved father. If Aegeus dies because of his son post-traumatic chaotic mind, who misses to change the sails, in this fairy tale, a father keeps his life through the empathetic point of view of the Beauty. Curiosity saves herself and her father, as well as with compassion, whereas the courage if Theseus is not enough to prevent fatal events.

The Beauty has chosen to live  in a “quest” attitude,  knowing that a Beast, which belongs to the Danger is always behind, and that however only good manners, empathy, fascination for the oddity, and inclusion skills might be the trigger factors not for Defeating the Beast but for controlling and accepting it.

While the Labyrinth is an architecture, which has ground in the soil, the Castle is a building, which elevates itself towards the sky, above the Labyrinth of the ordinary lives. Its walls are able to let people in and out, protecting them during the attacks. Castle is a fascinating architecture, since there is almost no fairy tales without such a palace.

The Castle, although in dark time might become a prison– think to the cellars, is something beloved by people, and gives protection and security: with no need of thread; one just can try to accomplish with it. If it’s too high and isolated, there is a close village where people can go and have a chat in a bar, or in open air…or can open it to give a party, with the roses of the gardens as decorations. The Trauma is gone, by reflecting upon it, by living with it, through the talking of the fears, the living and doing arts and music, by committing to do something personally meaningful and important every day, and by writing down the traumatic experiences, as narrative medicine teaches, and Beauty knows to tell story and to write. From the patients with multiple sclerosis, we learnt that they were able to cope with the Beast by finding something new and beautiful every single day in their lives.

Indeed, in patients’ narratives, in the “quest” attitude, with coping resources, the Disease from Beast mutes its name and transforms in: “a part of myself”, “an invasive event”, up to a “mate”. A roommate, a live mate. A mate, a person who mirrors you and, if taken with the right rhythm, entertainment, and words, and gestures can bring also peace in this war.

In the Labyrinth, there are no decorations, while in the Castles the roses that the Beast had sown when he was alone, waiting for somebody to scare and to stand by at the same time are in blossom.

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Written by

Epidemiologist and counselor – 30 years of professional life in health care. Classic humanistic background, including the study of Latin and ancient Greek, followed by scientific academic studies, chemistry and pharmacology. First years of career, in private international environment. I worked in medical research, moved to health care organization, getting academic specialization in Epidemiology. Later, in consultancy and health care education. Counselor with transactional analysis orientation. Currently, director of Innovation in Health Care Area of Fondazione ISTUD, an independent not for profit Italian Business School with an humanistic approach acknowledged by the Italian Ministry of Researech.. Active member of the board of Italian Society of Narrative Medicine, tenured professor of Narrative Medicine at Hunimed, Milan, and in 2016, referee for World Health Organization for “Narrative Method in Public Health.” Writer of the book; “Narrative medicine: Bridging the gap between Evidence Based care and Medical Humanities,” edited with Springer and of international publications on narrative medicine in scientific journals. Last book “The Languages of care in narrative medicine: words, space and sounds in the healthcare ecosystem”. Lecturer in different international contexts from Academy to Public and Private Foundations.

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