The Metaphor: Robinson Crusoe, chronic pain, and illness

The Adventures of Robinson Crusoe: Saved or Cursed?

A Metaphor for Chronic conditions

September 30, 1659. I poor miserable Robinson Crusoe, being shipwrecked, during a dreadful Storm, in the offing, came on Shore on this dismal unfortunate Island, which I called the Island of Despair, all the rest of the Ship's Company being drowned, and my self almost dead.

Victims of circumstance

We have found that Robinson Crusoe provides a powerful archetypal image of the person who finds himself or herself thrust into another life dimension--living, not just as a stranger in an unknown society, but as a lone victim who must learn to survive without the preparation and support that accompanies most other drastic role changes.

Crusoe, after the shipwreck, found himself catapulted into a new existence--feeling abandoned and exiled. For the person who has a serious accident or gets a devastating medical diagnosis, the circumstances can be disturbingly similar. The feeling of being adrift may be accentuated by the related experience of being thrust into a health care system that tends to focus on the illness rather than the person who is experiencing it.

WHY ME? Seeking meaning

Why me? Robin asked himself this question countless times during the 27 years he lived on the island. It was a question that seemed always to lurk in the background, needing continual reappraisal. The question is one that is central our human experience.

Beliefs in predestination, karma, and "I told you so's" often merge into a sense that one must be guilty of something---even if it's not clear what the transgression might have been. For some this belief may provide a sense of predictability and continuity in life, as well as possible directions to take toward appeasement or recompense. For others, the question can become an added source of torture--pitting one against any and all who would impose their belief systems on an already suffering self.

Seeking Safety

Once he found himself washed up on the shore, Robin began to orient himself and plan how best to survive what he hoped would be a brief ordeal. His overwhelming need was to seek safety from known, imagined and unknown threats. Thus, finding shelter and identifying possible threats to safety became paramount concerns.

How best to find "safe haven" within a chronic condition is not always apparent. Even if one has healthcare options, they may be limited in access, coverage, or ability to adequately diagnose or treat the newly defined “patient’s” condition. When it's unknown whether a condition is potentially life-threatening the need to control one's life in every way possible can feel like a primal need.

Hoping and Waiting to be Rescued: Staying close to shore

Waiting for rescue Not surprisingly, Robin was reticent to go far from shore once he had found a safe cave in which to live and scan the horizon for passing ships. He also worried that other areas of the island might bring more dangers and-- more importantly--if he were not on shore he might miss his one opportunity to signal a ship. He spent several years, rarely leaving his cave, vigilantly keeping watch waiting to be rescued increasingly experiencing hopelessness with everyday.

It is this hopefulness that often sends patients into desperate "doctor-shopping". This phenomenon is often viewed with displeasure by health professionals, who see it as evidence of a lack of confidence in the health care provider and a source of frustration for the patient. In fact, it is confidence in the health profession which often keeps patients in an endless cycle of looking for a medical miracle and rescue by a savior who will be able to work the prayed for miracle. The search may also lead to a growing sense of despair and confusion, if treatments that are held Isolation and despair out as "sure cures" fall short of the claims.

Isolation and despair

Much of Robin's despair during his time on the island was a result of his sense of total isolation from the outside world and other human beings. Certainly many people who are experiencing chronic illness or chronic pain are not objectively alone in the world. Nevertheless, the inherent subjectivity of pain and suffering seems to universally bring about a sense of being separate from those around that is difficult to bridge. Their increasing experience of isolation understandably amplifies levels of despair.

Turning Point

Despite having been lost at sea, abandoned and alone on an island, without companionship and with fears for his safety and ultimate rescue, the point at which Robin reached bottom was when he fell ill with an infection accompanied by an extremely high fever.

In this state of ultimate vulnerability he was presented with gifts from the unconscious--fevered dreams that initially terrified him but ultimately gave him hope and direction. Surviving this experience Robin began to consider the possibility that he might create a satisfactory life on the island. After this turning point, Robin became more aware of the small blessings around him. He was astounded to see that, indeed, Nature was providing for him, in the shape of new growth from old seeds.

For patients suffering from chronic pain and illness, there may begin with a growing realization that they are not always in consistently severe pain, or that, despite a physical limitation, they have also developed greater abilities in other areas, physical or otherwise. For many, this begins an awareness of cycles that had heretofore been masked by the singular focus on getting back to life as it was or an insistence on total symptom relief. Exploring unknown territory

Exploring the territory

Robin had to be willing to leave his perpetual vigil at the shore's edge before he began exploring what the rest of the island might hold for him. Only after he had diminished his reliance on hope of rescue was he freed to find the beauty and abundance that he would never have imagined possible from his post near his small cave.

To those who are newly cast upon the shores of chronic pain and chronic illness, the specter of any gratitude for the crumbs of life may seem outrageous and absurd. Managing a chronic condition invariably demands major life changes, particularly with respect the use and conservation of our resources, however these are defined. Another aspect of this phase is coming to some peace with the ambiguity around that which we cannot predict or control. Thriving thru experimentation

Experimenting

Over time, Robin engaged in a series of experiments intended to improve his options and quality of life. His first experiments were attempts to create the resources he needed and didn’t have. Many of his experiments failed repeatedly as he refined his skills. He engaged in the time-honored process of trial and error, learning from each mistake and noting his progress so that he might improve his methods over time. Once Friday became part of the story, his skills were also incorporated in the experiments, building on what Robin had already learned.

Because few of us actually live on an island, we often are able to get the resources we don't already have by borrowing, or purchasing them from other people. In many cases, however, what we need cannot be obtained from another person--particularly personal skills that may be necessary for managing a chronic condition on a day-to-day basis. Recrafting a Life

In our experience patients become incredibly ingenious in developing routines and methods for making their lives easier. Many, if not most of these, are developed by refining what "works" over time. When one is carrying out an experiment, there is no such thing as an absolute "failure" since it is simply information about what does not work--at least not done exactly this way or at this time. .

Recrafting a Life

Robin had to be willing to leave his perpetual vigil at the shore's edge before he was able to recraft his life on the island. Only after he had diminished his reliance on hope of rescue was he freed to find the beauty and abundance that he would never have imagined possible from his post near his small cave. It is not necessary for the individual suffering from chronic pain and chronic illness to abandon hope of rescue or a cure. However, like Robin, they must diversify their focus to ultimately lead a recrafted life.

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