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Pain and Surgery: The Shamanic Experience

In this paper, Arthur Colman brings us a chilling view into the world of pain, surgery, and healing. Through various means of active imagination—and finally its apotheosis in a full-scale shamanic journey that was all too close to physical death on the surgical table instead of ego death in the psyche—Arthur brought the healing power of shamanism into the antiseptic rooms of a modern hospital.

For seven years of my adult life, I lived with continuous and severe back pain. The trouble first began in adolescence. I had bouts of pain that incapacitated me for three to six months at a time, but the big pain came without warning one morning when I was forty-six. I got out of bed, and as I stood I felt a jolt of searing fire down my right back and leg. The agony crescendoed until the pain filled me so completely that I fell to the floor unconscious. I vaguely remember the ambulance, a Demerol shot, a painful hospital stay, and a very slow return to chronic pain and limited function. Seven years in the world of pain—acute pain powerful enough to jolt me from ordinary consciousness, chronic pain powerful enough to change my "ordinary" work and social realities—initiated me into the study of shamanism, both experientially and as a healing art.

Shamanism and pain are intimately related. Shamanism, alone of the healing traditions, overtly depends on both the healer and healed achieving an altered state of consciousness for the healing process to occur. Pain is the key that unlocks the door to these states of consciousness and the "other world." While the body and mind's ultimate defense against pain is total loss of consciousness, pain gradually teaches all its sufferers to stay conscious and enter other states of consciousness—other worlds—where pain can be dealt with differently. Shamans and shamanic initiations take advantage of this and deliberately use a variety of painful conditions—extreme cold and heat; sensory, food, and water deprivation; prolonged immobility; burning, piercing, and cutting of the flesh—to learn how to make their other-world journeys for the purpose of healing themselves and others.

Even though initiates present themselves in many different ways, pain is at the center of all shamanic initiations. So it is that shaman acolytes are placed in ultimate survival situations: huddling in a tiny igloo with only a threadbare blanket and little food on the frozen Siberian tundra for six months; hanging from a tree by two hooks anchored in their chest in the middle of the Dakota plains at a ritual Sun Dance; covered with bloody wounds from scarification, piercing, and tattoos in an Indonesian jungle. The initiatory circumstances vary from culture to culture and tradition to tradition, but using the context of pain to learn the way of crossing into the other world is fairly constant. Not everybody successfully emerges from the initiation experience. Some initiates are permanently maimed, while others return broken, humiliated, or just a bit wiser about their need to find another path in their lives. Furthermore, as Montero and I discuss in another essay in this volume ("Beyond Tourism: Travel with Shamanic Intent"), the human sacrifice implicit in these ordeals may actually have a healing purpose, unrelated to the individual's fate, for the larger community. But those who successfully survive the experience return as shamans fully authorized by their community to begin their healing work. Whatever their initial motivation—personal test, penitence, or duty—these initiatory experiences are so transcendent that those who pass through them have crossed into the collective realm of wounded healers.

This authorization by a community of a specified training and initiation is a critical matter in our own culture, in which shamanic techniques are often used but rarely sanctioned. All communities need to trust their healers. In today's western societies, we initiate and authorize our healers by sending our brightest college graduates to a training school that teaches them the science of medicine and sanctions their placing their hands on and in the body in the most intimate of ways. Our culture trusts information, technology, and pragmatic experience and therefore sees these schools, and the abstract and practical work that they entail, as a proper training for and initiation into the healing profession. And yet this kind of medicine, anchored as it is in science, technology, and the pragmatic, does not altogether fulfill the spiritual and healing requirements of the ill and suffering among us. For almost all of us who have pain and illness, the medical center is only one of the stops in the healing odyssey. The physician who takes a medical history of a suffering patient is only sometimes told about the many other healers that are visited: the acupuncturists, massage therapists, psychotherapists, chiropractors, psychics, herbalists, and "urban shamans" on whom we spend vast amounts of money and time—almost as much as on traditional doctors and hospitals. In the present context of care, finding a perspective that integrates these two separated healing realms is left to the individual.

My own experience with severe chronic pain eventually led me to many kinds of healers, in both traditional and nontraditional realms. Along the way I experienced many techniques that purported to deal with pain and suffering, as well as many techniques for entering that other world. Some of what I learned was useful and helped me through my hardest times (and also helped some of my patients). Some were not helpful. But beyond efficacy, each new drug, herb, and meditation, each body massage and exercise and manipulation, brought hope and dashed hope. Each disturbed a hard-won acceptance of the status quo. And so, after seven years of initiation into the world of pain, I gradually learned what every pain patient must learn—to live in the tension of opposites between hope and acceptance. I emerged wiser (though far less happy). I was also essentially unrelieved of continuous incapacitating pain and, more ominously, of the likelihood of permanent nerve damage and muscle weakness as the condition continued.

Back surgery had always been a possibility, but because of the nature and placement of my particular anatomical lesion, it held a high risk of complications and a poor probability of success. However, as the pain increased to new and more debilitating levels and the weakness in my leg became increasingly disabling, I decided on yet another consultation with a surgeon, my third. This one was an eminent and skilled neurosurgeon who was also my colleague at the medical center. On a continuum of hope and acceptance, surgeons usually stand for that ultimate hope, the hope of cure. In many ways surgeons are the modern physician most closely related to the shamanic tradition. Like shamans, surgeons do not overly honor passivity or the Tao. They are magicians, not gurus. Like shamans, the extremity of their training and initiation supports a belief in the transformative potential of their own grand and decisive action. Like shaman 's too, the surgeon's healing method is a mysterious journey into an other world, a world—where hands and knives are placed inside another's body, beneath skin and membranes; a world where the living unconscious body is trans—formed for the purpose of healing; a difficult yet ecstatic world which they must leave to return to this world and bring back information and healing images and report these to the patient and his community.

The shaman-surgeon I consulted was considered very handy with the scalpel and had a reputation of being eager to use it. After reviewing my records and examining me, he was silent. Then he turned his gray eyes directly on me and held me in his gaze. "Arthur," he said, "the level of pain, spine and disk pathology, and nerve damage is great. But surgery is very risky. There is a reasonable possibility of impaired bowel, bladder, and sexual function, and the possibility of recurrent pain, even if the operation is anatomically successful. Frankly, I would not do it if I were you. I don't think I can help you except to seriously suggest that you addict yourself to narcotics. That may sound severe, but I do not believe you can continue to suffer as you have and remain functional much longer. "

When I now tell friends about this last comment, they usually shudder and question this man's ethics and humanity. They are wrong. Like all healers of the shamanic sort, he cut ruthlessly to the core by speaking the truth. His invitation to "addict" myself to narcotics was devastating to me not because of ethics or coarseness but because he was correctly mirroring the magnitude of the pain and the devastation it had already exacted on my life. Narcotic addiction was indeed the sensible option, yet I also remembered with horror the time I had used codeine for several weeks to diminish the pain. I had been lying on my back on the floor in the living room, stoned, a pillow under my knees. My daughter, who was beginning college and leaving home for the first time, had come to say good-bye. She had been in tears, but I had felt nothing. That experience upset me so much that I stopped the codeine that day and turned to strong rock music—a less potent and less dehumanizing soporific. Despite its risks, surgery was a better alternative than the nonrelational haze of the poppy.

So against his advice, I sought and found a surgeon, Michael, who felt he could help me and whose skills I trusted. The operation he suggested was relatively new: my back would be approached through my abdomen. Two surgeons would be required for this paradoxical strategy: a vascular surgeon to peel back the huge vital vessels—the inferior vena cava and the abdominal aorta—that lie anterior to the spine, and an orthopedic surgeon to remove the disk(s), scrape the nerves if needed, and transplant a small piece of bone from the femur of a dead man into the vacant space opened. Shamanic indeed. What he was describing was dismemberment on a scale that would make even a Siberian shaman proud. Of course, Michael did not define his work in this way. Perhaps if I had questioned him in depth he might have described trance induction as he dressed and scrubbed, and an altered reality as he put scalpel to flesh.

Michael outlined the same risks as the previous surgeon but also emphasized the significant possibility of a successful outcome. As I listened to his proposal and weighed it against the last seven years, a future of painkillers, and nontraditional and managed-care remedies, I felt a strong sense of rightness about trying the extreme solution. With that feeling came a surge of adrenaline along with the image of embarking on a great and dangerous adventure, a breakout from the siege I had been under for so long. The adventure required using this surgeon's skill and tradition, but if I was going to be successful I was sure it would also need a larger perspective, and that, for me, could only be the shamanic one. This would be the big journey, the culmination of all my prior journeys and work, for it would incorporate mind-altering drugs, out-of-body consciousness, altered realities, dismemberment, retrieval of body parts from another world, and a new body—literally somebody else's bone inside of mine—and all this would take place in a strange archetypal realm of death and rebirth. My seven-year initiation into the shamanic perspective was to become absolute reality.

It will be obvious to the reader that from the moment the first surgeon presented his alternatives—and particularly in my response to Michael's proposal, I had already crossed into an altered state. From a clinical perspective, the rush of adrenaline and the vainglorious conceptualization of surgery as some great shamanic journey was filled with denial and inflation. Understandably so, for the first surgeon had presented a paradoxical alternative that had brought me to the threshold of an entirely nonrational course of action, while Michael had described an utterly unreal scenario, a world of miracles and a world of horror that had propelled me directly into that other world. I had to be in an other world to go ahead with a journey of such risk, and so I found a frame that made that other world meaningful, a very large spiritual perspective that fit my experience. In Jungian terms, I wanted to find a way to work at the level of the second stage of the coniunctio, the conjoining of the unio mentalis (the unity of spirit and soul) with the body (Jung 1963). In my case, 1 wanted to conjoin the great Western tradition of surgery with the ancient tradition of shamanic healing. In concert with the surgeon and all the other medical personnel who would be involved in my repair, I needed to authorize myself as the shaman healer. Inflated or inspired, all of it felt critical to my survival and potential healing.

Writing now, it is easy to recapture the moment of decision, that exalted sense of crossing into the other world in which ordinary reality dims and becomes background for the gathering of the spirits and archetypes, that ecstatic realm where survival is the issue and all thought and action is entrained to its purpose. I was leaving my long incubation in a sacred space of pain; I was entering a most dangerous transitional world in which, by joining forces with Michael the archangel with burning sword in hand, I would become my own shaman enacting a long and difficult journey into the land of death, rebirth, and recovery.

I had two months to prepare and one procedure to undergo before the actual surgery. In that procedure, called a discogram, a long needle was placed directly into the diseased disk and a dye injected to increase the pressure and reproduce the in vivo conditions in which the pain occurred. If the pain was not reproducible, the surgery had less chance of succeeding. Of course, no anesthesia could be used, since I had to be able to feel the pain. I can only describe what happened as akin to medieval torture. I lay almost naked on a cold slab of steel. A nurse stood by with a fixed smile on her lips. The radiologist inserted his long needle deep into my innards and injected the burning dye into the place of pain. Each bit of injected fluid increased the pressure, and pain surged through me until I raised a finger signaling I could no longer bear it. Then he would reposition the needle and begin again. It took every meditative technique I had ever used not to physically move, which I was assured would create further damage, or to disassociate, which would have decreased the information available to my surgeon. At one point the nurse held out her hand and gripped mine and that moment was sweeter than morphine. Later, when I asked the nurse what had motivated her to do that, she said that it had been suggested in her procedure manual as a help in such procedures. (That day I blessed manuals for the first time in my life.) While I lay recuperating on the day ward, my woman friend braved hospital convention by creeping into my narrow bed and holding me. This was another huge balm, this one even better for its enactment from a personally compassionate and loving frame. Both actions got me through a procedure deemed successful for the pain it produced and the kind of back lesion visualized with the spreading dye. The synergistic balance between inner control and interpersonal connections was very important throughout the process. Human connection and love is part of any healing endeavor. But love comforted me best, in concert with an intense, isolating inner work that reduced all human connection. This paradox is well known to shamans; I" think it is part of the sacrifice that healers and those who will be healed must accept.

With the surgery rapidly approaching I took several hours most evenings to meditate, drum, and in general allow visionary material to emerge as it would. What I did was not substantively different from what I had done in meditation previously except that now I had a different, very specific intent: that of facilitating the surgical healing. No shaman lacks this intent in a journey; intent, j I believe, is what separates this tradition from other kinds of altered consciousness. I conjured up my intent whenever I went into a trance, focusing sometimes on the surgical procedure, sometimes on the tangibles and intangibles of healing. Occasionally I actively imagined the surgery, even anxiously "forcing" a successful completion and outcome. I found such visualizations , extremely seductive, in the way that magic is seductive, but also far less meaningful than allowing mental space for the unimagined and unanticipated. In this latter mode, one image kept emerging quite spontaneously, first in just a flicker of feeling and then over the next few weeks in a series of images of ever increasing clarity and detail. What I saw was Michael and I dancing in the ecstatic Hasidic manner in front of the Wailing Wall in Jerusalem. (In the Hasidic dance tradition two men often dance together sometimes holding hands, sometimes holding a handkerchief between their hands.) In our dance our hands were outstretched toward each other, and we were holding something strange and sinister between our fingers as we dipped and whirled together. Night after night I saw this dance and never could quite get what it was we were holding. And then three nights before the surgery I saw that it was the gelatinous, amorphous sticky, blotchy, diseased disk that had been removed from my back. And with that realization came another image: Our dance had become a surgical ballet, a joyous operation in which both of us first placed a glistening white bone deep in my back and then threw back our heads and danced in utter abandon.

Hasidism was not unfamiliar to me. When I was a little boy I would spend every other Friday night at the house of my great-uncle, Rabbi Jacob Minkin, in what I thought was a traditional Friday evening Sabbath dinner. I say "thought" because I had no way of knowing that it was unusual for a rabbi to get up suddenly from the table in the middle of dinner and dance, slowly at first and then faster and faster, while singing and chanting in an unfamiliar language. Minkin had introduced Hasidism into America in a book called The Romance of Hasidism (1935) .He apparently had his own version of this discipline—an ecstatic Hasidism that made traditional Jewish worship feel dry and stodgy to me, then and now. I remember watching him dancing, singing, and praying on those magical nights, seeing the light around him shimmer and glow like emanations from a burning candle. Later, as a young man, I spent two years in Jerusalem searching for more experiential communion with his mysterious practices, finding something like them for myself in the weekly celebrations at the Wailing Wall on Friday night. At that time I thought hard about staying in the sacred bubble of Jerusalem but eventually decided to leave with the hope of bringing something of Jerusalem into myself rather than relying on its awesome vicarious power. Jerusalem—not just the real and sacred city but also Jerusalem as metaphor for the Self—remains a central image in my spiritual life. So when these presurgical visions occurred at the holiest place in my sacred city, I knew that I was in very special hands. I took the dance image with me into surgery, a moving mandala that permeated and colored and largely contained the preoperative world.

When I came to the hospital the morning of the operation, I felt part of two worlds: the steel-and-glass world of the surgical suite, and the other world of this and other visions. I held the latter world myself; there was no one among the medical personnel whom I could trust to understand it; there was certainly no way to ask for one who might. I stayed in the dance at the Wailing Wall as the anesthetist asked me to count backward from ten slowly.

I woke up in both worlds. There was a total euphoric thought that whirled in my brain, something like, "My God, I did it. I really did it. I've had back surgery. It's happened. " The feeling was exuberance, amazement, and exultation. I knew that I was drugged and that the morphine must be part of the euphoria, but that knowledge was irrelevant. From the moment I awoke I was aware of an absence; something was missing that had been part of me for seven years. The pain was gone; the pain that I had thought would be my fate as long as I lived was totally gone. In amazement and joy I moved slightly, and a different kind of pain, unbelievable in its own right, flooded in. This was the surgical pain, the pain of the body that has been disrupted on the most fundamental level: organ bruises, spinal dismemberment, bone transplantation, cutting, sutures, catheters, stomach tubes. That pain also contained a closeness to death and the possibility of a new life after a very long journey up from the lowest reaches of vulnerability to healing and health.

With that pain and vulnerability also came a light, an emanation that entered through the other world, a door of perception very different from my thought of the operation and its effects. The light was not the blinding brilliance described in spiritual epiphanies or near-death experiences. It was very small but very bright, and it seemed to dance just in front of my chest, defining a path that I could and should move along. This light was a strong positive force, and the light was also me, the vitality of me, as I existed in that other world. Lying euphoric in the recovery room, I watched that light intently even as part of my mind was taking in the fact that I was alive and there was no more back pain, just the pain of surgery and healing. During the next several months, but especially in the first few postsurgical weeks, I learned to work with this light, and that work was synonymous with healing. Pragmatically, the light was my guide through the agonies of the postsurgical period; in spiritual terms, it was the closest experience I have yet known of a very personal life force, a kernel of energy that was neither Self nor self but a connecting link between the two.

The work I did with that light was the hardest physical and spiritual work that I had ever attempted. This was particularly true as my ego emerged from the shock, pain, and haze of postoperative drugs. Ego consciousness was antithetical to this healing work. My connection to the light needed to be absolute and there were many ego parts of me that would have none of it. Whenever ego consciousness dominated, the light flickered and dimmed, the healing stopped, and my tolerance for the formidable post-operative pain decreased. At these times the long effort to recover function seemed overwhelming. But as long as that light danced and made its path mine, I knew there was no danger of dying, no danger of not recovering. When the light dimmed, though, I knew failure and even death were too close. I knew with certainty at these moments that this was the light that would go out when death called my name.

I can best describe the process of this work with the light by analogizing it to extreme forms of mind-body meditations and other profound and difficult body-mind adventures in which everything depends on the discipline of letting go and the sense of a journey. As every shaman must know, one of the critical aspects of these journeys is the creation of a supportive and sacred ambiance that contains the journeyer. Fasting, drumming, smudging, community praying, the creation of altars, and cleansing rituals are all needed to protect the journeyer from the considerable dangers of the other world as the healing mission is pursued. Unfortunately, the hospital room and the medical environment and personnel afforded little protection for my spirit, for medical personnel are almost exclusively concerned with the body. Friends and family were of some use in this, but I felt the lack of a sympathetic hospital "spirit" very keenly. It would have made my own work much easier, because creating and protecting my own sacred environment was often antithetical to my extreme dependence and vulnerability as well as to the state of consciousness I needed to hold.

There were far too many disruptions from inertia-driven hospital routines. When meaningless activities were forced on me, my concentration lapsed, the pain would increase and the light would flicker and dim, and I had to work even harder to refine a deep connection to my light-guide and return to the healing task. Drugs were another potentially powerful intrusion. I had a self-administered morphine drip at my side. When I let my ego take over, no matter how slightly, the level of pain increased; I could decrease it by pressing the plunger. But then the light became distorted and hazy, and I had to wait for the drug to wear off until I could get back to the business of healing. But it was not only the hospital activities that were difficult and disruptive. Almost anything that was unrelated to non-ego-intentional state was intrusive. Even the beautiful view of the hills of Sausalito from my window, ordinarily one of my greatest delights, was an intrusion. People who visited me oohed and aahed about what I could see from my bed, but I was in a different dimension of experience, connected to a vision whose meaning transcended any outside beauty. Even the most powerful force in my room besides the light—the love of the people around me—could deter my concentration. Time and time again I learned from the way that the light flickered, the way the pain increased, and the way healing seemed to ebb that I had to withdraw from family or friends and their loving world in order to stay self-aligned.

Sometimes the disruptions were unexpected and functioned as both a trial and a seduction. During my third postoperative night I was awakened by a nurse who told me that there was a psychiatric emergency going on. She explained that a postoperative patient who had undergone throat surgery was psychotic and pulling at his stitches. She said he had bipolar disorder and had been taken off lithium for his surgery, and she asked if I could advise them. The surgical resident on duty knew nothing of psychiatric drugs and the psychiatric consultant was nowhere to be found. "I hear that you're a famous psychiatrist," the nurse added, "and I read your book on pregnancy when I had my first child." And, she whispered confidentially, "I know that you're the shrink for one of the heads of department here." My ego rose like a phallus. "I" wanted to help and "I" knew how. The light flickered and bounced. I disregarded it and began to get a history, then caught myself as the light dimmed further and the pain increased. This wasn't my job; the light was. I stopped talking and closed my eyes, watching the flickering change to a steady glow. With relief I heard the nurse sigh and leave the room.

I count the discovery of this light of mine as one of the best, if eccentric, outcomes of my surgery. It stayed in the foreground all the while I was in the hospital and only gradually receded over the next six months. It is a variant of the light that is described in so many spiritual experiences. It is certainly similar to the kind of guiding light described in many shamanic initiations and healings. For those familiar with the literature of shamanism, a light such as I experienced is sometimes described as a companion or helper similar to more-usual helpers such as animals, gods, or humans. Perhaps the actual body dismemberment was so great that something as primal as light emerged and was never embodied in any other way. I'm sure that for some people this power comes as a tone and that for others it is a particular kind of body feeling or more formed image, such as a totem animal. Having the light so central and so important for so long was and is a great gift. I believe it to be an embodiment of my vital energy focused as a healing force, the vital energy that must be harnessed for any kind of healing to occur. It is not surprising that the oldest healing tradition, shamanism, operating without today's technical miracles (of which I was a major recipient), would seek out this force in other-world journeys; it is sad that modern surgery, with so much of the miraculous at its disposal, would ignore it.

I have taken many other spiritual journeys, some consciously invoking hardship and pain, some also adding powerful drugs such as Ipegan and psychedelics; most important, of course, was the journey of seven years of pain and its effects on my body and soul. But the trial of surgery and my recuperation and healing brought me to a different dimension of difficulty and, ultimately, meaning. I wonder whether others who experience surgery feel it as a remarkable journey into body and psyche? Can it ever be just something to get through? I imagine it is possible to dull the whole experience with drugs, television, and all the rest of the secular environment that a hospital provides. I imagine, too, that many more would engage with the profound crossing that is an element in such a potent dismemberment, or death-rebirth experience if instead of an aseptic and mechanistic setting and perspective, there was a context for another kind of experience. The surgical environment could do much more to help provide this context for those who want it, and maybe it will as patients demand more from medicine. After all, only thirty years ago birth in the hospital was partly a surgical procedure that excluded husband, family, and spiritual and initiatory context. Birthing centers and other humanized in-hospital environments are now the rule, and they work because women and their families want the larger purview and alternatives of experience they offer (Colman and Colman 1991). It would have taken very little to alter my pre- and postsurgical environment, and I would have changed hospitals—but not surgeons—to be in one.

There is a great deal more that could be said about the many connections between the surgery experience and the shaman's healing journey, but I want to end by briefly describing one eccentric and unexpected connection. I said earlier that when Michael described the surgery I was struck by a sense of a great adventure about to happen. The journey I have described above felt like pure adventure in the very highest sense of the term, despite a context in which the surgeon was the hero and the patient was the victim. just before surgery Don Sandner, one of the editors of this volume, gave me a book to read that he thought would be interesting for my recuperation. The book was Gary Jenning's Raptor (1990), which describes the journey of survival and self discovery of a foundling left at a monastery in Italy in the sixth century. His travels took him through the declining Roman Empire of southern and eastern Europe. The physical aspects of his journey were extreme enough for me to feel a bond between his adventure and my own recovery from the pain and surgery. But the most intriguing part of the journey was the hero's coming to terms with being a true hermaphrodite, for he was born with both a penis and a vagina, both pleasurably functional, and felt a matching male and female soul within. When I read at all postoperatively, I found myself turning again and again to this book; in fact, it was the only external stimulus besides carefully selected music that didn't destroy the kind of ego concentration that was so necessary to my recovery.

I began to understand my fascination with Raptor when, on the fourth day after the surgery, Michael entered my room, took off my bandages, and inspected the gaping abdominal wound that lay below. I felt like a woman lying undressed on an examination table, my vagina open and exposed. What I experienced was not so much sexual as organic, as if my body had added a new sexual organ and my psyche had formed a corresponding structure deep within me that matched. The physical reality of my surgery was that I had added a new inner pathway and a new structure. The incision had begun deep in my lower abdomen, almost at my pubic bone, and the cut had gone straight through to my spine. Michael had used that channel to insert his instruments and leave a piece of bone and several steel screws deep between my lumbar vertebrae. Lying in the bed as he inspected that wound, I could feel his penetration from front to back. The feelings I experienced as he inspected the wound, the new channel, were the sensitive stirrings of newborn flesh. Undoubtedly my transference to the healing surgeon was part of this response, but what I felt and still feel evolving in me went beyond that psychological reaction. It was if I had gained a new sex and a new sexual identity, and that too was a necessary part of my healing.

I now understand why so many shamanic journeys include sex change and why so many experienced shamans refuse to be coerced into the dress or role of either a male or a female. To heal at the deepest level is to accept dismemberment and ego dissolution. The change in the ego is the last and most dangerous part of the transformation, just as the last two hours of a psychedelic drug trip are the most dangerous and most important, the time when the archetypal wonders no longer hold sway and change must be incorporated into the very small consciousness of personal identity or split off as some strange presence in the psyche. As Freud correctly pointed out, the earliest and strongest part of ego identity is sexual identity, so that too has to become fluid and change for the ego feeling to change.

For healing to occur, a sacrifice is required. The sacrifice of a persistent and accepted sexual reality may be the strongest offering possible. As I lay in my bed feeling that strange new twinning—the aching new channel and its connection to my catheterized penis—I glimpsed an incipient, perverse, but potentially viable wholeness that might just make the light spinning in front of my chest glow a little more brightly in the future.

REFERENCES

Reprinted from The Sacred Heritage. Donald F. Sandner & Steven H. Wong, editors. Routledge, 1997.

Copyright © Arthur C. Colman