Here follow the notes of Bíld, son of Bóurr, on all he has learned on the subject of the soul, its wounds, ‘scarring’, and the treatment thereof, for presentation to his teachers at Rivendell.
All creations touched by the Secret Fire are sensible to joy and sorrow, hope and fear; it is the consequence natural of that sensibility, and of our self-awareness and capacity for rumination, that our emotional experiences have on us long-lasting effects. And in this world we inherit, touched as it is by the Shadow, it is sadly common that experiences leave long-lasting grief on the hearts of sufferers, grief that we as healers sadly often see, and that we by simple kindness or by arts of medicine or music do what we may to alleviate.
Every experience of grief is unique, and to generalize about it, as I am about to, is folly; nevertheless I shall so attempt and press on to write of ‘patterns’. For it is the case that — in my limited learning, dominated by case-studies of Dwarves and Men — even intense terror and grief consequent to the most horrific imaginable trials does oft attenuate with time. Perhaps some of that may be attributed, at least among my mortal brethren, to the curse or blessing of imperfect memory; but I think the assumption that grief fades because of simple forgetting does disservice to the patient who, after suffering the depths of despair, picks himself up and begins living again. For time also provides the opportunity to find again beauty in the world and reaffirm what bonds of love remain after loss and still bind, to reimagine oneself as one who has survived and so discover new roles and identities, and generally to rebuild hope and courage that evil tried to take away.
None, of course, emerge unchanged by the experience of crushing grief; many, though, come out into the light on the other side in a functional state, alike to their former selves, though carrying now the weight of sad memories. But others emerge changed, sometimes profoundly, in disposition, character, and behavior. And even with the cause of his original grief at long remove, the shadow it casts can grow so long it comes to dominate his entire life, producing new obsessions, anxieties, and compulsions — dysfunctions, in short, that become a new source of misery and limitation in his life after the event.
Therefore the questions that I, little Bíld Bóurrul, have now begun to contemplate:
• What is the nature of this phenomenon?
• What is its etiology?
• And what can the healer do to reduce the suffering by it caused?
… though to answer them, more than one lifetime it may require.
My first question: ‘Where is located the lesion, and what is its nature?’
When I attempt to describe my area of interest to others, I try to put it succinctly as ‘the scarring of the soul’ or ‘wounds of the heart and mind’. Yet it remains unanswered whether these phrasings are metaphors or true descriptions of what is happening to the patients who emerge from grief and horror into prolonged suffering and dysfunction. What, exactly, has happened to them?
I think there two angles by which this question must be attacked, one observational and one theoretical; therefore I will begin by listing everything I know about the specific phenomenon I am trying to study, based on my reading, the accounts of other healers, and my own limited observations.
Among my kin this condition is already a little known, even in the popular imagining; if you speak to a Dwarf of ‘war-sickness’, or ask him to picture an ancient veteran who is ‘haunted by the War’, or who ‘cannot bear to smell burning, after Azanulbizar’, he is like to know what you mean. For we are a hardy people, and our soldiers are able to survive wounds and battlefield horrors that others might not — but while we may endure and survive, we do not do so without cost.
Even so, that little familiarity does not mean we understand the condition or its treatment. Indeed, while the stereotypical association is with a war-veteran, civilians suffer it too. And putting their experiences together with the soldiers’, if any pattern I may assign to the sorts of events that precipitate it, I would say that they tend not merely to be situations of extreme pain and distress but especially ones of fear and powerlessness. Besides physical violence, extreme intimidation and interpersonal abuse might result in a similar reaction.
The symptoms of these patients are varied, but very frequently seen is a heightened sensitivity to specific ‘cues’ that remind the sufferer of the event: sounds, tastes, smells, even general environmental types or social contexts. These ‘cues’ set off a state of anxiety — a mixture both of uncomfortably heightened alertness and distraction by a flood of unwanted memories. Such a state feels almost like reexperiencing the event, and so naturally the patient is inclined to react accordingly, by fighting back, fleeing, or hunkering down in a state of fear. The patient’s logical understanding that the original event is not actually recurring is of limited help; most I have spoken to are aware their fear is irrational and wish dearly to stop it by force of will, but cannot. And this reexperiencing is itself so aversive that a patient’s anticipatory fear may worsen, rather than abate, with time, and he will frequently begin to rearrange his life to avoid all possibility of encountering his ‘cues’, limiting his own opportunities and freedom.
Common symptoms too are depressed mood, nightmares — frequently very bad and disruptive to daily functioning — a change in personality (oft to more anxious, cowardly, or prone to anger), collapse of previously strong relationships, a feeling of detachment or ‘floating’ observationally over oneself rather than inhabiting one’s body and participating actively in life, and escalating abuse of alcohol, sleep aids, or analgesics ‘to take off the edge’; less common, spells of amnesia or catatonia, pain or paralysis with no discernable physical cause, hallucinations and paranoia.
If from all this any summary may be made, it must be that this is a disorder of fear and of memory.
Next I take the theoretical angle — with which I am not confident and so hope to obtain the aid of Elvish mentors — to answer the question of whence comes fear, and where is kept memory. I think the obvious and only standard answer is the fëa (or fae), which carries memory from life to life and hröa to hröa. My conclusion, then, is that a persistent dysfunction of this sort, a disorder of fear and memory, is an ‘ill-ness’ or ‘dis-ease’ of the spirit.
For me not little difficulty from this follows, for I am not very learned in the metaphysics of fëar, and my people have not the arts of the Elves in treating them. But in this half-year I have learned what I can on the subject and tried to put that together with my observations to put forth a first theory on its cause and, following from that theory, some possibilities for treatment.
In the contemplation of this illness I keep circling back to the metaphor of the ‘scar upon the soul’. That in turn has led me to wonder this: if this disease truly results from a scar upon the soul, how and why might such a scar be formed?
Dwarvish healers can hardly brag to understand everything about the process of bodily healing and scarring, but I will summarize my understanding here. When any but the smallest wounds close (at least on the body of a mortal, who has not the natural healing capabilities of the Firstborn), the soft and flexible skin of mother’s long and careful making is replaced by a quick-forming, coarse-textured skin, oft of a slightly different color. Some believe that scar-skin is tougher than the original because it feels hard to the touch; healers, however, know this is not so, and that scars bring many troubles with them. They can cause discomfort by itching and pain; they limit motion when around a joint, which can seriously reduce a warrior’s effectiveness; they are mechanically weaker, and wounds to the same sites heal slower.
We understand a scar as like to patching-mortar, a means of quick emergency repair that staves off disastrous bleeding or invasion but is inherently inferior to the strength of fine-dressed ashlar.
I compare this disease affecting the soul to a scar because of its creation by a terrible trauma, its long endurance, and the discomfort and limitation it brings. But — and I readily grant this to be a leap — if its similarities to a physical scar were more than just superficial, what guesses about it could we make, and how could those guesses inform our treatments?
What has struck me, listening to the stories of patients first- or second-hand, is how truly horrific their experiences have been. Theirs are not ordinary sorrows, but grief at some of the worst evils that come of a marred world. And though it is true that these patients come to our attention because they are not thriving, still sometimes I wonder at how they managed to survive at all, and that they are able to somewhat function day-to-day and not be wholly lost to weeping.
What strikes me also is that, while at first glance the symptoms of his illness seem plainly maladaptive and his fear illogical, if deep into the patient’s boots I place myself, some amount of logic in his reactions I actually can see. After all, when we assure him, ‘You are safe here, no harm shall to you come’ — should he trust that, when the very horror of his experience proved the world is not safe, and harm does come suddenly upon the innocent? And since he has had that experience of total horror, worse than any soul should ever have to know, to reorient his entire life to avoidance of its repetition makes a sort of sense. From our outside perspective as healers we judge that this causes him more pain than it prevents, but — if a soul can be said to have instincts and reflexes and natural processes, perhaps this is one of them that springs up in defense of the self, in extreme circumstances.
Perhaps it is truly like a scar: though it causes him pain and circumscribes his life, nevertheless by its formation he was able to survive.
If this insight is not misguided, what ideas from it may spring for the treatment of patients?
A true song-healer I am shy to call myself, given that those arts I have only just begun to study. But I think I am not wrong to say that the song-healer’s first response to grief that weighs down the soul is to sing — and by deep arts use music’s connection to the world’s deeper Music to bring unhappy souls back into tranquil harmony and broken hearts back into resonance with Notes of life, amity, hope, and joy. And a physician I am not either, but enough of that art I know that likewise, the simplest treatment is to support the patient’s own natural healing capabilities: the hröa by rest and nutrition, the fëa by understanding and love.
But the profoundly scarred patient challenges us because he is not easily healed by these simple means. Certainly they benefit him; I have seen some come into a much easier, better-functioning state just from their companions’ unconditional acceptance. But — just as no matter how many times a simple salve is applied to a bodily scar, it will not turn back into skin, I suspect that ordinary song-arts and lovingkindness are insufficient to truly change the state of the soul-scar.
I, a young apprentice, have no hope of suggesting a miracle treatment that can. But I think there are a few possibilities to explore inspired by the notion of ‘illness of memory’, of ‘illness of fear’, and of ‘a scar on the soul’.
Of course, when I write of ‘treating memory’, I do not mean altering memories; if that is even a power available to Elves and mortals, rather than the Valar alone, I cannot think it ethical to use. And the trouble with these patients is not even their horrific memories, I suspect, as after all not everyone who has similar experiences and remembers them is so badly affected. I suspect instead that the trouble comes from these memories’ total domination over and intrusion into daily life.
Rather than remove the shadowing memory, perhaps the healer can assist the patient in forming new memories and alternative beliefs, context added to the original memory that make it easier to bear. As simple (I write, as though to accomplish it is any sort of ‘simple’) that may be as convincing him that his experience was not his own fault, nor the end of his meaningful life, nor his only choice now for the core of his identity. But deeper and more intricate work to do with memory there may be as well:
I was consulted, while in Bree-land, on the treatment of a case of soul-scarring manifesting chiefly as nightmares, and while contemplating it I had the insight that the nightmare and indeed the panic-response to a ‘cue’ may be something akin to a reflex that is trained-in to the fëa, like the drills of a soldier train-in his axe-skills to the reflexes of his hröa. The initial shock of the experience embeds it as a reaction, and every subsequent exposure to a ‘cue’ that sets it off acts as practice-drilling, reinforcing it and causing the shadow of the original trauma to lengthen over time. And — as the natural response to fear is avoidance, a loop emerges wherein a preoccupation with avoidance feeds fear and each experience of fear increases the perceived urgency of avoidance.
Perhaps this reflex is what the soul-scar is, the location of the lesion, and the fear-loop the heart of the resulting dysfunction.
If so then it seems the healer’s task must be to be to guide the patient in puncturing that loop and escaping. And what I wonder is if a truly cunning healer, which I cannot yet claim to be, might accomplish that task by gently guiding the patient in the training-in of alternative reactions, reactions that are incompatible with panicked withdrawal — at first in a safely controlled environment at a remove from the ‘cue’, then gradually closer and closer to that ‘cue’, until eventually the newly-practiced reaction has become the reflexive one, and the patient is able to brave ‘cues’ in his daily life without distress.
The details of actually accomplishing this I may only guess at, but one method may be the crowding-out of fear by an alternative and incompatible emotion, such as tranquility. Such could be induced by the song-healer or the patient himself by (for example) techniques of bodily relaxation, which utilize the close-fittedness of the hröa to the fëa to use the body to change the soul’s emotional state.
Similarly, in the case of the nightmares, we discussed the rehearsal of dreams with alternative plots, crowding-out the unwanted scenario with an incompatible one. Unfortunately our caravan left before this treatment could be attempted; I would have liked to have seen its merits and difficulties in practice.
Some final thoughts occur to me, related to the concept of a ‘scar’, in which I as a young and inexperienced healer hope my vastly senior teachers in the Valley might be able to guide me.
Scars on the soul such as these are miserable and debilitating, and usually those who suffer them want to be rid of them. And of course a healer should reduce suffering and restore health when he can. But in the writing of this scroll I have thought repeatedly about competing ethical claims on the healer, and too wondered about the dignity of the patient who bears a scar and the respect he is owed.
‘I ought not feel this way, so long after it happened,’ a patient once said to me. ‘It was not such a weighty thing, and I make myself a burden on those around me now.’ And — hearing that, at once I felt my breast swell with indignance, because none of those things were to me true. This Dwarf had survived something horrific and unjust, something so terrible that perfect sense it made that it haunted him, and, while his symptoms were troublesome, what struck me is that those around him should have, at the time, done more to help and defend him, and they ought to be honored and grateful to be able to support him now.
Those were my impulsive feelings in the moment, but after contemplation some still remain. For I fear a great temptation there is for we healers to look on the wounded and make a judgment about how, and how much, they ought to be healed. That is not wrong — it is our craft and duty — but I fear that in a healer’s eagerness to help he may overreach.
For on the bodies of mortals, scars are permanent — and, though too little I know about scars on the soul to say if they are likewise, that possibility exists. Their effects may be minimized, the limits they impose reduced, but if a full cure is impossible, perhaps healers and patients must accept that — and what healing, comfort, and productivity the patient able to achieve despite that, celebrated.
Too, when these scars are formed by experiences of profound victimization and disempowerment, I cannot think it right to impose standards of ‘function’ and ‘wellness’ from without. To be just, the method of healing must at a minimum involve the patient’s consent, but even more than that the patient’s own vision of recovery. Encourage him not to become stuck living a shadow-life as an epilogue to that terrible disaster, we must; yet it is he who must become the author of his next chapter, and shape his story according to his own choosing.
And my last thought is this, as an Adopted Child:
We hadhodrim ought not put too much romance on the scar as a badge of valor and survival, for the truth of bearing one is painful and ugly. But — pain and ugliness, in their measure, must be borne, and neither denied nor hidden. They are what they are, the consequences of living as feeling beings in a complicated world. And complicated and imperfect may be their healing, and complicated and imperfect the resultant health — yet we keep repairing, and building, and repairing again, till by method of exhaustion the shape’s not quite become again a circle, but — near enough.
So concludes, with apologies for his horrifying long-windedness, Bíld, child of Erebor and son of Bóurr, son of Bíld, son of Vald.
