The document explores the application of Joseph Campbell's hero's journey framework to understand and address the challenges faced by veterans with PTSD and substance use disorders. It outlines the various stages of the hero's journey, highlighting the importance of initiation and return, while emphasizing the need for supportive structures during reintegration into society. Therapeutic approaches should focus on transforming the victim mentality and promoting personal growth through the reframing of trauma as part of the hero's narrative.

1. Presentation of the Hero’s Journey in thePresentation of the Hero’s Journey in the
Care of Veterans with PTSD andCare of Veterans with PTSD and
Substance Use DisorderSubstance Use Disorder
after Joseph Campbellafter Joseph Campbell
by Ede Frecska, M.D.* andby Ede Frecska, M.D.* and
with the help of veteranswith the help of veterans
at the Northport VAMC, NYat the Northport VAMC, NY
*former Medical Director of the*former Medical Director of the
Substance Abuse Services, Northport VAMCSubstance Abuse Services, Northport VAMC
PTSD Treatment Program, Gainesville VAMCPTSD Treatment Program, Gainesville VAMC

2. Joseph CampbellJoseph Campbell
•1904 – 1988
•Mythologist (Jungian
influence)
•He created the composite
portrait of the Hero and defined
the concept from ordinary
humans to mythical deities
•The Hero’s Journey is the
Monomyth, the eternally
returning arche-story with
specific stages
•It is a path what the Hero has
to follow and complete
•If not, s/he falls

3. Campbell claims that myth hasCampbell claims that myth has
four functionsfour functions
•Cosmological
− shows us the shape of the universe with us within
•Social
− supports and validates (codifies) the social order
•Pedagogical
− provides life model, sets example for human deeds
•Mystical
− helps to realize what a wonder the universe is,
what a wonder we are
Do we have it? Do we need it?

4. Monomyth, the arche-storyMonomyth, the arche-story
•Archetypical, for this very reason it applies to
all of us (not only to those demigods)
•It is the core of every story (from the Epic of
Gilgamesh through Odyssey to the Lord of the Rings
and Star Wars)
•Its elements can be discovered in movies or stories
about ordinary people (e.g., The Old Man and the
Sea; Rain Man; O Brother, Where Art Thou?)
•Basic pattern:
1. Departure
2. Initiation (Rite of Passage)
3. Return

5. Who can be a Hero?Who can be a Hero?
The central character of the Monomyth
can be not only The Warrior, but:
•The Healer, The Prophet, The King
(Queen), The Bard, The Wanderer
(Drifter), The Sage, The Jester, The
Martyr, or The Youngest Son
•Anyone, who sets on the path, leaves
comfort and conformity, gets skills and
knowledge what will be used for the
benefit of the community
In general: anyone, who is able to
transcend his/her personal and
provincial limits for good.

6. • Person able to battle
past his personal and
local limitations
• Goes on journey to
become “reborn” or
transcendent and then
returns to share
knowledge with others
Who is a Hero?Who is a Hero?

7. Conventional beginning:Conventional beginning:
the Hero at homethe Hero at home
•Mundane background: „Dorothy this is (yet) Kansas!”
•Frequently the Hero is a commoner (King Arthur),
s/he is the third one, has an arduous life (Cinderella) or –
on the contrary – lives Happily Ever Before
•Nevertheless, the Hero may exhibit the signs of
“The Chosen One” (miraculous birth, astrological
constellations, extra bones)
•Occasionally the Hero’s early life is
hyperconventional, bound to more taboos (like in the
case of an Inuit shaman’s apprentice)

8. Happily Ever BeforeHappily Ever Before

9. I. DepartureI. Departure
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10. Call to adventureCall to adventure

11. Call to adventure 1Call to adventure 1
•A herald or announcer appears
•Often (but not always) someone dark, loathly,
terrifying, and/or unordinary
•The Call promises both treasure/reward and
danger/difficulty
•The Call requires travel. The hero must
journey to a distant land, forest, or kingdom
somewhere underground, beneath the waves,
above the sky, on a secret island, atop a lofty
mountain – even into a profound dream state.
•The hero must leave his/her comfort zone

12. Call to adventure 2Call to adventure 2
•The Hero is challenged by the Unknown
•The chosenness manifests itself
•The spirit world divulges its choice
(on the shaman’s path)
•It may occur in form of tragedy, with
trauma (Hercules, Luke Skywalker) or not
(King Arthur legend)
•Crisis situation (initiation sickness), the
Hero’s life will be difficult either way
Many veterans with Native American
ancestry have heard about the Call

13. •The choice (limited though) is a central issue
in the Hero’s Journey
•Commonly heard in movies with a weak
plot: “I (we) ha(d)ve no choice!”
•The Hero’s Journey is not predetermined,
the supernatural control is just part of the test.
•The Call can be refused (but not without
consequences)
Choice and the HeroChoice and the Hero

14. • Many heroes at first refuse the adventureMany heroes at first refuse the adventure
• Eventually the Hero accepts the Call, but itEventually the Hero accepts the Call, but it
can take some timecan take some time
• The benefits of eventually accepting the Call:The benefits of eventually accepting the Call:
– The person gains self-awareness and controlThe person gains self-awareness and control
– The person gets answers to and competency overThe person gets answers to and competency over
the most profound problems faced in lifethe most profound problems faced in life
• The consequences of always refusing the Call:The consequences of always refusing the Call:
– The person loses the power of affirmative actionThe person loses the power of affirmative action
and becomes aand becomes a victimvictim to be savedto be saved
– According to Campbell, the person’s “floweringAccording to Campbell, the person’s “flowering
world becomes a wasteland of dry stones and hisworld becomes a wasteland of dry stones and his
life feels meaningless.”life feels meaningless.”
Refusal of the CallRefusal of the Call

15. The dilemmaThe dilemma
Accepting the Call may lead hereAccepting the Call may lead here
The outcome of refusing the CallThe outcome of refusing the Call

16. The crisisThe crisis
•The Hero hesitates due to false commitments, lack of
self-esteem, or simply to the unease of leaving comfort
•S/he tries to ignore the Call or gives wrong response
•Hollywood likes the character of the Reluctant Hero
•Some story ends here (Daphne, King Minos) with the
concluding lesson:
One cannot say ney to transcendental forces (to the
Spirit World – in the shamanic lore)
In other words: One cannot rebuff his/her inner
potentials (e.g., spiritual, social, or other intelligence)

17. Supernatural aidSupernatural aid
•The first entity showing up after the
Hero steps on the path
•Usually (but not always) masculine
•Sometimes his presence is not obvious
•Typically a wizard, hermit, or
shepherd – someone peripheral to the
community
•Supplies the boons, amulets, and
advice that the hero will require to begin
In essence: the Hero is never alone!
(We neither, regardless how it seems.)

18. Allies, sidekicks,Allies, sidekicks,
fallen onesfallen ones
•Not to be confused with the supernatural aid
•Allies can be Heroes (fallen exHeroes) of other stories
(for example, Gollum)

19. Crossing of the first threshold 1Crossing of the first threshold 1
•This is the point where the Hero
actually leaves the known limits of
his/her world and ventures into an
unknown and dangerous realm
where the rules are not known
•The Threshold often manifests
itself as a physical place, but it
does not have to be. Sometimes it
is manifested as an actual barrier
or boundary, such as a river,
bridge, doorway, etc.
•The Hero is no longer in the
world of common day and is
actually on the adventure itself
“We’re not in Kansas anymore.”

20. Crossing of the first threshold 2Crossing of the first threshold 2
•The Threshold is a boundary between
the ordinary and extraordinary realm
•The real show now begins…
•…with being tested by the Threshold
Guardian(s)

21. Threshold guardiansThreshold guardians
• At the Threshold, the Hero will not be
permitted to pass without effort. S/he must
earn the passage across. Threshold Guardians
help the worthy to do that, and turn less
worthy individuals away from the path
• The Threshold Guardian is not necessarily
evil, but its agenda initially adversarial to that
of the Hero. The job of the Threshold
Guardian is to get the Hero to rethink
whether or not s/he wishes to proceed on this
adventure
• Double role:
– protection (if the Hero is not ready)
– orientation (if the Hero is ready)
These archetypal figures are familiar to many
Native American veterans.

22. The belly of the whale 1The belly of the whale 1
• Crossing the threshold is a form of
self-annihilation. The Hero is
swallowed into the unknown, and
would appear to have died
• The belly of the whale represents
the final separation from the
Hero's known world and self.
It is actually the point when the
Hero is in between worlds and
selves. The separation between the
old world/self and the potential for
a new world/self has been made, or
is being fully recognized.

23. The belly of the whale 2The belly of the whale 2
The dark night of the soulThe dark night of the soul
•This stage is often symbolized by something dark,
unknown and frightening. Here the rules are different.
Entering this abyss the Hero indicates willingness to
undergo a metamorphosis, to shred his/her old
character for a new one
•Shredding the “secular self” comes with calvary,
perturbation, and it is not the only abysmal depth
(trauma again) on the path. More will follow!
The lesson: There is no transformation without
perturbation (perturbatio: Jesus’ suffering on the cross).
Or: No real change comes from the comfort zone!

24. II. InitiationII. Initiation
((Rite of PassageRite of Passage))
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25. The road of trials 1The road of trials 1
•Through a series of tests
and tribulations the Hero
gets to the breaking point of
his physical tolerance. He
must bow and submit to the
absolutely intolerable (but
not to human authorities*)
•At the end the Hero will
be changed forever:
s/he becomes initiated
* A common mistake of the old-
fashioned boot camps

26. The road of trials 2The road of trials 2
•The trials fall into two categories of hero deeds:
–The Physical Deed (the Hero performs a courageous act
in battle or save lives)
–The Spiritual Deed (the Hero learns to experience the
supernormal range of human spiritual life and then comes
back with a message)

27. Initiation ceremonyInitiation ceremony
•“White people are fools sending men into battle
without initiation!” (anonymous Native American)
•The more warrior-like a tribe is, the harder is their
initiation trial
•According to this author the essence of initiation
(Lakota Sun Dance, for example) is to expose the
novice to all possible physical and mental stresses
within a ritualistic context and with certain social
support (acceptance, “tough love”) in the background
•The result is “inoculation” against physical-mental
stress, endurance in hunt and combat

28. In lack of proper initiationIn lack of proper initiation
•“What doesn't kill you makes you stronger”
is not true if it comes with social rejection,
humiliation, and destroys human dignity*
Lack of social support reverses the
process and sensitizes to PTSD!
* A common mistake of the old-fashioned boot camps

29. Further on the road of trialsFurther on the road of trials
1. Meeting with the Goddess
2. The Temptation (frequently with
woman as Temptress)
3. Atonement with the Father
4. Journey to (harrowing of) Hell
5. Apotheosis
6. The Ultimate Boon
1. 2. 3. 4. 5.

30. The unhealable woundThe unhealable wound
•The hero may suffer a wound that will never heal
This may occur in his main fight, but could happen
anywhere in the story
•The wound may be emotional or psychological
•This is a basic motif during the Healer’s journey

31. Apotheosis, the Ultimate BoonApotheosis, the Ultimate Boon
•The Hero overcomes Death
•S/he has gained knowledge, skills, spiritual power
during the process
•This is what s/he brings back on the way of Return.
•The reward may be tangible as well (Indiana Jones)

32. III. ReturnIII. Return

33. Final steps in the return
Rescue from Without
Just as the HERO may need guides and assistants to set out on the quest,
often times he or she must have powerful guides and rescuers to bring them
back to everyday life, especially if the HERO has been wounded or weakened
by the experience. Or perhaps the HERO doesn't realize that it is time to
return, that he can return, or that others need his boon.
The Crossing of the Return Threshold
The trick in returning is to retain the wisdom gained on the quest, to integrate
that wisdom into a human life, and then maybe figure out how to share the
wisdom with the rest of the world. This is usually extremely difficult.
Master of the Two Worlds
In myth, this step is usually represented by a transcendental HERO like Jesus
or Buddha. For a human hero, it may mean achieving a balance between the
material and spiritual. The person has become comfortable and competent in
both the inner and outer worlds.

34. Common motives of the ReturnCommon motives of the Return
•Can be refused (like in the case of the Call)
•Can be as adventurous (magic flight) and arduous like the
Road of Trials (for example, Shawshank Redemption)
•Like before, the Hero may need the help of the Supernatural
Aid or must offer sacrifice (a slice from the Hero’s thigh to feed
the Griffith like in the tale of the Son of the White Horse)
•On Return the Hero gets confronted with the rejection of the
conventional world (e.g., the older brothers try to whack him)
•S/he must “re-enter … where men who are fractions imagine
themselves to be complete” (Campbell)
•S/he is master of two worlds (the mythical and the ordinary):
“powerful in insight, calm and free in action” (Campbell)
•Fruiting of the (transformed) soul – in Christian mysticism
•Freedom from the fear of death means freedom to live

35. Breaking points 1Breaking points 1
Points where the veteran has left the path
resulting in substance use and PTSD:
•Not noticing, ignoring, wrongly answering the
Call (this is not his/her fault, an err of culture)
•Drug use as response to the initiation crisis
•Assuming lack of choice
•Wrong choice at crossroads
•Inadequate initiation (again a cultural error)
•Assumption of loneliness, ignoring helping
hands
•Unresolved issues with father

36. Breaking points 2Breaking points 2
•Failed or painful Return due to rejection by the
society (e.g., after the Vietnam War)
•Too fast reintegration “as if nothing has happened”
(the Return took 20 years for Odysseus and 2 months
for WWII veterans, not a couple of days as later)
•Stratification of returning service members (WWII,
Korean war, Vietnam era, OEF/OIF)*
•Feeling victimized by the Trauma, which is inherent
in the Hero’s Journey, very important for his/her
development; most of all, it can take ANY form
*This was not in practice on the Great Plains (i.e., neither Pawnee war
veterans nor Comanche war veterans, etc.)

37. Therapeutic conclusions 1Therapeutic conclusions 1
•Putting the victim role behind eliminates a huge
roadblock in the way of healing and may promote post-
traumatic growth
•A spiritual approach (like one presented here) can
significantly help in reframing the trauma: regardless how
unbelievable it may sound, but it had to happen, it was
designed and ordered above in service of the Hero
•Abstinence is just an intermediate goal, the real goal is
the Return (supporting family, sponsoring mates, etc.)
•The Return is a complex and long process (the main
lesson of the Odyssey, which is the saga of the returning
warrior)
•The therapy in essence is helping the fallen Hero in

38. Therapeutic conclusions 2Therapeutic conclusions 2
•The patient has to face the Dark Father (Darth Vader), which
means that we have to accept our roots and make peace with our
past (if not, only we lose)
•A returning veteran cannot be reintegrated “as if nothing has
happened”, and it is not “entitlement” if s/he is protesting
against the short cuts
•Veterans of different wars and eras should have to be helped
in fathering the younger ones
•We have to find and cultivate the mythology of our culture
•There is a strong need for proper initiation
•The fallacy of Western psychotherapies: most of them is
reluctant to leave the comfort zone
•The power of tribal (shamanic) medicine: the knowledge of
using suffering in service of healing