The Alchemist, a novel written in 1988 by the author Paulo Coelho, whom received the Crystal Award by the World Economic Forum and France. He is known for other major works such as Aleph and Eleven Minutes. The Alchemist is his most famous work, which is one of the most translated works. The story take place in Spain as a young shepherd boy named Santiago start his search for finding his personal legend after having a dream about a treasure in the Pyramids of Egypt. In his journey he comes across different obstacles which he must confront in order to fulfill his dream. His journey for finding the treasure starts at Andalusia-Spain- and continue while crossing the large desert until he reaches the Pyramids of Egypt. In his journey Santiago learns that when someone really desires something, the whole world conspires in achieving it (Coelho 23).
The Monomyth in The Alchemist
“”A hero ventures forth from the world of common day into a region of supernatural wonder: fabulous forces are there encountered and a decisive victory is won: the hero comes back from this mysterious adventure with the power to bestow boons on his fellow man.”” (Campbell 28). As Campbell explained in his book The Hero with a Thousand Faces, the hero’s journey begins and ends in the hero’s ordinary world, but the adventure takes place in another different world than of the comfortable known world of the hero. While doing so, the hero comes across different stages in order to succeed and grow into a hero.
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In The Alchemist, Coelho uses many characteristics of the hero’s quest, all of the following patterns can be found in the journey of the protagonist Santiago, regardless of being clear or indirect. The following lines will explain the major traits of the pattern in the hero’s journey as presented in The Alchemist divided into three main sections: departure, initiation and return.
1. Departure
Firstly, The Call to Adventure which is one of the major traits in heroes’ journeys as it sets the start of the adventure. All heroes’ journey begin in the known comfortable world of the hero which would be presented in the beginning of myth and a call to adventure will occur in order for the hero to enter the unknown world in which the adventure will take place in. The unknown world would be presented as a far, mysterious or scary place (Campbell 58).
The first trait-the call to adventure- might be a little hard to notice In The Alchemist, as it take place when Santiago dreams of a treasure under the pyramids while he is in his homeland Andalusia. The vision Santiago dream of is his call, as a call to adventure can happen in any form. However this call is indirect and would not have been understood without the interpretation of the Gypsy woman who says “”…you must go to the Pyramids in Egypt…There you will find a treasure…”” (Coelho 15).
Secondly in the departure phase is meeting with the mentor, or as Campbell call it Supernatural Aid. Hero needs guidance for his adventure and this is what the supernatural aid is for, and the mentor can be anything or anyone but mostly, an old man. “”One has only to know and trust, and the ageless guardians will appear.”” (Campbell 66). A mentor gives an insight to what might await the hero, advices to what he should be prepared for and might even give magical aids to the hero so he or she can be confident and set to the adventure (Voytilla 5-12).
In The Alchemist the mentor is presented as Melchizedek a king of Salem whom Santiago meets after leaving the Gypsy woman store and being confused by her interpretation of his dream. The king encourages Santiago into taking a further step in his life, and not letting go of an adventure that he might have been waiting for, for a long time. The king gives advices to Santiago and also a pair of stones to help him in his journey, “”They are called Urim and Thummim. The black signifies ‘yes’, and the white ‘no’. When you are unable to read the omens, they will help you to do so.”” (Coelho 31). The pair of stones are the magical aid the mentor gave to Santiago.
The last trait in this phase is The Crossing of the First Threshold. After all preparation for the adventure have been made, fears are controlled and confident is gained and all that is left is for the hero is to commits to the adventure. In this trait the hero says his farewell to his family, friend or maybe his tribe. He might leave on the back of a horse or might be swallowed into the new world ( Volgar 127).
The crossing of the First Threshold is presented shortly in The Alchemist when Santiago sells his flock of sheep to a friend and sail to Tanger in North Africa, starting his adventure, as he feels the omens are on his side which gives him confidence.
2. Initiation
First trait in Initiation is The Road of Trial, “”Once having traversed the threshold, the hero moves in a dream landscape of curiously fluid, ambiguous forms, where he must survive a succession of trials.”” (Campbell 89). In addition the hero goes through different tests encountering enemies or making allies. This stage is important as it shows the difference between the ordinary world and the new unknown world, and it can take more than one trail for the hero to succeed (Voytilla 5-12).
In The Alchemist the first trail occur when Santiago loses his money to a thief who deceives him as being a friend who will guide him to the Pyramids. Santiago is then left with no money in hands and in a different place with a different language that he cannot yet speak. Santiago succeeds the first test when he makes his choice of continuing despite the hardships “”I’m an adventurer, looking for treasure.”” (Coelho 44). Another trial is when he meets the crystal merchant and start working for him, this trial is different from the first one as he makes a friend not an enemy. These trials do not end here but continues while Santiago learns more about the language of the world while working on the crystal shop and succeed in raising the business, Maktub while crossing the desert with the caravan, Alchemy when meeting the English man who wants to be an alchemist and even love after meeting Fatima the desert woman.
The second trait is The Approach to the Inmost Cave; this stage is the central of the journey where the hero make preparation physically and mentally for his final challenge and might develop his love with the beloved, this development make their love stronger as a preparation for what comes next (Volgar 143-144).
This is where Santiago makes his decision of going with the alchemist who will guide him to the Pyramids, also selling his camel and buying a horse to cross the desert faster. Moreover the love development happens when he proposes to Fatima the desert woman and promises to comeback for her, as she replies “”Before this, I always looked to the desert with longing…Now it will be with hope.”” (Coelho 128). Therefore Fatima accepts Santiago’s proposal and promises to wait for his return.
The last trait in this phase is The Ultimate Boon or the crises, in which the hero faces his ultimate challenge and the threat of death, “”The mainspring of the heroic form and the key to its magic power.”” (Volger 155). In this trait the hero faces death or might even die, only to be reborn again, having changed and grown into a stronger self, as the threat of death is the strongest emotion that can change people (Volger 156).
The Alchemist presents this trait in the alchemist’s challenge with the men of the desert right before arriving to the Pyramids, in which Santiago is challenged to destroy the camp of the desert’s men by turning himself into the wind in three days, or he will have to sacrifice his life to the leader of the camp. In this challenge, Santiago faces the threat of death as days go by without him knowing what to do, or of any magic to destroy the camp using wind force. But only in the third day he achieves his goal, after truly understanding the soul of the world and remembering that Fatima will be awaiting him.
3. Return
The Reward is the first trait in the last phase of the hero’s journey. After surviving the crisis, the hero receives his reward. The reward can be of different shapes and kinds, an elixir, a sword or even insight in life or moral lesson. This trait gives the hero a time to celebrate and gain his strength, preparing him for the road back (Voytilla 5-12).
This trait can be shown in two forms in The Alchemist, a physical reward and a mental or a spiritual reward. The first reward is when Santiago survives the challenge of the desert’s men, he then truly understands the soul of the world, and how everything works in life, this insight in life is a mental and a spiritual reward. The other form of reward which is the physical one takes more time to achieve, as Santiago continue his road until he arrives at the Pyramids where only his treasure location became clear when a boy tell him “”I dreamed that I should travel to the fields of Spain and look for a ruined church where shepherds and their sheep slept. In my dream, there was a sycamore growing out of the sacristy, and I was told that, if I dug at the roots of the sycamore, I would find a hidden treasure.”” (Coelho 171-172).This emerges the trait and the next one which is the road back together but does not prevent any of them.
The road back, which is the last trait of the return phase in the hero’s journey, requires the hero’s decision in staying in the new world or returning to the ordinary world. As the hero has acquired the skills of mastering both worlds, it is time for him or her to choose which world to stay in (Vogler 187).
As noticed in the previous trait reward, the second reward which is the treasure in the church requires the returning of the hero Santiago to his ordinary world, which is Andalusia-Spain- in order to obtain it. Therefore this could prevent the decision of choosing the world from occurring. However it does not, because even after returning to Andalusia and finding the treasure Santiago says his final words “”I’m coming, Fatima.”” (Coelho 177) and this gives a clear idea of Santiago’s decision in stay in the new world.
Conclusion
To summarize, many characteristics of each phase of the quest can be traced in The Alchemist as being clear in some parts and indirect in others.
Firstly the departure phase is presented in all of it major traits from the indirect call in Santiago’s vision to the mentor Melchizedek that guide Santiago to his adventure and the crossing from the ordinary world Andalusia to the new unknown world of North Africa as presented in Tanger, the big desert, Faiyum and the Pyramids of Egypt.
Secondly is the initiation phase as clear in the many trails Santiago goes through from meeting the thief, the crystal merchant, the English man, Fatima and others. As well as the approach of the Inmost Cave, in which the love development occur between Santiago and Fatima. Another is the crisis in which Santiago faces the alchemist’s challenge of summoning the wind force.
Lastly is the phase of return, in which Santiago receives his mental or spiritual reward by developing an insight to the world, and his physical reward which is the treasure in the church. Moreover, the last trait is presented in Santiago’s decision in staying in the new world, exactly in the Faiyum, with his beloved Fatima.
In conclusion, we can say that after applying Joseph Campbell’s theory of The Monomyth on The Alchemist; it is noticeable that despite The Alchemist being a postmodernism wok of literature, the author Coelho used all major patterns of the hero’s journey of ancient myth in his novel and this developed Santiago’s journey from an ordinary one into an archetypal one.
The Advantages Of Valproate For Bipolar Disorder
Valproate is an antiepileptic drug that has been proven to be effective in acute mania and is often used in the maintenance treatment of bipolar disorder (BPD). Valproate takes a shorter period than lithium before the patient may see benefits. Valproate can be useful as a short-term BPD treatment when rapid mood stabilization is warranted (Nemade & Dombeck, 2018). Valproic acid is thought to be more effective than lithium for treating mania, rapid cycling, or mixed states BPD. However, it does not seem to be as effective as lithium for the treatment of depressive states (Nemade & Dombeck, 2018).
The Advantage of Oxcarbazepine over Carbamazepine
Oxcarbazepine is a mood stabilizer chemically related to carbamazepine. Oxcarbazepine is less likely to cause bone marrow suppression and therefore, unlike with carbamazepine, repeated complete blood counts are not essential. Repeated measurement of serum levels is not needed. However, oxcarbazepine can cause bone marrow suppression in rare cases (Hsiao, Wei & Huang, 2010). Oxcarbazepine is not metabolized to the 10,11-epoxide that is believed to be responsible for several adverse effects associated with carbamazepine (Hsiao, Wei & Huang, 2010).
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Lamotrigine Use and Risks
Lamotrigine is an anticonvulsant drug that’s applied in the treatment of bipolar I disorder. It’s FDA-approved for the maintenance treatment of bipolar I disorder to retard the time of reoccurrence of mood episodes in patients treated for acute mood episodes with standard therapy (“Mood Stabilizers | Psych Education”, 2018). According to “Lamotrigine – FDA prescribing information, side effects, and uses” (2018), the treatment of acute manic or mixed episodes is not recommended with lamotrigine. The FDA warns that the medicine lamotrigine (Lamictal), used for seizures and bipolar disorder, could cause a rare, life-threatening reaction that excessively activates the body’s immune system, leading to severe, widespread inflammation in the body and could potentially lead to death. The immune system response, called hemophagocytic lymph histiocytosis (HLH), leads to an uncontrolled reaction by the immune system. HLH commonly presents as a persistent fever, usually greater than 101°F, and it can cause severe problems with blood cells and organs throughout the body, such as liver, kidneys, or lungs. It’s crucial to monitor for Stevens-Johnson Syndrome (SJS). Therefore, Lamotrigine is slowly titrated up to the therapeutic dose amount. The literature from “Lamotrigine – FDA prescribing information, side effects, and uses” (2018) indicates it should not be restarted at the optimal dosage after the patient has stopped taking the drug. It needs to be reintroduced slowly until the therapeutic level is reached. There are also drug interactions with lamotrigine. Valproate increases lamotrigine concentrations more than 2-fold. Carbamazepine, phenytoin, phenobarbital, primidone, and rifampin decrease lamotrigine concentrations by approximately 40%. Estrogen-containing oral contraceptives decrease lamotrigine concentrations by approximately 50%. Protease inhibitors lopinavir/ritonavir and atazanavir/ritonavir decrease lamotrigine exposure by approximately 50% and 32% respectively. Dosage readjustments may be necessary in moderate and severe hepatic impairment. Reduced maintenance doses of lamotrigine may be required in substantial renal impairment (“Lamotrigine – FDA prescribing information, side effects and uses”, 2018).
Mental Health Patients that Benefit from Gabapentin
Gabapentin is an analgesic and antiepileptic drug structurally associated with gamma-aminobutyric acid (GABA), the key inhibitory neurotransmitter in the cerebral cortex. While gabapentin isn’t approved by the FDA for the treatment of any anxiety disorder, numerous clinicians prescribe it off-label. According to Murray (2018), off-label gabapentin could be especially effective as an adjunct to benzodiazepines or serotonergic antidepressant drugs in individuals with anxiety who experienced a partial response. Practice guidelines recommend gabapentin as a third-line adjunctive treatment for maintenance treatment of bipolar disorder (Murray, 2018). Additionally, gabapentin works for anxiety, insomnia, and alcohol use disorder.
The Advantages of Topiramate
Topiramate is utilized to address posttraumatic stress disorder, mood disorders, and eating disorders. It’s an anti-convulsive drug that stands apart from all other drugs used to treat convulsions or mood disorders, for it doesn’t share the same chemical composition. There are two factors that set Topiramate apart from other drugs in its class. First, MDs sometimes prescribe it when other mood-stabilizing drugs fail to be effective for a patient. Secondly, the kinds of side effects that patients might experience are quite different with Topiramate compared to other mood stabilizers. Topiramate is most beneficial for people who have bipolar mood disorders that other mood stabilizers have been incapable of controlling (Lieber, 2018). It can relieve symptoms and make taking antidepressants possible for people who were not able to use them before without experiencing mania or a mixed state. Topiramate has a good side effect profile (Lieber, 2018).
The Advantage of using Chlorpromazine
This medicine is utilized to address disorders such as schizophrenia, psychotic disorders, the manic phase of bipolar disorder, and severe behavioral problems in children (“Chlorpromazine – DrugBank”, 2018). Chlorpromazine is a phenothiazine and conventional antipsychotic agent with anti-emetic action. Chlorpromazine maintains its antipsychotic effect by blocking postsynaptic dopamine receptors in cortical and limbic regions of the brain, thereby preventing the overabundance of dopamine (“Chlorpromazine – DrugBank”, 2018). This contributes to a decrease in psychotic symptoms. Chlorpromazine assists the patient to think more clearly and experience less anxiety. It can reduce aggressive behavior and the desire to harm oneself or others.
The Advantage of Olanzapine
Olanzapine is an atypical antipsychotic currently indicated for the treatment of schizophrenia, acute mania, and the prevention of relapse in bipolar disorder (Narasimhan, Bruce & Masand, 2007). Olanzapine-fluoxetine compound (OFC) therapy and quetiapine are the only FDA authorized medications for the treatment of acute bipolar depression. Acute mania trials have shown superior efficacy from olanzapine to placebo, equivalent or superior efficacy to valproate, and superior efficacy in combination therapy with lithium or valproate compared to mood stabilizer monotherapy (Narasimhan, Bruce & Masand, 2007). Olanzapine is an effective antipsychotic with fewer EPS, and has the potential to reduce positive and negative symptoms to a greater degree than some conventional antipsychotics and other ‘atypical’ antipsychotics. It also has good tolerability.
The Uses for Risperidone
Risperidone is an atypical antipsychotic, serotonin-dopamine antagonist, and second-generation antipsychotic utilized to address symptoms of schizophrenia in adolescents and adults. The medication is sometimes used to treat bipolar disorder. Second-generation antipsychotics, including risperidone, are efficacious in the treatment of manic symptoms in acute manic or mixed exacerbations of bipolar disorder (Yildiz, Vieta, Leucht & Baldessarini, 2014). In children and adolescents, risperidone may be more effective than lithium or divalproex, but has several metabolic side effects (Gitlin & Frye, 2012). As maintenance therapy, long-acting injectable risperidone is efficacious for the prevention of manic episodes but not depressive episodes (Gitlin & Frye, 2012). The long-acting injectable configuration of risperidone may be beneficial over long-acting first-generation antipsychotics because it’s better tolerated (less extrapyramidal issues), and the long-acting injectable preparations of first-generation antipsychotics could increase the chance of depression (Gitlin & Frye, 2012).
Aripiprazole use in the patient population
Aripiprazole is an atypical antipsychotic. It’s recommended and chiefly utilized for the treatment of schizophrenia and bipolar disorder. Additional uses include treatment in major depressive disorder (MDD), as an add-on, tic disorders, and irritability related to autism. Additionally, a 2014 systematic review concluded that add-on therapy with low-dose aripiprazole is an effective treatment for obsessive-compulsive disorder (OCD) that doesn’t improve on SSRIs alone. The determination was supported by the outcomes of two relatively small, short-term trials, each of which exhibited improvements in symptoms (Veale et al., 2014).
Advantage of Quetiapine with Patients Experiencing Mania
Quetiapine is a second-generation dibenzothiazepine that received Food and Drug Administration (FDA) approval for use as monotherapy or adjunctive therapy for acute mania, particularly when sensitivity to extrapyramidal effects limits treatment options (Brahm, Gutierres & Carnahan, 2018). Pharmacotherapy for acute mania typically involves a mood stabilizer, such as lithium or certain anticonvulsants, and often an antipsychotic is given to reduce excessive psychomotor agitation. Combination therapy with these agents during acute mania is quite common due to the need to rapidly stabilize patients (Brahm, Gutierres & Carnahan, 2018). The goal of treatment is to restore normal or near-normal functioning as quickly as possible and prevent further deterioration (Monson & Schoenstadt, 2018). Quetiapine is effective for treating episodes of mania or depression and helps prevent symptoms of bipolar disorder from returning (Monson & Schoenstadt, 2018). For bipolar mania episodes, it helps decrease the manic symptoms (Monson & Schoenstadt, 2018).
Reducing the Risk of Suicide with Bipolar Patients
“Risk factors could assist in distinguishing patients at increased suicidal risk, but ongoing clinical appraisal is crucial to limit the risk. Empirical short-term interventions to manage acute suicidal risk include close clinical oversight, rapid hospital care, and electroconvulsive therapy (ECT). However, evidence of the long-term effectiveness of most treatments against suicidal behavior is scarce. A notable exception is lithium (Li) prophylaxis, which is linked with consistent evidence of significant (approximately 80%), sustained reductions in the risk of suicides and attempts. These benefits are unproven for other treatments typically used to treat bipolar disorder patients, including anti-convulsants, antipsychotics, antidepressants, and psychosocial interventions.” (Baldessarini, Pompili & Tondo, 2006).
The Difference Between Bipolar Depression and Unipolar Depression
Patients with bipolar disorder are oftentimes misdiagnosed with major depressive disorder (unipolar depressive disorder) (Hirschfeld, Lewis & Vornik, 2003). Whenever these patients are treated with antidepressants for unipolar depression, this could prove to be an ineffectual treatment and could exacerbate their condition by bringing on rapid cycling or activating a change over to a manic/mixed, manic, or hypomanic episode (Hirschfeld, Lewis & Vornik, 2003). Olanzapine, quetiapine, aripiprazole, and olanzapine-fluoxetine have been found to be efficacious in treating bipolar depression. If antidepressant drugs are used to address bipolar depression, they’re compounded with the use of a mood stabilizer or atypical antipsychotic medicine to prevent the appearance of bipolar mania (“Mood Stabilizers | Psych Education”, 2018). The biological science of these disorders is dissimilar, efficacious treatments are different, and in a way, the symptoms are as well different. Both forms of depressive disorder can be very serious and carry a danger of suicide. However, the fundamental difference is that people with bipolar depression also undergo episodes of either mania or hypomania. Bipolar depression is more likely to be accompanied by more substantial symptoms of anxiety. One-half to two-thirds of patients with bipolar depression have a co-occurring anxiety disorder such as obsessive-compulsive disorder (OCD), panic disorder, or social anxiety disorder (“Mood Stabilizers | Psych Education”, 2018). According to “Mood Stabilizers | Psych Education” (2018), there are three specifically approved medications for bipolar depression treatment: Lurasidone HCI (Latuda), Olanzapine-fluoxetine combination (Symbax), Quetiapine (Seroquel). There are four medications approved for the maintenance of bipolar disorder symptoms: Lithium, Lamotrigine (Lamictal), Aripiprazole (Abilify), and Olanzapine (Zyprexa).
