As the old adage goes – what doesn’t kill you makes you stronger. Experiencing a traumatic event can feel like the end, but it can be a chance to start a new chapter.
Imagine you are going about your day-to-day life, perhaps at the supermarket, at the shops or at work, when one of the blood vessels in your brain suddenly ruptures. Your brain feels like it will explode as you experience the most excruciating pain you have ever experienced on the left side of your head. You try to call out to people, but inexplicably you can’t form the words. Your chest tightens and you are sure this is the end. Your vision blurs. You collapse and lose consciousness.
You wake up to an unfamiliar environment: you’re lying in a bed and you find your body no longer responds to your command. Doctors tell you that you can’t talk, walk, read, or write. You have suffered a severe stroke.
This is similar to what happened to Jill Bolte Taylor (a US neuroscientist) and is outlined in her book My Stroke of Insight (Penguin, 2008). Read it and you find that, surprisingly, Bolte Taylor is convinced the stroke was the best thing that could have happened to her. She writes: “I have learned so much from this experience with stroke, that I actually feel fortunate to have taken this journey. Thanks to this trauma, I have had the chance to witness firsthand a few things about my brain that otherwise I would never have imagined to be true.” How can we understand this phenomenon? The paradox that suffering can bring unexpected benefits?
In clinical psychology, we are much more familiar with negative outcomes following traumatic events, including post-traumatic stress disorder (PTSD). This has been necessary as people who have suffered trauma are usually very distressed, and the alleviation of their suffering has been the primary focus. Before turning our attention to benefits arising from trauma, let’s look at what we know about post-traumatic stress disorder in order to compare these different outcomes.
A COMMON EXPERIENCE
A New Zealand study in 2002 published in the New Zealand Journal of Social Psychiatry found that more than 50 per cent of us have experienced a traumatic event in our lives. Australian figures from a 2001 survey conducted by the National Centre for Post Traumatic Stress Disorder were similar, with 64 per cent of males and 50 per cent of females experiencing trauma (most commonly being involved in a life-threatening accident, natural disaster or witnessing someone getting injured or killed). PTSD can start after traumatic events where we either experience or witness situations where we or others are in danger and life is threatened. Feelings of intense fear, helplessness or horror are common. PTSD has been an outcome of serious road accidents, military combat, violent personal assault – sexual assault, rape, physical attack, robbery, mugging – being taken hostage, being in a terrorist attack, being a prisoner-of-war, natural or man-made disasters, being diagnosed with a life-threatening illness, unexpected sudden severe medical problems, and the experience of abuse or neglect as an adult or child.
It is normal for people to experience a range of emotions after such an event, which can include feeling depressed, anxious, guilty and angry. I heard PTSD succinctly explained by John Briere, a US trauma specialist as “a normal reaction to an abnormal event”.
WHAT ARE THE SYMPTOMS?
There are three main types of symptoms in addition to those above that are regularly seen in PTSD.
1. Flashbacks and nightmares
You re-live the event over and over in your mind and also feel the emotions and physical sensations of what happened.
2. Avoidance and numbing
You avoid places and people that remind you of the trauma, and try not to talk about it. You deal with the pain by being emotionally numb – trying to feel nothing at all.
3. Being ‘on guard’
You find that you stay alert all the time, as if you are looking out for danger. You can’t relax and are jumpy and irritable. You feel anxious and find it hard to sleep.
Most people find that they have symptoms of post-traumatic stress in the first few weeks after trauma. This can be understood as our body’s response to such a frightening and confusing experience. However, over time these stress reactions lessen for most people. In some people though, traumatic experiences set off a reaction that can last for many months or years. I recently finished therapy with a client who had suffered PTSD since the Vietnam War, not realising that this could be treated. The good news is that we now have strong evidence for psychological treatments for PTSD and the prognosis for sufferers is generally positive.
Traumatic events undermine our sense that life is safe and that we are secure. A traumatic experience heightens our sense that we can die at any time. Richard Tedeschi and Lawrence Calhoun, who have written extensively on post-traumatic growth (PTG), define PTG as “positive psychological change experienced as a result of the struggle with highly challenging life circumstances”. Central to the definition is the idea that it is the struggle with life circumstances that leads to post-traumatic growth, rather than the event itself. The event is not seen as ‘good’, rather people have survived and are able to find meaning and benefits (a silver lining) through the experience. For example, after her stroke Bolte Taylor explains that her sense of spirituality was heightened and she writes of finding her own deep inner peace and wanting to help others find theirs.
Tedeschi and Calhoun use the metaphor of an earthquake to describe the process that can follow trauma: just as an earthquake threatens concrete buildings and up-ends trees, trauma shatters our assumptions about the world, leaving ruin and debris. The rebuilding that takes place after an earthquake is comparable with the deliberate emotional and cognitive rebuilding a person who has been through trauma can go through to reach PTG. Bolte Taylor, captures this when she quotes Einstein: “I must be willing to give up what I am in order to become what I will be.”
The notion that people have the capacity to benefit from trauma is an ancient concept found in many ancient traditions, including those in the Hebrew, Greek, Christian, Hindu, Buddhist and Islamic writings. In the past 10 to 15 years, psychologists have attempted to understand this concept, and research into this area is growing rapidly. PTG has been documented following a wide range of negative events, including bereavement, illnesses, and man-made traumas. PTG has had different results including positive psychological changes, stress-related growth, discovery of meaning, thriving, positive reinterpretation and transformational coping. Interestingly, there are more reports of growth than psychiatric disorder following trauma.
FIVE POSITIVE OUTCOMES
There are five areas of change that have been documented in post-traumatic growth: people experience improved relationships, perhaps as a result of valuing those close to them; they see new possibilities for their lives and often re-evaluate career options; they experience a greater appreciation for life; they report a greater sense of personal strength and they develop spirituality as an important part of their lives. In the mid-1990s three levels of functioning were identified in post-traumatic growth:
– Survival: The trauma has impacted life to the extent that a person keeps living, but with a significantly lower quality of life.
– Recovery: A person recovers to the point of pre-trauma levels.
– Thriving: A person recovers beyond pre-trauma levels and goes on to experience a transformation.
DO YOU ONLY EXPERIENCE EITHER PTSD OR PTG?
Interestingly, studies are finding that just because a large number of people experience growth after trauma, this does not mean that they are not distressed or having symptoms related to the trauma. Growth and traumatic symptoms can be present at the same time.
A 2009 study from King’s College London found that almost 60 per cent of 180 people who had been assaulted reported some positive change, but that there were subsets of people experiencing different levels of growth.
For some people, the trauma they face is not seen as a crisis; it doesn’t shatter their world views and therefore they experience low post-traumatic symptoms and low post-traumatic growth. For others, the distress and grief they experience may propel them to seek meaning and benefit from the distressing experience they find themselves in, and thus report positive and negative changes. Some researchers propose that getting active (for example, joining support groups, going to therapy, becoming socially active), not just engaging in new ways of thinking, is essential to having a positive outcome after trauma.
The predictors of PTG are not well understood, but one predictor that has been identified in a number of studies is openness to experience. Easier said than done when you’re facing what looks like a catastrophe.
The research in the field is in its infancy, but authors caution against taking a one-size-fits-all approach to people who have undergone trauma. Pain and suffering after trauma is normal and the focus on growth is not an attempt to minimise this.
A statement from the literature on PTG captures the range of human experience after trauma: “We are reminded by trauma that the dialectical forces of positive and negative, loss and fulfilment, suffering and growth, may often go hand in hand.” Or, in the words of Soren Kierkegaard, “Life can only be understood backwards, but we have to live it forwards.”