One of my favorite affirmations has always been Nietzsche’s well-known quote,” That which does not kill us makes us stronger”.
One cannot deny that life-threatening experiences may lead to psychiatric conditions such as posttraumatic stress disorder (PTSD).
However, psychopathology only occurs to some of those exposed to such events and although this condition was denied and ignored up until the early 1970’s,I believe in the past 20 years or so Psychiatrists/Psychologists etc. have viewed those who haven’t developed PTSD after a traumatic incidence as slightly sociopathic.
Now at last Mental Health Professionals are agreeing with Nietzsche that positive psychological changes (such as: improved relationships with others, openness to new possibilities, greater appreciation of life, enhanced personal strength and spiritual development etc.) are more likely to happen following potentially traumatic events.
I think the study and expectation of this ‘Posttraumatic Growth Syndrome’ is more interesting and positive than dwelling on PTSD.
To me the most interesting question is whether the exposure to and experiencing of life threatening situations develops positive character traits, or whether some individuals are just ‘hard wired’ to be more resilient and positive.
Below are a couple of interesting articles on the subject.
Why do some suffer PTSD, others don’t?
By Gretel C. Kovach, UNION-TRIBUNE STAFF WRITER
Saturday, April 10, 2010.
When Sgt. Michael Blair awoke from a drug-induced coma four years ago, doctors gave him a choice.
Blair’s legs had been blasted by a roadside bomb in Iraq. The physicians could amputate both limbs, or they could try to save them through a series of grueling medical procedures. More than 60 surgeries later, the Marine, formerly stationed at Twentynine Palms, still struggles with chronic pain as he continues his care at Walter Reed Army Medical Center in Washington, D.C.
With the help of a cane, though, Blair walked amid the cherry blossoms at the White House this week with his wife and 4-year-old daughter. He has piloted his first solo flight, kayaked through the Grand Canyon, used a hand cycle to finish several marathons and dreamed of opening a therapeutic recreation center for wounded troops.
Blair relies on a strong support network that includes his family, sports organizations and the Marine Corps. But he also may be genetically predisposed to withstand physical and mental trauma.
“I am just so freakin’ grateful to be alive,” said Blair, 35, who will be a featured speaker next month at the Naval Center for Combat & Operational Stress Control’s conference in San Diego.
Researchers are just starting to understand what gives some service members the mental hardiness, or resilience, to fend off post-traumatic stress disorder. Is it innate, a matter of training or a complex interaction between the two?
The answers could help inoculate both combat veterans and civilians against potentially debilitating bouts of trauma-induced stress.
“It’s a really exciting time. This idea of resilience — we are just starting to scratch the surface,” said Steven Thorp from the Post-traumatic Stress Disorders Clinical Team at the San Diego VA Healthcare System and a research psychologist with the University of California San Diego.
The new focus on resilience comes as about 17,000 troops from Camp Pendleton and supporting bases are deploying to Afghanistan between now and fall.
As many as one in five veterans of the Iraq and Afghanistan wars suffers from PTSD, according to the Department of Veterans Affairs’ National Center for PTSD. High suicide rates among service members also are causing deep concern among Pentagon leaders and commanders at bases nationwide. The number of suicides among combat-experienced Marines doubled from 2006 to 2007, the Navy reported, and a record number of Marines and soldiers took their lives in 2008.
Scientists have developed some treatments for PTSD, which was once called shell shock or battle fatigue. The condition was recognized as a disorder in 1980, largely because of attention paid to affected Vietnam War veterans.
Last year, researchers published one of the first studies — by Robert H. Pietrzak and colleagues — about resilience against PTSD among Iraq and Afghanistan war veterans.
The biggest unknown is “what’s trainable and what’s hard-wired,” said Chris Johnson, a clinical and research psychologist in the Warfighter Performance Department at the San Diego-based Naval Health Research Center.
The center’s staff is using computerized rehabilitation environments and neuro-imaging to study how the brain functions under stress. It’s also evaluating the mental effects of immersive, or simulation-based, combat training at Camp Pendleton.
“We know a lot about effective treatments, how units function and how important biology and behavior are in terms of responding to it,” Johnson said. “But there is still a lot of work to be done in terms of prevention.”
Thorp focuses on “post-traumatic growth,” the phenomenon where some walk away from a traumatic experience — such as a car accident or deadly firefight — with better attitudes and behaviors.
“There is a point where just about any of us would get PTSD given a traumatic event,” he said. “But when exposed to combat, some get PTSD, some don’t, and some have an enhanced life. They value life even more.”
While resilience research gestates, controversy over the use of psychotropic medications to treat combat stress is being debated in Congress.
Bart Billings, a retired military medical officer from Carlsbad and founder of the longest-running combat-stress conference in the nation, submitted testimony for a Feb. 24 hearing on the issue by the U.S. House Committee on Veterans Affairs. Billings said he was troubled by “a surge in the number of suicides among service members and their family members that appears to correlate directly with the increased use of psychiatric medication.”
“Would you want your daughter or son who is carrying a loaded weapon in battle to be given a medication where the first warning on the label is suicidality?” he asked in an interview.
But Brig. Gen. Loree Sutton, a doctor and director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, testified that the Pentagon supports psychopharmacological treatments as a key component of mental health care.
“Scientific evidence over the past several decades points to the role of medications in limiting the severity and duration of illness, as well as for preventing relapses and recurrences,” she said.
The Marine Corps and Navy will present a new doctrine about combat and operational stress during the Navy conference in San Diego next month. Commanders have already rolled out the program, which teaches troops to identify signs of stress among their ranks, intervene before a crisis and reach out to a sailor or Marine overwhelmed with stress, for instance when a fighter under attack freezes.
The goal is to codify operational stress management, but “this is what a really good leader already does instinctively,” said Capt. Paul Hammer, a former enlisted Marine and a Navy-trained psychiatrist. He directs the Naval Center for Combat & Operational Stress Control, which began operating about two years ago at San Diego Naval Medical Center.
“I don’t think anybody thinks we are going to completely prevent everybody from getting PTSD,” Hammer said. “But we can minimize the impact. It is much like how we have better helmets, better surgical procedures.”
Once home from the war, Blair, the wounded sergeant, was buoyed by camaraderie among wounded Marines, the aviation community, kayakers and many others. He agreed to speak at the upcoming conference because he hopes his experiences will inspire others nursing physical and mental wounds.
“It is easy for guys to fall through the cracks, but you don’t have to sit around in your room,” he said. “You can get out and do things.”
Blair recently took a ride in a vintage Russian propeller plane. The pilot treated him to barrel rolls, half-Cubans and upside-down loop-the-loops.
For someone who still has trouble walking, soaring in the skies was a rush.
“It is great for the mind, body and spirit,” Blair said. “It is nice being up there, close to God.”
Psychiatric Times. Vol. 21 No. 4
Posttraumatic Growth: A New Perspective on Psychotraumatology.
By Richard G. Tedeschi, Ph.D., and Lawrence Calhoun, Ph.D. | 1 April 2004.
Dr. Tedeschi is professor of psychology at the University of North Carolina at Charlotte. Dr. Calhoun is professor of psychology at the University of North Carolina at Charlotte. Both authors have written three books and numerous articles on posttraumatic growth.
There is a long tradition in psychiatry, reaching at least back to World War I, of studying the response of people who are faced with traumatic circumstances and devising ways to restore them to psychological health. The main focus of this work has been on the ways in which traumatic events are precursors to psychological and physical problems. This negative focus is understandable and appropriate to the requirements of these contexts. However, only a minority of people exposed to traumatic events develop long-standing psychiatric disorders.
Although not prevalent in either clinical or research settings, there has been a very long tradition of viewing human suffering as offering the possibility for the origin of significant good. A central theme of much philosophical inquiry--and the work of novelists, dramatists and poets--has included attempts to understand and discover the meaning of human suffering (Tedeschi and Calhoun, 1995). In the 20th century, several clinicians and scientists have addressed the ways in which critical life crises offered possibilities for positive personal change (e.g., Caplan, 1964; Frankl, 1963; Maslow, 1970; Yalom and Lieberman, 1991). However, the widespread assumption that trauma will often result in disorder should not be replaced with expectations that growth is an inevitable result. Instead, continuing personal distress and growth often coexist (Cadell et al., 2003).
In the developing literature on posttraumatic growth, we have found that reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders (Quarantelli, 1985; Tedeschi, 1999). This is despite the fact that we are concerned with truly traumatic circumstances rather than everyday stressors. Reports of posttraumatic growth have been found in people who have experienced bereavement, rheumatoid arthritis, HIV infection, cancer, bone marrow transplantation, heart attacks, coping with the medical problems of children, transportation accidents, house fires, sexual assault and sexual abuse, combat, refugee experiences, and being taken hostage (Tedeschi and Calhoun, in press).
The Domains of Posttraumatic Growth
The kinds of positive changes individuals experience in their struggles with trauma are reflected in models of posttraumatic growth that we have been building (Calhoun and Tedeschi, 1998) and in a measure of posttraumatic growth that we developed based on interviews with many trauma survivors (Tedeschi and Calhoun, 1996). These changes include improved relationships, new possibilities for one's life, a greater appreciation for life, a greater sense of personal strength and spiritual development. There appears to be a basic paradox apprehended by trauma survivors who report these aspects of posttraumatic growth: Their losses have produced valuable gains.
We also find that other paradoxes are involved. For example: "I am more vulnerable, yet stronger." Individuals who experience traumatic life events tend to report--not surprisingly--an increased sense of vulnerability, congruent with the experience of suffering in ways they may not have been able to control or prevent. However, these same people also may report an increased sense of their own capacities to survive and prevail (Calhoun and Tedeschi, 1999). Another experience often reported by trauma survivors is a need to talk about the traumatic events, which sets into motion tests of interpersonal relationships--some pass, others fail. They also may find themselves becoming more comfortable with intimacy and having a greater sense of compassion for others who experience life difficulties.
Individuals who face trauma may be more likely to become cognitively engaged with fundamental existential questions about death and the purpose of life. A commonly reported change is for the individual to value the smaller things in life more and also to consider important changes in the religious, spiritual and existential components of philosophies of life. The specific content varies, of course, contingent on the individual's initial belief system and the cultural contexts within which the struggle with a life crisis occurs. A common theme, however, is that after a spiritual or existential quest, philosophies of life can become more fully developed, satisfying and meaningful. It appears that for many trauma survivors, a period of questioning their beliefs is ushered in because existential or spiritual issues have become more salient and less abstract. Although firm answers to the questions raised by trauma--why do traumatic events happen, what is the point to my life now that this trauma has occurred, why should I continue to struggle--are not necessarily found, grappling with these issues often produces a satisfaction in trauma survivors so that they are experiencing life at a deeper level of awareness. It should be clear by now that the reflections on one's traumas and their aftermath are often unpleasant, although necessary in reconstructing the life narrative and establishing a wiser perspective on living that accommodates these difficult circumstances. Therefore, posttraumatic growth does not necessarily yield less emotional distress.
Cognitive Engagement and Growth
A central theme of the life challenges that are the focus here is their seismic nature (Calhoun and Tedeschi, 1998). Much like earthquakes can impact the physical environment, traumatic circumstances, characterized by their unusual, uncontrollable, potentially irreversible and threatening qualities, can produce an upheaval in trauma survivors' major assumptions about the world, their place in it and how they make sense of their daily lives. In reconsidering these assumptions, there are the seeds for new perspectives on all these matters and a sense that valuable--although painful--lessons have been learned.
As the individual comes to recognize some goals as no longer attainable and that some components of the assumptive world can not assimilate the reality of the aftermath of the trauma, it is possible for the individual to begin to formulate new goals and to revise major components of the assumptive world in ways that acknowledge their changed life circumstances. The individual's cognitive engagement with and cognitive processing of trauma may be assisted by the disclosure of that internal process to others in socially supportive environments. At some point, trauma survivors may be able to engage in a sort of meta-cognition or reflection on their own processing of their life events, seeing themselves as having spent time making a major alteration of their understanding of themselves and their lives. This becomes part of the life narrative and includes an appreciation for new, more sophisticated ways of grappling with life events (McAdams, 1993).
Facilitating Posttraumatic Growth
The changes that trauma produces are experiential, not merely intellectual, and that is what makes them so powerful for many trauma survivors. This is the same for posttraumatic growth--there is a compelling affective or experiential flavor to it that is important for the clinician to honor. Therefore, the clinician's role is often subtle in this facilitation. The clinician must be well-attuned to the patient when the patient may be in the process of reconstructing schemas, thinking dialectically, recognizing paradox and generating a revised life narrative. What follows are some general guidelines for this process. More extensive discussion and case examples can be found in Calhoun and Tedeschi (1999).
Attention to elements of posttraumatic growth is compatible with a wide variety of approaches that are currently utilized to help people who are dealing with trauma. Initially, clinicians should address high levels of emotional distress, providing the kind of support that can help make this distress manageable (Tedeschi and Calhoun, 1995). Allowing a distressed patient to regain the ability to cognitively engage the aftermath of the trauma in a rather deliberate fashion will promote the possibility for posttraumatic growth.
Clinicians must feel comfortable and be willing to help their patients process their cognitive engagements with existential or spiritual matters and generally respect and work within the existential framework that patients have developed or are trying to rebuild in the aftermath of a trauma. Further-more, although individual patients may need additional specific interventions designed to alleviate crisis-related psychological symptoms, listening--without necessarily trying to solve--tends to allow patients to process trauma into growth (Calhoun and Tedeschi, 1999). In fact, one way of insuring that clinicians practice this sort of approach is to relate to the trauma survivor's story in a personal manner. Being changed oneself as a result of listening to the story of the trauma and its aftermath communicates the highest degree of respect for the patient and encourages them to see the value in their own experience. This acknowledged value is a short step away from posttraumatic growth.
The immediate aftermath of tragedy is a time during which clinicians must be particularly sensitive to the psychological needs of the patient. Never engage in the insensitive introduction of didactic information or trite comments about growth coming from suffering. This is not to say that systematic treatment programs designed for trauma survivors should not include growth-related components, because these may indeed be helpful (Antoni et al., 2001). A posttraumatic growth perspective can be used even in critical incident stress management (Calhoun and Tedeschi, 2000). However, even as part of a systematic intervention program, matters related to growth are best addressed after the individual has had a sufficient amount of time to adapt to the aftermath of the trauma.
Caveats About Posttraumatic Growth
In order to clarify the clinical perspective on posttraumatic growth, we offer these reminders. First, posttraumatic growth occurs in the context of suffering and significant psychological struggle, and a focus on this growth should not come at the expense of empathy for the pain and suffering of trauma survivors. For most trauma survivors, posttraumatic growth and distress will coexist, and the growth emerges from the struggle with coping, not from the trauma itself. Second, trauma is not necessary for growth. Individuals can mature and develop in meaningful ways without experiencing tragedy or trauma. Third, in no way are we suggesting that trauma is "good." We regard life crises, loss and trauma as undesirable, and our wish would be that nobody would have to experience such life events. Fourth, posttraumatic growth is neither universal nor inevitable. Although a majority of individuals experiencing a wide array of highly challenging life circumstances experience posttraumatic growth, there are also a significant number of people who experience little or no growth in their struggle with trauma. This sort of outcome is quite acceptable--we are not raising the bar on trauma survivors, so that they are to be expected to show posttraumatic growth before being considered recovered.
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