As Tsai was treating him (successfully) for PTSD, however, something unexpected emerged. The vet still described his Vietnam experiences as horrific, but he said the painful memories remind him of who he is. His experience typifies research psychologists’ new understanding of trauma: When people are least resilient—in the sense that they are knocked for a loop, do not bounce back quickly or at all, and suffer emotionally for months, if not years—they can eventually emerge from trauma stronger, more appreciative of life, more sympathetic to the suffering of others, and with different (arguably more enlightened) values and priorities. By no stretch of the imagination would the vet be called resilient in the sense that research psychologists use the term: an ability to go on with life, essentially unchanged mentally and emotionally, in the wake of profound adversity. To the contrary, environmental triggers returned the vet’s troubled mind to the horrors of land mines and ambushes and friends blown apart. At the same time, the vet’s military experience (and his triumph over PTSD) makes him feel that he can accomplish anything. “Nothing bothers him too much, because everything pales in comparison to Vietnam,” said Tsai. This effect, post-traumatic growth, was so named in 1996 by psychologists Lawrence Calhoun and Richard Tedeschi of the University of North Carolina. It can take many forms, but all involve positive psychological changes: a greater sense of personal strength (“if I survived that, I can survive anything”), deeper spiritual awareness, greater appreciation of life, and recognition of previously unseen pathways and possibilities for one’s life. For many, post-traumatic growth brings closer relationships—as family and other loved ones are more cherished—and a stronger sense of connection to other sufferers.
Stronger Than Before
The concept that from great suffering can come great wisdom is both ancient and familiar. An oncologist friend of mine talks about patients who say cancer was one of the best things that ever happened to them, cutting through life’s usual trivia and making them value the truly important. President Jimmy Carter’s Chief of Staff, Hamilton Jordan (1944–2008), said his battle with cancer made him see that “the simple joys of life are everywhere and are boundless.” After a car crash in which my childhood friend Joyce lost her right leg at age 20, her months-long recovery and rehab left her with hours upon empty hours to think. “Stuff that used to be a big deal, like being popular, just isn’t anymore,” I remember her saying. “I care about making a difference [she became a schoolteacher], and I think I’m more empathetic. I feel that when someone is suffering I understand in my bones what she’s experiencing. Before, it was just, oh, poor her.” However, post-traumatic growth does not mean traumas are desirable, let alone that they should be downplayed when they befall others. As bestselling author Rabbi Harold Kushner said about the spiritual growth he experienced after the death of his 14-year-old son, “I would give up all of those gains in a second if I could have him back.” Few lives are without suffering, crisis, and traumas, from extreme or rare ones, such as becoming a war refugee or being taken hostage, to common ones, such as bereavement, accidents, house fires, combat, or your own or a loved one’s serious or chronic illness. For years, psychology has assumed that the best inoculation against post-traumatic stress—as well as responses to trauma that fall well short of mental disorder—is resilience, the ability to pick up one’s life where it was before the trauma. Now that psychology has made post-traumatic growth a focus of research, what is emerging is a new understanding of the complicated relationship between trauma, resilience, PTSD, and post-traumatic growth.
Post-traumatic Growth vs. Resilience
Although the psychological concept of resilience dates back to the 1970s, scientists are still struggling to understand its origins. Some studies find it’s fostered in childhood by a strong relationship with a parent or other adult, and the belief that your fate is in your own hands (a sense of agency). But the opposite belief, that “God is in control and everything happens for a reason,” may contribute to resilience, too, said UNC’s Calhoun. A 2016 review of people who survived atrocities and war in nine countries from South Sudan and Uganda to Bosnia and Burundi found that resilience varied by culture. Strong emotional connections to others fostered resilience among survivors in some societies but not others, and a sense of agency actually backfired among some: If you believe your fate is in your hands and then see your family cut down by a sniper in Sarajevo, you feel not only grief but also crushing guilt. In the absence of resilience, post-traumatic growth—a very different response to trauma—might emerge instead. “Post-traumatic growth means you’ve been broken—but you put yourself back together” in a stronger, more meaningful way, Tsai said. This may come as a surprise to those who think of resilience as the ability to learn, change, and gain strength in the face of adversity. Among research psychologists, however, resilience is about bouncing back with relative ease to where you were before, not necessarily bouncing forward to a stronger place. By this understanding, without the breaking, there cannot be putting back together, so people with strong coping capacities will be less challenged by trauma and therefore less likely to experience post-traumatic growth. For post-traumatic growth to occur, the breaking need not be so extreme as to constitute PTSD, as was the case for the Vietnam War vet. Tsai and his colleagues found that among the 1,057 US military veterans they studied, the average number of lifetime traumas (such as bereavement, natural disaster, illness, and accidents, as well as military traumas) was 5.7. Only 1 in 10 had PTSD, yet 59% of the vets had experienced post-traumatic growth. And the strongest predictor of whether someone would avoid PTSD after additional trauma was whether they had experienced post-traumatic growth after an earlier one, Tsai and his colleagues reported in the Journal of Affective Disorders. It was the first study to examine whether previous post-traumatic growth can protect against PTSD if trauma strikes again. The findings suggest post-traumatic growth might in fact boost resilience. Post-traumatic growth—unlike resilience—is not a return to baseline. It is the product of reassembling your “general set of beliefs about the world/universe and your place in it,” said Calhoun: You question the benevolence, predictability, and controllability of the world, your sense of self, the path you expected life to follow. From the shards of previous beliefs, you create wholly new worldviews, and can perhaps emerge a stronger person than you were before.
What is Trauma?
Among psychiatrists, what constitutes “trauma” is controversial. Some define trauma based on the nature of the event: Psychiatry’s diagnostic manual, for instance, says a traumatic experience must be outside the range of what humans normally encounter. Others define trauma based on how people respond to an experience: Intense fear, helplessness, horror, or distress would be symptoms of trauma. A circular definition —“trauma is something that leaves you traumatized”—is obviously not ideal. Nor is “outside the range of normal experience” a reliable measure: Tragically, many experiences that once were outside that range no longer are, such as natural disasters, mass shootings, or wartime horrors. Scholars are therefore trying to do better. An emerging definition holds that trauma challenges a person’s “assumptive world”: her belief in how people behave, how the world works, and how her life would unfold. By this understanding, trauma needn’t threaten life or health, nor cause post-traumatic stress disorder. But it must make you question your bedrock assumptions, such as that the world is fair, that terrible things do not befall good people, that there are limits to humans’ capacity for inhumanity, that things will always work out, or that the old die before the young. By that definition, few of us make it through this life without experiencing trauma.
