Pathways
to posttraumatic growth
Paul T. P. Wong, Ph.D.,
C. Psych.
President, International Network on Personal Meaning
Coquitlam, B.C., Canada
On the fateful night of April 19, 1989, a young
woman known as the Central Park Jogger was raped, beaten, and left
to die. After a 14-year silence, she finally revealed her identity
as Trisha Meili. She has appeared at Larry King Live and other talk
shows. She also tells her story in her book entitled "I Am the Central
Park Jogger: A Story of Hope and Possibilities."
For Meili, after coming out of a coma, she lived
through the horror of having to overcome her physical/emotional
injuries and memory loss, and the struggles with many personal issues.
The traumatic event drastically changed her life. Yet today, at
42, she is happily married and devotes her life to help others who
have been traumatized. Her book is just part of such efforts.
What a comeback story! What a testimony to the
amazing human capacity for resilience! What has contributed to her
post-traumatic growth?
In this NHL playoff season, I can't help but
remember Wild Bill Hunter, who died at 82 in December 2002. Known
as Mr. Hockey of Canada, he was founder of the Western Hockey League,
the World Hockey League and was the original co-owner of Edmonton
Oilers. His story can be found in the book by Bob Weber: "Wild Bill:
Bill Hunter's legendary 65 years in Canadian sport."
Interestingly, he may be remembered not so much
for his contributions to hockey, but for his passion for life in
spite of his many personal tragedies. His wife died in a car accident;
his youngest son committed suicide at age 21; he went through financial
ruins and bitter disappointments; and for many years, he battled
with various forms of cancer. Through it all, Wild Bill never felt
sorry for himself and believed that he was the luckiest man on earth.
"Dale Carnegie once said all great happenings
were the result of a dream, and I've always believed that absolutely,"
Bill liked to tell others. Indeed, he had lived his dream fully,
and got every ounce out of life right to the very end. His infectious
optimistic spirit and his love for sports have left a mark on all
those who know him.
What accounts for Wild Bill's defiant human
spirit? What contributes to his zest for life in spite of the many
tragic events?
I can tell hundreds of real life stories of
individuals who have overcome traumas. Some of them are household
names, such as, Christopher Reeves and Rick Hanson. Some are unsung
heroes. Yet, there is so much we can learn from them.
The positive psychology of growing through traumas
is a much more fascinating topic for study than post-traumatic stress
disorder (PTSD), because such knowledge can help increase individual
resilience and reduce mental illness. I will briefly contrast post-traumatic
stress disorder (PTSD) with post-traumatic growth (PTG) and then
suggest several pathways to achieving the positive legacy of trauma.
What is post-traumatic stress disorder?
Generally speaking, traumatic events are so
unexpected and stressful that they overwhelm one's capacity to cope.
In many cases, these severe stressors rip people's lives apart,
shattered the foundation of their belief-meaning systems, and fundamentally
change their future.
Trauma happens to us all, but in different ways.
Sometimes, it strikes us with one devastating blow. At other times,
it torments us slowly until we disintegrate and succumb to psychiatric
illness. However, even ordinary events can have traumatic consequences.
For example, getting fired or divorced can be traumatic for some
people.
Vicarious trauma can occur simply by being exposed
to horrible events like the September 11 terrorist attack. Soldiers
can be traumatized by the carnage and destruction they have witnessed.
It is worth noting that the prevalence rates of PTSD for Vietnam
Veterans are quite high -- 31% male and 27% female.
According to the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV), PTSD consists of three core
symptom clusters: re-experiencing
(recurring thoughts or nightmares), avoidance
(avoiding places, activities or people reminiscent of the event)
and hyper-arousal (hyper-vigilance,
irritability and exaggerated startle response).
PTSD tends to occur with other disorders, such
as depression, anxiety, panic attack, substance addiction, and dissociative
disorders.
What is post-traumatic growth?
Interesting, a percentage of people show positive
changes as a result of trauma. Some of these individuals initially
may show stress-related symptoms, but eventually recover and demonstrate
personal growth. The recovery process may be slow as in the case
of Trisha Meili.
Tedeschi and Calhoun (1995) were among the first
to research and document PTG. Prior research has shown the following
positive changes:
- Increased perception of competence and self-reliance
- Enhanced acceptance of one's vulnerability
and negative emotional experiences
- Improved relationships with significant others
- Increased compassion and empathy for others
- Greater efforts directed at improving relationships
- Increased appreciation of own existence
- Greater appreciation for life
- Positive changes in one's priorities
- Stronger religious/spiritual beliefs
- Greater personal intimacy with God
- Greater sense of control and security through
belief in God
- Greater meaning about life and suffering
through religion
What are the characteristics of individuals
who show psychological growth rather than psychiatric impairment?
What are the psychological correlates? What factors contribute to
PTG? These are some of the research questions.
Pathways to post-traumatic growth
Even in the best of times, achieving personal
growth is not an easy task -- it is like paddling a canoe upstream
or climbing a steep, rocky mountain. However, after trauma the journey
of growth becomes even tougher - it is more like paddling a leaky
canoe upstream or climbing the mountain with broken legs.
The pathways to PTG begin with brokenness and
deficits. Before growth can take place, one needs to CHOOSE to embark
on the long journey of recovery - to restore shattered assumptions,
regain confidence and find healing at physical, emotional, and spiritual
levels.
The following pathways to PTG are based on both
the research and clinical literature.
(1) Acceptance
You no longer live in denial or avoidance. And
you no longer wallow in self-pity. You choose to confront your past
trauma or current tormentor. You accept your own limitations and
your misfortunes. More importantly, you accept that suffering is
necessary for you to gain valuable knowledge and grow character.
With acceptance, come a new sense of freedom and a more realistic
assessment of your situation.
(2) Affirmation
You have accepted the fact your life circumstances
could not have been worse. The world seems to be so dark and the
future so bleak. Based on your painful experience, you have concluded
that most people are selfish, and there is no justice. You have
been wondering: What is the point? What is the use of fighting a
losing battle? What is the meaning and purpose of suffering?
Yet, while hitting rock bottom and in the throes
of struggling, your eyes are opened to new possibilities. Yes, there
is goodness in life, and there is meaning and purpose in suffering.
You choose to take a positive stance, because this is the only way
out of the dark pit; the alternative to affirmation is self-destruction
and death. You affirm meaning, because there is no future without
believing that there is something worth living for.
By affirming life, you begin to appreciate all
the little things you used to take for granted. You learn to delight
in the natural beauty around you and the simple pleasures of life.
Yes, it is exciting to be alive. It is worth the fighting for.
(3) Determination
Once you have chosen to embark on the road of
recovery, you know that it will require perseverance and determination
to make progress. Once you have started your quest for meaning and
authenticity, you know that there will be obstacles, opposition,
and even dangers. Yes, you are prepared to persist with courage
and tenacity. Even if you may never arrive at the Promised Land,
to be able to strive towards a worthy goal is sufficient to fill
your heart with deep satisfaction.
(4) Confidence
You have been feeling helpless and powerless.
You have been saying, "I can't go on anymore. I am finished. There
is nothing left in me. Life has run over me like a 5-ton truck and
left me dying."
But with affirmation and determination, your
confidence gradually returns. With every small victory, your confidence
grows. Now you say to yourself: "If I can survive this, I can survive
anything. I know that the forces of evil are still there, and the
obstacles are still there. The difficulties are formidable but not
insurmountable. Yes, I CAN overcome with God's help and support
from others."
Your confidence is no longer solely based on
your own ability. Paradoxically, you have regained a sense of confidence
and control through accepting your vulnerability and surrendering
to someone much stronger than yourself.
(5) Religious faith
You have been wondering whether God listens
to your prayers and whether He really cares. Like the Job of the
Old Testament, you have complained bitterly about God's indifference
to your misfortunes. But now, the fog has lifted and you come to
the realization that God is with you, crying with you and sharing
your pain throughout your struggles. He does not shield you from
suffering, but gives you the grace to endure and learn. You begin
to hear God's reassuring whisper and experience his tender embrace
when you are feeling all alone and trembling with fear. Now you
can rebuild your life on the solid rock of faith.
(6) Relationships
You used to be preoccupied with your own needs.
You used to feel sorry for yourself. But now, your eyes are open
to all those who suffer more than you do. You begin to seek out
opportunities to help others. You discover that in helping other,
you find healing for yourself.
Your priorities have changed. Now, your family
and friends become more important than your personal achievements.
Their support and care have nurtured you back to health. Now, you
learn to appreciate and enjoy them in a way unknown to you before
the traumatic event. You have grown in relationships as a result
of the trauma.
(7) Optimism
At long last, you can hope again. Born of adversity
and baptized by trauma, your hope will be able to endure anything
that may come your way. You can now talk about your future with
excitement, even though you know that danger may be lurking just
around the corner. Your tragic sense of life is now married to a
positive outlook in life, resulting in a mature tragic optimism.
Conclusion
I have provided a roadmap, which extends beyond
the traditional psychological territory of self-efficacy and internal
locus of control. I have shown pathways to growth that go beyond
traditional modalities of treating PTSD.
Like tragic optimism, PTG is yet another example
of the kind of mature positive psychology that resonates with all
individuals who are going through suffering, pain and despair.
Reference:
Tedeschi, R. & Calhoun, L. (1995). Trauma &
Transformation. CA: Sage Publications.
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