Posttraumatic Growth: A Gift of the Gods
Trauma is a reality of the human experience that can leave individuals, families, and communities feeling broken and hopeless. However, traumatic experiences need not leave us feeling consumed in defeat and despair. In fact, traumatic experiences often inspire individual growth and collective transformation.
For more than a century, studying and observing our nation's combat veterans has profoundly influenced our medical, therapeutic, and academic understanding of trauma.1 Research with post-9/11 combat veterans has led many trauma experts to rethink many assumptions we have about post-traumatic stress disorder (PTSD), which was formerly known as shell shock, war neurosis, combat fatigue, and other medical definitions. Over the last few decades, researchers and clinicians have begun recognizing that trauma is a “surprising gift” that can promote personal growth and transformation.2 As psychologist Peter Levine stressed in Waking the Tiger: Healing Trauma, “While trauma can be hell on earth, trauma resolved is a gift of the gods – a heroic journey that belongs to each of us.”3 Some psychologists refer to this gift of the gods as posttraumatic growth.
Defining Posttraumatic Growth
In the mid-1990s, clinical psychologists Richard Tedeschi and Lawrence Calhoun coined the term posttraumatic growth to highlight the changes and transformations individuals experience after intense suffering. Calhoun and Tedeschi have defined posttraumatic growth as “the experience of positive change that the individual experiences as a result of the struggle with a traumatic event.”4 Posttraumatic growth often begins when individuals cognitively reframe their traumatic experiences. Examples of posttraumatic growth include “an increased appreciation of life, greater sense of personal strength and self-understanding, renewed appreciation for intimate relationships, and positive spiritual changes.”5 Such posttraumatic growth examples fall into three categories: a changed sense of oneself, a changed sense of relationships with others, and a changed philosophy of life.6
Calhoun and Tedeschi developed the term posttraumatic growth after observing significant growth and transformation in some of their traumatized clients and noticing examples of posttraumatic growth in ancient literature and sacred texts from around the world. Numerous trauma researchers have confirmed Calhoun and Tedeschi's assertion that traumatic experiences can foster deep psychological transformation and personal evolution. For example, researchers have discovered evidence of posttraumatic growth among survivors of violence, child survivors of traffic accidents, Israeli youth who endured terrorist attacks, former Israeli prisoners of war, children impacted by the trauma of Hurricane Katrina, Manhattan clinicians who endured the trauma of 9/11 and worked with other survivors, victims of clergy-perpetrated child
sexual abuse, survivors of adult interpersonal violence, and a host of other individuals and groups who have endured traumatic events.7
Psychologists often use the term resilient when they encounter those who seem “unaffected by trauma’s effect.”8 To be clear, posttraumatic growth is not the same as resilience, which “is characterized by a return to a pretrauma state.”9 Rather, posttraumatic growth is marked by positive cognitive, relational, social, and spiritual changes that result from traumatic experiences. Posttraumatic growth is both a process and an outcome.10 The process and the outcome are unique to each individual.
Calhoun and Tedeschi admit that not everyone experiences positive transformation after trauma. In fact, based on their research findings, the number of individuals who experience aspects of growth after trauma can range from anywhere between 30 to 90%.11 However, psychologists and mental health professionals cannot expect individuals to experience posttraumatic growth unless they understand the transformation process and are equipped with the proper tools for growth. If we want to better understand the process of posttraumatic growth, we should look to American warriors who have grown in the aftermath of combat trauma.
Posttraumatic Growth Among American Warriors
Though we instinctively know and now have decades of research confirming that individuals can be transformed in the aftermath of extreme suffering, in American culture, we are unfortunately still prone to dismiss those broken by trauma. Our nation's service members and veterans are often a primary target of such dismissal and demonization.
While speaking at the Marines' Memorial Club in San Francisco in 2014, retired General James Mattis attempted to refute the notion that our nation's military veterans are merely damaged and broken. While confronting cultural misconceptions of American warriors, Mattis argued, “I would just say that there is one misconception of our veterans, and that is they are somehow damaged goods. I don't buy it.”12 He continued, “There is also something called posttraumatic growth where you come out of a situation like that and you actually feel kinder toward your fellow man and fellow woman.”13 Mattis was conveying a message articulated by ancient philosophers and poets that has been confirmed by trauma researchers: Though war is certainly hell, the trauma and chaos of war can lead to personal growth and transformation.
In 2014, in the first study of its kind, 3157 U.S. veterans took part in the National Health and Resilience Study designed to measure posttraumatic growth. This study revealed that “50.1% of all veterans and 72.0% of veterans who screened positive for PTSD reported as least 'moderate' posttraumatic growth in relation to their worst traumatic event.”14 One of the most critical findings from this study is that veterans who re-experienced symptoms of PTSD showed greater signs of posttraumatic growth.15 The researchers of this specific study believe that trauma symptoms facilitate posttraumatic growth, which led them to conclude there is a “positive legacy of trauma" among our nation's military.”16 Through posttraumatic growth research, mental health professionals and researchers are starting to recognize an astonishing, positive relationship between symptoms of posttraumatic stress disorder (PTSD) and posttraumatic growth. We grow, not by avoiding trauma and trauma symptoms, but by working through them.
Growing Through Symptoms of Trauma
For centuries, Japanese artists have demonstrated how broken pottery can be transformed into priceless treasure. Through the process known as Kintsukuroi (gold mending), Japanese artisans use gold pigment to repair cracked and broken ceramics. Kintsukuroi artists maintain the philosophy that beauty, value, and uniqueness are found in the vessel's brokenness and imperfections. In fact, by using golden seams to mend the pottery, the artists forever highlight the brokenness of their artwork. Similarly, despite
brokenness caused by trauma, the human spirit can be redeemed and restored.
Trauma is a deep wound that often causes a break or rupture in the human psyche. The symptoms of such trauma can be seen in human brokenness, much like the cracks in earthen vessels. Just as broken pottery can be transformed with a bit of gold, trauma symptoms help us identify places where we can be redeemed, renewed, and remade into priceless treasure.
According to the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Health Disorders Fifth Edition (DSM-V), the primary symptoms of trauma include intrusions (i.e., rumination, memories, dreams, and flashbacks), avoidance (i.e., avoiding places that arouse memories of past trauma), negative alterations in cognition and mood (i.e., negative beliefs or expectations about oneself, others, or the world), and alterations in arousal and reactivity (i.e., anger, hypervigilance,
self-destructive behavior).17 Each of these symptoms are normal human responses to traumatic events. Unfortunately, the APA's diseased model of mental health leads many clinicians and laypersons to ignore how these trauma symptoms can facilitate personal evolution.
The 2014 National Health and Resilience Study confirmed observations made by trauma roughly a decade earlier. According to posttraumatic growth experts P. Alex Linley and Stephen Joseph, trauma symptoms such as rumination and intrusions are “positively associated with growth.”18 Lindley and Joseph explain that symptoms such as rumination can provoke “the cognitive processing necessary for the rebuilding of shattered world views following trauma.”19 Rumination involves repetitive and disruptive thoughts about past trauma. Rumination can be intrusive or deliberate.20 Deliberate rumination is intentionally thinking about and cognitively processing past trauma. Unfortunately, rumination is often perceived as negative because it is related to stress.21 However, intrusions can prompt deliberate rumination, a form of productive stress that can spur growth.22
Similarly, though mental health professionals often demonize arousal states such as anger, there is a positive relationship between anger and posttraumatic growth.23 Trauma experts who have researched the relationship between anger and posttraumatic growth believe “anger in response to trauma may serve as a motivator for problem-focused coping, and depressive reactions could lead to avoidance and other forms of negative coping.”24 Trauma researchers concluded that “feeling angry was the predominant emotion related to reports of growth, and feelings of depression were primarily related to posttraumatic stress symptoms.”25 Such research leads us to question much of the clinical and cultural demonization of anger.
Anger researchers Ryan Martin and Eric Dahlen explain, “Anger is a universal emotion which most people experience frequently and which can be beneficial when mild.”26 Anger often serves as a warning that something is wrong in our environment. As Martin explains, “Just as your fear alerts you to danger, your anger alerts you to injustice... What's more, it energizes you to confront that injustice.”27 In a world full of injustice, anger can inspire individuals who have experienced trauma to confront the institutions, tactics, and behaviors that lead to the traumatization of others.
Intrusion, rumination, and anger are just a few examples of the trauma symptoms that trauma survivors struggle with even while experiencing transformation and growth.28 In fact, unlike most clinical PTSD treatment methods, which attempt to sooth symptoms, the posttraumatic growth process encourages to individuals to intentionally wrestle with their trauma symptoms. Unfortunately, demonization of specific emotions such as anger often leads clinicians and laypersons to dismiss the empowering potential of trauma
symptoms.
Conclusion
For decades, labels such as PTSD have been used to demonize and dismiss hurting individuals seeking healing. Posttraumatic growth research is leading some Americans to question our cultural narratives about trauma. Studies on post-9/11 veterans have proven that those who have endured intense combat trauma can also experience profound personal growth and transformation. Trauma researchers have shown that struggling with symptoms does not indicate a lack of posttraumatic growth. In fact, intentionally wrestling with trauma symptoms can promote posttraumatic growth, restore hearts and minds, and transform brokenness into priceless treasure.
“Ring the bells that still can ring
Forget your perfect offering
There is a crack, a crack in everything
That's how the light gets in”
Anthem by Leonard Cohen
Notes
1. Judith Herman, Trauma and Recovery: The Aftermath of Violencefrom Domestic Abuse to Political Terror (New York, NY: Basic Books, 1997);
Richard G. Tedeschi and Bret A. Moore, Transformed by Trauma: Stories of
Posttraumatic Growth (Bluemont, VA: Boulder Press, 2020).
2. Tedeschi and Moore, Transformed by Trauma, 10.
3. Peter Levine, Waking the Tiger: Healing Trauma (Berkeley,CA: North Atlantic Books, 1997), 12.
4. Lawrence G. Calhoun and Richard G. Tedeschi, Posttraumatic Growth in Clinical Practice (New York, NY: Routledge, 2013), 6.
5. J. Tsai, R. El-Gabalaway, W. H. Sledge, S. M. Southwick, and R. H. Pietrzak, (2015). Posttraumatic Growth Among Veterans In The USA: Results From The National Health And Resilience In Veterans Study, Psychological Medicine Vol. 45 (2015), 165-179.
6. Calhoun and Tedeschi, Posttraumatic Growth in Clinical Practice,7.
7. Survivors of violence: Richard G. Tedeschi, Violence Transformed: Posttraumatic Growth in Survivors and their Societies, Aggression and Violent Behavior, Vol. 4, No. 3 (1999), 319–341. Child survivors of traffic accidents: Emma Salter and Paul Stallard, Posttraumatic Growth in ChildSurvivors of a Road Traffic Accident, Journal of Traumatic Stress Vol. 17 (2004), 335–340. Israeli youth who endured terrorists attacks: AvitalLaufer and Zahava Solomon, Posttraumatic Symptoms and Posttraumatic Growth Among Israeli Youth Exposed to Terror Incidents, Journal of Social and Clinical Psychology Vol. 25, No. 4 (2006), 429-447. Former Israeli prisoners of war:Zahava Solomon and Rachel Dekel, Posttraumatic Stress Disorder and Posttraumatic Growth Among Israeli Ex-POWs, Journal of Traumatic Stress Vol. 20, No. 3 (2007), 303–312. Children impacted by the trauma of HurricaneKatrina: Ryan P. Kilmer and Virginia Gil-Rivas, Exploring Posttraumatic Growth in Children Impacted by Hurricane Katrina: Correlates of the Phenomenon and Developmental Considerations, Child Development Vol. 81, No. 4 (JULY/AUGUST 2010), 1211-1227. Manhattan clinicians: Jennifer Bauwens And CarolTosone, Professional Posttraumatic Growth After a Shared Traumatic Experience: Manhattan Clinicians’ Perspectives on Post-9/11 Practice, Journal of Loss and Trauma Vol. 15 (2010),498–517. Victims of clergy-perpetrated child sexual abuse: Leia Y. Saltzman, Scott D. Easton and Christopher P. Salas-Wright, AValidation Study of the Posttraumatic Growth Inventory Among Survivors of Clergy- Perpetrated Child Sexual Abuse, Journal of the Society for Social Work and Research Vol.6, No. 3 (September 2015), 305-315. Survivors of adultinterpersonal violence: Anna Elderton, Alexis Berry and Carmen Chan, ASystematic Review of Posttraumatic Growth in Survivors of Interpersonal
Violence in Adulthood, Trauma, Violence & Abuse Vol. 18, No. 2 (April 2017), 223-236. Other individuals and groups who have endured traumaticevents: Stephen Joseph and P. Alex Linley, Trauma, Recovery, and Growth:Positive Psychological Perspectives on Posttraumatic Stress (Hoboken, NJ: John Wiley & Sons,2008); Lawrence G. Calhoun and Richard G. Tedeschi, Handbook of Posttraumatic Growth: Research and Practice (New York, NY: Psychology Press, 2014).
8. Tedeschi and Moore, Transformed by Trauma, 7.
9. Jennifer Bauwens and Carol Tosone, Professional PosttraumaticGrowth After a Shared Traumatic Experience: Manhattan Clinicians’ Perspectives
on Post-9/11 Practice, Journal of Loss and Trauma Vol. 15(2010), 501.
10. Tedeschi and Moore, Transformed by Trauma, 7.
11.Calhoun and Tedeschi, Posttraumatic Growth in Clinical Practice, 13.
12. Jim Michaels, Mattis: Veterans Are Not Victims (McLean, VA:USA Today, May 5, 2014),
http://www.usatoday.com/story/nation/2014/05/05/mattis-iraq-afghanistan-marines-usmc/8632093/.
13. Michaels, Mattis: Veterans Are Not Victims.
14. Tsai, El-Gabalaway, Sledge, Southwick, and Pietrzak, Post-traumaticGrowth Among Veterans in the USA, 165.
15. Tsai, El-Gabalaway, Sledge, Southwick, and Pietrzak, Post-traumaticGrowth among Veterans.
16. Tsai, El-Gabalaway, Sledge, Southwick, and Pietrzak, Post-traumaticGrowth among Veterans, 165.
17. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), (Washington, D.C.: American
Psychiatric Association, 2013), 271-272.
18. P. Alex Linley and Stephen Joseph, Positive Change FollowingTrauma and Adversity: A Review, Journal of Traumatic Stress Vol. 17, No. 1
(2004), 16.
19. Linley and Joseph, Positive Change Following Trauma and Adversity, 16.
20. Felipe E. Garcia, Almudena Duque, and Félix Cova, The Four Faces of Rumination to Stressful Events: A Psychometric Analysis, Psychological
Trauma: Theory, Research, Practice, and Policy Vol 9, No. 6, (2017), 758 –765.
21. Calhoun and Tedeschi, 2013.
22. Stephen Joseph, What Doesn’t Kill Us: The new psychologyof posttraumatic growth. New York, NY: Basic Books, 2011); Calhoun and Tedeschi, 2013; Garcia, Duque, and Cova, The Four Faces of Rumination to Stressful Events.
23. Crystal L. Park, Carolyn M. Aldwin, Juliane R. Fenster, andLeslie B. Snyder, Pathways to Posttraumatic Growth Versus Posttraumatic Stress: Coping and Emotional Reactions Following the September 11, 2001, Terrorist Attacks, American Journal of Orthopsychiatry Vol. 78, No. 3(2008), 300–312.
24. Park, Aldwin, Fenster, and Snyder, Pathways to Posttraumatic Growth Versus Posttraumatic Stress, 302.
25. Park, Aldwin, Fenster, and Snyder, Pathways to Posttraumatic Growth Versus Posttraumatic Stress, 307.
26. Ryan C. Martin and Eric R. Dahlen, Angry Thoughts and Response to Provocation: Validity of the Angry Cognitions Scale, Journal of Rational-Emotive
and Cognitive Behavior Therapy Vol. 29 (2011), 65.
27. Ryan Martin, The Upside of Anger, TEDx,https://www.youtube.com/watch?v=kfcQaXG_Qhs.
28. Tedeschi and Moore, Transformed by Trauma, 9.