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Mindful : April 2019
Among psychiatrists, what constitutes “trauma” is controversial. Some define trauma based on the nature of the event: Psychiatry’s diag- nostic 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 mea- sure: Tragically, many experi- ences that once were outside that range no longer are, such as natural disasters, mass shootings, or war time 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 under- standing, 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. WHAT IS “Trauma” ? DEFINITION 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 under- stand its origins. Some studies find it’s fostered in childhood by a strong rela- tionship 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 peo- ple who survived atrocities and war in nine countries from South Sudan and Uganda to Bosnia and Burundi found that resilience varied by cul- ture. 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 sur- prise 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 capaci- ties 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 expe- rienced post-traumatic g rowth. 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 base- line. 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 benev- olence, predictability, and controlla- bility 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. ● April 2019 mindful 35