Now don’t start throwing things. No one invites trauma into their life and no one but a wild-eyed terrorist or one of those sickos on Criminal Minds would wish it on any other human. Trauma is bad. Paralysis is bad. Losing a child is bad. But once traumatized, there are various ways to deal with it. This is a story that explores one of those ways — an academic-born theory called “Posttraumatic Growth,” the seemingly outrageous but surprisingly commonsensical idea that certain forms of trauma can help usher in — alongside the pain, sadness, depression and cynicism – positive transformations of one kind or another.
My own interest in this idea grew out of the reality of my own experience. I kind of knew what these theorists were talking about before I knew there was a theory. There were certain aspects of my personality that shifted radically after acquiring T10 paralysis at age 51, and in a good way. Of course, you can bend “reality” in about any shape you want, including deluding yourself into thinking happy thoughts. But researchers have looked long and hard at this, and according to one expert, there are around 380 published studies on posttraumatic growth. If it’s all a delusion, it’s a mass delusion.
Two men at the University of North Carolina, Lawrence Calhoun and Richard Tedeschi, both with doctorates in psychology, coined the term, “posttraumatic growth,” in 1995. They were reporting on what they heard directly from trauma survivors. They talked to people physically disabled as adults, recent widows, couples who had lost children, a whole array of posttraumatic subjects. After thousands of these encounters, they ended up with what they have dubbed a “posttraumatic growth inventory.”
Get your pencils, please. Calhoun and Tedeschi calculated five main areas of positive change:
• a greater sense of personal strength;
• closer relationships with others;
• a greater overall appreciation of life;
• a new guiding philosophy;
• and new opportunities and life paths.
Arwen Bird was just embarking on her journey when trauma interrupted her life. Her path, she says, suddenly became very clear. “It literally cleared my path. This is the path for you, Arwen.” Bird, a paraplegic wheelchair user now in her mid-30s, was a student at Lewis and Clark College in Portland, Ore., 17 years ago when her car was hit by a drunken driver. Her experience both does and doesn’t line up with the PTG theory. For instance, such growth rarely happens the moment they wheel you into the ER. Tell someone early on that, “Hey, this could be good for you!” and you’ll get a bedpan upside the head. No one in that state wants to hear, “Just think of how much more you’re going to appreciate life or the whole new life path you get to follow!”
Bird sidestepped that initial phase of shock and disbelief. “I didn’t have a traditional period of grieving,” she says. “I was already in counseling, so my therapist and I simply worked on a behavioral-cognitive mindset where I could identify what I could change and what I couldn’t change.”
Some changes, of course, just happen. Many posttraumatic survivors, for example, become more spiritual, or, to borrow from AA, have an enhanced “conscious contact with God, as we understand Him.” Bird sees this very clearly in her own life: “Right after the crash, because I was so young and closer than I ever was to crossing over to the next life, or the afterlife, I was closer to God. I had a level of intimacy with the divine that I didn’t grow up with.”
But her life-shift may also have been less a wholesale leap from A to B than it was an acceleration of how she wanted to live. “For me, the transformation of having a disability is that it strengthened my compassion muscles. I was already someone with compassion towards human suffering. Having a disability has let me relate on a very intimate level, and propelled me to want to act.”
Among other pursuits, Bird serves on the board of the Portland Human Rights Commission, and much of her work is only tangentially related to her paralysis. Recently she’s been part of weekly inter-racial dialogues for the city of Portland, working to “create more opportunities for people of color to explore race and racism through dialogue.” She’s a stone idealist, a rare breed in the reigning culture of cynicism. “My resolve to make the world a better place, to work for peace and justice and all these laudable goals, has really been strengthened and fortified by the experience of living with a disability.”
She is also the founder of a crime victims group that wants to see a more compassionate approach toward criminals. She has opposed the death penalty and testified against several tough-on-crime measures in her state, a position that is unpopular with some other crime victims. Clearly, forgiveness is a part of her mindset.
At the same time, Bird has had to live with emotional pain and frustration, which in her case is related to a sense of accelerated aging and having a group of highly active, athletic friends, many of whom “cannot relate to many of my physical experiences. Sometimes I feel very isolated.”
This growth/pain duality is not unusual in PTG survivors. Calhoun and Tedeschi see the negative effects of trauma — put your list here — and the positive effects as operating on two different emotional tracks. One does not lead to the elimination or even diminution of the other. They occur concurrently and paradoxically. Life is seldom not messy.
Starting Over: The Blank Slate
A 1999 University of California-San Francisco Medical School study on people with multiple sclerosis, sometimes called the Mohr Study, set out to understand the effects, in doctorese, “of the disease [of MS] on their psychosocial functioning.” Big on the negative track were the obvious — “made me more dependent on others” (65.3 percent in agreement) and “I feel more useless” (80 percent). On the positive track, on the other hand, were these responses: “I am more compassionate towards others since having MS (64.9 percent), “MS has helped me be closer to my family” (70.5 percent), and “MS has made me appreciate life more” (73.7 percent). And almost 50 percent of the respondents said they were more motivated to succeed.
For those of you who hear psychobabble in all of this — kind of Horatio Alger mixed with a very special edition of Oprah — please read on. Response to trauma appears so individualistic as to often make categories of response fuzzy and imprecise. So, assuming there is such growth, who best fits the PTG model?
One starting point is pretty clear to the researchers. Calhoun: “We think that a very key ingredient is that the more the set of circumstances rocks your world, the more you are going to experience PTG.” It could be rolling your car and losing your life-mate. It could be the announcement of cancer. It could be losing a child to a drunk driver. No one should be excluded out of hand. “The rethinking of one’s life course, principles, and assumptions,” says Tedeschi, is the central common event.
Minna Hong’s experience certainly fits that model. You may have read about her in these pages before — she was featured in NM in 2003. Now in her mid-40s, Hong lives in the Atlanta area and is halfway through raising two kids. At 34, she was driving the family Land Rover across North Carolina when the driver of an 18-wheel tractor-trailer lost her in his blind spot and started merging into her lane. She swerved, hit the center median, lost control of the car, and when it stopped rolling, she was paralyzed from the waist down and her husband, Tony, was dead. One of the children had a broken leg; the other, hardly a scratch. The truck driver never even slowed down.
Hong’s vision of her life going forward was obliterated. Her future was a blank slate. She thought she was a confirmed stay-at-home mom. She never figured she’d have to work a minimum of 17 hours a week to cover health insurance. Nor, at the same time, had she ever experienced such profound sadness and guilt. After all, she was driving the car. Her kids would grow up without a dad. In one horrific moment, she experienced not one but two of the top 10 on the big list of life’s harshest afflictions. She lost her spouse and she was now paralyzed. The next step was either to smoke crack or re-arrange her most basic precepts to deal with the situation.
“If you have children with you (ages 6 and 8 at the time) and you don’t want to be an invalid, and your head is probably clearer than it’s ever been, and knowing what the possibilities are, how could you not organize your life to take care of yourself?”
With that attitude, in a very objective, clear-cut way, she changed. In her mom-only role, she says, “I thought I was a dinosaur,” but when she realized she could learn new things, “it gave me immense power. To be able to participate in a 403(d) savings plan, that was exciting to me. To get a paycheck of $200 (after insurance) was like $20,000 to me.”
She developed a reassuring mantra. “It is what it is and it’s beyond my control. I always say that.”
Ten years later, she is a peer-support counselor and marketing liaison at the famed Shepherd Center for spinal cord and brain injury rehab in Atlanta; has an online, handmade jewelry business serving shops all over the country; tries to wrangle two teenagers into adulthood; and in general, is moving along through life, notwithstanding the inevitable intrusion of guilt, sadness and constant worry. She is an example of some of the ways you can get stronger by trauma. She is not a “super” anything. She’s just done a better job than most in recalibrating her whole life course.
Why Not Me?
German Parodi was a 17-year-old kid growing up in Puerto Rico, living the life — “I would drink, party, and thought I was invincible” — when he was shot in the neck while being carjacked and ended up a C-7 quad. He went from being very athletic to completely immobile and was even unable to speak for the first nine months of his recovery. In a state of utter detachment, he had plenty of time to think about his life.
Today in Philadelphia, nine years later, Parodi is a full-time disability rights advocate, serving as board vice-president of the civil rights group, Disabled in Action of Pennsylvania; organizer with the grassroots organization, ADAPT; and a frequent public speaker. How has he changed? “I am definitely more hopeful than my old friends and other people overall. I enjoy living. I say that truthfully, not just to say it. I was faced with the possibility of not living any longer, and now I want to appreciate every little thing I can get out of it.”
He also found a ready-made community of people who needed a voice, and who he could now identify with. “Before, I used to have relationships where it didn’t matter much. Now when I enter a relationship, I tend to involve myself a lot more. I am a more open person and more open to other points of view.”
As in the PTG model, he gradually took on a sense of personal strength that grew from his dealing with trauma. “It’s weird, but I’m more confident after ending up in a wheelchair than I was before. There are more important things than what other people think about me. I believe I’m someone who has something to say. There are rights someone has to fight for. Why not me?”
Spinal cord injury/disease may or may not fit the PTG model depending on multiple factors, but Parodi’s story is probably not how someone traumatized or disabled from birth or at an early age would experience things, because there is no transformation to be had, only formation. They are not changing horses in midstream; they are just trying to ride the horse they were thrown on. In general, PTG seems to be an event that comes in the wake of sudden, mind-clearing trauma in young adulthood or after. But not even that is a certainty.
Doug Lathrop, senior editor of NM who was born with osteogenesis imperfecta, or brittle bones disease, has this reaction to the general idea of posttraumatic growth:
“Even with my condition, there’s been a lot of trauma — fractures (in the case of OI), surgeries, tortuous medical treatments, the whole humiliating and ego-stripping experience of being examined in front of rooms full of med students … there are definite PTSD effects from all of those things. I, and others, have likened the experience of growing up with a disability to being an abused child, a POW, or a sexual assault victim.”
Understandably, those with disabilities from birth might be skeptical of the PTG theory. “Perhaps I’m biased because of my own history,” says Lathrop, “but I have trouble viewing trauma as anything other than damaging. With hard work you can move past the damage, but that doesn’t make trauma a positive thing.”
We are all the authors of our own stories, and for those who see no usefulness in this growing from trauma idea, you are not alone. Beyond those traumatized at birth or soon after, Calhoun mentions two other categories of survivors who often don’t sense growth from trauma. First, there are those with such an all-encompassing religious outlook that they don’t question either themselves or the reason for their misfortune.
“God is in control, this is God’s will, He did it for a reason, next question.” As Calhoun says, “This is not someone who is going to experience a lot of change.”
This is not to say that spiritual transformation does not take place. Hong, living through a double trauma, has her own pragmatic way of expressing her heightened sense of the sacred:
“I think I’m a lot more spiritual than I was before, and it’s because of a need. I need to believe that my husband is OK. I need to believe that there is someone special looking after me and the kids. And I need to believe that one day I’m going to see him again. It’s not about church but a personal relationship one has with God … and I see God in my husband and my children and in people around me. … So for all of that and then some, I need to believe that life doesn’t end when we die. It makes sense to me and gives me great comfort. When I do die and find out this was all a joke, it will have helped me live a better life.”
Then there are those who simply aren’t fazed by trauma. Calhoun mentions the example of a woman he interviewed who was held at gunpoint in a botched robbery and told repeatedly that her head was about to get blown off. Afterwards, she experienced no effects from this horror, positive or negative. She must have put it in a cerebral lockbox marked “shit happens” that the rest of us don’t have.
“Most people exposed to even the most horrible things,” Calhoun goes on to say, “are probably going to do fine in the long run. They are not going to need psychotherapy or be impaired in any way.” This conclusion probably doesn’t sit well with a whole class of professional headshrinkers who see trauma as, well, traumatic.
Sometimes, the change in course after a trauma is wildly unorthodox. Such is the case with Jim Troesh, a C4-5 quad who currently reigns as the only quadriplegic member in good standing in both the Writers Guild of America and the Screen Actors Guild. Why would a man in Troesh’s condition, injured in a freak electrical accident at age 15, aspire to be an actor?
At such a tender age, Troesh was faced with having to manufacture a life from whole cloth. He is currently shopping his improbable life story to publishers. Along the way, he once dreamed of opening an electronics store and selling you your next big-screen TV. Realizing that it’s really hard to solder in his new situation, he took a high-school writing class where the teacher would write down what Troesh told him — nice teacher — and then encourage him to write more. After high school, in Troesh’s words, “I got high and watched cartoons for a couple of years,” then went to college and took the easiest class on the schedule, “Critical Thinking In TV and Film.” Sick of having the person taking dictation offering his own rewrites, Troesh learned to type with a stick in his mouth, and soon found himself the entertainment editor of the student rag.
Writing with a stick may be one insane career choice, but acting? As Troesh tells it, “Before the accident, I was in a speech class I absolutely hated. I gave my big speech in front of the class and just read it right off the paper — ‘Andrew Johnson … was the 17th president of the …’ I was terrible. Only after my accident did it dawn on me that the guys in drama and speech always got the girl, and why did I want to go into freaking electronics where there were no girls!”
Troesh acted and wrote because he liked to, not to hear people tell him what an inspiration he was. He got to Hollywood, got into an early-’80s program called Performing Arts Theatre for the Handicapped, and through the dice roll called show business, ended up in a recurring role and a script assignment on the ’80s CBS hit, Highway to Heaven. He was in show biz to stay. His latest offering is a comedy pilot called Hollywood Quad, a Larry Davidish twist on reality that ends with a classic scene where a brainless network exec, played by two-time Emmy winner Bryan Cranston, is so clueless about how to deal with this quad in his office that he ends up throwing grapes in his mouth.
Troesh is no poster boy for positivity — he says things like, “I’m the guy who wants to have the tattoo, ‘Do Not Resuscitate,’ permanently inked on my chest because I’ve been through so much shit.” But he is clearly focused, driven, and transformed by his disability. Humor is what he writes, humor is what he acts — though available for serious roles, too — and humor is how he navigates his existence. He has a good friend who is blind, the noted actor, playwright, and former blind Judo champion of the world, Lynn Manning. When they get together, Troesh says things like,” You know, if I were blind, I’d be really fucked.” Manning then replies, “If I were a quad, I’d be really screwed.”
“But,” as Troesh notes, “we are both fine. As long as we don’t cross disabilities, then we’re OK.”
So, in the wake of some kinds of trauma, some people of a certain mindset can find strength, compassion, and direction. Is there any rhyme or reason to this? Is it like the old Kubler-Ross five stages of grief where you logically move from A to B? Can it be systematically taught? No, no, and unlikely, say the experts.
“It’s a matter of timing,” says Tedeschi, “what you say when people are receptive. It’s not telling them what to think or feel. It’s loosening up their thinking to entertain other outcomes.”
Tedeschi, for one, is looking to develop ways to include the ideas of PTG alongside those of PTSD in helping soldiers deal with both the expectation and the outcome of combat. The U.S. Army already has a program in place called Comprehensive Soldier Fitness, the mission of which is, in the words of the Army, “to develop and institute a holistic fitness program … in order to enhance performance and build resilience.” If only in hearing the stories of others who found a positive way through trauma, combat vets might be able to invent a different narrative for themselves.
And of course there is always the possibility that, over time, assuming you felt this way in the first place, the stronger, more compassionate, more life-loving you could revert back to the old doubt-tormented, short-tempered, what-did-I-do-to-deserve-this you. Calhoun admits that that can happen, but less so, he thinks, with those who live with the results of their trauma day by day. He calls it the pebble-in-the-shoe response. Every time you look down at, say, the wheelchair you’re riding in, it’s a blunt reminder that you pulled through an awful thing and are moving forward. This, at least for some of us, is a very reassuring thought.
The Roots of Posttraumatic Growth
The obvious inspiration for the theory that positive growth can come from dealing with trauma is its evil twin — Posttraumatic Stress Disorder — something so recognized and accepted that it’s a household word: PTSD. The theory of PTG might not reach such heights, given that many people in the aftermath of trauma — including a vast swatch of people with disabilities — are suspicious of upbeat positive thinking, especially coming from the un-traumatized. They don’t want to hear sappy preachments a la “God only gives us what we can handle.” Many psychologists are skeptical when even posttraumatic survivors say positive things; they see it as cognitive self-deception. And if these survivors actually profit from the experience, why would they need psychologists?
Indeed, there seems to be enough research out there, along with personal testimony, to talk about PTG outside of its academic base. The idea has not only been in peer-review journals for years but in human history since the dawn of instructional writing. The Bible is replete with references to the benefits of suffering. Here’s one passage, from the Epistle of James in the New Testament:
Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be mature and complete, not lacking anything.
Salvation through suffering is also one of those ancient storylines that Joseph Campbell, acclaimed American mythologist, talks about, summed up by one expert as: “The hero goes off, gets beaten up, goes through trials and tribulations, and is now ready to be the just philosopher-king.” Seneca, the Roman Stoic, wrote: “Who has struggled with his ills becomes hardened with suffering and yields to no misfortune.” Or, more currently, the ever-popular epigram, “What doesn’t kill you will only make you stronger.” That’s actually a quote from Friedrich Nietzsche reduced to a refrigerator magnet.
Posttraumatic Growth: The Aha Moment
In the wake of sudden trauma, many people reach a point where a light goes off and they realize they’ve turned a corner. If you’re waiting on a Road-to-Damascus brush with the divine, you might be disappointed. Epiphanies can arrive in strange packages:
Minna Hong: “Of course I fell apart — and still do — but I distinctly remember the moment, in the kitchen, where I felt something change. Before the accident, I always flipped things on the stove and never stirred them. Now I had reached the point where I was strong enough to hold a pan and flip the food without any spillage. And I remember thinking, at that very moment, “Hmm, it’s going to be all right. …”
Jim Troesh: “There was an actual moment and it had to do with my uncle Fred. I had gotten money from my accident and it was to last the rest of my life. I’m 18, about to graduate from high school, and I’m lying in bed, watching TV, when Uncle Fred — the patriarch of the family — comes over and says: ‘Here’s what you should do with the money. Put it in the bank, put yourself in a nursing home for four years, let the money build up, and when you come out, you’ll have enough to go on and live your life.’
I said, ‘But I don’t want to go into a nursing home,’ and he said, ‘Well, all I ever see you do is watch TV and you can do that in a nursing home.’ I said, ‘I do plenty,’ and he said, ‘What?’ The next day I started working on my van so I could tell people what I did that day. My transformation was ‘There, take that, Uncle Fred.’ That was the pivotal moment.”