Post-Traumatic Stress’s Surprisingly Positive Flip Side

http://www.nytimes.com/2012/03/25/magazine/post-traumatic-stresss-surprisingly-positive-flip-side.html

Is it possible that trauma is good for you? Is there such a thing as Post-traumatic Growth? Are we supporting soldiers in coming forth for assistance or are we engaging in denial when we strip away the “D” (disorder) from PTSD?   As a clinician and advocate for those who develop PTSD and its more severe variant, Complex PTSD, I am tortured by the contradictions and questions.

Like many in my profession I have read the research and the controversy associated with  resilience training.  I am critical of many aspects of these endeavors; they promise more than is reasonable, have been implemented prior to empirical validation, and the assessments done during training have resulted in lawsuits by soldiers objecting to being ordered for additional training on spiritual development. Nonetheless, there is such a phenomenon as Post-traumatic Growth.  I see it all the time, and in fact have been a strong advocate of this construct for decades. I have always encouraged clients to “find meaning from the misery”, something much easier said than done. It is no great surprise to observe that like heroes of mythology and bible, adversity is often the precursor of strength. Many soldiers and civilians go through a long ‘dark’ period before finding hope, meaning and strength. Some never find the positives and die from their condition(s). On the other hand, it is possible that some individual skip the downside and move spontaneously toward “growth”. Whether this is common, rare, the result of training or genetics is still not known.

The military does an outstanding job in training soldiers survive in combat. However, is it possible to prevent PTSD? The armed forces would love to be able to select those who are most resilient and train them in all ways to become “immune” to trauma, perhaps even strengthened by trauma.  I am reminded by the headline of a recent military newspaper “Bullet-proof Your Brain”. Perhaps this concept can be taken a bit too far. We are already struggling with questions about how many tours someone should have before they “break”.  I seriously doubt we will be able to precisely predict an individual’s breaking point, find a medication that will prevent PTSD, or have cognitive techniques that permit individuals to tolerate the impossible. As cited in the article “These programs were designed to make people happier and healthier,” says George Bonanno, a professor at Columbia University who studies trauma and resilience. “That is not the same thing as inoculating people for serious urinate-in-your-clothing type stress — once-in-a-lifetime stress.”

So, how do we make sense of the contradictions: is trauma neutral, negative or a positive? Can we expect resilience, growth or a lifetime of symptoms? Will introducing positive possibility help or hurt?  I am concerned that the expectation of ‘Growth’ can add burden, perhaps shame to those who have PTSD or Complex PTSD.  I recall a very powerful example. My client, a high school teacher who had severe PTSD was being evaluated by a renowned psychiatrist as part of her lawsuit against the physician who misdiagnosed her near fatal colon cancer. She lived in dread of a recurrence of her cancer; she had severe anxiety symptoms and was not adjusting well to her colostomy bag. The psychiatrist was representing the defense team and his objective was to gather information to deny the existence of her PTSD. She was expecting critical questions and did very well during the hour, no signs of anxiety or anger at his attempts to undermine the reality of her PTSD. At the very end of the interview the psychiatrist switched tone and tried to display empathy. He was an elderly man, partially blind and said to her “I had some health problems myself and medical errors were made. I decided that I had to put my memories and emotions in the attic of my brain and then I was over it. You need to do what I did”. Ironically, he was trying to be kind but the result was powerful; my client burst into tears, felt invalidated and humiliated. It took me a full hour to help her recover from the trauma expert’s mistimed attempt to validate and encourage. She felt shamed and criticized. A positive message delivered at the wrong time may have unintended consequences. So, while we endure the rare but horrible outcomes like the Afghanistan massacre, we must also be aware that “trauma’s surprisingly positive flip side” can be invalidating as well. It is all a matter of context and timing.

 

Jerry A. Boriskin, Ph.D.

March 25, 2012