A Change in Outlook

The field of psychological trauma is evolving to recognize that adversity may actually be good for you.

Stephen Joseph has taken the blinders off. For the past 20 years, the pioneering psychologist has worked with survivors of trauma, hearing their stories and making sense of the bigger picture. While his peers have focused solely on the destructive and marring implications of trauma, Joseph has been holistically cataloguing the positive changes that survivors have articulated alongside the negative.

In his book, What Doesn't Kill Us: The New Psychology of Posttraumatic Growth, he boldly challenges the traditional notion that suffering should be avoided at all costs and clarifies that appreciating the benefits of trauma is not the same as condoning the cause of it. He has built a comprehensive model for understanding the duality of posttraumatic stress and growth; an indispensable framework for navigation and progress through adversity, not only for individuals, but potentially groups and entire communities hoping to strengthen their resilience as well.

AR — The idea that trauma can actually yield positive results is a sensitive topic, why is it useful to explore the benefits of trauma?

Stephen Joseph — The task of psychological science is to understand human experiences; complete understanding of trauma includes both posttraumatic stress disorder (PTSD) and posttraumatic growth. We gain from seeing both sides of the coin. Posttraumatic stress benefits from understanding posttraumatic growth because we then understand more about the processes of posttraumatic stress. And on the other side of the coin, we understand posttraumatic growth better when we see that it is something that arises out of the distress and the chaos of posttraumatic stress. It’s useful because it’s more scientifically valid to have a complete picture.

What triggered this exploration?

I was already primed to see things differently because of my academic background as a social psychologist. I approached the study of trauma from a slightly different angle to many of my colleagues who were clinical psychologists, who are used to the language of disorder and dysfunction. Part of my early PhD work was a survey of the survivors of the ‘Herald of Free Enterprises’ disaster (a horrific shipping disaster in the mid 1980s). In my research, we used surveys and some interviews, asking people about their experiences. I noticed that in the midst of the things that people were telling me (which were often very, very horrific stories) and the distress and the difficulties they were experiencing in their lives, there were sometimes these glimmers of how things had changed for people [for the good]. So we developed the first questionnaire to try to assess both the positive and the negative experiences that people had. We called it the “Changes in Outlook Questionnaire” and it had some open-ended questions that related to the negative experiences (things like not trusting oneself anymore, not looking forward to the future, etc.) and then we had some positive questions derived from what people had actually said on our survey where we had asked for their responses. We had a list of positive things as well, such as valuing life more now, things like that. This questionnaire became the trigger for the research that we carried out. We found this wasn’t uncommon; it wasn’t just typical of this one group of survivors, but rather quite common for a range of survivors from other events as well. It wasn’t that we were only picking out the positive; it was understanding that people were saying these positive things in the midst of, and alongside, all the negative things. Rather than skipping past anything non-negative, as maybe some of my colleagues may have done in other institutions that we more clinically focused, I put the spotlight on it. It was very interesting that people were saying this and yet it was not being noted in the trauma literature.

Is it because it’s ‘good business’ for psychologists and certainly, the media, that we only talk about the negative side of trauma and we seldom want to explore the positive? Is there such a thing as an ‘industry of trauma’ that would prefer keeping the growth aspect under wraps?

I think that there is some truth to that—that it has been better business. Of course it is a complex issue. For the last 40 or 50 years, we’ve been trapped as psychologists in the language of medicine. Psychology in a sense has grown out of medicine, if we dip psychology back to Freud, who was a medical doctor and introduced psychological thinking within the concept of medicine. We’ve gotten used to thinking about things in that way, and that’s trapped us in terms of thinking of things as either ‘broken’ or ‘not broken.’ We’ve developed this illness ideology around understanding human experience and so the language we’ve created (if you flip through any textbook on clinical psychology over the last 50 years, it’s a series of chapters: depression, anxiety, schizophrenia, and so on) hasn’t provided a way of talking about anything else. It’s only in the last 10 years that we’ve begun shifting that paradigm to enable psychologists to be more confident talking psychologically as opposed to psychiatrically. Psychology has been the servant of psychiatry, it’s used its language of the various disorders; now we’re beginning to have the confidence to understand psychological experiences from a fully psychological point of view.

Speaking of regaining control, are we somewhat divorced from the realities of life with respect to adversity? ‘Culture of expectations’ comes to mind. We are trained to have complete control (children playing video games have a ‘controller’, using the ‘control panel’, and having unlimited and immediate answers available online), and does this negatively impact our natural ability for resilience?

Traditionally people have learned from experience. As human beings we are built through millions of years of evolution to be resilient to traumas. It’s fundamental to being human. We’re built so that when things happen to us we then try to learn from our experiences to move forward in life and be autonomous and masterful in the world around us. We’re built to be resilient when small things happen to us, and yes, the more experience we have with that then the better equipped we can be when something else happens to us later on. I think you’re right, there are other things in the world around us that can thwart that process. Whether modern technology is one of those things, I think it’s too early to say. It may be that modern technology could make people more resilient. It’s really hard to know because it’s such a double edged sword. There are so many things about modern technology that are giving younger people that experience of the world and of interpersonal relationships that my generation certainly didn’t have. There are going to be other experiences in life that they have that could be traumatic to them that I, and people of my age, wouldn’t have had. With a lot of younger people there are traumas associated with interpersonal relationships, with friendship groups, and so on, maybe those experiences can be heightened and made more real via modern technology and social networking. I think that these are questions we’ll just have to see with time.

This makes me think of Aaron Swartz, the Internet activist who committed suicide and triggered a broader discussion on the public domain, the culture of ‘open’ and copyright laws. Can there be ‘collective growth’ from heavily mediatized trauma? In other words, can we benefit from trauma without being personally affected? Are the same response mechanisms at play in these cases?

Very much so. The example is a very good one but what also comes to mind to me is the Holocaust and Nazi Germany, and how over many years that message has been repeated by many leading thinkers, of “We mustn’t forget what happened. We have to learn from that experience for the betterment of humanity.” It was Holocaust Memorial Day earlier this week and the message was in all the papers reminding us of that. It’s part of the human condition, we’re built to learn from experience. In some ways it’s easier to learn from experiences that happen to us directly, but we’re also built to learn from experiencing what we observe around us. In these days of social media, the vehicle for that is much stronger than it was many years ago. Traumas like you said, in this case a suicide, may have gone unnoticed but due to Twitter and so on many people are aware of it very quickly.

Traumas and tragedies are indeed more visible than ever, but do you think our cultural obsession with control has left us, in fact, more vulnerable to stress than before we invented ways to dodge it? Will all the small traumas we’ve avoided amount to much larger ones down the road?

That’s a really interesting question, and I’ve thought of that. I think that inevitably the nature of trauma has changed over the generations because of the nature of the way we live and technology. The nature of trauma has changed. Whether the magnitude of trauma has changed, I’m not sure. We do live in an increasingly risk-averse society. We try to live our lives in ways which don’t fully embrace or recognize the inevitability of adversity befalling us, to the point where it has become very marginal in our consciousness. We go from day-to-day life without a full awareness of the inevitability of misfortune and the tragedy of life, and I think that that is to the detriment of humanity. There’s something very wise about being able to live in full awareness of the inevitability of tragedy and trauma.

Does that leave us weaker in our ability to respond to trauma?

The research seems to suggest that generally as a whole, people are fairly resilient to the effects of trauma, which is encouraging. But again, that’s a slightly different angle than the idea of a weakness of the will. Because of the medicalization of human suffering I was mentioning before, it’s not such a weakening of the will, but that willpower is in the wrong seat. It’s with the therapist, it’s with the psychiatrist, rather than the patient or the client. When we go to see a psychiatrist, when we are seeking help, we rely on them, as we do when we see any doctor. We rely on them to identify exactly what the problem is and then to tell us what to do to get better. I think that is fine when it is a medical problems, and with trauma, inevitably there is a little bit of that, but trauma is an existential crisis in many ways. Nobody else can tell us the answers to an existential crisis. That’s something we’ve got to work through ourselves. Maybe in a companionship with somebody else who can help us along that road, but we need to be the experts on ourselves. We need to be the authority on ourselves, on how to make sense of an existential crisis, and how to move forward in life. That’s not a medical condition. We’ve forgotten that and medicalized trauma into PTSD. That’s lead to the sense of taking away of our personal responsibility, our personal agency, for how to move forward. We’ve put that personal agency into the hands of the helping professions.

At The World Economic Forum in Davos earlier this year, they were using the term ‘dynamic resilience,’ which seems to be code for posttraumatic growth. Resilience seems to be on everyone’s mind... do you associate with the term?

The concept of resilience has really become a part of mainstream culture in a way that it wasn’t 10 years ago. To find that it’s so much a part of the discourse of modern life in so many different contexts is a good thing. Discourse on resilience is necessary as we need to be able to think resiliently. Of course, as we’ve discussed, resiliency means different things to different people. For some people, it’s a way of talking about posttraumatic growth, but for other people it’s a way of talking about avoiding the impact of trauma in the first place. Resilience can mean resistance to the effects of trauma so that the tree, so to speak, is unbending in the wind. My form of resilience is about bending in the wind and then bouncing back. With the tree that stands unbending in the wind, there is often no potential or possibility for change or growth. If resilience means being hardened to the effects of life, then that can be a good thing in some cases, for example, we need our military to be resilient in that sense, but in other ways, maybe that form of resilience is an impediment to change and to learning. We’ve got to look at that side as well and raise questions about whether we want that kind of resilience only.

Do you think the framework of posttraumatic growth can be applied to nations, cities and organizations as well?

That’s a really good question. We need to have scholars interested in this subject, it’s one of the directions we need to move to now. Up to this point, this type of research has been very psychological, it’s been about the individual and how individual people stand against the stressors of life. That’s important for clinical psychologists, cognitive psychologists and people who work on a one-on-one basis to understand these processes so we can figure out how they think and what they’re doing. It’s very important, but we also need to enter into a more sociological discourse into what this means for groups and communities; how to foster and nurture resilience in those wider groupings. That’s the way forward. I don’t think there’s that much research and scholarship around that topic yet. As you pointed to earlier, it is something that is beginning to happen, there is beginning to be a social discourse around it which is very valuable.

Can you tell me a little bit about the ‘THRIVE model’? Looking forward, what do we need to put in place as a society, to achieve not only resilience, but growth?

In a way it’s been developed about the individual. ‘THRIVE,’ in this first instance, is about Taking stock of what we have around us, our resources, working out what the difficulties are and the challenges. Then, Harvesting hope, we’ve got to be able to look forward and be hopeful about the future. Re-authoring, is the idea of discourse, whether it’s at a social level or individual level, it’s about how we have to tell and write stories to help us move forward in life. Any cognitive psychologist knows this, we can tell stories that are destructive to ourselves, or to our nations, or to our group; or stories that are hopeful, provide inspiration, provide ways of overcoming obstacles, to seek new solutions. If we pair the right kinds of stories and re-author our experiences, that helps us move forward. We then must Identify when positive changes occur, and we have to Value those changes to hold onto them. Often the things that happen that are positive that change in us can go overlooked. If we’re busy at work and valuing our career on a day-to-day basis, we may not put as much effort into valuing our friends or family as we do after a traumatic event happens. We begin to value things differently. Lastly, Effort for action; not just seeing change as something that has changed our emotional state and how we think about the world, but beginning to try and make a difference in the world. Doing things differently. Thinking about how to use these positive changes and what you can do differently next week. It was developed as a way of thinking to help therapists, and as a self-help technique for people moving forward, but there’s no reason we can’t take those principles and extrapolate them for reframing adversity in other contexts and finding the progress amongst the pain.

This interview has been edited and condensed.

Resilience has become a mode d’emploi for modern times, and while at first it might seem counterintuitive to look to traumas and tragedies, taking into account their positive sides is a welcome development. Quoting Andrew Zolli, “the dialogue around disasters rarely exceeds a tally of what has been lost, harmed and broken.” For individuals, the tendency to treat all sorts of conditions with drugs, rather than looking at the more profound psycho-social and situational causes is also taking us in the wrong direction. We need to learn how to celebrate our ability to bounce back_ — AR_

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