This week’s essay contains some sentiments that are closely related to what I wrote last week. It is stimulated by something the good Dr Phil has taught me. He tells me that when we experience trauma we should make sure we “come out better and not bitter.”

Whilst this is wise advice it is somewhat unfashionable. Conventional wisdom has it that trauma harms us. We are led to believe that experiencing the pain and stress of great hurt has a long term deleterious effect on our lives. And of course sometimes it does. The phenomenon of post traumatic stress disorder is well known. As a consequence those suffering trauma have come to expect that their lives are likely to be impaired.

Unfortunately we don’t hear much about post traumatic growth. And yet I am sure most of my readers will know people who, despite encountering painful disasters in their lives, have continued to thrive as well-functioning human beings.

I am often amused to hear people say something to the effect, “Isn’t old Joe Smith a nice guy – despite all the things that have happened to him!” They don’t stop to think that perhaps he is a nice guy because of all the things that have happened to him. Those that have experienced great travails and have integrated that experience constructively into their lives become more psychologically robust and are better able to prioritise what is really important in their lives. This helps them achieve a greater sense of personal well-being.

In his book “Flourish”, Martin Seligman relates how he had people respond to a questionnaire asking them had they experienced any of the worst things they believed could happen to a person. The list of such experiences contained fifteen atrocities including such things as torture, grave illness, death of a child, imprisonment and so on. To his surprise he found that those who had suffered such an atrocity, on average, had a higher sense of well-being than those who hadn’t. And even more surprisingly if they had experienced more than one of these traumatic events their sense of well-being was even higher.

Friedrich Nietzsche in “Twilight of the Idols” (Die Götzen-Dämmerung) had something to say about this issue. He wrote, “What does not kill me makes me stronger.” And in a general sense this is true.

Amongst evidence in support of this thesis is the paper written by William H. Sledge, MD; Col James A. Boydstun, MC, USAF; and Alton J. Rabe, MS, published in the archives of General Psychiatry in 1980. They sent out a questionnaire to all the airmen who had been imprisoned and tortured by the North Vietnamese in the Vietnam War. Results were analysed to determine long-term consequences of the war imprisonment experience. They hypothesised that individuals experiencing the greatest stress and frustration might believe they gained more psychologically than those less stressed. More than 60% of those imprisoned and tortured confirmed this was the case.

Studies have shown that those who are in poor physical and mental health to begin with are more likely to suffer from PTSD.

Seligman hypothesises that for the more pessimistic and depressed, PTSD becomes a self-fulfilling prophecy. Most people are now aware of PTSD. As a result when those who are not mentally robust suffer trauma they expect there to be long term consequences. Most everybody suffering trauma suffer distressing side effects but for the majority of people these symptoms eventually pass and they get on with their lives. For the less robust their expectation of long term and disabling symptoms is reinforced and they naturally languish into PTSD. And then often PTSD has become a greater burden than the initial trauma itself.

More robust people experience the distress as a natural consequence of trauma but understand that the distress does not have to endure in the long term and can in fact lead to post traumatic growth. A substantial number of people suffering trauma initially display symptoms of anxiety and depression to the level of those diagnosed with PTSD but they then overcome these symptoms and subsequently grow psychologically.

Now of course I am not trying to trivialize PTSD, but it seems to be that we are striving to find evidence of the harm caused by stress and trauma and it is not therefore surprising that we find something that we call PSTD. And of course it has only been recognised by psychologists as a “disorder” since 1980. It is concerning that, just like that other recently recognised psychological illness attention deficit hyperactivity disorder (ADHD), it seems far more prevalent in the USA and more latterly Australia than it is, for instance, in European countries. As an example, American soldiers returning from the wars in Iraq and Afghanistan report a 20% incidence of PTSD whilst British soldiers returning from these same theatres of conflict report a mere 4% incidence of PTSD.

One can only wonder what might happen if we could convince people that post traumatic growth is a far more likely outcome than PTSD.

No reasonable person would wish trauma on another human being. But there is so much in our lives that is outside our ability to control and few of us can expect to live a life entirely free of pain and disaster. But if we have no choice over much of what happens to us, we do have choice over how we interpret it. If we can come to understand that out of trauma can come growth and indeed that this is more likely outcome than experiencing PTSD, then we are better placed to follow the advice of the good Dr Phil and “come out better and not bitter!”