Open Book

Life after Trauma

What are the possibilities for post-traumatic growth?

Magazine Issue
September/October 2015
Bookmarks Sept-Oct 2015

Upside: The New Science of Post-Traumatic Growth
by Jim Rendon
Touchstone / Simon & Schuster. 288 pages.

“How could you stand to live through so much loss and shock?” It’s a question I became used to hearing on too many occasions through the years: most dramatically, when I was 24, after being among the more than 100 hostages held for 39 hours by Hanafi Muslim gunmen at the B’nai B’rith Building in Washington, DC, where I worked. Even though they threatened us with death and inflicted a range of injuries, we all walked out alive. Only after we were freed did we learn that members of this group had simultaneously taken over the city’s Islamic Center and District Building, where they shot and killed a young radio reporter. Two years earlier, my mother had died and Peter, my then 23-year-old fiancé, had suffered face-disfiguring cancer surgery. And more sadness followed, with two grueling pregnancy losses and the challenges of caring for Peter through his losing battle against illnesses contracted from tainted blood transfusions. Despite these grim experiences, I thought about how fortunate I feel to have arrived where I am today as I read Jim Rendon’s new book, Upside: The New Science of Post-Traumatic Growth.

Rendon begins by challenging an all-too-common stereotype: that most trauma survivors remain forever stuck in place, embittered, broken in core ways. As psychotherapists know, the emotional (and sometimes physical) damage may sometimes be so vast and entrenched that repair comes slowly, if at all. But as therapists also know, and as Rendon’s father, who survived the Holocaust, taught him, this isn’t always the case. To be sure, his father remains prone to nervousness and insomnia, but as Rendon writes, he’s lived a full life and “is accepting, coping,” with a good sense of humor, which allows him to joke himself out of his anxiety. In other words, like so many trauma victims, he’s managed to make life go on—and even thrive.

How that happens is the focus of a growing field called post-traumatic growth (PTG), led by researchers Lawrence Calhoun and Richard Tedeschi. Starting in the 1980s, rather than emphasizing the pathology of post-traumatic stress disorder (PTSD), they concentrated on the unbidden life lessons that trauma can teach. These are the so-called sweeter uses of adversity—a misnomer, in my view, since the immediate aftertaste is just the opposite. But it points to a larger truth: over time, loss, trauma, or tragedy can give way to an internal overhaul, a wake-up call that compels you to reframe your values and reenvision the way you live.

The title of Rendon’s book claims that PTG is a “new science.” But throughout history, a broad range of writers, psychologists, social scientists, theologians, and poets have described this trajectory in numerous ways, including recovery, adaptation, accommodation, resilience, and spiritual or emotional rebirth (think AA and every confessional memoir from St. Augustine to the present). Rendon is therefore not accurate when he claims, in an early chapter, that Calhoun and Tedeschi were the first to discover the dynamic of PTG.

As if to correct himself, however, he goes on in a following chapter to give rightful credit to the Viennese psychiatrist Viktor Frankl for his crucial contributions to understanding the essential role played by a sense of purpose in life. Frankl wrote extensively on this theme in his classic book, Man’s Search for Meaning, and in numerous other volumes that described logotherapy, his meaning-centered approach to therapy. Frankl’s ideas were forged by his years of imprisonment in Nazi concentration camps from 1942 until the end of WWII. In Theresienstadt and subsequently in Auschwitz, he observed that prisoners who managed to conceive an inner goal—such as to live to bear witness, to help another prisoner, to remain religiously faithful—were better able to endure the unendurable than those who’d lost all hope and saw no reason to go on. For them, as for Frankl himself, this sense of purpose or meaning meant the difference between life and death.

Also, Rendon cites the debt that Calhoun and Tedeschi owe to the humanist-psychologist Abraham Maslow, whose hierarchy of needs theory places the ideal of self-actualization and its self-fulfillment and growth as the highest goal. In this regard, Rendon writes, Maslow “found that life’s most important learning experiences are often the tragedies and traumas that force people to take a new perspective on life.”

Rendon highlights a range of key factors that incline a person toward positive adaptation to trauma, including a basic sense of optimism, faith, or hope in the future; the presence of one or more caring others, to whom one can turn for solace, advice, and more; a problem-solver mindset, which allows one to set goals and make strategies, step by step, to plan for what comes next, as well as provide a Plan B to protect against possible setbacks; the kind of self-confidence that’s coupled with a realistic view of one’s own strengths and weaknesses; the ability to reach out and ask others for help when needed; and the capacity to find meaning in the struggle as a fuel to keep going.

Rendon is at his best in his chapter-length profiles of a variety of men and women struggling and coping in the aftermath of debilitating injuries, war experiences, and other losses. Some of these individuals are well known, such as Max Cleland, who returned from combat service in Vietnam with both legs and his right arm amputated. After years of grappling with his physical and emotional wounds, he began his comeback to life through a career helping other Vietnam veterans (he was the first Administrator of Veterans Affairs) and then politics (he was US Senator from Georgia).

For Cleland, as for others who are less well known, psychotherapy was a vital part of the mix. Shane Mullins, who survived a calamitous car crash with debilitating brain injuries, was required to see a psychotherapist as part of a program to stop drinking. Much to his surprise, the sessions led him to a greater perspective about what he wanted to do (go to college, despite his brain injuries) and how to reinvent his self-image (from disabled victim to resolute hero). Evaluating what helped him and what didn’t, he devised the acronym D’MESS (Determination, Motivation, Emotional, Support, and Social Life) to describe the core qualities he’d drawn on to confront the accident and its aftermath. These ideas then became the basis for inspirational talks and presentations he’s given to help others facing challenges.

Many stories feature men and women whose new post-tragedy goals became giving back to society or “paying forward” the support and care they received. They make new careers as inspirational speakers (like Mullins) or in public service (like Cleland). And often that’s only part of a larger, ongoing makeover story. Mariam Davies, after her rehabilitation from an accident that threw her under an oncoming train, switched gears from telemarketer to professional psychotherapist for low-income clients. Indeed, a near-universal theme in these examples is trauma as the catalyst for resetting priorities. Often that’s expressed through volunteer work or the creation of nonprofit charities or research organizations to find cures for the diseases or ailments that seized loved ones.

All these stories will surely provide lessons both inspiring and practical for anyone dealing with the challenges posed by a wide range of traumas. But I worry that so much emphasis on “the transformative power of trauma” is a template for a new set of false assumptions about trauma and recovery.

This fear seems borne out by some of the language Rendon uses. For example, a heading in the book’s first section is “Why terrible experiences can be good for you.” If even the most well-meaning person had told me that my mother’s or husband’s illnesses and deaths were good for me, I’d have been tempted to punch them then and there. Ditto, for the most part, regarding the use of the word gift to refer to trauma. While several of Rendon’s interviewees do refer to their injuries and traumas as ultimately proving to have been a gift that allowed them to turn their lives around, their reframing was retrospective, and it was their way of making sense of their ordeal. But especially in the immediate aftermath of trauma, for anyone—and especially a psychotherapist—to refer to someone’s trauma as a gift is an insensitive phrase that stings. Just remember that instead of return slips, these gifts often come with recurring nightmares, trigger reactions, anxiety, or other symptoms. Worse, focusing only on a positive outcome in the future can belittle the pain and suffering in the past and present. The danger in this emphasis is that it can become one more way to shy away from the horror, to filter out the undertow of suffering, to rationalize away loss or trauma as “character-building.” Further, if growth becomes the expected goal, what about those who don’t succeed in growing as much as others? Are we setting them up for guilt and stigma? Unfortunately, Rendon doesn’t seem to have the sensitivity or psychological underpinning to grapple with these questions. Furthermore, he doesn’t discuss at length one of the major criticisms of PTG research: that it’s based primarily on self-reported outcomes. Are people providing sunnier outlooks for the record, or simply rationalizing in retrospect?

What often strikes people about the concept of PTG is the man-bites-dog headline aspect of someone who’s undergone suffering still to be able to say that out of that darkness they’ve they found a new light. But behind that headline is a long story, often filled with more pain along the way. Rendon has provided glimmers of insight, but the subject deserves a more balanced and thoughtful examination.


Photo © Erin Scott

Diane Cole

Diane Cole is the author of the memoir After Great Pain: A New Life Emerges and writes for The Wall Street Journal and many other publications.