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Is it true that ‘what doesn’t kill you makes you stronger’? Exploring the idea of post-traumatic growth

A phoenix looks backwards.
(Patrick Hruby / Los Angeles Times)
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This story was originally published in Group Therapy, a weekly newsletter answering questions sent by readers about what’s been weighing on their hearts and minds. Sign up here to get it in your inbox.

When I look back on the past three years, I wouldn’t say I look for a silver lining. But I can definitely see how I’ve grown because of the challenges I encountered during the COVID-19 pandemic.

I want to be clear that these realizations came in no small part because of privilege. I’ve had a stable income since March 2020, I was able to work from home. No one I love has died from COVID-19.

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Instead, I spent months alone — because of fear of other bodies who could be disease vectors, because it was unsafe to travel on holidays, and because of a breakup — and I had time to realize that I had been moving at 100 miles per hour since graduate school, and I simply couldn’t do that anymore. This breaking point pushed me to find healthier ways to cope with pain and stress, like meditation and being more careful in how I communicate with others. I spent time reflecting on whether my life mirrored my needs and values, and I shifted accordingly.

This week’s question from a Group Therapy reader speaks to this tendency in Western culture (and others) to find meaning in our suffering: “Due to the Great Resignation, I am curious to know more about the topic of burnout. ... With what I have sought out about burnout, the literature seems to have a negative connotation. How can burnout become more transformative in the sense that one can grow from it and continue to thrive?”

In psychology research, there’s a concept that explores this line of thinking: post-traumatic growth. This week, I spoke with a leading researcher in post-traumatic growth, Eranda Jayawickreme, an associate professor of psychology at Wake Forest University. Before we get to the Q&A, here’s a brief history of these concepts.

What is post-traumatic growth?

“Post-traumatic growth” is a theory developed by psychologists Richard Tedeschi and Lawrence Calhoun in the mid-1990s. The researchers interviewed people who lived through traumatic life events such as death of a loved one, serious illness (such as cancer), house fires, violence, or becoming refugees. They found that for many of their subjects, such trauma was a catalyst for personal development.

“People develop new understandings of themselves, the world they live in, how to relate to other people, the kind of future they might have and a better understanding of how to live life,” Tedeschi said in a 2016 interview with the American Psychological Assn.

To measure these changes, Tedeschi and Calhoun developed a self-report scale called the Post-Traumatic Growth Inventory (PTGI). It looks for positive responses in five areas: appreciation of life, relationships with others, new possibilities in life, personal strength, and spiritual change.

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In the following decades, researchers have found evidence of post-traumatic growth in those who’ve endured many different kinds of crises — including relationship break-ups, bereavement, cancer diagnoses, sexual abuse and immigration from war zones. Some estimates suggest that 30% to 70% of trauma survivors may benefit from this phenomenon.

In his work, Jayawickreme has found that suffering can indeed have its benefits; but he also says that nuance has been lost in the public understanding of post-traumatic growth. “The concept lends itself to a pretty ‘Pollyannaish’ understanding of recovering from adversity,” Jayawickreme said in an interview with the BBC.

Jayawickreme believes that media coverage and flawed research methodologies have unintentionally exaggerated the prevalence of post-traumatic growth. I spoke with Jayawickreme about the difficulty of measuring post-traumatic growth, how his own experiences with adversity have influenced his work, and which people are more likely to change in positive ways after life-shattering events. Our conversation has been edited for length and clarity.

A Q&A with Eranda Jayawickreme

Group Therapy: What was your initial motivation for researching post-traumatic growth? Why were you so interested in this topic?

Eranda Jayawickreme: There’s this line that researchers say: “All research is me-research.” So to some extent, my interest in post-traumatic growth stemmed from my childhood. I grew up in Sri Lanka from the early 1980s through 2001, which is when I left to come to the U.S. for college. And during the ’80s and ’90s there was a long-standing civil war between the Sri Lankan government and the Liberation Tigers of Tamil Eelam. And between around 1987 and 1990, there was an insurrection where a Marxist group tried to overturn the government. I grew up in a relatively privileged middle-class family, and we were spared from the worst of the violence. That said, violence as part of my everyday life got normalized. I have vivid memories of hearing bombs going off a couple miles away — and these are bombs that killed hundreds of people, right? And I would just shrug my shoulders. We would drive to school in the morning and see the bodies of people in the street who had been assassinated and killed the night before.

It took a few years after I came to the United States to realize that this was a very strange way to grow up. So as I got older, I became increasingly interested in how people cope with really challenging traumas and adversities and get on with their everyday lives. I was always struck by the fact that many people somehow managed to fulfill their everyday responsibilities after these things happen.

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Group Therapy: Your research has found that while personal traumas can lead to growth, they don’t always. Can you explain how post-traumatic growth emerges, and the conditions that make it more — or less — likely to happen?

Jayawickreme: The idea behind post-traumatic growth is, when you experience a terrible challenging life event, by reflecting on your life in the aftermath, that process of reflection can lead to new perspectives and a greater appreciation of your relationships, and a recommitment to your values. There’s some evidence that suggests that when there are other people around you who have gone through a similar experience, that can be helpful. You can resolve with them what betterment means to you, how you can make sense of it all.

There was a study published a few years ago suggesting that people who had survived school shootings were much more likely to successfully recover and move on from the event if they felt they had high levels of social support. Compare that to people who return from active combat and who tend to really struggle when they return home. An explanation that’s given for why they struggle is that when someone is on active duty, they’re with other people who know what they’re going through. But when they come back home, they feel like their loved ones can’t really understand what they’ve gone through, and it leads to this cycle where people feel less comfortable talking about their trauma, leading to isolation.

So one factor contributing to post-traumatic growth may be feeling that other people are there who can support you and relate to you. That said, one of the big challenges in trying to understand the conditions under which post-traumatic growth may or may not occur is how we measure it. We need more and better measurements to get a better handle on the conditions that make post-traumatic growth more likely.

Group Therapy: How common is post-traumatic growth, actually? And how is it measured?

Jayawickreme: In the ideal world, if you’re interested in looking at changes in well-being or depression or any psychological construct, typically what you would do is measure someone at one time point, and then you would measure them at a later time point and look at how much they’ve changed. Now in a lot of research on post-traumatic growth, this work is done on people who have already gone through the traumatic life event. So what a lot of researchers do is simply ask them: How much have you changed because of the trauma? But the problem is that, when you’re asking someone to do this, you’re asking them to do a multi-step process, right? You’re asking them to think, OK— what is my current level of relationship satisfaction? And what was my relationship satisfaction before the trauma? Is there a positive change or a negative change?

Now, the problem here is that we are motivated by self-enhancement. People are motivated to describe the best version of themselves. I’m motivated to say I changed for the better. And then you ask people how much of that change is due to the trauma. The problem there is that we don’t actually know how much of the change is due to the trauma, right? It could be that in a different world where you hadn’t gone through the trauma, maybe you wouldn’t have changed in the same way.

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In short, it’s not clear whether when people report that they have changed for the better that they’re reporting actual change, or whether they’re reporting a self-enhanced assessment of how much they think they’ve changed. We also don’t know whether these reports reflect their own experience or whether they reflect expectations about how you’re supposed to respond to adversity. I think one question I’m very interested in is the extent to which people’s reports represent socially desirable ways of thinking. When someone asks you whether you’ve changed or how your experience has been in the aftermath of adversity, there’s this expectation that you’re supposed to say, “Yes, this terrible thing happened, but I’m gonna learn something valuable from this. I’m gonna become stronger than ever.”

Group Therapy: You’ve noted in the past that this “what doesn’t kill you makes you stronger” mentality is a quintessentially American way of thinking about trauma. Why is this the case, and how does this frame of mind tend to shape the way we move through our own suffering?

Jayawickreme: One concept that’s uniquely American is the redemption narrative. It’s this idea that we’re always getting better, and that our lives are progressing toward this ideal self. People really like the narrative of the past being challenging but the future being hopeful. The fact that these narratives have such a cachet in American society has to do with what I think is a uniquely American brand of optimism — that as long as you have the right mindset, only good things can come to you.

American thinkers like Dale Carnegie and Norman Vincent Peale have argued that if you have the right attitude, you could do anything in this country. And I think this speaks to a certain view of American history where, if you came to this country as an immigrant, it’s on you to succeed because the U.S. has so many resources, so much opportunity. And if you don’t succeed, it’s not anyone else’s fault. I do think that this broad belief has seeped into the culture, such that when something bad happens to you, it’s assumed that you’re going to pick yourself up and overcome it.

But if you’re expected to grow from adversity, that places a burden on you. Now if something bad happens to you, it’s not just that you need to cope with it, but ultimately you also have to find some lesson in it. If you are living in America and you’re dealing with systematic oppression or issues related to systematic injustice, there is this cultural narrative that would suggest that, well, some of this is your fault. Because if it’s possible for us to grow in the wake of adversity, why aren’t you?

Group Therapy: Can you tell me a bit more about your own challenges in early life, and how these speak or do not speak to this concept of post-traumatic growth?

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Jayawickreme: I do think that one skill that I have that might have grown as a function of me growing up in Sri Lanka — both in the family and societal context — is this sort of Buddhist non-reactivity. I’m very good at not being overtly emotionally reactive to any stressor or change that comes my way. I’m able to stay calm, to stay patient and move on afterward. And an interesting question is whether this represents growth. On the one hand, it means that I don’t get emotionally drawn into conflict as easily. On the other hand, you could say it’s a form of depersonalization, right? Which works well in Sri Lanka or in a context of adversity, but it might be less adaptive in an environment where there’s less stress.

Group Therapy: The pandemic was a global, collective trauma. In what ways has the idea of post-traumatic growth crept into our narrative of the pain and suffering caused by COVID-19?

Jayawickreme: I remember these articles coming out about the pandemic’s silver linings — the benefits of working from home, not having to commute as much, spending more time with your family. It’s true that some people have experienced benefits. I have two young kids, and in the early months of the pandemic I got to spend more time with my son, who had just turned 1. And looking back, I think, “That was a blessing.” But only a relatively small demographic got to experience this benefit. There were many people who had job insecurity, or people working in the medical sector who experienced extreme stress. And some of them are still recovering from it.

I understand that some people want to look for silver linings, and for some people there definitely were silver linings. But I think that in some cases, the real benefits and the real insights that you can learn from COVID may not be apparent for a while, and there might be a danger in trying to seek out those benefits too quickly, or grabbing too hard for growth instead of focusing more on accepting and understanding what happened to us.

Group Therapy: While I like the idea of post-traumatic growth in one respect — that we can find meaning in our suffering — I get this icky feeling from the pressure it puts on us to show evidence that we’ve come out stronger on the other side. Can you say more about this pressure to have something to show for your pain?

Jayawickreme: It can be really helpful to feel like you’ve learned something from a traumatic event; you’re reestablishing a sense of control. At the same time, it could be that instead of reflecting on their trauma and how it’s affected them, they’re thinking about how this might be a growth opportunity. It could distract them from the work of trying to accept and understand how the event has harmed them. So in some ways, it could short-circuit natural coping processes that we would typically engage in. And at the worst, some people may be in denial about the impact of the event.

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Group Therapy: Many people turn to religion and spirituality in order to understand the role of suffering in their lives. And they may certainly find meaningful answers there. For example, according to Buddhist teachings, suffering and impermanence is an unavoidable part of life that should be accepted, and resisting that reality causes more pain. How do spirituality and faith practices influence the way we think about and respond to trauma?

Jayawickreme: One interesting argument that has been made by a number of social scientists, religious thinkers and philosophers is that the core role of religion isn’t to tell you how to live your life, or to give you a set of commandments or to make a judgment about whether you’re moral or not. It’s to help explain the unexplainable. Religion tries to explain, for example, why a loving God would allow suffering in the world. And religions provide all different kinds of explanations. One is that suffering can bring you closer to God. The experiences of suffering can also remind us that our lives are fundamentally vulnerable, that we need one another. That’s one perspective provided by Christianity.

Now, in the Buddhist perspective, there’s the idea that in order for you to achieve a certain level of wisdom, you need to accept that a core feature of human existence is suffering. And this moves us toward compassion toward other people because if we acknowledge that life is suffering, we know that other people are suffering too.

Group Therapy: Last but not least, how would you start to answer this question from our reader: How can burnout become more transformative in the sense that one can grow from it and continue to thrive?

Jayawickreme: One way to frame burnout is in terms of opportunity. I think reflecting on whether your work — or any domain in which you’re suffering burnout — is central to your values is really important. If you remind yourself that what you’re doing is intrinsically important to you and you see value in it, it can give you strength. You can ask yourself, “How can I continue doing this job in a way that enables me to also take care of myself?”

Similarly, if you reflect on your life and realize that your job doesn’t resonate with your sense of self or your values, it can cause you to reassess. If you have the support to do so, it might be that you could rebalance how much time you spend on your career compared to how much time you commit to your family. So I do think one helpful way to think about burnout would be to almost use it as an opportunity to take stock and potentially make different decisions going forward.

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. . .

My interview with Jayawickreme complicated the way I think of growth in the face of adversity, but not in a cynical way. I agree that while finding meaning in pain can be so helpful, the pivotal life lessons may not arrive right away — and that’s OK.

Until next week,

Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email GroupTherapy@latimes.com gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

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More perspectives on today’s topic and other resources

We are often told about people’s capacity to thrive after trauma — but these claims may put unnecessary pressure on survivors. In this piece from the BBC, Jayawickreme and other researchers go into greater detail about the academic literature surrounding post-traumatic growth, and the importance of presenting the theory in a responsible and nuanced way.

Millennials are the “burnout generation,” according to writer Anne Helen Petersen, who wrote an illuminating book on the topic. In this 2019 Buzzfeed piece, Peterson writes: “Why can’t I get this mundane stuff done? Because I’m burned out. Why am I burned out? Because I’ve internalized the idea that I should be working all the time. Why have I internalized that idea? Because everything and everyone in my life has reinforced it — explicitly and implicitly — since I was young. Life has always been hard, but many millennials are unequipped to deal with the particular ways in which it’s become hard for us.”

Other interesting stuff

Research from the last decade has shown that the more ultraprocessed foods a person eats, the higher the chances that they feel depressed and anxious (it should also be noted that low-income people are far more likely to need to eat these foods, as they tend to be both inexpensive, high in caloric content and more available than healthier foods in food deserts where people can’t easily shop at grocery stores). Here’s what is known so far about the connection between ultraprocessed foods and mental health, according to the New York Times.

Pregnancy, childbirth and motherhood can cause someone’s entire reality to transform — from hormonal and physical changes, to motherhood itself, which entails gaining a new role in family and at the workplace. In this interactive piece from CNN, nine women describe their mental health challenges during their pregnancies, at a time that society expected them to feel joyful and fulfilled.

Sixteen-year-old Summer Oriyavong was the beneficiary of what her mom described as lifesaving mental health care from an early psychosis program at UC Davis, covered largely by Medi-Cal. The UC Davis program offers intensive treatment that doctors hope will enable people with severe mental health challenges to live normal lives.

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