Saturday, November 18, 2017

Developing Resilience

Yesterday, I wrote a post about Elizabeth Smart’s resilience. In the current public discussions about trauma victims, many victims present themselves as damaged for life, as ruined forever. And those who cue up the outrage on these events often present the issue in the same terms. 

I took exception to that characterization. I remarked that the more you believe that sexual abuse, for example, destroys your life forever, the more difficult recovery will be. Anyone who gets over it easily seems to be suggesting that it wasn't really that bad. If we want the abusers to receive the maximum punishment, we do not want to give them impression. No one wants to diminish the trauma. But, no one should want to suggest that these women have no real chance of a meaningful recovery. No responsible professional will tell a trauma victim that her life is over and that she will never recover.

We should also examine the way cultural attitudes impact mental illness and how they influence the ability to recover. I have occasionally mentioned Ethan Watters’ book, Crazy Like Us, which discusses the issue at length. It addresses the way that society’s attitudes can produce epidemics of anorexia or can aggravate the symptoms of PTSD. 

Of course, PTSD is a complex issue, because in some cases it is a neurological condition with a psychological aspect. Some aspects of PTSD do respond to psychological therapies, but many do not. We ought not confuse neurological disorders with psychological disorders.

As for the larger issue of resilience, University of Virginia psychologist Meg Jay has written a new book about it. She offered some of her ideas in an extensive article for the Wall Street Journal.

Psychologists have performed many studies about resilience. Some involve being brought up in a bad home environment. Some involve repeated traumas. The studies deal with numerous complex variables and thus are not all relevant to the issue we are examining today. 

Take the example of children who are brought up in unstable family environments. For the most part children brought in this way have significant problems. No one should be surprised by these findings. What is surprising is the fact that the damage is not experienced equally by every child. Two thirds of the children who are brought up in such families have significant problems when they grow up, but one third rise above them:

Consider the Kauai Longitudinal Study, an ongoing project begun in 1955 by psychologists Emmy Werner and Ruth Smith, and summarized most recently in their 2001 book “Journeys From Childhood to Midlife.” The Kauai Study’s subjects are the 698 babies born on the island that year, with assessments so far at ages 1, 2, 10, 18, 32 and 40.

Of the children in the study, Drs. Werner and Smith identified 129 as being at high risk for future problems, because they faced four or more adversities at birth, ranging from poverty and family discord to alcoholism or mental illness in the home.

Two-thirds of these high-risk children went on to have difficulties of their own, such as delinquency, unplanned pregnancies and underemployment. One-third, however, fared well. At school and at work, they did as well as, or better than, their low-risk peers from more affluent, stable homes. In adulthood, they found supportive partners and built loving families that, often, differed greatly from the ones they grew up with. They became, as Drs. Werner and Smith described, “competent, confident, caring adults.” How did they do it?

We might also want to know how many of these children inherited genetic predispositions from their alcoholic or mentally ill parents. And we see that the children who escaped their conditions often found support systems outside of the home, in school, in youth groups, and eventually in the military. We should not underestimate the importance of group support or even of teachers and coaches who act as replacement parents. 

Jay continues:

They sought out friends, teachers, neighbors or relatives who cared. They made plans to better themselves and set ambitious but realistic goals for the future. In early adulthood, they seized opportunities to move forward in life, by way of higher education, the military, a new job, a supportive partner or parenthood.

But resilient people are everywhere, not just in the ranks of celebrities. They are ordinary women and men, in every walk of life, who meet the definition of resilience set forth by American Psychological Association: “adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress.”

As for the mental attitudes that promoted resilience, one study found that prisoners who had overcome the traumatic effects of torture had told themselves, as Elizabeth Smart told herself, that the torture was not about them.

Jay writes:

In a 2010 paper in the Journal of Abnormal Psychology, Anke Ehlers of the University of Oxford reported on 81 adults who had formerly been held as political prisoners in East Germany. They had been subjected to mental and physical abuse, including beatings, threats and being kept in the dark. Decades after their release, about two-thirds of the former prisoners had, at some point, met criteria for post-traumatic stress disorder (PTSD), while about one-third of the prisoners had not.

What made some more likely to suffer from PTSD? Dr. Ehlers found that the extent to which prisoners had fought back in their own minds made a bigger difference than the severity of the abuse they had suffered. Those who felt mentally defeated—who felt like they were “nothing” or who quit caring what became of them—were more likely to report symptoms of PTSD later. By contrast, prisoners who had resisted from within—even if they appeared to have given up on the outside, by complying with guards or signing false confessions—fared better down the line….

This sort of inner defiance is, in part, how one man—an officer in the military who came to me for a consultation—told me he survived years of bullying as a child and teen: “I refused to accept what they said about me was true.”

That is, in my slightly more sophisticated version, he refused to accept that it was happening to him.


AesopFan said...

"And we see that the children who escaped their conditions often found support systems outside of the home, in school, in youth groups, and eventually in the military. We should not underestimate the importance of group support or even of teachers and coaches who act as replacement parents. "

Particularly in the light of Elizabeth Smart's case, I would add to that list the influence of her religious beliefs and the support of her church members.

"She was surrounded by a strong and moral community, a community that insisted on treating her as though nothing had happened."

Here is a detail from a media report that might explain some of her resilience. Mormon missionaries are generally very committed in their religious testimony and diligent about their calling, but Elizabeth is clearly extraordinary.

"Smart’s parents, Ed and Lois Smart, were on hand to hear the painful testimony. They have said they never pressed her for details about her ordeal. Smart leaves on a mission to France next month for the Church of Jesus-Christ of Latter-Day Saints. Her testimony will be used during Mitchell’s federal competency hearing on Nov. 30."

Ares Olympus said...

I like to consider the worst events fit on a continuum with ordinary ones and this helps avoid thinking that "we're damaged" while everyone else is fine.

I know a futurist who uses the term unlearning, not in the context of PTSD, but it seems important for healing from psychological pain, lesson learned in a past level of development no longer serve us and we need directed attention to change.

I also recall the original studies of PTSD in regards to soldiers found a difference between those who developed this is that they had previous hidden symptoms, so the trauma source wasn't the original source, but a trigger for an older source.

So I imagine he way it works is that we all develop defense mechanisms that serve us in one context, but have hidden side-effects or vulnerabilities, and once we develop a way of defending ourselves, it's hard to see what we do to ourselves. So unlearning starts as detached attention to our reactions, and slowing down thoughts and reactions.

Its certainly interesting to consider our defenses as blocking not just harm but our own development, so an external trauma can become a blessing in the long run, if it leads to attention we'd never otherwise risk. "Personal growth" is often a crock, but there's a reality there despite its false promise.