Complicated truth of post-traumatic growth

Eranda Jayawickreme was born in London but grew up in Sri Lanka during the 80s and 90s, in one of the most turbulent periods in its history. He witnessed the insurrection by the People’s Liberation Front, and the ongoing civil war with the Liberation Tigers of Tamil Eelam. 

“There was a lot of violence,” he says. “But growing up with so much adversity and trauma going on around me, I was often struck by the extent to which people somehow managed to ‘keep on keeping on’ in the wake of all these bad experiences.” 

When he moved to the US to study psychology at university, it was perhaps only natural that he would be drawn to the science of human resilience. Jayawickreme was particularly fascinated by the concept of “post-traumatic growth”. This is the idea that many people not only recover from life-shattering events, but also experience a positive transformation in their values, actions and relationships. The research seemed to affirm Nietzsche’s aphorism that “what doesn’t kill me makes me stronger”. 

The intuitive appeal of the concept is obvious – and it has been promoted in numerous magazine articles and books, including Sheryl Sandberg and Adam Grant’s best-selling book Option B. As Jayawickreme delved into the research, however, he found that the truth was much more complicated than some of the media coverage would suggest – and that many of the scientific studies themselves may have serious flaws. 

Jayawickreme’s conclusions are nuanced, but it now seems increasingly likely that the reported prevalence of post-traumatic growth has been exaggerated. This is not just nit-picking or pessimistic naysaying: it might have serious consequences. 

“In some cases, this narrative around the potential to grow could be oppressive,” says Jayawickreme, who is now a professor of psychology at Wake Forest University in North Carolina, US. “It creates the expectation that not only do I have to recover from what happened to me, but apparently, I'm supposed to become better than ever before.” And this pressure, he thinks, could lead to worse mental health outcomes for some individuals.

 

The phoenix from the ashes 

Nietzsche may have hinted at the existence of post-traumatic growth (PTG) in the 19th Century, but the scientific study of the phenomenon only emerged in the 90s, with pioneering research by the psychologists Richard Tedeschi and Lawrence Calhoun. To measure PTG, they asked participants to consider how they felt now, compared to how they felt before their trauma, in five domains: appreciation of life, relationships with others, new possibilities in life, personal strength and spiritual change. They then had to estimate how much of that change was linked to the trauma itself. 

As one example, they cited the words of Rabbi Harold Kushner, describing his life after the death of his son: 

I am a more sensitive person, a more effective pastor, a more sympathetic counsellor because of Aaron's life and death than I would ever have been without it. And I would give up all of those gains in a second if I could have my son back. If I could choose, I would forego all of the spiritual growth and depth which has come my way because of our experiences... But I cannot choose.

Such accounts suggest a positive transformation that goes far beyond recovery and coping. “Post-traumatic growth is not simply a return to baseline – it is an experience of improvement that for some persons is deeply profound,” Tedeschi and Calhoun wrote in one of their early papers. 

Subsequent research found evidence of post-traumatic growth in the survivors of many different crises – including relationship break-ups, bereavement, cancer diagnoses, sexual abuse and immigration from war zones. And it seemed to be astonishingly common, with some estimates suggesting that as many as 70% of trauma survivors might experience PTG. 

Along the way, the researchers have had to understand how post-traumatic growth emerges. Amy Canevello, a psychology professor at the University of North Carolina, US, describes it as a constructive process. “Trauma shatters your worldview and disrupts your core beliefs,” she says. “And post-traumatic growth, at least theoretically, is the result of you trying to put your worldview back together in a way that incorporates that traumatic event. You come out the other side looking different in some way.” 

Supporting this hypothesis, Canevello has found that levels of post-traumatic growth tend to correlate with levels of rumination after the event: the more people think about it, the more likely they are to see a positive transformation. At first, these thoughts may be intrusive and unwanted, she says, but over time the thinking can become more controlled and reflective. “It allows you to start cognitively putting those pieces together and make sense of the event.” 

Some people reporting post-traumatic growth describe enormous grit and determination to come to terms with their adversity. Ann Wild was born with a congenital spine condition and describes experiencing a series of traumas as a result of her disability and the medical procedures that she has endured – the last of which has resulted in complications that may prove fatal in the years to come. She competed in five Paralympics, has an OBE and works as an occupational therapist.

“I was constantly growing as a person and always held the principles of independence optimism, gratitude and kindness,” she adds. “Although I don't follow an organised religion, I have a deep unwavering spirituality and faith in what I do in the world and what I can achieve past the limitations of my impairments… I think for some people it takes trauma to make us realise our potential.” Wild recognises that many people do not see that growth, however. 

Positive illusions? 

The researchers studying post-traumatic growth have been careful not to dismiss the pain of overcoming adversity. “It certainly isn’t all sunshine and rainbows,” says Canevello. “It means that you have come out the other side of this thing – that you are having these growth experiences, despite the stress.” 

This message is sometimes lost in the media coverage and public understanding of post-traumatic growth, however, which can focus on the inspirational elements of the phenomenon. “The concept lends itself to a pretty ‘Pollyannaish’ understanding of recovering for adversity,” says Jayawickreme.