Resilient qualities are not only what we’re born with but also the strengths that we build through encountering life’s challenges and developing the personal and interpersonal skills to meet them. It is one of life’s paradoxes that the worst circumstances can bring the best out of us. According to the Adverse Childhood Experience (ACE) studies performed by Robert Anda (2006) and his team at Kaiser Permanente’s Health Appraisal Clinic in San Diego, we will all experience four or more serious life stressors that may be traumatizing, and according to positive psychology research, most of us will grow from them.
Is it possible that trauma is good for you? Is there such a thing as Post-traumatic Growth? Are we supporting soldiers coming forth for assistance or are we engaging in denial when we strip away the "D" (disorder) from PTSD? As a clinician and advocate for those who develop PTSD and its more severe variant, Complex PTSD, I am tortured by the contradictions and questions.
Like many in my profession I have read the research and the controversy associated with resilience training. I am critical of many aspects of these endeavors; they promise more than is reasonable and have been implemented prior to empirical validation. Also, the assessments done during training have resulted in lawsuits due to soldiers objecting to being ordered for additional training on spiritual development (viewed as a resilience booster). Nonetheless, there is such a phenomenon as Post-traumatic Growth. I see it all the time, and in fact have been a strong advocate of this construct for decades. I have always encouraged clients with PTSD to "find meaning from the misery", something much easier said than done. It is no great surprise to observe that like heroes of mythology and bible, adversity is often the precursor of strength. Many soldiers and civilians suffering from PTSD go through a long "dark" period before finding hope, meaning and strength. Some never find the positives and withdraw from life or die from their condition(s). On the other hand, it is possible that some individuals skip the downside and move spontaneously toward "growth".
Whether this is common, rare, or the result of training or genetics is still not known.
The military does an outstanding job in training soldiers to survive in combat. However, is it possible to prevent PTSD? The armed forces would love to be able to select those who are most resilient and train them in all ways to become "immune" to trauma, perhaps even strengthened by trauma. I am reminded by the headline in a recent military newspaper: "Bullet-proof Your Brain". Perhaps this concept can be taken a bit too far. We are already struggling with questions about how many tours someone should have before they "break". I seriously doubt we will be able to precisely predict an individual's breaking point, find a medication that will prevent PTSD, or have cognitive techniques that permit individuals to tolerate the impossible. As cited in the article, "These programs were designed to make people happier and healthier," says George Bonanno, a professor at Columbia University who studies trauma and resilience. "That is not the same thing as inoculating people for serious urinate-in-your-clothing type stress - once-in-a-lifetime stress."
So, how do we make sense of the contradictions: is trauma neutral, negative or a positive? Can we expect resilience, growth or a lifetime of symptoms? Will a mistimed introduction of "the positive" possibility help or hurt someone with active PTSD? I am concerned that the expectation of "Growth" can add burden, perhaps shame to those who have PTSD or Complex PTSD. I recall a very powerful example. My client, a high school teacher who had severe PTSD, was being evaluated by a renowned psychiatrist as part of her lawsuit against the physician who misdiagnosed her near-fatal colon cancer. She lived in dread of a recurrence of her cancer; she had severe anxiety symptoms and was not adjusting well to her colostomy bag. The psychiatrist was representing the defense team and his objective was to gather information to deny the existence of her PTSD. She was expecting critical questions and did very well during the hour, no signs of anxiety or anger at his attempts to undermine the reality of her PTSD. At the very end of the interview the psychiatrist switched tone and tried to display empathy. He was an elderly man, partially blind, and said to her, "I had some health problems myself and medical errors were made. I decided that I had to put my memories and emotions in the attic of my brain and then I was over it. You need to do what I did." Ironically, he was trying to be kind but the result was powerful; my client burst into tears, felt invalidated and humiliated. It took us a full hour to help her recover from the trauma expert's mistimed attempt to validate and encourage. She felt shamed and criticized. In this case, a positive message delivered at the wrong time had unintended consequences.
So, while focusing on the positive results of surviving trauma is empowering, it can be invalidating as well. It is all a matter of context and timing.
Jerry Boriskin, Ph.D, has been at the forefront of the treatment of PTSD, addiction, and co-occurring disorders for more than 30 years. He is the author of several books, including PTSD and Addiction: A Practical Guide for Clinicians and Counselors and At Wit's End: What Families Need to Know When a Loved One is Diagnosed With Addiction and Mental Illness.
For more about The Meadows' innovative treatment program for PTSD and other disorders, see www.themeadows.com or call The Meadows at 800-244-4949.
Note: This article was originally published in the Summer 2005 edition of Cutting Edge, the online newsletter of The Meadows.
Somatic Experiencing: Resilience, Regulation, and Self
By Peter A. Levine, Ph.D., Clinical Consultant for The Meadows and Mellody House
My life's work, encompassing nearly four decades, as a stress researcher and trauma therapist, has taught me how vulnerable we humans are to the effects of stress and trauma. An apparent contradiction to this fragility surfaced during a study I conducted at NASA with Apollo astronauts. In monitoring their physiological responses transmitted to Earth, I was surprised to observe an extraordinary capacity to successfully withstand extreme levels of stress.
However, the most exciting discovery of my career was the recognition that "ordinary" trauma sufferers had the same innate, though latent, ability to rebound from stress. I was both humbled and amazed to witness their ability to learn the very skills that I believe facilitated the astronauts' spontaneous resilience.
In the 1960s, as a student in the fledgling field of mind/body psychology, I learned how to "read" people's postures and assess the patterns of tension held in their bodies (in the vernacular, many were "uptight," "twisted" in angst, "scared-stiff," or helplessly "collapsed" and without energy). I was experimenting with using body awareness to help these individuals learn to normalize their excessive tension patterns. However, a deeper truth emerged from those shared efforts. I discovered that "long-forgotten" events, which had originally been perceived as significantly threatening or highly stressful, had left deep, organismic imprints on my clients. These stress patterns played out in the theaters of their bodies as habitual postures, recurring symptoms, stereotyped movements and repetitive behaviors.
As I continued to explore these body narratives, it became clear that, given the appropriate support and guidance, most individuals could unlock the somatic "stress memories" trapped in their bodies. In so doing, they experienced a rebound (albeit delayed) similar to what the astronauts exhibited as a spontaneous response to the stress of liftoff and space flight. With their self-possession restored, former trauma victims were relieved of their constrained postures, freed in their movements and behaviors, and liberated from many of their symptoms. I began to recognize that effective treatment was not a matter of remembering or erasing painful memories, but of establishing a resilient nervous system, similar to those possessed by the naturally endowed astronauts.
With the resilience of their nervous systems restored, my clients and I sometimes saw remarkable patterns of behavioral and psychological change. Rather than the repetitive and self-reinforcing patterns of symptoms, new adaptations emerged. Often, without the client even noticing, lifelong symptoms of pain, anxiety and sleep disturbances were replaced with engagement and interest in life.
Thirty years ago, Jody's life was shattered. While walking in the woods near her boyfriend's house, a hunter approached her and began an "innocent"conversation. It was mid-September. There was a crisp New England chill in the air. Her boyfriend and others thought nothing when they saw someone, behind the bushes, apparently chopping wood. A madman, however, was smashing Jody's head again and again with his rifle. The police found Jody unconscious. Chips from the butt of the rifle were nearby, where they had broken off in the violent attack.
The only recollection Jody had of the event was scant and confused. She vaguely remembered meeting the man and then waking up in the hospital some days later. As she tried to recollect the event, she went blank in panic. Jody had been suffering from anxiety, migraines, concentration and memory problems, depression, chronic fatigue, and chronic pain in her head, back and neck (diagnosed as fibromyalgia). She had been treated by numerous physical therapists, chiropractors and physicians. Jody, like so many traumatized individuals, grasped desperately and obsessively in an attempt to retrieve memories of her trauma. However, her body revealed a clearer "snapshot" of the event. The upper half of her body, particularly her neck, back and shoulders, were extremely stiff. Her shoulders were high, with the right one practically touching her ear. Her upper body moved almost as one unit, stiff and jerky. Jody's head seemed like it was retracted into her trunk, like a turtle that had been startled. Her movements were tentative, even furtive; she seemed to be always glancing to the right. It was as though she was on guard, waiting to be struck.
When I suggested to Jody that it was possible to experience healing without having to remember the event, I saw a flicker of hope and a momentary look of relief pass across her face. We talked for a while, reviewing her history and her day-by-day struggle to function. Focusing on bodily sensations, Jody slowly became aware of various tension patterns in her head and neck. With this focus, she began to notice a particular urge to turn to the right and retract her neck. In following this urge, in slow, gradual "micro movements," she experienced momentary fear, followed by a strong tingling sensation. Through "tracking" these sensations and movements, Jody began a journey that her mind could not understand. In learning to move between flexible control and surrender, she began to experience shaking and trembling, which gradually spread throughout her body. Thus began, ever so gently, the discharging of her trauma - and the recharging of her life with its lost vitality.
In later sessions, Jody experienced other spontaneous movements, as well as sounds and impulses to run, bare her teeth and claw like a cornered animal. By gradually carrying out and experiencing these biologically established protective responses, Jody was able to sense how her body had prepared to react in that fraction of a second when the hunter raised the rifle to strike her. By allowing these incomplete movements and sounds to be mindfully expressed, Jody began a deep, organic experience of her body's innate capacity to defend and protect itself. Through "owning" the life-preserving actions that her body activated at the time of her attack, she released that bound energy and realized - from deep within - that she in fact could, and did, act to defend herself. Gradually, as more of these "defensive" and "orienting" responses reinstated, her panic and anxiety decreased, as did her physical symptoms.
As Jody came to appreciate the return of her animal instincts, I came to appreciate how animals, while preyed upon in the wild, respond to constant, life-or-death threats without breaking down. If animals did not possess a natural "immunity" to stress, the survival of the individual, as well as the species, would be tenuous at best. This innate "hardiness" was in line with my observations of the astronauts" stress responses, and it sharply contrasted with the symptomatic people I was beginning to treat with my body/mind techniques. This was the final piece of the trauma puzzle.
While humans and animals share the part of the nervous system designed to respond to threat, many of us have somehow lost the capacity to "shake off" our encounters with danger; instead we become paralyzed - physically, emotionally and mentally - as trauma victims. As I worked with more and more people, I became increasingly convinced that freeing that bound "survival energy" - and finding access to our innate restorative capacity - is what allows us to return fully to life. This became the central therapeutic goal. The story of how we have "forgotten" the capacity for self-regulation, and how we can regain it, is at the core of what I describe in my writings. It is what we teach in our Somatic Experiencing® (SE) professional trainings.