The Table Video

Making Sense of Suffering: The Psychology of Post-Traumatic Growth - Eranda Jayawickreme

How are we to make sense of suffering in this world? Are despair and ill-being the only outcomes we can expect following tragedy and trauma? Or can enduring significant failure and adversity change your character in truly meaningful ways? Many people’s intuition on the question suggests that perhaps yes, our character could be strengthened. This intuition was shared by St. Paul, who wrote that “suffering produces endurance, and endurance produces character, and character produces hope” (Romans 5: 3-5). Similarly, Friedrich Nietzsche’s maxim “What does not destroy me, makes me stronger” has become ubiquitous in popular culture. We also admire people who have overcome adversity in achieving laudable goals, such as Nelson Mandela, Mahatma Gandhi and Martin Luther King. What does current psychology research say about this question? Can we trust it? And what insights can we take from this work that can help us successfully address the problem of suffering? Eranda Jayawickreme is an assistant professor of psychology at Wake Forest University. He received his Ph.D. from the University of Pennsylvania in 2010. He is currently the Project Co-Leader of the Pathways to Character Project, a $3.4 million initiative funded by the John Templeton Foundation examining the possibilities for the strengthening of character following adversity, challenge or failure. His research focuses on well-being, moral psychology, growth following adversity, wisdom, and integrative theories of personality, and has worked with populations in Rwanda, Sri Lanka and the USA. His awards include the 2015 Rising Star award from the Association for Psychological Science, a Mellon Refugee Initiative Fund Fellowship, and grants from the John Templeton Foundation, the Templeton Religion Trust, and the Asia Foundation/ USAID.

Transcript:

Okay, good evening to all of you. First of all I wanna thank Evan and Laura for making this possible and for allowing me to speak to you this evening. I should also mention that this could be my first talk to a non-psychology audience. [audience laughter] So two days ago I sent these slides in to Laura and then I gave a test presentation to my fiancee who is a historian. And her first response, after I finished was, so this is for a psychology conference right? [Audience laughter]

And I said, no. And her response was, so. [audience laughter] We’ll see how we do here. I did revise the slides. So my talk today is about my primary area of research which is post-traumatic growth. And this is an area that many of you are probably familiar with. In part because there’s so much that is written about this. So, for those of you who spend at least two minutes on the internet every day, there are several articles written by psychologist, therapists, counselors talking about the ubiquity of grief, how we deal with it and at some point, the silver lining. And a good proportion of how we’re expected to cope with adversity and cope with trauma involves looking at the bright side.

This is something that’s not just the focus of therapist, it’s become the focus of research by psychologist, by clinicians, it’s become the focus of interest by journalists. So this journalist recently wrote a book on post-traumatic growth, and I met him when he was researching the book a couple years ago, and his motivation for writing the book which was an audible one, was that his father was a holocaust survivor, and he was surprised with how well he had managed through the effects of surviving the holocaust, and that was enough to convince him that post-traumatic growth was a real phenomenon.

Now in addition to these stories, you might’ve heard the meme “What doesn’t kill you makes you stronger”, so depending on your cultural touchstone, it’s Friedrich Neitchze, or Kelly Clarkson [audience laughter] or Kanye West, so it’s pretty ubiquitous. And you know we’re at the stage where we’re sort of making fun of it. Getting myself to the bit of Futurama reference, but the point is this idea that struggle, adversity, trauma, is something to be overcome is something that is pretty much a part of mainstream culture. So, in addition to it being part of mainstream culture, its something that resonates with us.

So it wouldn’t be a part of mainstream culture if it didn’t feel true to us, this is a quote from Hamilton Jordan, who I think was the Chief of Staff during President Carter’s time in office. And this is him talking about his experience with multiple bouts of cancer. “After my first cancer, even the smallest joys in life took on a special meaning, watching a beautiful sunset, a hug from my child, a laugh with Dorothy.

That feeling has not diminished with time. After second and third cancers, the simple joys are everywhere and are boundless, as I cherish my family and my friends and contemplate the rest of my life, a life I certainly do not take for granted. ” So if these types of personal experiences can make us feel that there’s something to this idea, the dark benefits to be gained from going to adversity. And its from these type of experiences that researches started examining this phenomenon that they term post traumatic growth. So this is an article that came out in November of last year, that focus on the phenomenon, the possibility, of growth following trauma. So, the two researches who’ve probably done the most to popularize this idea of post-traumatic growth in psychology, are Rich Tedeschi and Lawrence Calhoun, at the University of North Carolina, Charlotte. And they define post-traumatic growth as “changes that occur as a result of the struggle with threat of life circumstances, and these changes are positive. ”

So by this definition, if you go through adversity, and you experience post-traumatic growth, or PTG, you do end up a better person at the end of it. That’s the way in which they define it. So, why are we interested in post-traumatic growth research? Why do we click on that link that says “Research shows that what doesn’t kill you makes you stronger”. Well we click on that link because it resonates with us, we all have a personal story that involves overcoming something in our lives, we consider our life narrative, or the story we tell about our life.

Part of that story involves overcoming something challenging, so it feels true to us. Also, they’ve now, as lot of research on the topic, there are a lot of books like the New York Times Journalist new book that just came out few months ago, there are multiple articles, so its a very popular theory. Part of the reason why the articles and books, we are interested on it. Hopefully part of the reason you’re listening to me right now, is that you’re interested in it.

But part of it, as a psychologist, because this is a topic that we believe is true because it resonates with our life, and because its a topic where if you do research, a lot of people are gonna be interested in it, it means we have to treat this research with extra scrutiny. Because as psychologists, part of the reason why we commit ourselves to the scientific method is that we want to avoid believing pleasant truths about the world.

We want a subject believe that fear true too, strengthen tests. So let’s talk a little bit about the psychology of post-traumatic growth, and see what we find there. I just got interested in post-traumatic growth, because I, as a graduate student, at years in Pennsylvania, did my dissertation research on resilience among survivors of the Civil war in Sri Lanka. So, Sri Lanka is a island, it’s around the size of West Virginia, so it’s a very small island, and it’s on the southern coast of India. And until 2009, in the northern east of the country, there was a civil war between the Tamil tiger rebels, who were fighting for an independent homeland, and the Sri Lanka army, which was dominated by the majority Sinhalese community, and this point will become important in the end of my talk, in 2009 the war ended when over a hundred thousand civilians were trapped in-between the Tamil Tiger Rebels, and the Sri Lankan army, and the Tamil tigers expected that the army would not breakthrough because it didn’t want to harm any civilians.

The war ended because the army did breakthrough, and thousands and thousands of people were killed, no one knows the exact number. So five years after the end of the war, I did a qualitative study with 50 survivors of the war, and these are people who’ve gone through unimaginable suffering, these are people who have been subject to sexual violence, they’ve been imprisoned multiple times, they’ve been tortured, in all types of ways, and we ask them what is the daily life like. What is the psychological experience? And not surprisingly, they struggle.

These are the types of symptoms they experience. Some of you who study psychology might know that how people express symptoms of distress varies from culture to culture, so it’s important for us to understand how people express distress by doing qualitative research, so that we’re not missing people who’re struggling by using standard measures of depression, so that’s what we did here. And these are some of the symptoms that they reported. But we also ask, what are some of the strategies that you try to use to try and deal with those problems?

And these are the ones that they reported. For many of them, it was leaning on the religious rituals, that they perform at the temple or the church. So many of these people were Hindu, some of them were Catholic, mostly Hindu, some Christians and most of the Christians in East Sri Lanka are Catholic. So for many of them performing religious rituals was important. Trying to find employment so they could distract themselves from the tension was important. Talking was important, but they also felt that talking was a sign of weakness.

We did a similar study in Rwanda. Talking to 200 genocide survivors, and we ask them in the years following the genocide, this is 15 years after the genocide, so 2009. We ask them what are the changes you report experiencing since the genocide. And they reported a mix of changes. Some of them are positive, so they reported that they could fulfill their basic needs, much more easy than before, they had greater aspirations, a lot of them are very motivated to further their education.

But they also reported a significant decrease in trust, which if you think about, I don’t wanna go into the context of the genocide, the different community involved, but they talk about how they couldn’t talk to people of the other community, and that was something that felt, they couldn’t be open about . So this type of work, which I did early on when I was a graduate student, got me interest in post-traumatic growth. So, I looked at how it was measured. This is the most widely used measured post-traumatic growth, it’s called the post-traumatic growth inventory, it assesses five domains of post-traumatic growth. The extent to which you feel a greater appreciation in your life, the extent to which you think the new possibility because of the trauma, the extent to which you think you have a greater sense of personal strength than you had before the trauma, the extent to which your religious faith has increased, and the extent to which your quality of relationships has changed.

And, I’m not gonna have you take a psychological test now, but pretty much the measure asks, because of the adverse event, how much would you say you’ve changed on these different items. So that’s what the measure does, it asks you, “because of this stressful event that you just reported to me, how much have you changed on these items?” So it’s a very face valid measure, and by that I mean, it seems pretty obvious, right. “Oh, you had this event, tell me because of this event, how much have you changed?”. Most of these studies you read about post-traumatic growth are gonna be studies that use this measure, okay. So this is what the measure is asking you to do. When I am asking you ”

Because of the trauma, how much have you changed?” I am asking you to think, “How am I doing now?” “How was I doing before the trauma?” “How is the state I’m in now comparing to the state I was in before the trauma”, “How much have I changed?” and “How much of that change is due to the trauma ?”. Now the issue is that, that’s pretty complex, right? It’s not clear that most people are doing that when they’re answering the measure. Another problem is that I’m asking you “How much did you change because of that event”. We know from psychological research that we can tell people a story about why we changed, but we actually don’t know why we changed. I can tell you a really good story about how I became a lot more extroverted after I moved the south in 2010, it involves, you know, program myself in improvement, being outgoing, making new friends, but who knows why I became extroverted?

It could just be because I got older, right? So the point is that we can tell a story about why we changed because an event, but that doesn’t correspond usually to what actually happened. So the point is that this measure isn’t very precise in identifying true change from adversity, so when you give me an answer to this measure, that measure is capturing actual change, to some extent, so when you tell me you changed because of a traumatic event, or adverse event, it might be because you changed, it might be because believing you changed helps you deal with sadness, and there’s good psychological research on this, it helps you dampen sadness, the very strong cultural norms about telling people you’ve grown because of adversity, and also people might be in denial about the fact that it’s hard.

This explains why levels of post-traumatic growth don’t correlate very strongly with other measures of functioning, across multiple studies. So, are these reports useful? I have long answer to this. [Audience laughter] The short answer is not particularly. [Audience and speaker laughter] Only have three minutes left. I did a study couple years ago where we identify people experience a clinical trauma, gave them this measure, and then track their behavior five times a day for two weeks, and then we compare their daily behavior to the trait measure, to the post-traumatic growth inventory, only their daily spirituality matched onto their trait measure, not the other dimensions.

So, do we know what the ultimate outcomes of adversity are? I would say that our current research doesn’t provide us with a good picture, and I think part of the problem is that we have tied current research in post-traumatic growth too tightly with mental health outcomes, we want the silver lining, whereas I think if we really wanna know what the outcome of adversity is, we need to take the long view. Every single theological, philosophical and most psychological traditions that talk about the link between character development and life experience say that some form of adversity is needed for you to develop in character or to achieve wisdom. So I’m gonna leave you with two thoughts, because I know my time is up. One issue is that we need to think about trauma in broader terms when we consider how it transforms us, can someone tell me who the author of this book is?

Audience: C.S.Lewis Right. So the thing I found really interesting is that he publish this book under pseudonym, and the fact that he publish this book under pseudonym started makes me think that Nietzsche’s maxim that “What doesn’t kill you makes you stronger” has actually done us a disservice, because to go back to Kelly’s point in during the first session, instead of inspire this vase, macho attitude towards adversity, “I’m gonna knock you out”, whereas Lewis’s book talks about the vulnerability, the doubt that comes with enduring suffering, enduring adversity, and the lessons of adversity comes somewhere down the line. I think that’s a perspective a psychologist need to take.

My second and final thought is that it might not be growth or benefits necessarily that come out of adversity, but learning something about what you need to do, or learning something about what your values are in the face of adversity. So what St.Paul said when he, in the book of Romans, when he spoke about suffering leads to endurance, and endurance leads to character, and character leads to hope, that capture very nicely Maya Angelou’s quote over here, it’s also captured in a chapter in this book, by the BBC reporter Francis Harrison, it’s book about the end of the Civil war, and in this book, there’s a chapter about a nun in the eastern province, who witnesses unimaginable suffering and death, but she still keeps to her task, so taking care of the population she was charged with, making sure as many people are evacuated, and she’s saved. But a lot of people around her died.

And as Migur pointed out in his talk, she’s very aware of the fact that she survived, but a lot of people didn’t, but with all is clear is that despite the doubt she has, despite the guilt, she still does what she has to do. So maybe we need to think differently about what the benefits of hardship are. That’s it from me, thank you so much. [Applaud]