Bez’s Blog #15: Post Traumatic Growth

March 16, 2023

Are there any benefits to having adverse childhood experiences (ACEs)?  What we explored in Blog #12 suggested mostly harms. 

In the clinical setting suggesting that people be screened for ACEs is sometimes met with asking why do it when there is no treatment for them. 

Within clinical medicine there tends to be a reluctance to look for conditions for which little or nothing of benefit can be done.  Dr. Felitti, who developed the concept of ACEs, recognizes that victims acknowledging negative ACE impact can also be impacted positively.  And we’ve mentioned Van Der Kolk’s continuous best seller The Body Keeps the Score as evidence of a major effect of recognition.

Do adverse early life experiences result in any benefits?  My trajectory started in looking at ongoing studies of social determinants of health (SDOH) among older people in different regions of Japan.  The Japan Gerontological Evaluation Study (JAGES) began in 2010 as a follow up to a previous similar study in one prefecture there.  They wanted to better understand SDOHs, health inequalities and developed better strategies for prevention.  Surveys of those aged 65 and above were done in different municipalities across Japan.  One was completed in 2010 in Iwanuma City which suffered severe damage as a result of the 2011 Great East Japan earthquake and tsunami.   A repeat survey was completed two years later.  This provided ACE and Post Traumatic Stress Disorder (PTSD) data for the participants.  They found that subjects who had experienced ACEs had less PTSD. 

Similar findings have been reported for some Gulf War and Vietnam veterans who may have developed better coping mechanisms to deal with stressful life events after ACEs. 

There may be Posttraumatic Growth (PTG).  In such cases those who have had ACEs or other forms of trauma had positive changes resulting from their struggles.  A student of mine, a Ukrainian doctor, is studying PTG among those exposed to the Russian invasion of Ukraine. 

PTG entered the academic realm with Tedeschi and Calhoun’s 2004 paper Posttraumatic growth: conceptual foundations and empirical evidence which has been cited over 8600 times to date which is strong evidence of its impact.  The 1953 epoch-launching Watson and Crick paper on the structure of DNA has received only twice that number.  Let’s explore the key ideas of PTG.

Posttraumatic growth is a process and an outcome, namely the experience of positive changes in oneself through the struggle with traumatic events.  In contrast to resilience, which refers to recovering from illness or trauma, PTG is a transformative response to a new level of functioning.  Things get better!  There is a process involving one’s belief’s about how the world works, rumination over the trauma, leading to acceptance of the changed world and being further ahead than before the hardship.

Negative experiences can foster recognizing one’s personal strength.  It can lead to exploring new possibilities, as well as improving relationships, leading to spiritual growth.

Many factors can facilitate PTG.  One is an expert companion to listen, tolerate and be there for the long haul.  Such a person can take the pressure off of you.  There are vast cultural differences in this process and there are not predictable stages.  Action instead of or in addition to talk may be required.  Psychotherapy and other clinical interventions may also help you emerge stronger.

Human animal companion interaction is another way of intervening to foster PTG.  This has been studied with U.S. veterans by organizations using dogs and horses to improve quality of life.  The series of essays in Transforming trauma: Resilience and healing through our connections with animals presents many examples. 

There is now a vast literature on the healing power of nature in its various forms.  I have always sought out mountains as a sustaining and healing force in my life.  So-called green therapy can be prescribed and paid for by the healthcare system in other countries than the United States.  In Canada those with physical disabilities can be provided with free adaptive devices[JDLZ1] [SB2]  to allow them to be in the mountains and other natural environments.  Wheelchairs, for example, are not well suited for trails in the wilderness.  There are a range of equipment produced for such purposes.   I once organized a conference for the Wilderness Medical Society on the theme of “Wilderness as Medicine for the Disabled.”   

A useful summary of growth after trauma by Tedeschi can be found online.

How does the country in which you reside impact post traumatic growth?  Are you better off experiencing an earthquake in Japan or in the United States?  There are few studies making such comparisons.  One looked at PTSD and PTG among US and Japanese college students.  American students scored better on PTG than Japanese.  The study suggested differences in cognitive processing employed by US and Japanese.  Americans focus on individual attributes, looking for the good, while Japanese have a more holistic perspective.  As a general tendency Americans tend to beat their chests optimistically and say everything is great.  Japanese do not want to stand out this way.   Such cultural differences can be found with those in other countries. 

So far our population health approach has considered more precisely defined outcomes such as mortality which is difficult to fudge.  PTSD and PTG are softer outcomes and so leave much to cultural interpretations.

Nevertheless, what hurts you may help you live a better, more meaningful life. 

Dr. Stephen Bezruchka

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