To Hell and Back With Gifts

Survivors can learn to avoid worrying about the small stuff and attend to the awe and wonder all around us. But how does this dramatic transformation happen?
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Stacey Kramer happened upon a counterintuitive phenomenon. An excruciating struggle with a dreaded disease changed her life for the better! I would have been a skeptic had I not myself come upon this realization through a horrific ordeal. During house renovations I suffered severe exposure to toxic chemicals that resulted in catastrophic illness. The medical establishment had no clear diagnosis or treatment and I had no place for recovery because I could not live in my house. All the elements that rooted me in life and gave me a sense of identity were torn away, and I descended into hell. Yet, about a year later, I returned from exile beyond the mountains of darkness with the feeling that my life had been positively transformed.

I decided to look at this bizarre occurrence in my research. Could it be that after encounters with traumatic events people feel that they are better off? Luckily, it was the mid-1990s, and Rich Tedeschi and Lawrence Calhoun had just coined the term post-traumatic growth (PTG) and developed a model about the process. The myth of the hero who returns from a supreme ordeal transformed and bearing gifts and the age-old idea that suffering may have its rewards became the subject of intense scientific exploration.

I ended up studying PTG in women with breast cancer and their husbands. My work, and the work of many others, provided ample evidence that a large proportion of people who struggled with potentially traumatic events such as life-threatening illness, military combat and natural disasters report positive changes. Like Stacey, women survivors of breast cancer often said that cancer was the worst and the best thing that ever happened to them. Many of their husbands reported PTG as well. Studies have found that PTG is experienced by survivors' family members and care providers who share both the pain and the potential for gain. Moreover, PTG is a universal phenomenon that has been documented around the globe. Examples include PTG among survivors of earthquakes in Turkey and Japan as well as survivors of terrorism, imprisonment and war experiences in the Middle East and Europe.

As a husband of a breast cancer survivor attested, you learn "to live life like there is no tomorrow, but hope there is, because the threat of death brings you closer to life." -- Tzipi Weiss

As Stacey identified, the trigger for the process that yields PTG is a severe stressor event that is unexpected, unwanted and uncertain. During my illness I wondered: How does one live a broken life, in a tortured body, without a future? She also identifies the domains of transformation: Changes in the sense of self, relating to others and philosophy of life. In the aftermath of a struggle with highly stressful events, individuals may see themselves as stronger and more vital. They may be more sensitive to the suffering of others and more willing to invest in relationships. They may have a greater appreciation of life and a much deeper spiritual or religious perspective. As a husband of a breast cancer survivor attested, you learn "to live life like there is no tomorrow, but hope there is, because the threat of death brings you closer to life." Survivors can learn to avoid worrying about the small stuff and attend to the awe and wonder all around us.

But how does this dramatic transformation happen? PTG is the result of a long, arduous and painful searching process. When a traumatic experience challenges individuals' basic assumptions about life and throws them into an existential crisis, they engage in what Stacey calls "recalibrating what is important in life." As life is interrupted, survivors search for meaning and new goals. Individual and social context characteristics may facilitate or inhibit this search. For example, individuals who employ active and problem-focused coping strategies are more likely to develop PTG. Coping by avoidance and the denial of loss and suffering tends to inhibit PTG. It is through oscillating between hope and despair and facing the deep terror of our vulnerability in rumination, talking or writing that we may also come to see our strengths. Experiencing positive emotions also facilitates PTG -- distilling a few drops of joy from an ocean of misery, finding moments of love among the grief and uncertainty.

The cognitive-emotional processing of traumatic events is facilitated when the social context provides survivors opportunities to disclose their pain and suffering and offers role models. In my research, the best predictor of PTG was contact with another breast cancer survivor who perceived benefits from the struggle. Inspiration for growth may be found in novels, biographies, mythology, existential writings, nature, movies and art. When living without a script, the stories that one is exposed to play a powerful role in the narrative reconstruction associated with PTG. Thus, Stacy's story of emerging from the underworld with gifts has the potential to transform lives.

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