Leader's Digest: Post-Traumatic Growth

Leader’s Digest is a bimonthly column produced in partnership with Cambridge Consulting Group (CCG), a group of subject matter experts in paramedicine, ambulance operations of every organizational structure, and medical transportation services. Visit www.CambridgeCG.net.

My father was a member of the Greatest Generation. He grew up poor during the Great Depression, lost his mother to a car crash at age 10, and joined the Navy at 17. He spent the final years of World War II on Guam, on the heels of the Marines who had taken the island just before he arrived. In July and August of 1944, there were 30,000 casualties (20,000 dead) on the island, which is just 32 miles long and 8 miles wide. 

Poverty, the loss of a parent as a child, and a terrible war: all key ingredients that could have led my dad down a very different path. Today we call that path post-traumatic stress disorder. But that never happened during the 90 years of his largely happy and full life.

New Terms, Old Concepts

In 2018 I couldn’t help but think of my dad while I sat in a conference room in Warwickshire, England, at the annual meeting of the Global Paramedic Leadership Alliance. A clinical psychologist from New Zealand got up to speak about his work supporting the mental health and well-being of paramedics in his country. It was the first time I remember hearing the phrase post-traumatic growth. It was wrapped up in research he reported on in the field of salutogenesis (study of the factors that help promote and maintain health), another new word for me at the time.

Both terms took me off guard. I looked around the room, wondering if others had had the same reaction. They did. After his presentation I asked a number of my colleagues if they’d ever heard of post-traumatic growth or salutogenesis, and to a person they had not.

The psychologist explained that this was not a new concept. It first showed up in the 1979 book Health, Stress, and Coping written by Aaron Antonovsky, an Israeli-American medical sociologist. Turns out post-traumatic growth is rooted in the study of health and wellness. Salutogenesis is a field that examines what makes human beings well, rather than what makes them sick. It’s the opposite of illness—the study of health, as opposed to the study of disease. Interestingly, salutogenesis was only added to the dictionary in 2019.

As reported in the literature, “Salutogenesis focuses on the resources that move people toward overall well-being, even during stressful times. Antonovsky was particularly interested in people’s sense of coherence—a view of the world as comprehensible, manageable, and meaningful. He believed people with a strong sense of coherence were better able to mobilize their personal resources to cope with life’s challenges and demands.”

Later, in the 1990s, psychotraumatology researchers Richard G. Tedeschi, PhD, and Lawrence Calhoun, PhD, coined the phrase post-traumatic growth. They defined it as positive change experienced as a result of struggle with a major life crisis or a traumatic event. They elaborated, “Post-traumatic growth occurs in the context of suffering and significant psychological struggle, and a focus on this growth should not come at the expense of empathy for the pain and suffering of trauma survivors. For most trauma survivors post-traumatic growth and distress will coexist, and the growth emerges from the struggle with coping, not from the trauma itself.”

Coming Out Stronger

The science of post-traumatic growth demonstrates that some people who go through major adversity can come out the other side stronger. The question seems to be, why is this true for some and not others? Research suggests somewhere around 50% of people who experience life-changing trauma also experience post-traumatic growth. But it’s a sequential process, and the old adage about it being darkest before the dawn applies here. Experts counsel that efforts aimed toward growth should only be addressed after a person has had appropriate time to grapple with the trauma they’ve been exposed to—and with professional oversight. Post-traumatic growth is not a cure for damage done by traumatic events but one possible outcome of that trauma.

These are some of the reported characteristics of post-traumatic growth:

• A sense of new opportunities;
• Increased connection with and compassion for other people;
• Greater sense of one’s own strength, e.g., If I lived through that, I can face anything!
• A greater appreciation for life in general;
• Increased development in spiritual and/or religious domains;
• A significant change in one’s belief system.

I’m a card-carrying member of the critical incident stress management (CISM) club. I was privileged to have been trained in CISM in the early days by groundbreakers like Jeff Mitchell and George Everly. I vividly recall these thought leaders instructing a group of students that it’s OK if terrible events have less impact on you than others. “No one should ever be required to feel bad,” they said. That made some intuitive sense to me at the time, but I never had the language to talk about it until that day in Warwickshire.

A Blessing and a Curse

People in the helping professions are routinely exposed to the raw side of humanity. This is both a blessing and a curse. It’s a blessing because few people are privileged to witness these things: When a dying person looks into your eyes, when you console a parent who lost their child or ease the respirations of a COVID patient struggling for breathe, you bear witness to life’s sacred moments. It’s a curse for the same reason: That witness sometimes comes at a price. 

Some good news is that post-traumatic stress disorder is a specific clinical diagnosis, not just a convenient label to be thrown around. Even following catastrophic traumatic events, most people never develop true, long-standing psychiatric disorders.

Notwithstanding, there is no way to minimize the real psychological trauma so many public safety and healthcare professionals live with daily. We also know cumulative trauma has a detrimental impact. And for all of us, living through the incredibly disruptive and difficult times of the COVID-19 pandemic can exacerbate all issues.

But this is a message about hope. If you must pass through the depths of traumatic despair, there may indeed be growth on the other side.

We have scarcely referenced the domain of resilience in this essay. But it’s important to note there is a difference between resilience and post-traumatic growth. One is about adjusting and adapting to tragic experiences. The other is about the positive changes that can result from going through hell and surviving the trip. Both are gifts.

Antonovsky believed people with a strong sense of coherence were best equipped to navigate adversity. At a time when that sort of world view may seem difficult, I believe it can be achieved by using the tools that have become so familiar to us all lately. Leverage your support networks; practice self-care like exercise, meditation, and substance moderation; seek purpose through your own belief systems, including religion and spirituality; and try new things such as learning a foreign language or playing the guitar.

Post-traumatic growth could be the hope you’ve never heard of.   

Resources

Andrews LW. Why Salutogenesis Is the Best New Word in the Dictionary. Psychology Today, 2019 Apr 26; www.psychologytoday.com/us/blog/minding-the-body/201904/why-salutogenesis-is-the-best-new-word-in-the-dictionary. 

Antonovsky A. Health, Stress and Coping. San Francisco: Jossey-Bass Publishers, 1979.

Antonovsky A. Unraveling The Mystery of Health—How People Manage Stress and Stay Well. San Francisco: Jossey-Bass Publishers, 1987. 

Collier L. Growth After Trauma. American Psychological Association, 2016 Nov; www.apa.org/monitor/2016/11/growth-trauma. 

Joseph S. What Doesn’t Kill Us: The New Psychology of Posttraumatic Growth. New York: Basic Books, 2011. 

Joseph S, Sagy S. Ch. 10: Positive Psychology in the Context of Salutogenesis. In: Mittelmark MB, Sagy S, Eriksson M, et al., eds. The Handbook of Salutogenesis. Cham (CH): Springer, 2017; www.ncbi.nlm.nih.gov/books/NBK435833/. 

Kaufman SB. Post-Traumatic Growth: Finding Meaning and Creativity in Adversity. Scientific American, 2020 Apr 20; https://blogs.scientificamerican.com/beautiful-minds/post-traumatic-growth-finding-meaning-and-creativity-in-adversity/. 

Tedeschi RG, Calhoun L. Posttraumatic Growth: A New Perspective on Psychotraumatology. Psychiatric Times, 2004 Apr; 21(4); www.psychiatrictimes.com/view/posttraumatic-growth-new-perspective-psychotraumatology. 

Brian LaCroix, FACPE, NRP (ret.), is an executive advisor and cofounder of the Cambridge Consulting Group (CCG). He serves as EMS coordinator at the Center for Patient Safety and is a retired EMS chief at Allina Health EMS in Minnesota.