Recover after major trauma

This abridged excerpt from John Marzillier's To Hell and Back looks at how we can grow and recover after major trauma.

A major trauma destabilises and disrupts a person’s world. It can lead to feelings of vulnerability and uncertainty, undermining the illusion that life proceeds in an orderly, rational and friendly way. It can provoke powerful emotions on the one hand and a sense of detachment and numbing on the other. It challenges core beliefs, in the fairness of the world, for example. It undermines our sense of control, showing how fragile that control really is.

It is out of these experiences that Post-Traumatic Stress Disorder (PTSD) and other emotional problems can arise. But equally they are fertile ground for post-traumatic growth (PTG). Just as new shoots will grow from the blackened devastation left by a forest fire, so the very destructiveness of the trauma opens up the possibility of something positive. As the term ‘growth’ implies, it is not just the case that people recover from trauma, returning to a form of normality, but also that something new develops. 

This is an old idea. The ancient myth of the phoenix rising from the ashes of its old self is a familiar metaphor of renewal through destruction. In literature and film, it is a common theme for the hero to emerge from a traumatic ordeal to become a changed and better person. 

However, for the forty or so years that I worked as a clinical psychologist, the focus of psychological work has been more on post-traumatic stress than post-traumatic growth, on documenting the pathological effects of trauma, and on helping individuals to recover from recognized mental conditions or illnesses. 

There is no doubt that major traumas can wreak havoc on individuals and families, but a focus on illness can too readily be interpreted as the belief that trauma inevitably leads to psychological damage, and that the damage is long-lasting or even permanent. 

At a talk in London in late 2010, I listened while a major figure in the trauma field, who had himself suffered from PTSD, stated that once you had PTSD you had it for life: it never went away. This bleak and, in my view, erroneous conclusion comes from a misperception of how major traumas affect people. The majority of people are not severely affected by trauma, even a major one. While many will experience some acute-stress symptoms in the trauma’s immediate aftermath, those symptoms generally decline over time. Only a minority develop PTSD or other problems. Most of those who do so will recover, sometimes with professional help, sometimes on their own initiative, sometimes simply with the passage of time. The experience of trauma is not a life sentence of emotional distress; nor is it right to assume that the experience is wholly or largely negative. Anyone who has suffered the loss of someone they love knows about the pain of grieving and the emptiness that remains. At the same time the loss can be liberating as the survivor adapts to a new and changed world. The emptiness gets filled and, although the pain never goes away, it lessens and is transformed into something else. 

We are biological creatures, programmed to experience both pain and pleasure. The cliché ‘life goes on’ tells a truth: that even in the darkest moments, there are times of joy or simple pleasure.