Trauma and Transformation Growing in the Aftermath of

Suffering, 1st Edition

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TVansformation
Growing in the
Aftermath of Suffering

Richard G. Tedeschi
Lawrence G. Calhoun

j^vSAGE Publications
,JL) International Educational and Professional Publisher
$^ 5 5 ' Thousand Oaks London New Delhi
Copyright © 1995 by Sage Publications, Inc.

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Library of Congress Cataloging-in-Publication Data

Tedeschi, Richard G.
Trauma and transformation: Growing in the aftermath of suffering
/ Richard G. Tedeschi, Lawrence G. Calhoun.
p. cm.
Includes bibliographical references and index.
ISBN 0-8039-5256-2 (alk. paper).—ISBN 0-8039-5257-0 (pbk.:
alk. paper)
1. Suffering. 2. Life change events—Psychological aspects.
3. Adjustment (Psychology) 4. Self-actualization (Psychology)
I. Title.
BF789.S8T 1995
155.9'3—dc20 95-11803

This book is printed on acid-free paper.

99 10 9 8 7 6 5 4 3

Sage Production Editor: Tricia K. Bennett

Sage Typesetter: Andrea D. Swanson
Cover Illustration: Dawn Anderson
 CONTENTS

Preface ix

1. The Uses of Suffering: Religious and

Psychological Roots 1
Tragedy in Philosophy and Literature 2
Religious Views of Suffering 5
Psychological Views of Suffering 10
Plan for This Book 13

2. The Negative Consequences of Trauma 15

What Makes Events Traumatic? 16
The Negative Impact of Traumatic Events 19
Negative Psychological Effects 19
Physical Problems and Complaints 24
Life Stress and Psychiatric Disorder 25
Does Time Heal All Wounds? 26
Is There a Positive Side? 28

3. Psychological Growth From Trauma:

Research Findings 29
Perceived Changes in Self: Self-Reliance
and Vulnerability 30
Increased Self-Reliance and Personal Strength 30
Recognition and Appreciation of Vulnerability 33
 A Changed Sense of Relationship With Others 34
Self-Disclosure and Emotional Expressiveness 35
Compassion, Empathy, and Effort in Relationships 36
A Changed Philosophy of Life 37
Conclusions 40

4. Personality Characteristics and Successful Coping 43

Locus of Control 44
Self-Efficacy 45
Optimism 46
Hardiness 48
Resilience 49
Sense of Coherence 52
The "Big Five" Personality Factors 53
Creative Copers: Common Themes 55

5. Tasks and Cognitive Processes in Coping With Trauma 59

Rumination 60
Making the Crisis Manageable 61
Primary and Secondary Control 62
Use of Religious Beliefs 64
Vicarious Learning 64
Downward Social Comparisons 65
Reducing Emotional Distress 66
Making the Crisis Comprehensible 67
Schemas: Basic Assumptions About Life 67
Traumas as Challenges to Schemas 69
Finding That Life Continues to Be Meaningful 71
Religious Routes to Meaning 72
Benefits of Religious Meanings 74
Conclusions 75

6. How Growth Happens: A Model for Coping

With Trauma 77
Principle 1: Growth Occurs When Schemas Are
Changed by Traumatic Events 78
Principle 2: Certain Assumptions Are More
Resistant to Disconfirmation by Any Events,
and Therefore Reduce Possibilities for Schema
Change and Growth 81
 Principle 3: The Reconstrual After Trauma Must
Include Some Positive Evaluation for Growth
to Occur 82
Principle 4: Different Types of Events Are Likely
to Produce Different Types of Growth 83
Principle 5: Personality Characteristics Are Related
to Possibility for Growth 84
Principle 6: Growth Occurs When the Trauma
Assumes a Central Place in the Life Story 85
Principle 7: Wisdom Is a Product of Growth 86
Summary of Principles of Growth 87
A General Model for Personal Growth Resulting
From Trauma 88

7. Support and Intervention 93

The Role of Friends and Family 94
Mutual Help 97
Professional Help 100
Supporting Self-Perceptions of Benefits and Growth 101
Respectful Intervention 102
Is the Client Ready for Growth? 104
Using the Survivor's Belief System 106
Narrative Development 108
Conclusions 110

8. Research Directions 113

Unanswered Questions 114
Person Variables 114
Situational Variables 117
The Validity of Personal Experience 118
Which Perspective and Which Methods? 121
Qualitative Approaches 122
Quantitative Approaches 123
A Research Strategy 125

9. Guideposts for People Challenged by Trauma 127

Experience Is the Teacher 128
A Willingness to Accept and Endure 128
The Challenge Perspective 129
Searching for Humor 130
 Needing and Serving Others 130
An Active Search for the Gains in the Losses 132
Readings in Transformation 133
Conclusions 137

Appendix: The Post Traumatic Growth Inventory 139

References 143

Index 161

About the Authors 163

 PREFACE

This volume is an attempt to weave together material from various

writings in philosophy, religion, and especially psychology to account
for a phenomenon that has been recognized since ancient times but
given little attention by psychologists: the experience of personal
growth or strengthening that often occurs in persons who have faced
traumatic events. We use an essentially cognitive framework to ex-
plain this experience because changes in belief systems seem to be so
often reported by persons who describe their growth, and these beliefs
appear to play a central role in relieving emotional distress and
encouraging useful activity.
Although both of us have experienced traumatic events in our lives,
we are personally unfamiliar with many of the events mentioned in
this book. Our teachers have been the clients with whom we have
worked as clinicians, and the people who have agreed to talk with us,
sometimes for hours, as part of our research studies in this area. It is
to these people we owe the greatest debt. They have not only informed
us as psychologists, but made us more sensitive to the struggles and
victories of those who have been most painfully touched by life.
We hope that we have presented information in a way that is
accessible to clinicians, laypersons, and especially in Chapter 9, other
people who have experienced trauma. We have also tried to summa-
rize a far-flung literature and describe a way of understanding the
process of growth that will encourage more attention from researchers.
In addition, we believe that this book can be used as a supplementary

IX
X TRAUMA AND T R A N S F O R M A T I O N

text in courses on human development, crisis intervention, and intro-

ductory courses in counseling and psychotherapy. It is also our hope
that this book will be useful as a resource for helping professionals in
a variety of disciplines, including psychology, social work, psychiatry,
family counseling, human services, nursing, and sociology.
We wish to acknowledge the assistance of Arnie Cann, Lori Folk,
Carl Frye, Donna Harding, and the other students and colleagues with
whom we have the pleasure to work. We thank Raymond Berger for
his helpful and incisive review of our manuscript. We are especially
grateful for the reassignment of duties granted to the senior author by
the University of North Carolina at Charlotte. This greatly facilitated
the completion of this project. Finally, we express our appreciation to
our editors at Sage, Marquita Flemming and Jim Nageotte, for sup-
porting our work.

Richard G. Tedeschi
Lawrence G. Calhoun
Charlotte, North Carolina
 THE USES OF SUFFERING
Religious and Psychological Roots

But we also boast in our sufferings, knowing that suffering produces

endurance, and endurance produces character, and character
produces hope, and hope does not disappoint us.
—Romans 5:5

Jerry is a 34-year-old paraplegic man who has been disabled for 8

years following an automobile accident. Most able-bodied people
would assume that this was the most traumatic 1 event of this man's
life. But Jerry sees it differently.

This was the one thing that happened in my life that I needed to have
happen; it was probably the best thing that ever happened to me. On the
outside looking in that's pretty hard to swallow, I'm sure, but hey, that's
the way I view it. If I hadn't experienced this and lived through it, I likely
wouldn't be here today because of my lifestyle previously—I was on a
real self-destructive path. If I had it to do all over again, I would want it
to happen the same way. I would not want it not to happen.

Jerry is certainly correct when he says this viewpoint is hard for

most people to accept. But researchers are discovering that this is
precisely the approach to life trauma that many people adopt. Even if

1
2 TRAUMA AND T R A N S F O R M A T I O N

they do not always state that, in hindsight, they are pleased the
traumatic event occurred, many people at least view the aftermath of
the event as something that has benefited them. Furthermore, the
people who take this point of view feel that they have made a very
satisfactory adjustment, and to the outside world they may even
appear inspirational. For example, in her autobiography, Helen Keller
speaks of her teacher's dedication to her: "So I say my education was
accomplished in the tragedy of my teacher's life. She understood the
void in my soul because her childhood had been so empty of joy"
(Keller, 1968, p. 346).
We have been interested in learning more about these people and
this remarkable process of strengthening that may occur when they
confront tragedies in their lives. There is nothing new or remarkable
in the assertion that psychological growth can be precipitated by the
pain of unfortunate events. What we have found new and remarkable
is how often this happens and how apparently ordinary people achieve
extraordinary wisdom through their struggle with circumstances that
are initially aversive in the extreme. We have also developed some
principles that we believe explain the process by which the struggle
is successfully resolved and this wisdom is attained. First, we will
consider briefly some of the accumulated wisdom about trauma and
suffering and how approaching these aspects of life in certain ways
leads to the strength to persevere and insight into why it is worthwhile
to do so.

Tragedy in P h i l o s o p h y and Literature

From the time of the ancient Greeks to the present day, tragedy has
been a dominant theme in great literary works. The enduring popu-
larity of this literature has prompted authors, philosophers, and liter-
ary critics to ponder what continues to attract people to tragic themes,
and somehow to enjoy observing the human struggle with the tragic
through literature. Aristotle addresses the importance of this litera-
ture in his Poetics. He defines tragedy very broadly as sad or serious
stories, but also describes the best kind, where a good but flawed man
commits an immoral deed, only recognizing later what he has done
(Kelly, 1993). The hero's remorse provides a catharsis that is purifying,
The Uses of Suffering 3

and perhaps therapeutic for the spectator (Aristotle, 1970). These

tragic figures become their best selves, enlarged (Rorty, 1992). Hegel
(Paolucci & Paolucci, 1962) wrote extensively on tragedy, which for
him is the conflict and action of the tragic figure that produces his
eventual suffering—mere suffering alone is not truly tragic. He also
concluded that "reconciliation" with the gods is the best conclusion
for tragedy By witnessing the drama, the viewer is also transformed
by the recognition of his or her connection to the tragic figures.
Of course, tragedy presented as art gives an aesthetic pleasure not
gained in real-life tragedy. In the literature of tragedy our pity for the
hero is combined with admiration, whereas in life, we are likely only
to pity those enduring tragedy (Raphael, 1960). When we consider the
reactions of the involved audience for tragedy, we recognize that there
is a felt knowledge that is gained through the "immediacy and physi-
cality of tragic drama" (Berlin, 1981, p. 174), which is a reflection of
life's mystery. Confrontation with the mystery is what occurs in this
involved audience and with the individual who is involved in the
struggle of suffering. The hero is on the brink of the abyss—what is
unknown and incomprehensible—and this is the situation confronted
by those facing crises. When these crises occur, we are given the oppor-
tunity, and are forced, to confront the most threatening questions that
are always there, but hidden. Berlin (1981) terms this the "secret
cause"—what is behind the play and verified by our life experience.
Therefore, we have good reason to seek out the next best thing to
real suffering, and that is its representation in a vivid, accessible form
in tragic literature. Because people living through crisis cannot give
an effective running commentary, the characters of drama, given
words by the dramatist, overcome this limitation (Schier, 1983). If we
ourselves suffer, we must find our own words for this experience and
the way the experience illuminates life's mystery, thus enabling us to
benefit from it as the audience may benefit from the performance of
tragedy. We can find some connection between what is learned by the
readers of tragic literature and the victims of tragedy in life if we
consider what can be learned from both these experiences.
Krook (1969) described four universal elements of tragedy that
illuminate the relationship of tragedy as explored in literature to the
focus of this book on individual growth as a result of trauma. The first
element of tragedy is the act of shame or horror that precipitates the
4 TRAUMA AND T R A N S F O R M A T I O N

suffering. The precipitant may be set in motion by the tragic hero,

intended or only imagined, although, according to Krook, in all cases
these tragic circumstances arise from the fundamental nature of hu-
mans. Not all life crises can be subjects of such tragedy, according to
these criteria. The second element of tragedy, suffering, is "properly
tragic if and only if it generates knowledge, in the sense of insight into,
understanding of, man's fundamental nature or the fundamental
human condition" (Krook, 1969, p. 8). This knowledge is the third
element of tragedy. In turn, this knowledge is tragic to the extent that
it provides an affirmation of the worthwhile nature of human life and
the dignity of the human spirit. This affirmation is the final element of
tragedy.
These final three elements are closely related to the consequences
of the struggle in which people engage as they cope with life crises.
Krook describes the knowledge gained as simple and self-explana-
tory, and it is felt intensely, genuinely, and sincerely. However, this
knowledge may or may not be self-knowledge. It may instead be
universal. Therefore, although the tragic hero may not gain knowl-
edge, the readers or audience receive this knowledge through their
"God's-eye view" (Raphael, 1960). In Athenian tragedy, this universal
knowledge was shared by the members of the community who at-
tended the theater, so that traumatized soldiers could heal and all
could cherish mortality and personal attachments in the face of the
losses of war (Shay, 1994). This knowledge reveals things about life
that produce a sense of affirmation in spite of the suffering. Again, we
will see that this appears to be an important element in the individual
experience of people who are traumatized by life events but who
accomplish psychological growth.
What is ultimately affirmed for some people who grow through
their trauma is that there is an objective, transcendent moral order that
reaches beyond the individual and even humanity. According to
Krook (1969), this illumination comes with the recognition and accep-
tance that suffering is necessary. In people suffering life crises, the
events producing the suffering may not be viewed as necessary, but
the suffering, the struggle, can be viewed as necessary to gain the
valuable knowledge and affirmation that succeeds it. Hence, a person
such as Jerry, described at the outset, can come to see the event and its
consequent suffering as not only necessary but desirable.
The Uses of Suffering 5

People show a persistent interest in literary tragedy and religious

study, indicating enduring concern with the most troubling issues of
the human condition. But reading tragedy or attending a performance
of it allows us to be in the position of learning the lessons without the
pain, and in this way we have a very different experience from people
who may be profoundly changed in a positive way by adversity.
People experiencing crises have the good fortune to be put in a
position in which their misfortune is a classroom for learning these
things in the most intense, genuine way. Kierkegaard (1983) wrote that
these experiences of crisis were necessary for full personal develop-
ment. Schopenhauer (1942) sees boredom as the price to be paid if we
somehow avoid pain. As Krook (1969) stated in referring to the
literature of tragedy, the lessons reach beyond the individual and
speak to the existential issues, providing an affirmation for living. But
there are other viewpoints on this. For example, Nietzsche (1955)
warns that "spiritual arrogance" (p. 220) can come from suffering
deeply, when people believe that the knowledge gained through
suffering is beyond that of the wisest people.

R e l i g i o u s V i e w s of Suffering

There is a tradition in religious and philosophical writings that

supports the notion that the greatest and wisest have suffered turmoil
in their explorations of meaning that may be concealed in the most
trying circumstances. Little (1989) points out that it is inconceivable
to consider religion apart from suffering, and that each religion faces
the difficulty of producing a consistent and satisfying explanation of
it. He has provided a categorization scheme for the themes of suffering
found in the Eastern and Western theological literature, including four
types of legitimate suffering: retributive suffering, therapeutic suffer-
ing, pedagogical suffering, and vicarious suffering.
In considering Judaic and Christian explanations of suffering, Little
sees all four types of legitimate suffering represented. Especially in
the Old Testament and the rewards and punishments to come in the
Last Judgment, the retributive notion of "an eye for an eye" is common-
place. But other themes of suffering are present in the Judeo-Christian
tradition that can provide a vehicle for renewal. In a discussion of
6 TRAUMA AND T R A N S F O R M A T I O N

doxology, Brueggemann (1984) notes that the book of Psalms was

written in a stylized fashion expressing continuing faith in the face of
misery. He notes that the people of Israel do not try ad hoc to make
faith affirmations out of private experience. Instead, in times of strug-
gle, Israel returns to the traditional formulations that seem to have
special credibility in difficult times. The Psalms continue to provide
an alternative, "especially in a time of 'subjective consciousness' as
ours, which wants always to find 'meaning' through personal feeling
and inclination. Israel knew another way made available in this
stylized speech" (Brueggemann, 1984, pp. 61-62).
In the rabbinic period, suffering was viewed as a test, and in the
control of God. Indeed, it is one of the blessings bestowed by God to
draw people close to Him. People are encouraged to look for suffering
as an opportunity for advancement (Bowker, 1970), as well as a way
of atonement. This understanding of suffering as a means of grace for
all of the faithful allowed the Jews to endure persecution. In the trials
of the biblical figure Job, painful experiences serve as messages from
God. Adversity has been viewed as including messages that cause
people to reflect on why they suffer. Sickness has been viewed as a
type of suffering that removes people from material pursuits, so that
time is available for quiet reflection. Moral lapses resulting in rejection
from others can prompt people to reconsider their behavior and
ponder eternal values (Singer, 1964).
Little's (1989) categories of suffering can be seen in the Christian
faith. The suffering of Christ, especially because it was undeserved,
provides a counterpoint to retributive suffering. The events of Christ's
life, death, and resurrection cannot be erased by any experience of
suffering, and this can have a healing or therapeutic effect for the
sufferer. Whenever God's will is made clearer as a result of suffering,
a pedagogical element is present as well.

Every tribulation is a medicine or blessing in disguise, provided men accept

and use it in the right spirit. This is so because God sends tribulation either
to inspire us to repentance for past sin; or to prevent us from falling into
potential sin; or to test our patience. (Miles, 1965, p. 25)

An important distinction is made by writers who note that life's

difficulties, although they may bring us closer to God and promote a