Suffering and growth-a psycho-spiritual perspective.
There has been increased attention in the recent times, on the positive outcome stemming from traumatic experiences. Studies done posttraumatic experiences reveal that there is a potential for trauma to create transformative experiences in some individual that have been reported as positive and valued(Sheikh, 2008). Tadeschi and Calhoun in 1996 termed this phenomenon as Posttraumatic growth (PTG), implying “positive psychological change experienced as a result of the struggle with highly challenging life circumstances” (Tadeschi& Calhoun, 2004, p.1).This change has been referred to in diverse terms like stress-related growth (Park, Cohen &Murch, 1996), thriving (O’Leary &Ickovics, 1995), adversarial growth (Linley & Joseph, 2004), and flourishing (Ryff& singer, 1998).
Traditionally, people believe that an individual can learn valuable lessons from his or her personal tragedies in life. Most of the ancient religious and philosophical traditions speak of the transforming power of suffering which, when transcended, is transformed into a resource for internal power and meaning (Sheikh, 2008).
Domains of PTG
Tadeschi and Calhoun (1996) defined five broad domains of PTG. They are: A greater appreciation of life, closer relationships, new possibilities, increased personal strength, and spiritual change. These domains have been replicated across the majority of studies in this area, and they continue to emerge even in qualitative studies (e.g., Thompson, 1985; Woodward & Joseph, 2003).Greater appreciation of life is exemplified by a greater connection to the “simple” things of life and finding greater meaning in life (Sheikh, 2008). People are likely to make a shift in priorities, in appreciating what one has, and recognizing and valuing aspects of life that were not cared for earlier (Janoff-Bulman, 2000).
A second domain of growth is seen in the enhanced relationship with close family and friends. They are better able to distinguish who their relatives and friends are, and who they need to disengage from. Thus, they create more room for deepening existing relationships, and developing new ones. Survivors also experience deep compassion and empathy towards others and the connectedness they experience help them appreciate others, and relate with others, in more open and meaningful ways (Sheikh, 2008).
PTG can also be experienced in the form of new possibilities for life (Sheikh, 2008). Trauma survivors are able to identify more fulfilling paths for their future–perhaps in the form of a change in career, or an initiative in a social cause (e. g., Herman, 1997).
Increased personal self-efficacy is another sign of PTG. Individuals may feel that since they have been able to cope with the trauma, they are able to cope with anything in the future (Sheikh, 2008). These feelings of increased self-efficacy tend to coexist with their knowledge of their own vulnerability, given the fact that, traumatic events can and do happen and yet feeling able to handle the crises in the future (e. g., Calhoun &Tedeschi, 1999).
The fifth domain of PTG is spiritual change. During this change, individuals report that they are able to connect to something beyond and greater than themselves, whether they experience that as God, nature, the universe, or a higher purpose. This domain of growth is not limited only to people who are religious. One common theme across all these five areas of change is that all seem to involve active engagement and openness to change (Sheikh, 2008).
PTG can be understood as a spiritual experience, as traumatic experiences can force a person to look at his or her previously held values and world views, and impels him or her to look for new meaning and purpose (Parlotz, 2007; Decker, 1993). The new meaning and purpose thus drawn from such experiences can provide a new framework for a new set of beliefs which can broaden one’s perspectives on good and evil, responsibility, guilt and forgiveness (Smith, 2004; Grant, 1999). Perception of the Divine as the source of strength and support during, and posttraumatic phase can help individual lessen the impact of trauma and enable PTG (Tedeschi& Calhoun, 1996; Smith, Pargament, Brant, & Oliver, 2000).
If major stressors in life can provide a level of experience that enhances mastery, competence, and coping resources, then, PTG can lead to wisdom (Aldwin&Levenson, 2004). Stress Related Growth can result in greater self-knowledge and enhanced empathy, which also characterize wisdom (Beardslee, 1989). Tadeschi and Calhoun (2004) give some intriguing argument that resilient individuals may be less likely to undergo transformational change vis-à-vis people who are more vulnerable. However, Aldwin and Levenson (2004) argue that resilient people have the ability to stand considerable stressors without developing stress-related disorders, and may be more likely to perceive benefits from such events and grow from such adverse life’s circumstances. For Tadeschi and Calhoun, traumatic loss stimulates growth. “From wisdom perspectives loss is not just a catalyst but is critical to growth” (Aldwin&Levenson, 2004, p. 21).
Model of PTG.Tedeschi and Calhoun (2004) proposed a model that describes the process by which growth may occur. According to this model, a traumatic event can challenge an individual’s basic schemas, belief system, goals and competence to deal with emotional distress. Trauma can profoundly affect one’s life story. This impact can lead the individual to intense ruminations of negative automatic thoughts. In order to cope with the emotional distress that might arise from this rumination, the individual may choose to self-disclose by way of writing, talking it over and praying. Seeking social support may be another way the individual may choose to cope. All these efforts can provide the individual an opportunity to develop new schemas and life narratives. Cognitive processing is central to the development of positive change (Tedeschi& Calhoun, 2004). There is some evidence to show that cognitive processing can be related to higher levels of PTG. For example, Calhoun, Cann, Tedeschi, and McMillan (2000) found that event-related rumination (such as making sense and problem-solving) and openness to religious change (including thinking about the event and its meaning and significance) were positively related to PTG. Moreover, Ullrich and Lutgendorf (2002) reported that emotional expression which focused specifically, on cognitive processing (i.e., writing in a journal about emotions and making sense of a traumatic event) was related to increased positive growth.
Effect of religion and spirituality on PTG. Traumatic experiences can deepen one’s religious faith andstrengthen vocation. One gives witness to this deepened faith by being more open to religious change and being able to recreate new experiences. Calhoun et al. (2000) in their study found that people who are more open to religious change, may be better able to recreate their spiritual beliefs after a traumatic event.
From the review of some of the published empirical studies,Shaw, Joseph, and Linley (2005), reported the link between religion, spirituality and PTG. The review produced three findings. First, the review revealed that religion and spirituality in general, is beneficial to people dealing with posttraumatic stress. Second, that traumatic experience can deepen one’s faith in one’s religion or spirituality. Third, that there is an association between PTG and aspects of religion and spirituality such as, religious openness, readiness to face existential questions, positive religious coping, intrinsic religiousness, and religious participation (Shaw et al., 2005).
Human suffering in Growth. Hall, Langer and McMartin (2010) in their paper “The role of Suffering in Human Flourishing” highlight major contributions from positive psychology, theology and philosophy. They highlighted three purposes of suffering, emerging from theological and psychological perspectives: (1) Suffering can serve as a marker of disordered living; (2) Suffering can be an opportunity for character formation; (3) Suffering can help people change their deeply held world views and beliefs.
Unlike in some of the religious traditions, in Christianity, Christ’s followers are called to endure suffering which they did not seek out, for some greater good. The Bible gives this perspective. For example in James (1: 2-4) says, “ my brothers and sisters, whenever you face trials of any kind, consider it nothing but joy, because you know that the testing of your faith produces endurance; and let endurance have its full effect, so that you may be mature and complete, lacking in nothing” (New Revised Standard Version Bible [NRSVB]).The narratives of flourishing individuals are characterized by redemptive themes in which negative life events are seen as transformative (Bauer, McAdams & Pals, 2008). Hauerwas (1996) notes, “the ability to make the suffering mine, that is crucial if I’m to be an integral self” (p.25).
Suffering can lead us to flourishing in becoming increasingly conformed to the image of God, accomplished in Christ. Suffering can also be understood as accomplishing God’s purposes and living out our vocation. Scripture is replete with references to suffering; accomplishing God’s calling in the lines of individual’s calling (Hall et al., 2010). For examples, suffering that includes: God’s approval and giving hope (Rom 5:3-5); that makes us mature and complete (James 1: 2-4); that advances the spread of the Gospel (Philippians, 1: 12); that validate one’s calling (2 Corinthians 11: 23-29), or that establishes one’s identity as a child of God (Hebrews12: 7) (NRSVB).
I have highlighted some of the factors that contribute to PTG such as enhanced positive self- beliefs, increased personalself-efficacy, deeper connectedness with the higher power, increased ability to make meaning of adverse life circumstances and discern life’s purpose, a marked increase in self-knowledge and empathyas sign of wisdom, and higher cognitive functioning and emotional expression.The personality characteristics that have consistently been associated with PTG are: Extraversion, openness to experience, agreeableness, and conscientiousness (Sheikh, 2004; Tedeschi& Calhoun, 1996). Optimism (e.g., Davis, Nolen-Hoeksema, & Larson, 1998; Tennen, Affleck, Urrows, Higgins, &Mendola, 1992), high self-esteem and self-efficacy (e.g., Abraido-Lanza, Guier, & Colon, 1998), and hardiness (Waysman, Schwarzwald, & Solomon, 2001) were found to be associated with growth.
Coping variables such as problem-focused coping (e.g., Armeli, Gunthert, & Cohen, 2001; Sheikh, 2004), acceptance coping (e.g., Schulz & Mohamed, 2004), positive religious coping (e.g., Pargament, Smith et al., 1998), positive reappraisal (e.g., Sears, Stanton, &Danoff-Burg, 2003; Widows, Jacobsen, Booth-Jones, & Fields, 2005), and social support seeking (e.g., Stanton, Bower, & Low, 2006) are positively related to growth.
Abraido-Lanza, A. F., Guier, C., & Colon, R. M. (1998). Psychological thrivingamongLatinas with chronic illness. Journal of Social Issues, 54, 405–424.http://dx.doi.org/10.1111/0022-4537.741998074
Aldwin, C. M., &Levenson, M. R. (2004). Posttraumatic Growth: A developmental perspective. Psychological Inquiry, 15 (1), 19-92.Url: http://www.jstor.org/stable/20447195
Armeli, S., Gunthert, K. C., & Cohen, L. C. (2001). Stressor appraisals, coping, and post-outcomes: The dimensionality and antecedents of stress-related growth. Journal of Social and Clinical Psychology, 20 (3), 366–395. doi: 10.1521/jscp.20.3.366.22304
Bauer, J. J., McAdams, D. P., & Pals, J. L. (2008). Narrative identity and eudaimonic well-being. Journal of Happiness Studies, 9, 81-104.doi: 10.1007/s10902-006-9021-6
Beardslee, W. R. (1989). The role of self-understanding in resilient individuals: The development of a perspective. American Journal of Orthopsychiatry, 59 (2),266–278. doi: 10.1111/j.1939-0025.1989.tb01659.x
Calhoun, L. G., Cann, A., Tedeschi, R. G., & McMillan, J. (2000). A correlation test of the relationship between posttraumatic growth, religion, and cognitive processing. Journal of Traumatic Stress, 13, 521-527
Calhoun, L. G., &Tedeschi, R. G. (1999). Facilitating posttraumatic growth: A clinician’s guide. London: Lawrence Erlbaum Associates.
Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology, 75, 561–574.
Decker, L. R. (1993). The role of trauma in spiritual development. Journal of Humanistic Psychology, 33(4), 33-46.doi:10.1177/00221678930334004
Grant, R. (1999). Spirituality and trauma: An essay. Traumatology: The InternationalJournal, 5 (1), Essay #2. http://www.greencross.org.
Hall, M. E. L., Langer, R., McMartin, J. (2010). The role of suffering in human flourishing: Contributions from positive psychology, Theology and Philosophy. Journal of Psychology and Theology, 38 (2), 111-121. Retrieved from http://www.questia.com/library/1G1-231530220/the-role-of-suffering-in- human-flourishing-contributions
Hauerwas, S. (1986). Suffering presence. Notre Dame, IN: University of Notre Dame Press.
Herman, J. (1997). Trauma and recovery: From domestic abuse to political terror. London: Rivers Orams Press.
Janoff-Bulman, R. (2000). The other side of trauma: Towards a psychology of appreciation. In J.H. Harvey & E.D. Miller (Eds.), Loss and trauma: General and close relationship perspectives (pp. 29–44). Philadelphia, PA: Brunner-Routledge
Linley, P. A., & Joseph, S. (2004). Positive change following trauma and adversity: A reviewJournal of Traumatic Stress, 17 (1), 11–21.
O’Leary, V. E., &Ickovics, J. R. (1995). Resilience and thriving in response tochallenge: An opportunity for a paradigm shift in women’s health. Women’s Health: Research on Gender, Behavior, and Policy, 1, 121–142.
Pargament, K. I., Smith, B. W., Koenig, H. G., & Perez, L. (1998). Patterns ofpositive and negative religious coping with major life stressors. Journal for the Scientific Study ofReligion, 37 (4), 710-724.
Park, C. L., Cohen, L. H., &Murch, R. L. (1996). Assessment and prediction of stress-related growth. Journal of Personality, 64 (1), 71–105. Retrieved fromhttp://www.chip.uconn.edu/chipweb/documents/Research/Park-1996-Stress-Related%20Growth%20Scale.pdf
Parlotz, R. D. (2007). The Institute for the Study of Spirituality and Trauma, downloaded Oct. 23, 2010, from http://www.geocities.com/frbobparlotz/isstparlotz.html
Ryff, C. D., & Singer, G. (1998). The contours of positive human health.Psychological Inquiry, 9 (1), 1–28.
Schulz, U., & Mohamed, N. E. (2004). Turning the tide: Benefit finding after cancer surgery. Social Science and Medicine, 59, 653–662. doi:10.1016/j.socscimed.2003.11.019
Sears, S. R., Stanton, A. L., &Danoff-Burg, S. (2003). The yellow brick road and the Emerald City: Benefit finding, positive reappraisal coping, and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22, 487-497. doi: 10.1037/0278-6126.96.36.1997
Shaw, A., Joseph, S., & Linley, P. A. (2005). Religion, Spirituality, and Posttraumatic Growth: a systematic Review. Mental health, religion & Culture, 8 (1), 1-11. doi: 10.1080/1367467032000157981
Sheikh, A. I. (2004). Posttraumatic growth in the context of heart disease. Journal of Clinical Psychology in Medical Settings, 11, 265–273.
Sheikh, A. I. (2008). Posttraumatic growth in trauma survivors: Implications for practiceCounselling Psychology Quarterly, 21 (1), 85–97. doi:10.1080/09515070801896186
Smith, B. W., Pargament, K. I., Brant, C. R., & Oliver, J. M. (2000). Noah revisited: Religious coping by church members and the impact of the 1993 Midwest flood. Journal of Community Psychology, 28 (2), 169-186.doi: 10.1002/(sici)1520-629(200003)28:2<169::aid-jcop5>3.0.co;2-i
Smith, S. (2004). Exploring the Interaction of Trauma and Spirituality. Traumatology, 10 (4), 231-243. doi: 10.1177/153476560401000403
Stanton, A. L., Bower, J. E., & Low, C. A. (2006). Posttraumatic growth after cancer. In L.G. Calhoun & R.G. Tedeschi (Eds.), Handbook of posttraumatic growth (pp. 138–175). Retrieved from PsycINFO database.
Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress, 9 (3),455- 471. doi: 10.1007/BF02103658
Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychology Inquiry, 15 (1), 1–18.doi:10.1207/s15327965pli1501_01
Tennen, H., Affleck, G., Urrows, S., Higgins, P., &Mendola, R. (1992). Perceivingcontrol, construing benefits, and daily processes in rheumatoid arthritis. Canadian Journal of behavioral Science, 24, 186–203.
Thompson, S. C. (1985). Finding positive meaning in a stressful event and coping.Basic andApplied Social Psychology, 6 (4), 279–295.doi:10.1207/s15324834basp0604_1
Ullrich, P.M., &Lutgendorf, A. K. (2002). Journaling about stressful events: Effectsof cognitive processing and emotional expression. Annals of Behavioral Medicine, 24, 244–250.doi: 10.1207/s15324796abm2403_10
Waysman, M., Schwarzwald, J., & Solomon, Z. (2001). Hardiness: An examination of its relationship with positive and negative long-term changes following trauma. Journal of Traumatic Stress, 14 (3), 531–548.
Widows, M. R., Jacobsen, P. G., Booth-Jones, M., & Fields, K. K. (2005). Predictors of posttraumatic growth following bone marrow transplantation for cancer. HealthPsychology, 24, 266–273. doi: 10.1037/0278-6188.8.131.526.
Woodward, C., & Joseph, S. (2003). Positive change processes and post-traumaticgrowth in people who have experienced childhood abuse: Understanding vehicles of change. Psychology and Psychotherapy: Theory, Research, and Practice, 76, 267–283.