Trauma can lead to…Growth?

Register for the Marguerite Casey Foundation book club today to get the latest information about our upcoming events and a chance to have one of their book club featured titles sent directly to your door for free while supplies last. Join the MCF book club at caseygrants.org slash book club. That's C-A-S-E-Y-G-R-A-N-T-S dot org slash book club.

The CDC confirms a second bird flu case in a dairy worker in Michigan. Louisiana lawmakers vote to make abortion pills controlled substances. The only tribal medical school in the nation graduates its first class. This is America Dissected. I'm your host, Dr.

Abdul El-Sayed.

So you're saying trauma can unlock growth? Not to get downright existential with you all, but I think the central struggle of being human is the concept of agency. How much of what happens to us is in our control? How much is a function of our own doing versus divine decree or sheer dumb luck, however you choose to ascribe it? We had absolutely zero choice about the circumstances in which we came to this world, about what our genetic makeup would be, about, who our parents were, about the household we grew up in.

We like to take credit for our best skills, but so much of what defines us to others, how we look, how we sound, our cognitive abilities, our personality quirks, the substrate for those things were defined for us before we were ever born. But the semblance of control is so intriguing, the idea that with enough grit or resilience or willpower that we can change what is fundamental about us. And that sets up a brutal hierarchy. Those who are gifted with the things that society deems valuable, for whom it may have come, easily, assume that it was their work, rather than their provenance, that made them smarter, richer, better looking, thinner, whatever. And rather than gratitude, or, better yet, an honest effort to even the playing field, they blame others for failing to work hard enough.

This struggle over the bounds of our own agency is the root of so many of our deepest debates. What is fairness? Free will versus predestination, just to name a few. I wanted to start this episode on that note, because I think it's the best way to talk about a subject that complicates these already vexing questions even more. See, the things about us that are just part of our firmament, our basic biology and genetics, if you will, those are things that we may not love, but usually come to some sort of peace with.

But what about the things that happen to us, the things that we don't see coming, the stuff that shakes our fundamental sense of how the world works? That's trauma. And though we rightly try to build a world that exposes people to less of it, it still happens. And when it does, it can shake us to our core. Trauma has emerged as a central buzzword of the modern lexicon.

A quick Google Trends search shows that conversations about trauma really picked up in the mid-2010s, right around 2016.

. I have my thoughts. But as the word has emerged, it's also taken on expanded meaning. Where trauma had been rather tightly defined by experts in the DSM-III, which came out in 1980, to mean, quote, an event that is markedly distressing to almost anyone and involves a serious threat to life, the term has grown to encompass much more. The most recent DSM, which came out in 2013,, DSM-V, defines trauma as, quote, a physical or emotional response to one or more life-threatening or physically harmful circumstances or events.

But our modern vernacular has expanded trauma even further, and the word has gained power, largely because of its best-known consequence, which is post-traumatic stress disorder. PTSD is a well-described mental health disorder that occurs among some folks who are exposed to trauma. Its symptoms can include flashbacks, hyperarousal to certain stimuli, hyperreactivity, avoidance of potentially arousing stimuli that can trigger responses, and depression, anxiety, and difficulty sleeping. It's debilitating to those who experience it. But as awful as PTSD is, it's not the only response to trauma.

While trauma is always bad, it turns out that our response to it isn't uniform. In fact, some folks who experience trauma actually grow through the experience. Back in 2020, I was preparing to give a talk. This, of course, was the dreadful first year of the pandemic, a complex collective trauma. So I wanted to leave my listeners with something, anything at all, that could empower us through the experience.

And that's when I came across Professor Richard Tedeschi's pioneering work on post-traumatic growth. It's the notion that, after a traumatic experience that shatters our sense of the world and our place in it, wading through the disorder that arises can actually lead us to a more grounded, balanced perspective on the world. While it might violate everything we've ever heard about trauma, if you think about it, it's not as improbable as it may seem. So much of what we talk about when we think of, quote, resilience or anti-fragility or grit is the ability to metabolize adversity, the ability to make sense of that space between what is, in fact, in our control and what's not, the limit of our agency. I knew then that I really wanted to have him on the show to share more about what post-traumatic growth is, how it happens, and how we can cultivate the mindset of growth, hopefully without the trauma.

But if we must, then in the face of it. Here's my conversation with Professor Richard Tedeschi. Okay, can you introduce yourself with the tape?

Served on a number of amphibious landings in the Pacific, Purple Heart.

But I never remember him saying anything about the war. So I didn't really learn anything about that.

And then, I remember, years after he died, I was helping my uncle clean out his house.

And he had a bunch of letters that my father had written to him during World War II. He asked me, do you want these letters? I said, sure.

And so I have some letters he wrote. And then a fellow I know, a military man I know, asked me one time if I had my father's records. I said, no. He told me how to get these records, so I got those. And in those records, it was clear.

And from my uncle's report to me, it was clear that my father had PTSD.

And I think that that probably had something to do with the fact that he didn't want to talk about his years of service.

So I was kind of informed that way about my father's experience, but not directly through him.

And I was fortunate enough when I went to college, I didn't quite know what I wanted to do, but I had an idea about that, but I never read any psychology or didn't have any coursework or anything in high school, none of that. But when I went to college, the professors there, the faculty who were teaching those courses, were very good and really interesting and piqued my interest. And then, as I got further through college, some of them were very helpful in giving me opportunities to do research and, as an undergraduate, actually take graduate courses. So they were very generous with me. And so they really provided me with these kinds of opportunities, and I'm grateful for that.

So it's not so much a particular kind of event. It's the impact on people's thinking processes, and that creates a lot of emotional turmoil. And that's the key to what makes things traumatic. And so it's a different sort of way of thinking about it, rather than focus on the event itself, focus on what kind of impact it's had on the person. So events are potentially traumatic, but then we see what happens when they actually have their effects.

And as far as why this has become so commonplace concern in the sort of general public, I guess we could say, I think it's a recognition that there are so many people that are struggling with circumstances in life that have these kinds of impacts, and we're starting to recognize that these kinds of struggles are more commonplace than we've often thought. And trauma has then proceeded into thinking about all kinds of different events. But I can also say that it's probably in some ways overused, and people apply it to things that really aren't traumas in the way that I'm talking about it. Just like we overuse the word depression. People say they're depressed, and that's really not so true.

Maybe they're unhappy about something or have a down day or something. They say they're depressed, but that's a different use of the term than we think clinically. Probably the same for trauma. A lot of people might say something was traumatizing, and the way that I'm talking about it here is different from how it's sometimes used in that sort of general vernacular, like you say.

it matters here. And I think, to your point about the use of it, when we start to define noxious stimuli that still fit within our understanding of the world as trauma, it starts to shake that sort of sense of what is actually trauma. And I want to dig a little bit more into that. To begin with, as we continue to explore this idea, how common do we understand trauma to be in the general population?

I remember with a psychotherapy client of mine who was dying of cancer,

and I made a stupid assumption, I suppose, but not an unusual one, I think, that dying of cancer might be the hardest thing you'd have to go through.

And he said, actually, no, this isn't the hardest thing. My divorce was a lot harder than this cancer. And I said, well, tell me, explain how that is. And he said, well, you know, I always figured I was going to die. We all die.

So this isn't surprising that I'm going to die. This just happens to be the particular way that's going to happen for me. Now, my divorce was a shock. I never thought that I'd lose my family and I'd go through something like that. That really was a shock.

I never anticipated that. I didn't think I was going to have that happen in my life. Dying, yeah, that makes sense. The divorce, didn't. So there you have it.

You know, you can't tell. You have to be inside the other person's life in a way to really understand what trauma is for a person.

I want to ask, right, because to talk about post-traumatic growth, you almost have to do it in contraposition to the thing we usually talk about when we talk about trauma, which is post-traumatic stress or post-traumatic stress disorder. And you talked about it with respect to your father's experience after World War II. What is post-traumatic stress disorder and how do we think about it? How does it arise?

Now we're going to talk about the diagnostic criteria for it, which I have some trouble with, to tell you the truth.

So people are depressed and anxious. They have negative thoughts about themselves and the world. They're more reactive to stimuli. So they have a startle response. They have intrusions.

They have thoughts that they can't stop, or nightmares and things like that they're out of control of and they're thinking. So these are the different criteria that define post-traumatic stress disorder. And so it's something that's not produced by situations that are different from post-traumatic growth. And this is where these things arise out of the same fertile ground, I guess we could say. All those negative experiences that I just mentioned come out of events that are shocking to people.

And the way I'm talking about it is. they're shocking in terms of making it hard to predict and control and understand the world as it is. And you mentioned a moment ago, Abdullah, you mentioned the narrative that people have. And that's another way of thinking about it is the life narrative is disrupted. People think that life is going to go on a certain way and then suddenly it takes a turn for the worse.

It's like, I can't believe this happened to me. So there's that disruption in a life narrative. So traumas that are the beginnings of post-traumatic growth are often the beginnings of post-traumatic stress disorder as well. It all comes from the same kind of experience, the same place.

Can you tell us a little bit about what it is and how it operates?

And a metaphor that my colleague Lawrence Calhoun and I, when we developed this concept, that we started using from the start, was a metaphor of an earthquake. So the core belief disruption is like a psychological earthquake. And what earthquakes do to a city is they bring down the infrastructure. So we have a psychological infrastructure, too. And just like a city's water system, electric grid, buildings, roads, all that stuff gets shattered in an earthquake, our psychological infrastructure is shattered, too.

And we've got to rebuild it. The city's got to rebuild. And in rebuilding, hopefully they rebuild something that's a better version of the city, something that's stronger, more resilient. So resilience comes out of the rebuilding or reconstruction experience. But more than that, wisdom.

Psychologically, we become wiser about life and how to live it, and the best things for us to be doing in our lives. So that reconstruction process results in these growth outcomes.

It's just kind of rolling forward. And then you have the stress, which violates what you thought was going to happen, which really robs you of your control. And then what happens next, if you're able to, as you said, kind of rebuild your internal infrastructure, your city, you prove to yourself that you can actually change the course of your life. And I can imagine that that's an extremely empowering experience, as opposed to that stress that took everything, that changed what you thought was going to happen, that robbed you of something that you thought was coming in your future. And I think, you know, if you've sort of come through a trauma like this, and you've proven to yourself that you can rebuild, you become then more fortified against the next one, because you just say, well, if that happens again, I'll just rebuild again.

Because I can do that thing. And I'm wondering how that shows up in the choices that people make around what they do in their life, either related to the trauma that happened or maybe, independent of the trauma that happened, around the decisions that they make, the risks that they take, the willingness to sort of exert a level of agency in their lives.

And very often after traumatic events, people may start to think about control in a different way, define it differently, have a different understanding of what control means.

So the meaning of things often starts to change for people.

You know, having control over my life, what does that actually mean? And sometimes there's a paradox that people start to recognize about such things, where they feel more in control by giving up the attempt to control everything. So the understandings of living life well, or living life in a fulfilling fashion, can start to change because people have a change in this perspective.

So one of the, I mean, the major paradox of PTG, post-traumatic growth, is out of loss comes gain. I mean, loss sounds like a horrible thing and who wants to lose? But, you know, another part of loss is grief.

So people grieve, but then sometimes they find out that in their grieving, they become more grateful for what they still might have, even though they've lost something of great value or relationship or person. They become more grateful because of the grief. So another kind of paradox. So there's all these sorts of paradoxes that people have. And, you know, the one of, you know, feeling more in control when you're less intent on exerting control is another one.

And that shows up in a lot of places in life that start to become clearer and might not have considered before.

So, you know, a lot of times when we try to make things happen a certain way, we're working against ourselves and we have to relax and let things happen. And then it's better.

Sex is a good example of that. If you try to make sex happen and, you know, it doesn't work very well, but you have to relax and let it be and be enjoying it. And then it's okay. So, I mean, there's all sorts of examples of this in life. A lot of athletic examples, too, you know, where people try too hard and then their performance suffers for it.

And, you know, all sorts of ways. we make ourselves anxious about things because we're trying too hard or trying to control something. And then it doesn't go very well because our anxiety is too high.

We try to control relationships with other people because we want them so badly. And in the process, we annoy the heck out of them and they don't want to be with us and they leave us. So there's another one of these paradoxes that we have to learn about. So, you see, there's all this learning that can start to happen in the aftermath of trauma, because we're forced to reconsider how we've been doing things and how we're going to do it in the future. So there's an opportunity there for us.

And it's such an empowering concept. Why do you feel like, when we think about trauma, we're less focused on the potential positives and the opportunity in it and more focused on the loss and the negative of it?

Some people have misunderstood post-traumatic growth because they think that I might be suggesting that trauma is a good thing. And that's certainly not the case. Nobody wants it.

But it attracts our attention because it is so horrific. These things are so sad or frightening. And so, of course, we're going to get our attention pulled in that direction. And then the other part of it, of course, is when things are that bad, they're not easily healed. They're not easily managed.

It's really difficult.

So, of course, we're going to pay attention to something like that. that is a problem that's hard to solve.

So we're going to pay attention to that.

It creates chaos in our lives. We don't like that. So, of course, we're going to pay attention. So that's all well and good. And, of course, as professionals who are treating people with trauma, we're going to pay attention to their misery and their heartache and their suffering.

And we want to relieve it. So we're going to be focused on trauma and relieving all that experience and those symptoms and all of that stuff. So that's natural, of course, as well. All of that's natural.

But, strangely enough, the common experience that we have in the aftermath of so much trauma, if we pay attention to people's stories, if we look over a long enough period of time, we also see these growth outcomes, too. But we just have to stay with it long enough to see that part of the story.

They're suffering. And they're in a process of growth at the same time. In the early stages of this, it looks like just the suffering and the misery. But if you track this long enough, you start to see it shift, so that people can notice some kinds of changes that they value. So that's something I want to mention.

Now, what are the predictors of this and what can people do? One of the most important things that people can do is to find an expert companion through this process. So, instead of emphasizing so much that certain kind of people are more likely to experience post-traumatic growth, I like to emphasize the kinds of circumstances that could help people move towards post-traumatic growth. And those circumstances are interpersonal.

Having what we have called—and I say we, referring to the people that I work with, not just that I'm king or something—what we call expert companionship is really important. And that means a person or persons who are willing to hear your story and notice what's valuable in your experience and in you, encourage you to be open about that experience, help you find ways to regulate your emotions that are making that experience so difficult,

and to see a story going forward in your life that carries possibility and makes use of your capabilities and strengths and maybe what you're learning in this process. A person who can be with you through all of that, a companion with you through all of that, is very useful. Not a person who gives you a lot of advice or tells you what to do or thinks that they have a formula or thinks they know you better than you know yourself, but a person who is joining with you in going through this perhaps lengthy process and is someone who holds out hope for you and appreciates you and appreciates how hard the process is. That kind of expert at companionship, the expert at being that sort of person who you can count on in these times, that's a crucial part of the post-traumatic growth process, that interpersonal part.

And I want to ask, how impactful has that been on our ability to process trauma? I feel like part of what's coming out of this conversation is that so much of the reason we focus on trauma is not just because we live in traumatic times and also are exposed to so much information that generations past didn't get in the rawest form, but also because those same methods that are giving us constant exposure to what's traumatizing in the world are also taking us away from each other. And I want to ask you, as you think about your career, you've practiced for some time, how have trends in the ability to unlock post-traumatic growth changed with these changing means of conversations, changing units in which we engage?

So just what we're doing here now, like, Abdul, I'm not even sure where you are in the world right now. But we're not in the same room, and we're having this conversation. We know that. So we have this connection that we couldn't have had decades ago. So we've got those kinds of possibilities, connecting with people in all sorts of places and learning from each other and having those kinds of companionships that wouldn't have been possible before.

So there's that. But then, of course, given that we've become so dependent and reliant on these electronic means, and we kind of hunker down, looking at our phones in every place that we go, rather than looking at other people or talking to them, creates this disconnection. So, you know, it's kind of a paradox. There's good and bad in the developments this way. So I guess we have to sometimes relearn how to be personally connected.

And it's kind of an unfortunate thing that sometimes traumas are. what force that relearning.

But that's part of post-traumatic growth, too. There's these different elements of post-traumatic growth that we've talked about. One of them is strengthening of your relationships, where you feel more connected, more empathic, more compassionate, perhaps because you've experienced expert companionship, because someone's come into your aid, or because you've had to find some people to be connected to.

So there's that part of it, too.

The pandemic isolated us from one another as we were afraid to have social contact, right? We need to do social distancing. Remember all that? Social distancing. Keep your distance.

I mean, that's really unfortunate. That just plays havoc with social fabric and our interpersonal relationships, our ability to make new connections with people, all that scary stuff. So that was unfortunate. But of course, it created more of what we're doing here.

We're social distancing, but we're connecting this way.

So people started to do more of this. You know, I never thought, as a psychotherapist, I would ever do virtual therapy and video therapy and stuff like that. Before the pandemic, I didn't do any. Zero. Never did.

And I thought that's not a very good way to do this. But of course, in the pandemic, I had to switch over to doing that entirely. And I did. And now most of my practice is video. And, you know, now I'm licensed in all kinds of different states, and I see people across the country that I never would have talked to otherwise.

So it's worked out positively in some ways that I can work with people I would not have been able to work with before.

And I see it in the way that you answer questions, which I appreciate.

And thinking dialectically means recognizing the flip sides to things, and that both those things are true at the same time.

And that's a way of thinking that allows people to consider the possibilities that otherwise would be hidden from them.

And I think so much of our experience of that is, I wanted the other one. And it's a unique thing, and we understand as adults that we can't really go back and get the other one. But that ability to sort of let go of what you wanted in the other one, to find what you can want in this one, I think, is so much of what you're really pointing us to here, which I appreciate. I want to ask one more question, because you've really done a lot of work around the well-being of veterans. And your foundation, Boulder Crest Foundation, is really focused on providing a level of service to folks who, for a lot of reasons, have challenges obtaining that.

Can you talk a little bit about that work and why it's so important to you?

But they're all human beings, and these things can really take a toll. So in our work at Boulder Crest, we have very innovative programs that help people see the possibilities for growth in these experiences. And one of the things that we do that is so important is we emphasize this expert companionship that I'm talking about by having all our programs be peer-driven. So they're peer-to-peer programs. So I help develop them.

I help do the research on evaluating them and do training and all that. But I don't deliver any of the programs. Those are all delivered by veterans themselves, first responders themselves.

We help people learn how to help their fellow first responders and veterans, because they're the people that get it. They know it. They've lived it. They've been there. And they're the ones that are going to be best able to connect, form those kinds of connections, and foster post-traumatic growth in these ways.

And the other thing about Boulder Crest I think is so important is that all our programs are free. So the founder of Boulder Crest, Ken Falk, who's a Navy veteran, has done an amazing job of getting funding for our work and building this network of places. people can go to experience these programs. So they're free. And then all our first responder work is done in a fashion where we go to the police departments or the fire departments or emergency medical departments and help them figure out how to get grants or funding or whatnot, so that all their employees can benefit from all of this.

So we try to make it very democratic, available, accessible to all these people who really need this. So it's been a very fulfilling place to work for the past 10 years.

And it's amazing what's going to be happening in the future. It's remarkable how, just by word of mouth, this takes off. So, for example, in our first responder programs, we don't advertise anything. We don't try to get anyone. It's one police department tells another police department, that kind of thing.

And it goes across the country. All these people talk to one another. And that's how it happens.

I really appreciate you sharing the work that you and your colleagues have done on this and joining us today to share some more of your experience and your insight. Thank you so much.

S. has been infected with the bird flu.

But in some respects, this news helps to define the boundaries of what we're dealing with a little better. Here's the facts. The individual was a dairy worker who had close contact with infected animals. Much like the first case, the worker's symptoms were mild and largely limited to conjunctivitis, or inflammation of the eye. He's since recovered.

Bad news first. A second case is bad. Full stop. Particularly considering the fact that, despite a lot of effort, H5N1 continues to spread in cattle. But here's the good news.

Yeah, good news. The fact that the second case looks a lot like the first, that it was limited to irritation of the eye and not the more fulminant throat and lung infection that we usually think of when we talk about flu, is somewhat reassuring. Though two cases do not a pattern make, this does suggest that this virus' ability to infect humans may be limited to a very specific tissue. In this case, the eye. There is, of course, nothing certain about that.

And we have a lot more to learn. There's also a second piece of good news. It took two months for there to be a second case, and it was picked up quickly and efficiently. That means that our public health efforts to protect dairy workers and to monitor for signs that this virus could spread into humans, well, they're working. Toward that end, other news out of the CDC this week was, we'll call it, unsurprising.

Usually, state and local health departments keep more meticulous records of influenza infections in the fall, winter, and spring months, considering that flu is usually seasonal. This year, the CDC is requesting that departments maintain a fulsome approach through the summer to track infections. Maintaining flu surveillance seems like an obvious thing to do when, well, we're worried about the potential for human H5N1 bird flu transmission. I think this is critical, of course. What I think is even more promising is the emerging ability to track wastewater, which gives us a much clearer picture of exactly how much circulation there might be.

Rather than having to rely on people who may never report their illness, wastewater offers us an objective, real-time picture of the circulation of infectious agents in a given place. As we've discussed before, communities with high H5N1 transmission in cattle have also seen increases of influenza shed in wastewater. Though we can't really differentiate between human and cattle H5N1, and if it ever does gain the capacity to jump between humans, it's likely to happen in a place with high animal infection in the first place, this is one of the first post-COVID uses of what has emerged as a really promising public health surveillance approach. In today's installment of Crazy Shit Conservative States Will Do to Criminalize Bodily Autonomy, there's this. Louisiana's governor signing a controversial bill reclassifying two abortion pills as controlled and dangerous substances.

It will make it illegal in the state, and that's punishable by up to 10 years in prison. Medication abortions have been literally the last gasp of abortion access in states that have banned abortions, like Louisiana, where there is a near-total abortion ban on the books. And now, this law renders these medications, Schedule IV, akin to substances with abuse potential like Xanax or Valium. The law would make it so that being caught with the abortion medications mifepristone or misoprostol without a prescription could lead to a 10-year jail sentence. I want folks to understand where this is headed.

Classifying a medication designed to control birth as a controlled substance sets a pretty clear standard, and it leaves a short walk from here to trying to control access to, say, oral contraceptives. There's also a clear ratcheting effect we're seeing. Once one state passes anti-abortion legislation, it creates a bar that other conservative states feel they need to clear. I fear this won't be the last. we're hearing about the attempt to render abortion medications controlled substances.

Finally, let's end on a positive note.

Only 0.

3 percent of all physicians in America identify as Native, and too often, physicians who work in the Indian Health Service are only there for short stints, burnt out by the limited funding and pressing need. Investing in Native healthcare professionals is a critical part of the answer. Now, how about a school of public health, huh? That's it for today. Thank you so much to Professor Richard Tedeschi for joining us.

And if you have guest recommendations for the show, share them with us at info at incisionmedia.

co. On your way out, don't forget to rate and review our show. It really does go a long way. America Dissected is also on YouTube. Follow us on YouTube at Abdul El-Sayed.

That's also where you can follow me on IG, TikTok, and Twitter. Remember, no dash. Finally, to check out more of my content and subscribe to our newsletter, head on over to incisionmedia.co. Links to our sponsors are available in the show notes. I really do hope you'll check them out and show them some love.

They make this show possible every single week.

America Dissected is a product of Incision Media. Our producer is Andy Gardner-Bernstein. Video editing by Nare Malconian. Our theme song is by Taka Sazawa and Alex Uguiera. Sales and marketing by Joel Fowler and Nick Freeman at Big Little Media.

Our executive producers are Taran Shurpstra and me, Dr. Abdul El-Sayed, your host. Thanks for listening.

This show is for general information and entertainment purposes only. It is not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human, and Veteran Services.