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What Doesn't Kill Us

The New Psychology of Posttraumatic Growth

by Stephen Joseph Ph.D.

|Basic Books©2013·288 pages

Stephen Joseph is one of the world’s leading researchers on the science of posttraumatic growth. He is also a professor and therapist. He started his career studying posttraumatic stress. In the process, he saw that many people experienced significant growth as a result of the stress they endured--at which point, he started developing his ideas on posttraumatic growth. Fast-forward a few decades and here we are. the title is a play on Nietzsche’s famous dictum: “What doesn’t kill me makes me stronger.” While the sub-title perfectly captures the focus of the book: “The New Psychology of Posttraumatic Growth.” Big Ideas we explore include: Eudaimonic Treadmills (note: there aren't any!), posttraumatic growth (and how to use stress as the engine for growth), the shattered vase (taking the pieces and making an antifragile mosaic), harvesting hope (the 1 + 2 + 3s for trauma survivors).


Big Ideas

“In short, while the adoption of PTSD as a diagnostic category has been beneficial in terms of increasing access to psychological therapies for those who need them, it has been detrimental in these three ways: in taking responsibility away from people, in creating a culture of expectation, and ignoring the personal growth that often arises following trauma.

The aim of this book is to correct the imbalance—to show that trauma can have both negative and positive implications, and that the negative and positive go hand in hand. I challenge the trauma industry by offering a new perspective: namely, that posttraumatic stress is a natural and normal process of adaptation to adversity that marks the beginning of a transformative journey. Recovery from trauma consists of finding new meaning, creating new webs of understanding, and finding reparative methods centered on the sharing of memories. Viewed in this light, posttraumatic stress can be understood as a search for meaning in which the drive to revisit, remember, and think about the trauma is a normal urge to make sense of a shocking experience, to grasp new realities and incorporate them into one’s own life story. At the heart of this book is the idea that posttraumatic stress is the engine of transformation—of a process known as posttraumatic growth. …

Drawing on the wisdom of the ancient philosophers, the insights of existential and evolutionary psychologists, and the optimism of modern positive psychology, I present the new psychology of adversity—a fresh, inspiring, and humanizing perspective on how to manage life and its inevitable challenges.”

~ Stephen Joseph from What Doesn’t Kill Us

I got this book after I saw Stephen Joseph’s testimonial in Positive Psychology and the Body by Kate Hefferon. It was another one of those titles/sub-title combos that just jumped out at me.

Of course, the title is a play on Nietzsche’s famous dictum:What doesn’t kill me makes me stronger.While the sub-title perfectly captures the focus of the book: “The New Psychology of Posttraumatic Growth.” (Get a copy of the book here.)

Stephen Joseph is one of the world’s leading researchers on the science of posttraumatic growth. He is also a professor and therapist.

He started his career studying posttraumatic stress. In the process, he saw that many people experienced significant growth as a result of the stress they endured. At which point, he started developing his ideas on posttraumatic growth. Fast-forward a few decades and here we are.

btw: Martin Seligman followed a similar track. He started out studying learned helplessness, discovered that some people, no matter how much stress they endured, maintained optimism and then shifted his research to Learned Optimism to figure out what made THOSE people tick.

The book is packed with scientific wisdom on how to use stress as an engine for growth and I’m excited to share some of my favorite Big Ideas so let’s jump straight in!

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What doesn’t kill me makes me stronger.
Friedrich Nietzsche
In one study published in 2010, investigators examined the results of a survey conducted by 5,630 people when they were fifty-five to fifty-six years of age and, again, when they were sixty-five to sixty-six. Those who scored higher on a measure of eudaimonic well-being at the younger age were over seven times less likely to be depressed ten years later than those whose scores were lower.
Stephen Joseph Ph.D.
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There are no Eudaimonic Treadmills

“On the other hand, there is no eudaimonic treadmill. Striving for eudaimonic well-being may not lead to immediate pleasure, but it is likely that, in the longer term, satisfaction of the need for eudaimonic well-being will lead to hedonic well-being as a by-product. Thus the pursuit of happiness as a goal in itself is doomed to failure; happiness can be achieved only as a by-product of other activities. By the same token, aiming for pleasure without thinking about meaning is less likely to lead to fulfillment than aiming for meaning to begin with: Meaning does not follow pleasure, whereas pleasure does follow meaning. Viktor Frankl recognized this phenomenon when he wrote: ‘Happiness cannot be pursued; it must ensue. One must have a reason to be happy. Once the reason is found, however, one becomes happy automatically.’

The philosopher John Stuart Mill believed that the only people who are happy are those who ‘have their minds fixed on some object other than their own happiness; on the happiness of others, on the improvement of mankind, even on some art or pursuit, followed not as a means, but as itself an ideal end.’ This is a profound point; it challenges us to reflect on what our minds are fixed upon. Those who can honestly say they couldn’t live more fully are few and far between. Most of us, if we are honest with ourselves, know that we don’t live life as wisely, as responsibly, as compassionately, and as maturely as we could.

Trauma is a wake-up call for us to reflect on what our minds are fixed upon.”

That’s from Chapter 1 called The Flipside of Trauma in which Stephen gives us a quick overview of the history of the field of psychology and juxtaposes hedonic and eudaimonic happiness.

It’s also from Part I of the book which is called “Everything Changes”—which points to the way in which trauma can serve as an engine for growth.

When we face trauma, Stephen tells us, our old way of seeing the world is often shattered. (We’ll talk about the metaphor of “the shattered vase” in more detail in a moment.)

Oftentimes, “trauma is a wake-up call for us to reflect on what our minds are fixed upon.”

And, that wake-up call often leads to a shift from an hedonic (pleasure and approval seeking) way of living to a more eudaimonic (intrinsically meaningful) way of living.

And, THAT’s how trauma can lead to growth and the high-level overview of how we can go from posttraumatic stress to posttraumatic growth.

Stepping back to the juxtaposition between hedonic and eudaimonic pursuits of well-being…

Of course, we talk about this ALL the time. I’m constantly trying to shift our orientation from our culture’s hedonic orientation to the eudaimonic approach that ancient wisdom and modern science says leads to a true sense of well-being.

In fact, that Viktor Frankl quote is one of our go-to gems. We just talked about it (again!) in our Notes on Ward Farnsworth’s great book The Practicing Stoic where he says almost EXACTLY the same thing as Stephen while reflecting on the Stoic approach to well-being.

Here’s how he puts it:Stoics regard virtue as sufficient to produce happiness on all occasions, and also as necessary for it. The happiness centrally valued by the Stoic is eudaimonia, or well-being—the good life rather than the good mood. But the Stoic believes that virtue gives rise to joy and to peace of mind as well. Virtue produces these good consequences as side effects. The primary mission of the Stoics, in other words, is to be helpful to others and serve the greater good, and they don’t do this to make themselves happy. They do it because it is the right and natural way to live. But doing it in that spirit, as it turns out, makes them happy.”

Finally, we need to shine a spotlight on the fact that there is no “eudaimonic treadmill.”

As we’ve discussed, we adapt to all the “things” we get in our lives. That shiny new car isn’t so shiny a few months after we get it. Same thing with the new phone or TV or whatever.

Sonja Lyubomirksy is one of the world’s leading researchers on the subject of hedonic adaptation. In The Myths of Happiness she tells us: “Indeed, it turns out that we are prone to take for granted pretty much everything positive that happens to us. When we move into a beautiful new loft with a grand view, when we partake of plastic surgery, when we purchase a fancy new automobile or nth-generation smartphone, when we earn the corner office and a raise at work, when we become immersed in a new hobby, and even when we wed, we obtain an immediate boost of happiness from the improved situation; but the thrill only lasts for a short time. Over the coming days, weeks, and months, we find our expectations ramping upward and we begin taking our new improved circumstances for granted. We are left with ‘felicific stagnation.'”

So… We adapt to the hedonic pleasures in our lives. It’s like we’re on a treadmill. Moving faster and faster but not getting any further in our pursuit of true happiness.

But… The exciting news: THERE IS NO EUDAIMONIC TREADMILL. You know what happens when we joyfully commit to using everything as fuel for our growth while living with more Wisdom + Self-Mastery + Courage + Love + Hope + Gratitude + Curiosity + Zest?

We actually get happier. (Laughing.)

Oh! And in the context of trauma, we KNOW that life isn’t supposed to be one long ride on the unicorn of bliss so we’re more prepared to alchemize life’s inevitable challenges into opportunities to get back up, dust ourselves off, practice our philosophy and GROW.

Posttraumatic Growth

“Many survivors of trauma have experiences that haunt them for the rest of their lives, experiences they can never forget. They may struggle for many years with considerable psychological pain. The new psychology of posttraumatic growth does not deny this fact but, rather, simply recognizes that there is another side to the coin—that in the midst of great psychological pain there can also be a new recognition of one’s personal qualities and a deeper and more satisfying connection to others.

Three existential themes are at the core of posttraumatic growth. The first is the recognition that life is uncertain and that things change. This amounts to a tolerance of uncertainty that, in turn, reflects the ability to embrace it as a fundamental tenet of human existence. The second is psychological mindfulness, which reflects self-awareness and an understanding of how one’s thoughts, emotions, and behaviors are related to each other as well as a flexible attitude toward personal change. The third is acknowledgment of personal agency, which entails a sense of responsibility for the choices one makes in life and an awareness that choices have consequences.”

Posttraumatic growth.

Very importantly, it doesn’t deny the fact that trauma can create considerable psychological stress and pain.

Stephen tells us that the stress is like an “engine” for growth. The challenge is to make sure the engine doesn’t overheat.

As he says, But the diagnosis of PTSD does not describe a lifelong condition. It describes a set of problems that a person experiences at a specific point in his or her life—one that, when understood properly, can be the engine of posttraumatic growth. But this ‘engine’ can overheat. And, when it does, we need to stop and check the radiator, thermostat, pump, and antifreeze. The point I’m making metaphorically here is that, when confronted by adversity, we need to actively search for new emotion-regulation and self-soothing strategies so as to get ourselves running smoothly again.”

Like so many other things we’ve discussed, stress following trauma tends to follow an inverted U. Too little stress and there isn’t much growth. Too MUCH stress and we run the risk of posttraumatic stress disorder rather than posttraumatic growth. It’s right in the middle of that inverted U where we find the optimal level of stress that leads to growth.

Helping us understand this point theoretically and then implement the wisdom practically is, of course, what the book is all about.

Let’s take a quick look at the three existential themes at the core of posttraumatic growth.

First, we need to be willing to embrace the uncertainty that is inherently part of life. We run the risk of being unnecessarily fragile if we don’t allow room for the inevitable (!) obstacles and challenges and even traumas to be a part of a deeply meaningful life.

As Abraham Maslow once said about the self-actualizers he studied: the most important learning experiences . . . were tragedies, deaths, and trauma . . . which forced change in the life-outlook of the person and consequently in everything they did.”

Of course, that doesn’t mean that we are expected to enjoy those tragedies per se. But, when we allow for the presence of these tough times, we are more likely to find that optimal growth point.

Second, we need to practice psychological mindfulness. We want to cultivate self-awareness and notice of how our thoughts, emotions and behaviors are related to each other while we cultivate a flexible attitude toward change.

And, third, we need a sense of “agency”—a belief that we have what it takes to meet those inevitable challenges life throws our way.

One of my favorite books on the subject is called The Power of Agency. In our Notes we reflect on wisdom from Paul Napper and Anthony Rao who tell us: When we set out to write this book, we were struck by one thing above all. We observed the link between people’s general confidence and their ability to meet significant challenges. It seemed that those who were confident more of the time–that is, they were feeling more in charge of their lives and connected to their sense of agency–reported less anxiety and overwhelm, even when they were placed under highly challenging pressure situations.

For us, this was a eureka moment. It wasn’t just that less anxious people felt more confident but that confidence itself fended off anxiety and moments of overwhelm.

There is a biological parallel here. The sympathetic nervous system (which ignites fear and aggression when the brain perceives threat) and the parasympathetic nervous system (which returns the mind and body to calm and homeostasis) work in this seesaw way.

The breakthrough idea we had is this: instead of trying to lower people’s worry or anxiousness (as many practitioners now do with pills and therapies), we attack it from the other end. We encourage a confidence that can actually help keep stress away. And we do it by figuring out what empowers people, what gives people greater capacity to cope and adapt, and nurturing that. Our theory was that the resulting confidence would neutralize–or at least keep at bay–the negative emotions that so often drag people down.”

Here’s to practicing our tolerance of uncertainty, psychological mindfulness and sense of agency with the little things TODAY so we can more powerfully use stress as fuel for our growth for the rest of our lives.

The Shattered Vase

“At the core of this book is the theory of the shattered vase. Imagine that a treasured vase sits in a place of prominence in your house. One day, you accidentally knock it off its perch. It smashes. Sometimes when vases shatter, there is enough left intact to provide a base from which to start the process of reconstruction. In this case, however, only shards remain.

What do you do? Do you try to put the vase back together as it was, using glue and sticky tape? Do you collect the shards and drop them in the garbage, as the vase is a total loss? Or do you pick up the beautiful colored pieces and use them to make something new—such as a colorful mosaic?

When adversity strikes, people often feel that at least some part of them—their views of the world, their sense of themselves, their relationships—have been smashed. Those who try to put their lives back together exactly as they were remain fractured and vulnerable. But those who accept the breakage and build themselves anew become more resilient and open to new ways of living. The guiding principle that underscores this book is the belief, drawn from years of research and clinical practice, that focusing on, and understanding, and deliberately taking control of what we do in our thoughts and actions can enable us to move forward in life following adversity.”

Imagine that precious vase breaking.

It’s in so many pieces that it can’t be restored to its original state. :/

What do you do?

Stephen tells us that we can either try to tape it up and glue it back together (and remain forever fragile in the process) or we can recognize that we can never go back to where it was but… we CAN choose to use those beautiful pieces to make something new.

We can take those broken pieces of the vase and create a new mosaic—using the trauma as an engine to creating a new us.

How’s THAT for a new take on being ANTIfragile?

In this chapter, Stephen also talks about Jean Piaget’s ideas on how children learn about the world and draws parallels with how adults deal with trauma.

As he says: “Posttraumatic growth arises through the process of accommodation during which our assumptions are modified so that they fit the new information, rather than through the process of assimilation, which involves effort to make the new information fit our assumptions. I explain these processes using the theory of the shattered vase.”

He continues by saying: Trauma survivors who are caught up in their attempts to assimilate are characterized by increased defensiveness. Such people appear fragile. Like the shattered vase held together with sticky tape and glue, they are vulnerable to further trauma. Attempts at assimilation are like a game of tug-of-war against an elephant. We just cannot win.”

Harvesting Hope

“In order to thrive, people need to be able to nurture hope within themselves. Hope can be the spark for change. All psychotherapists know that, no matter what else is going on, if a client feels hopeless change will be difficult to come by. Research has shown that hopeful children, adolescents, and adults do better in school and athletics, are in better health, have better problem-solving skills, and are better adjusted psychologically. …

Don’t underestimate the power of hope. Hope is the secret ingredient of psychotherapy. If you posses hope that the future will bring new possibilities, you are already on the road to change.”

Hope.

IT’S THE SECRET INGREDIENT of not only psychotherapy but life—especially for those of us who have been or are going through trauma.

As we’ve discussed many times, Rick Snyder, the leading researcher on the science of hope tells us (in The Psychology of Hope) that there are three components to Hope: 1. We need to be able to see a better future for ourselves. 2. We need to believe we can make that better future a reality. And, 3. We need to be willing to create multiple pathways to get there.

Stephen walks us through the Big 3 of Hope for trauma survivors. He tells us:Indeed, being hopeful will allow you to summon enough mental energy to set your sights on a more optimistic future and identify pathways to achieve your goals.

Hope is fueled by three ways of thinking: goal setting, agency thinking, and pathways thinking.

  1. Goal setting. Trauma survivors need to have goals to aim for. There are significant goals such as obtaining one’s college degree, getting promoted at work, opening a new business, becoming a writer and so on. And there are mundane goals such as taking the car to the workshop for a yearly service or picking up the dry cleaning. Both kinds of goals fuel hope.
  2. Agency thinking. Trauma survivors need to have a sense of personal agency that gives them the motivation to move toward their goals. In short, they need to be able to both initiate and sustain the motivation.
  3. Pathways thinking. Trauma survivors need to know what pathways to take to get to their goals—the routes to take, what obstacles will be in the way, and how to get around these obstacles. They also need to develop specific strategies to reach their goals.”

So… One more time: Goal Setting + Agency thinking + Pathways thinking. If you feel so inspired, let’s cultivate some Hope RIGHT NOW. What’s ONE goal that inspires you? How’s your agency and how can you boost it? What’s your plan to achieve your goal and are you willing to adapt it?!

Here’s to using EVERYTHING as fuel for our antifragile growth. TODAY.

About the author

Stephen Joseph Ph.D.
Author

Stephen Joseph Ph.D.

Coaching Psychologist. Author, Think Like A Therapist. Six Life-Changing Insights for Leading a Good Life