Trauma Recovery: Between Resilience and Permanent Damage by @AprylPooley

Please welcome my guest, neuroscientist, author (Fortitude), and survivor Apryl Pooley! 

Why Are Some People Resilient To Trauma?

In my field of PTSD research, the word resilience comes up a lot. Why are some people resilient to trauma while others develop PTSD and other lasting consequences? That’s the million-dollar question so many scientists are trying to figure out by looking at genetic differences between people, hormonal differences, and structural and functional differences in the brain. The answer may help people recover from trauma.

But I don’t think developing PTSD necessarily represents a lack of resilience. It’s a normal response to an abnormal situation that allows one to survive a life-threatening event. Thinking about resilience in terms of recovery from trauma, not in terms of how one responds to trauma, may promote a more useful approach to research and to healing.

PTSD symptoms like hyper-vigilance and dissociation can be necessary for surviving traumatic situations, and the vast majority of people (>90%) who experience trauma show symptoms that resemble PTSD immediately afterwards—but for many people, they are able to recover relatively quickly and return to healthy functioning.

But what about the others? Why don’t they recover? Research indicates that there is a genetic component to the trauma response (people whose parents had PTSD are more likely to develop PTSD themselves) and a hormonal component (women are twice as likely to develop PTSD as men). Are some people biologically doomed to never recover from trauma?

That may depend on how we define “recovery” and “resilience.”

Merriam-Webster defines psychological resilience as “an ability to recover from or adjust easily to misfortune or change.” I would expand this definition to say “an ability to adapt one’s functioning in the face of adversity—and to return to healthy functioning in the absence of adversity.”

PTSD-like symptoms are helpful in the face of trauma, but once you reach a place of safety, they are no longer adaptive and interfere with relationships and healthy functioning. Resilience is being able to focus on survival instincts when needed, but also experiencing vulnerability when safe. But the problem is, that for many people, the trauma never stops and safety is never found.

In a society that blames victims of sexual assault for “asking for it,” ridicules people who stay in abusive relationships, accuses veterans of “just looking for benefits,” ostracizes those who speak out about their trauma, and embraces retaliatory reactions to someone showing any signs of struggle, the place of safety required to really heal from trauma can be hard to find.

Trauma and PTSD

The people who don’t develop PTSD after trauma are most likely those who had healthy social support surrounding the trauma. Lack of social support is the number one risk factor for developing PTSD—more than any contributions made by genes, other biological factors, or the nature of the trauma itself. So I speculate that in order to help people recover from trauma, we have to create a society that allows people to talk about their trauma, that validates the range of reactions that come along with trauma instead of questioning them, that focuses on helping people recover rather than finding ways to blame them, and above all, really believing that victims of trauma deserve to be healthy functioning human beings, not outcasts.

I gave a talk at an advocacy conference earlier this year about what people can do to promote the recovery of sexual assault victims. I discussed how trauma affects the brain, active listening techniques, empathy, and I mentioned that victims are not permanently damaged, worthless, or part of an “other” category of human beings, and treating them as such (even though they might believe that about themselves) does nothing but hinder their healing.

Afterward, a renowned psychology professor and former vice-president of one of the largest universities in the country came up to me and said, “Do you really believe all that about not being permanently damaged?” I replied, “Yes, I absolutely do.” He made a point to tell me that he’s been counseling people for decades and that some people have been abused so badly that they will never recover. I agreed that after trauma, a person will never be the same again—there are parts of them that are forever changed—but I really believe that in the sense that one can recover their self-worth and value as a human being, nobody is permanently damaged. He replied with, “You need to tone it down a bit,” and I walked away before I said something silly like, “You need to tone your face down a bit.”

How Do We Define Recovery or Damage from Trauma?

This got me thinking: how do we define “recovery” or “damage?” I know how trauma affects the brain, I’ve seen the brain cells shrinking away and the electrical activity of brain circuits changing. I know how violence and abuse can leave physical and emotional scars that never go away. But still, I do not believe anyone is permanently damaged, because no matter what happens, they are still worthy of love, respect, and support and the only reason they would be permanently damaged is if nobody around them gave them that. Which unfortunately does happen.

On the flip side of this interaction, a professor who designed a popular human sexuality course focused a portion of a lecture on how childhood sexual abuse doesn’t result in any lasting damage in many children who experience it. This particular assertion was really a misrepresentation of research and of reality, so I crafted a detailed review of what the research actually shows and why some studies found that child sex abuse didn’t cause harm (because they defined “harm” in a very narrow manner that excluded, among other things, PTSD—the most common outcome of sexual abuse). To my rebuttal, the professor simply wrote, “Politically it is powerful and emotionally charging to declare that everyone who was sexually molested as a child was damaged forever but I’m not interested in delivering political messages.”

Maybe his thought was that if we tell people they are damaged and can’t recover, then they won’t. But this whole interaction left me wondering what is wrong with me that I was one of the ones who suffered long-term consequences as a result of my abuse?

I found myself teetering on a delicate balance between not wanting to be “damaged goods” and wanting my pain to be acknowledged for what it is, a consequence of abuse and an environment not conducive to healing, not of a weakness or lack of resilience on my part. (To be fair, I don’t think the professor was suggesting that people who suffer long-term consequences as a result of abuse are weaker or did something wrong, compared to those who recovered, but that’s just the way it felt to me at the time.)

So, What Does All This Mean?

It means that some people may never recover from trauma but it’s not because they didn’t try hard enough or couldn’t biologically recover—it’s because we sadly couldn’t find a way to help them quickly enough. It means that just because some people don’t develop long-term traumatic stress responses, doesn’t mean that those who did are “less than” in any way. It means that we need to consider that if someone isn’t recovering from trauma in the way we think they should, maybe it’s because we aren’t giving them what they need to heal—or maybe we need to re-define our perception of recovery. We need to consider that some people will never recover in the way we think they should, but that doesn’t mean they are permanently damaged—it’s up to them to determine what recovery means to them and us (as their fellow human beings) to help them get there.

Everybody responds differently to trauma. Recovery looks different in everybody. Survivors of trauma will most likely struggle from time to time for the rest of their life, but that doesn’t diminish their worth as a person or brand them as permanently damaged. In fact, in spite of some of the lasting consequences of trauma, many survivors experience what is called post-traumatic growth and find a renewed sense of purpose and vitality that they may have never had otherwise. At the very least, there is no reason to believe that we should ever give up on helping a trauma survivor lead the life the want to live.

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Apryl Pooley is a scientist by training, a writer by practice, and an artist by nature who strives to make sense of the world around her and help others do the same. She is a neuroscientist at Michigan State University where she researches the effects of traumatic stress on the brain and is author of Fortitude: A PTSD Memoir. Apryl lives in Michigan with her beautiful wife and two rambunctious dogs, Lady and Bean. Read more about her at http://www.aprylpooley.com. You can also find Apryl on Twitter, Facebook, and LinkedIn.

 

 

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