Wednesday, January 21, 2009

A Forensic Look at Resilience

It is, alas, chiefly the evil emotions that are able to leave their photographs on surrounding scenes and objects. And whoever heard of a place haunted by a noble deed, or of beautiful and lovely ghosts revisiting the glimpses of the moon?

- Algernon H. Blackwood

Barn’s burnt down –
I can see the moon.

- Masahide (c. 1688 Samurai)[i]

In forensic psychiatry, one is heavily exposed to the more traumatic and tragic aspects of the human condition. Very often, the deed has been done and there is no turning back. The tragic has unfolded, and one is left only to perform a retrospective analysis of how it could have happened. On rare occasion, one might have a chance to witness a fellow human being demonstrate amazing resilience, and thereby achieve a triumph of human spirit. In this sense, a triumph of the human spirit is less about external outcomes than it is about an internal experience. In terms of mental health, resilience is the capacity to cope with stress, trauma and tragedy. In other words, to be resilient is to bend rather than break – and to be made somehow stronger and more flexible by the process. This sentiment was put most clearly over 2, 500 years ago by Lao Tzu in the Tao Te Ching: “The hard and inflexible are friends of death. The soft and yielding are friends of life.”[i]

Because of psychiatry’s necessary focus on the psychopathology and symptoms of trauma, it has been only recently that phenomena such as resilience have been studied. In the past, resilience was largely thought to occur only rarely, yet more recent research suggests that it is actually a common reaction among (healthy) adults exposed to serious trauma. Such resilience has been associated with an enduring capacity for positive emotion and generative experiences. Interestingly, there does not appear to be a single “resilient type” person. Instead, there are likely multiple and unexpected ways for survivors to be resilient.[ii] Indeed, resilient coping appears to be multifaceted, relying on many variables such as personality, affect regulation, coping, ego defenses, and various other protective factors.[iii]

As a result of large-scale tragedies over the last decade, the field of traumatology has grown rapidly. Posttraumatic Stress Disorder and depression were frequently observed in the aftermath of the September 11, 2001 attacks.[iv] Yet, the research on resilience following the 9-11 attacks remains relatively sparse. Available research does suggest that resilience may be more prevalent than previously believed. In a study examining the prevalence of resilience (defined as having either no PTSD symptoms or one symptom) among 2,752 New York area residents during the six months following the 9-11 terrorist attack, resilience was observed in over half (65.1%) of subjects.[v]

How do resilient people adapt and/or change their worldview to cope? The early research seems to suggest that after a major trauma, people's belief systems are impacted and may be modified. For example, they may experience changes to their view of the world “as they knew it,” their views on human nature, spirituality, and their own identity. Certainly, a grief and recovery process is a necessity, but many will still need to assimilate or accommodate new values.[vi] In essence, it appears as though the resilient survivor copes, in part, by developing new values and beliefs in order to achieve an emotional equipoise. Resilient persons may also find a way to turn the trauma into a “psychic reorganizer,” whereby the trauma becomes the stimulus and opportunity for positive change.

This November 18th will be the 30-year anniversary of the Jonestown tragedy which occurred deep in the jungle of Guyana on November 18, 1978. After California Congressman Leo Ryan visited Jonestown on a fact-finding mission, a volatile situation that had been building finally exploded. Ryan, three journalists and over 900 Jonestown residents were dead at the end of the day.[vii] The Jonestown (JT) tragedy has become woven into the fabric of our culture, and many misunderstandings and inaccuracies have become part of the tapestry. Perhaps the most visible parts of the tapestry are the cultural icons of “drinking the Kool Aid,” and the frightening charisma of Jim Jones. In reality, JT was not a mass suicide, but is more accurately described as a mass murder, followed by the suicides of Jim Jones and a few of his inner circle administrators. The JT mass murder-suicide was the result of a complex constellation of historical, cultural, and psychological factors that continue to haunt and perplex.

Another myth about JT was that everyone there was a “brain washed” cult member who had no will of his or her own. In reality, there were “a variety of reasons why people had joined the Peoples Temple. For some, it was a political statement; Jones offered the promise of a socialist society free of materialism and racism at a time when such a society was particularly attractive. For others, the Temple offered religion, structure, and discipline – a way to escape the violence of the ghetto and the dead end of alcohol and drugs.”[viii] Tim Carter joined the Peoples Temple in 1973. After surviving combat as a marine in the Vietnam War, he returned to America in search of greater meaning. He was driven by an internal need to become a part of something positive and greater than himself: “We shared a passionate idealism to make the world a better place…. We were a reflection of the economic and political and cultural realities and dynamics of the Civil Rights and Vietnam War generation”(p. 155).[ix]

In 2007, Mr. Carter graciously spent time with me to help me get a better understanding of the JT tragedy. He provided a true insider’s view, rich with contextual detail and heartbreaking tragedy. He gave a gripping and enlightening talk on a panel we did together at the 38th annual meeting of the American Academy of Psychiatry and the Law.[x] After meeting Mr. Carter, it became apparent to me that he was a supreme example of resilience and triumph of human spirit. I asked him to help me and other readers better understand how he was able to “bounce back” from a lifetime of trauma that would seem to have crushed most of us. His answers to my questions will be part of a forthcoming article on the subject.

[i] Stryk L: Zen Poetry: Let the Spring Breeze Enter. New York, NY: Grove Press, 1995.
[i] Lao Tzu: The Tao Te Ching. Translated by Brian Walker. New York, NY: St. Martin’s Press, 1995.
[ii] Bonanno G: Resilience in the Face of Potential Trauma. Current Directions in Psychological Science, 2005; 14(3): 135 - 138
[iii] Agaibi C, Wilson J: Trauma, PTSD and Resilience. Trauma, Violence, & Abuse, 2005; 6(3): 195-216.
[iv] Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982–987.[
[v] Bonanno G, Galea S, Bucciarelli A, Vlahov D: Psychological Resilience After Disaster: New York City in the Aftermath of the September 11th Terrorist Attack. Psychological Science, 2006; 17(3): 181-186
[vi] Jordan K: What We Learned From 9/11: A Terrorism Grief and Recovery Process Model. Brief Treatment and Crisis Intervention, 2005; 5(4):340-355.
[vii] Stephenson D: Dear People: Remembering Jonestown. Heyday Books: Berkley, Calif., 2005.
[viii] Krause C: Foreward. In: Layton, D: Seductive Poison: A Jonestown Survivor’s Story of Life and Death in the Peoples Temple. New York: Anchor Books, 1998.
[ix] Carter T: The Big Grey. In: Dear People: Remembering Jonestown (D. Stephenson, ed.). Heyday Books: Berkley, Calif., 2005.
[x] Knoll J, Carter T, Leonard C, Crowder J: Mass Murder & Mind Control: Understanding the Jonestown Tragedy. 38th annual meeting of the American Academy of Psychiatry and the Law; Miami, Florida, October 20, 2007.

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