Does What Doesn’t Kill Us Make Us Stronger?

Positive Psychology in the Combat Setting

By guest author Dr. Roger Pitman with Maria Rosasco

BOSTON 21 September 2009 - Maybe Nietzsche got it right when he claimed that personal growth can arise from struggling with and adapting to difficult life events. Reports of growth of character following adversity have been described in patients with debilitating illnesses and survivors of natural disasters. Numerous literary figures have been portrayed as emerging from harrowing circumstances with a transformed understanding of themselves and the world. However, not all stressed individuals experience post-traumatic growth. Recent research has focused on identifying psychological and biological characteristics that may predispose an individual to flourish, or founder, in the aftermath of a stressful event.

Dr. Martin Seligman, the director of the Positive Psychology Center at the University of Pennsylvania, believes he has developed a program to train people in mental resilience. In a 1999 address to the American Psychological Association, Seligman introduced the concept of positive psychology. He argued for reorienting the field of psychology away from its emphasis on the disease model of mental illness toward the positive qualities that allow individuals and communities to thrive. Seligman launched the modern conception of positive psychology and post-traumatic growth during a period of national prosperity, a time in which we could, in Seligman’s words, “look forward to more buying power, more education, more technology, and more choices than ever before.” Over a decade later, in a time of relative national distress, practical strategies for growth from adversity may be more necessary than ever before.

Impressed by this approach, the U.S. Army is now taking steps to employ positive psychology in its Comprehensive Soldier Fitness (CSF) program, a holistic training model designed to enhance mental resiliency. The curriculum is based on the cognitive-behavioral theories of depression of Aaron Beck, Albert Ellis, and Seligman and is centered on the idea that the way we feel about events mediates their effect on our emotions and behavior. Its aim is to train soldiers to convert adverse events into opportunities for growth, rather than sources of distress. Seligman believes that this program may be a cognitive vaccine that can protect against the tangible psychological tolls of war, including post-traumatic stress disorder (PTSD). In short, his goal is to train soldiers to be less psychologically vulnerable.

The CSF training program is promising precisely because it recognizes and attempts to deal with vulnerability. It incorporates into the combat ethos an acknowledgment that mental health is an essential component of fitness. However, increasing awareness of PTSD within and outside the military may be a double-edged sword. Although it helps lessen stigma and encourages individuals who are struggling to seek care, it may also create an expectation that experiencing stressful events such as combat will lead to emotional problems. CSF training may help to counteract this expectation by offering possibilities for coping with combat stress so as to increase the possibility of positive, rather than negative, outcomes.

The practical utility of training in positive psychology remains to be demonstrated in the military setting, and some officials remain skeptical of its efficacy. Some wonder why the military did not choose to test the effectiveness of this intervention in controlled studies with measurable post-combat outcomes before disseminating it. Others are concerned that positive psychology may represent a subtle whitewashing of the horrors of war. The kinds of gruesome combat events that are capable of causing PTSD, which include such things as witnessing a buddy cut in half by machine gun fire, represent formidable “psychological bullets.”  It may be naïve to assume that attempts to strengthen a combatant’s psychological skin against the penetration of such bullets into the mind will be any more effective than thickening the dermis with skin ointments would be in preventing the penetration of physical bullets into the body.

Some even suggest that creating an expectation of post-traumatic growth could be harmful, in that it could discourage soldiers from reporting mental health problems. By defining fitness in terms of growth, the CSF program may convey the implicit message that those who do not grow but rather decompensate following trauma are defective or weak-willed, thereby re-stigmatizing PTSD. Discussing a recent New York Times article about the “strength” of cancer patients, Tara Parker-Pope wrote, “…by focusing on strength and grace, we may deny people the opportunity to be weak, to crumble and to cry” - which may represent other paths to personal growth. Here, as in other health areas, the needs of the military and the needs of the individual may conflict.

While some evidence supports Seligman’s claim that PTG negatively correlates with PTSD, other research indicates the contrary. For example, a 2005 study by Morris and colleagues found that self-reported post-traumatic growth is positively correlated with self-reported PTSD symptoms. This association suggests that the positive and negative effects of trauma coexist, and that some negative effects may be necessary in order to cognitively process an event in a beneficial way. These findings support other research suggesting that recovery following a traumatic event involves the inseparable processes of growth and pain. Ultimately, while a pathogenic approach to post-traumatic outcomes would benefit from incorporating elements of salutogenic theory, these considerations suggest that an exclusive emphasis on post-traumatic growth may not positively affect clinical outcomes.

Even if the CSF program proves to be incompletely effective, it makes a laudable effort to supplement reactive therapy of psychological trauma with proactive prevention. For most individuals, the development of PTSD after trauma is the result of a complicated interplay of constitutional and environmental factors. Identifying factors that promote psychological resilience is a critical research area, and more studies are needed. Seligman’s work holds promise that while some components of vulnerability may be innate, it may also be possible to foster resilience to psychological stress.

By guest author Dr. Roger Pitman with Maria Rosasco

Dr. Pitman will be a faculty member, October 28-29 at the CIMIT Innovation Congress 2009 in Boston. For more information on attending please click here

CIMIT blog is a publication of the Center for Integration of Medicine and Innovative Technology (CIMIT)

Comments

[Jordan Trunner]

This post really had me thinking about this particular issue in way I havent before. Its something I do believe we need to talk about more. Thankyou.

[Lynn Osborn]

Recommended Reading for the generalist on this topic - Learning to Fall: The Blessings of an Imperfect Life by ~ Philip Simmons