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)
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