Resilience in Recovery
“There’s not a whole lot I can’t be”. – Bryan Anderson
I don’t know if you saw this story or not. I hope you did. Or will. It was the cover story of the weekend edition of USA Today, April 13-15. At first, I involuntarily recoiled a bit, but then came some emerging tears of sadness that turned into tears of astonishment, almost joy.
No, it was not a story about the Titanic 100 years later, although that, too, was a traumatic event for America and those who survived the sinking of the ship. This story was “Defending America, then inspiring her: wounded veterans of Iraq and Afghanistan become motivational speakers, sharing stories of valor and survival before riveted audiences”, by Chuck Raasch.
The picture of Bryan Anderson showed his resilience and what he was recovering from, at least outwardly. He was in a wheelchair, missing both legs and his left hand, but with arms outstretched and mouth depicting pride, determination, and triumph. He had just spoken at a fundraiser for the 1st Lt. Cleary Memorial Fund. Cleary was killed in Iraq. Anderson himself joined the Army on September 11, 2001, and suffered those injuries 4 years later from an improvised explosive device. Now he snowboards and gives motivational speeches, among many other activities.
There can be no question that the armed forces were late in preparing to treat the physical and mental injuries from this prolonged war. But they’re catching up, often with some innovative treatments, especially of so-called Posttraumatic Stress Disorder (PTSD).
We know pretty well that psychiatric medication does not have a whole lot of long-term success in PTSD. Maybe some brief symptom relief, at best, in preparation for other therapies. I don’t even recall that PTSD was covered in Mr. Whitaker’s book, “Anatomy of an Epidemic”. There is no anti-trauma medication. And, in contrast to most official psychiatric disorders, we know the major cause of PTSD, severe trauma that feels threatening to one’s life.
So, after trying to catch up with traditional treatments, the armed forces are now also innovating. One is the use of therapeutic dogs. Another is inspirational music, such as the song “Survive” by Rise Against, that helped rescue Mr. Anderson. I would like to think that Mr. Anderson would also like the Beatle’s song “With a Little Help From My Friends”. Another is to not hide their physical damage from a public that at first may be horrified and guilty, but to show and relate what happened to them. All this would fit so well how he and another buddy who lost his legs rented a car and drove it. Mr. Anderson steered, while directing his friend on the floor to work the brake and gas by hand. It seemed so astonishingly successful that the Army guard at the Walter Reed hospital gate, after a long pause, waved them on with: “You’ve gotten this far. Move on”. Of course, this won’t work or be possible for many others, but even so can be a model of inspiration. Social media and YouTube can spread their stories easily and quickly. Seeing this story reminded me of so many others in my own work.
I think of patients of mine that I’ve worked with in prison. One was formerly in the Army Reserves, hoping for a long and successful career in the Army. However, after an atypical night of drinking, he killed a young woman while driving. At first, he was quite depressed and his family physician gave him an antidepressant. But after he was in prison for awhile, he was determined to make amends and get off the medication. I worked with him to slowly decrease and stop the medication as he contacted the family of the deceased, asking for – and eventually receiving – forgiveness, a version of the Truth & Reconciliation process developed in South Africa after apartheid ended.
I think of my patient with cerebral palsy, always in a wheelchair, but always with a smile on her face. Actually, the physical limitations turned out to be the least of her problems. Powerless as a child, she was horribly sexually and physically abused, but slowly and courageously, was able to remember and reframe that abuse, now becoming a peer specialist.
I think of the many transgendered individuals, trying to hide their desire to be the opposite gender growing up, but being ridiculed anyways. Often having tried to suppress their desire, they marry for love but not attraction, going on pretending until they felt they would have to change or die. Then often having to risk losing most everything to go through the painful and expensive physical changes and possible social rejection if they don’t “pass”.
I think of my own mother. From her I got whatever resilience I seem to have. Suffering damage to her heart valves from rheumatic fever at age 19, she stayed in bed for almost a year. Later, taking at risk of her own life, she took the chance of having 2 children. Her health slowly deteriorated, though you wouldn’t know any of this if you saw her. Or heard her. Not a mean word did I ever hear. Finally, after again staying in bed for many months at a time, she had some of the first valve replacements, with long and painful recuperations, seemingly willing herself to live until all her grandchildren were born.
Everyone I’ve ever known in life has suffered trauma, loss, and/or setbacks. Resilience seems to be the one key quality of all who move on successfully. New studies even indicate that resilience is a key factor in those who recover from what is called schizophrenia (Anne-Kari Torgalsboen, Clinical & Related Psychoses, January 2012).
Though it may be hard to define exactly what resilience is, there is a measure of resilience, the Conner-Davidson Resilience Scale. We do know that resilience has little to do with continuing anger, blame, and self-pity; it has a lot to do with hope, forgiveness, and the courage to move on. Keeping in mind the inspiring stories of others helps; taking joy in the failures of others does not.
Our genetics can help or hinder. Just think of babies who bounce right back up instead of becoming overly fearful. The love and encouragement of others helps. Veterans coming back from Viet Nam 40 years ago were unfortunately and inappropriately much more ostracized than our current “wounded warriors”. Adequate resources are necessary, but not sufficient.
Robert Jay Lifton has spent a half century around the world researching our destructive and dark sides, and has come to appreciate how resilience can help us recover and adapt to a rapidly changing and risky world (The Protean Self, University of Chicago Press, 1993). By using humor and even self-mockery, being open to new ideas, being inclusive whenever possible, and maintaining an ethical commitment, a protean self may emerge that is able transform trauma into various expressions of insight, compassion, and innovation. He views Vaclav Havel, the former President of post-communist Czechoslovakia, who recently died, as a major example of public proteanism.
Whether one believes or not in the ongoing “war on terror” is not the issue here. Nor is whether one believes that PTSD is a psychiatric disorder or a normal response to extreme trauma in the more vulnerable. What is of issue is how we can become as resilient as possible to be our best protean selves. This is not easy, but we must try.
Sad in Psychiatry: Affectionately called a "gadfly," and known as "da man in psychiatric ethics," Steven Moffic writes about what makes him sad about modern day psychiatry, and how to "treat" that condition so that we will become glad about what psychiatrists can do to help.