The debilitating effects of post traumatic stress are well documented. But studies suggest that surviving trauma might also lead to personal growth.
Psychological trauma, it turns out, can not only trigger the sometimes debilitating symptoms of post traumatic stress disorder (PTSD). It can also make you better in some ways - even if you have PTSD symptoms.
A new study by North Carolina State University researchers found that a long-recognized phenomenon called post traumatic growth is more likely to occur in veterans who also had the highest level of PTSD symptoms.
"Post traumatic growth is this sort of paradoxical experience where people report positive psychological changes following something we would consider to be a very stressful experience," said Jessica Morgan, who studied post traumatic growth among 197 military veterans.
The study recently was published online in the journal Military Psychology.
Morgan, an N.C. State graduate student, also works for the non-profit research organization RTI International. She said the research team focused on the relationship between PTG and PTSD because previous research looked mainly at one or the other.
"What we have found is that, yes indeed people report both," Morgan said. "Which makes sense intuitively because it's the same event that's causing both of them, but they're operating in different ways in your overall well-being."
"Post traumatic stress is predicting lower quality of life, and post traumatic growth is predicting better quality of life, but you have them at the same time," she said.
That paradox might offer a new opportunity to improve lives.
A dark recovery, then a period of growth
Veterans who have experienced post traumatic growth say there's no question that it has made their lives better.
"I have grown in so many ways," said Sgt. Kevin Hoffman, whose truck rolled over one of the biggest improvised bombs ever used against American troops in Afghanistan. Hoffman was riding in the machine gun turret when the blast flipped the truck backwards like a pancake.
He had a long list of injuries, including serious ones to his face, spine, and legs.
"My buddy who was in the vehicle in front of me, but is now behind me, actually told me I got up and walked a few steps and started dusting myself off like nothing happened," Hoffman said. "And then I collapsed."
He had emergency surgery in Afghanistan and Germany, then came back to the United States. He lived at Walter Reed Military Medical Center in Maryland for more than four years undergoing treatment and more operations.
"Among the command staff and the hospital staff and the Marine liaisons, I was the Grand Old Man of Walter Reed," Hoffman said.
He said the doctors, nurses, and therapists did amazing things for him physically. But his psychological burden was growing and he became so withdrawn that he hardly left his room.
He even had to start taking vitamin D supplements because he wasn't getting any sun.
Now, though, he says the harsh experiences have made him stronger.
"The biggest thing I've learned is life is too short," he said. "I think I'm a thousand times more focused."
Experts say they've noticed a similar phenomenon for years among many retired veterans and active duty troops.
"Deployments are rough," said Sgt. Maj. David Devaney, who wrote a book on the psychological aspects of combat. "But they make you stronger because everything else becomes easier."
Trying to make sense of trauma
Not everyone who has a traumatic experience grows from it. Some of of the most intriguing questions about post traumatic growth are whether it can be encouraged, and if so, how.
Richard Tedeschi, who has been called the father of PTG research, said in an interview that previous studies have convinced him that it can be fostered.
"There's no question in my mind," said Tedeschi, who along with his colleague Lawrence Calhoun coined the term post traumatic growth in 1995. Both Tedeschi and Calhoun are professors at the University of North Carolina-Charlotte.
The N.C. State study, like other research, suggests growth might best be fostered by encouraging intentional reflection on traumatic experiences -- trying to make sense of them rather than suppressing them.
Researchers believe that helps rebuild personal belief systems about the way the world works after those beliefs are shaken by the traumatic experience.
Sgt. Hoffman, for example, was asked by commanders to tell his story to groups of service members. He was reluctant, but later embraced the role.
A private, non-profit group has begun what it said is the first effort outside of clinical environments to try to foster PTG.
Working with groups of combat veterans at a retreat in Northern Virginia, the Warrior PATHH program is using methods based on Tedeschi's research, and he's helping analyze the results.
'I can hear the birds chirping'
Tedeschi and Calhoun found growth can take several forms, including improved relationships, a sense of psychological growth, and a stronger spiritual life.
But the most common type of growth among veterans in the N.C. State study was increased appreciation for life.
That's something retired Marine Sgt. Richard Uranga knows about. He served tours Iraq and Afghanistan, and at times was certain he would die in combat.
He sometimes drove in supply convoys, but mainly rode in the gun turret. Trucks in the convoy would often hit three or four improvised bombs on a single mission.
Now, he still has lingering symptoms including hypervigilance.
"But I've come to embrace that, because you can look at it as hypervigilance or you can look at it as being present in the moment," he said.
"So, if I take my kids out to the park, or something like that, you just notice a lot of people who aren't there," Uranga said. "They're on their phone or on their tablet and or just spaced out."
"When I'm sitting there I'm absorbing everything in," he said. "I can hear the birds chirping, I can hear the wind blowing, I can see the people walk across the path. I can hear their footsteps.'
He has three kids now and tries to spend as much time as possible with them.
"Just being present there with them and letting them know that, 'I'm here for you, I'm here with you, and this is our time right now,'" he said.
And he has experienced another form of post traumatic growth -- seeing new possibilities in life. Uranga is now a social worker, doing mental health counseling with children. He's almost got his Master's degree and plans to seek a doctorate.
Changing the narrative of veterans
Morgan, the N.C. State researcher, said a broader understanding of PTG may not only help patients directly, but also erode stereotypes about veterans.
"There's certainly a cultural narrative right now that our veterans are broken," she said. "But there's a whole other story that isn't being told, and that is that many of these men and women who are coming back are extraordinarily grateful for the experiences that they've had and have seen some very difficult things, but are able to really show resilient outcomes."
If researchers succeed in fostering PTG, it may mean more veterans will get benefits from traumatic stress, just as Sgt. Hoffman has.
"I appreciate little things, like sunrises and sunsets," Hoffman said. "Like the other day, I was up early enough. I pulled over on the side of the road, watched the sunrise and took a picture."
"I thought it was appropriate that it was a beautiful coastal Carolina sunrise on the seventh anniversary of me getting turned into a human lawn dart," he said.
Sgt. Hoffman said he hasn't needed those vitamin D supplements for awhile. He's got the sun.