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Posted 2.7.12

David Blore's book "In Search of the Antonym to Trauma" was published on 24th June and is now available on Amazon at: Amazon.co.uk The book is the result of over six years study of the 'lived experience' of psychological changes that occur after Road Traffic Accidents (RTAs) and subsequent treatment, particularly with Eye Movement Desensitisation & Reprocessing. The following is from the back cover: "...Negative changes such as psychiatric diagnoses, have understandably, been the focus of research for well over a century as the relief of suffering is probably the foremost role of the mental health practitioner worldwide. On the other hand, positive psychological change is a developing field for which there is no standard terminology. The plethora of labels of which 'Post Traumatic Growth' is the most common descriptor, masks a significant gap in clinical and theoretical uunderstanding. Even less well understood is the totality of psychological change after trauma... the book's findings are quite remarkable and suggest that a totally new perspective on psychological trauma is needed." .


Posted 18.10.11

'Sad/Mad/Bad: Psychological Factors in Medical Fitness' was the theme of the 2011 ARIOPS Conference (Association of Rail Industry Occupational health PractitionerS) held at the National Train Museum in York. The Conference was attended by David Blore who gave a presentation on the 'Treatment of Psychological Trauma on the Rail Network' subtitled "Psychiatry owes a lot to British Rail" - the famous quote from The European History of Psychotraumatology (Lars Weisaeth 2002). David stressed that until the advent of the March 2005 NICE report on psychological trauma, interventions had largely not been evidence-based. Now they were, and David identified impressive results obtained over the past 8 years by using, primarily, Eye Movement Desensitisation & Reprocessing (EMDR) by itself or in combination with trauma-focussed Cognitive Behaviour Therapy. David's presentation will be available soon by clicking here.


Posted 6.6.11

This website is currently undergoing a major overhaul. It is being done in a way that should create the minimum disruption to users. However not all material may be currently available, particularly on the information pages. Hopefully this will be rectified by 30.6.11. If you are trying to find something, but are unable to do so please fill out and submit the form on the contact us page. We will reply as soon as possible.


Originally posted 2008

Some notes on a contextual background to Post Traumatic Growth: The ‘rediscovery’ of positiveness in psychology

David C. Blore
School of Health Sciences, University of Birmingham

It may seem ‘strange’ from the perspective of the first decade of the 21st century, that what superficially seems like a ‘discovery of positiveness’ is actually nothing new. Indeed it is the negative perspective on health that is historically atypical. ‘Strangeness’, in this context, is an artefact of the present age.

In the West, at least, we are used to medicine finding answers to age-old problems. The older generations will recall the advent of Sulphonamides, Penicillin, new treatments for this that and the other, with one success after another, and arguably culminating with the ‘high tide mark’ for Western orthodox medicine, when on the 12th April 1955 Dr. Jonas Salk announced a “safe, effective and potent” vaccine for polio (LeFanu 1999). This ‘golden-age’ was comparatively short-lived, however, as Western orthodox medicine appears to have commenced a steady decline thereafter. A mere 2½ years later, on 1st October 1957, to combat morning sickness in pregnant mothers and to aid with their sleep, Thalidomide became available. The drug’s teratogenic side-effects (from the Greek, literally meaning monster-making) were to seriously undermine public confidence in modern medicine’s seemingly unstoppable advance, or at least by its association with the pharmaceutical industry. From the mid 1960’s:

"...the pictures of Thalidomide victims as they grew up over the next 20 years acquired in the public imagination a sort of symbolic significance, a metaphor of the negligence and avarice of the pharmaceutical industry.
(LeFanu 1999, p.247)

Of course the reasons for the rise and fall of modern medicine is a far more complicated one than merely the story of Thalidomide. However, Le Fanu’s excellent analysis of the subject greatly helps contextualise the apparent re-discovery of positiveness.

The predicted decline of modern medicine was first told by René Dubos as early as 1959 in The Mirage of Health, perhaps not surprisingly given that the Thalidomide tragedy was in the headlines at the time. By 1975, Ivan Illich had declared:

“The medical establishment has become a major threat to health.”
(Illich 1975/1995 p.3)

Nowadays:

“...It would be absurd to suggest that medical progress had completely ground to a halt by the end of the 1970s...”
(LeFanu 1999, p.266)

...but Western orthodox medicine was, and still is, receiving a great deal of ‘bad press’

LeFanu describes the ensuing “intellectual vacuum” and how social theories of prevention replaced the search to cure illness:

“The rapidity with which this new paradigm filled medicine’s intellectual vacuum is striking testimony to the declining power of empirical therapeutic innovation.”
(Ibid, p.271)

Fitzpatrick, in his (2001) book The Tyranny of Health focuses on the political urge to move towards a prevention paradigm. Indeed prevention was epitomised by publications such as The Health of the Nation (DOH 1992). Although space, does not permit a detailed examination of healthcare politics in the 1990’s, it could be argued that the emergence of positive psychology represented the third step in a ‘healthcare process’, the first step of which being the war against illness and step two the war by ‘prevention’.

Understanding the rise of positiveness within healthcare requires an awareness of the decline of the corresponding negative, a position not dissimilar to the principles underpinning Hegel’s second law also known as the Law of the Unity of Opposites (see Woodfin & Zarate 2004) in which opposites:

“...form unions outside of which neither can exist… the identity of each depends on the identity of the other.”
(Ibid, p.25)

In other words understanding positiveness requires an understanding of negativeness. To gain some understanding of the historical dimension of ‘positiveness-negativeness’ in healthcare, it is useful (as per Tedeschi & Calhoun 1995, pp. 1-13), to commence with the traditional views of tragedy and suffering.

Poole (2005) tells us that:

“Tragedy is a precious word. We use it to confer dignity and value on violence, catastrophe, agony and bereavement. ‘Tragedy’ claims that this death is exceptional.”
(p.1 underlined word signifies original italics)

A view which could be seen as diametrically opposite to the philosophical pessimism espoused by Schopenhauer, who famously argues that our purpose must be to suffer:

“If the immediate and direct purpose of our life is not suffering then our existence is the most ill-adapted to its purpose in the world: for it is absurd to suppose that the endless affliction of which the world is everywhere full, and which arises out of the need and distress pertaining essentially to life, should be purposeless and purely accidental. Each individual misfortune, to be sure, seems an exceptional occurrence; but misfortune in general is the rule.”
Schopenhauer(1850/2004, p.3)

So, whether it is dignity and value, or suffering, Tedeschi & Calhoun (1995, pp. 5-9) point out that:

“...a tradition in religious and philosophical writings that supports the notion that the greatest and wisest have suffered turmoil in their explorations of meaning that may be concealed in the most trying circumstances.”
(Ibid p.5)

...suggesting that there has been a long history of positive outcomes to adversity.

Little (1989), in categorising ‘legitimate suffering’ as: retributive, therapeutic, pedagogical or vicarious, argues that religion and suffering are intimately entwined at least partly because religion faces the enduring problem of having difficulty explaining suffering. It is interesting therefore that The Bible effectively contains an explanation:

“But we also rejoice in our sufferings, because we know that suffering produces perseverance, and perseverance, character; and character, hope. And hope does not disappoint us…”
(Romans 5:3-5)

...clearly a position that underpins a positive view of the aftermath of suffering - and is roughly akin to the modern concept of PTG.

Indeed, McGrath (2006), in applying the categories of positive outcomes after trauma as described by Tedeschi & Calhoun (1995), has proposed that the followers of Jesus experienced PTG after the death of Christ and that Christianity itself was effectively a manifestation of PTG:

“Christianity grew in the context of adversity but was first born in the immediate aftermath of trauma (i.e. Christ’s crucifixion). Indeed, its emergence has been described, in an image attributed to its founder, as a posttraumatic birth.”
(McGrath 2006, p.291 – brackets added)

...this ‘post traumatic birth’ being described also in Biblical terms:

“Very truly, I tell you, you must weep and mourn… you will have pain, but your pain will turn to joy. When a woman is in labour, she has pain… But when her child is born, she no longer remembers the anguish because of the joy of having brought a human into the world.”
(John 16: 20-21)

The same theme of positive stemming from adversity can be found in the Book of Common Prayer:

“…giving them patience under their sufferings, and a happy issue out of all their afflictions.”
(Book of Common Prayer 1662/1815)

However, the history of PTG is not merely the history of Christianity. Indeed, suffering, whose origin in Middle English, is from Anglo-Norman Fr. Suffrir, from Latin sufferer, from sub- ‘from below’ + ferre ‘to bear’ (OED 2001, p.1432), has a central role in many religions and many explanations of theological and philosophical natures are given.

Suffering is also an integral part of psychological trauma. The principle of something ‘arising from adversity’ strongly suggests both a positive outcome when a negative would has been predicted and the religious corollaries of reincarnation and resurrection. However, there are other non-religious examples such as the mythological phoenix being born from its own ashes. The rainbow is another example, which probably because of its powerful visual impact, has been pressed into symbolic explanation throughout history. One example is the biblical narrative of the flood followed by the rainbow and God’s promise to Noah not to kill all living beings again. This can be seen as a promise of less suffering, if not of positive outcomes. Although this begs the question: is less suffering the same as a positive outcome?

Other mythologies cite elaborate explanations for rainbows including Irish mythology, which regards the end of the rainbow to be the secret hiding place of leprechaun’s gold. Extrapolating this mythology may result in the conclusion that a positive outcome is actually beyond mortals. Or, perhaps like Wordsworth’s 1802 poem ‘My Heart Leaps Up When I Behold The Rainbow’, the rainbow is merely a reminder of the positive. Possibly most positive of all is the Buddhists’ belief that the rainbow is the highest state achievable before attaining Nirvana, where individual desire and consciousness are extinguished.

A very old association between the rainbow – almost certainly also because of the visual impact - is that of the arch or bridge providing a ‘way out’ of trouble. The Simon and Garfunkel song ‘Bridge over troubled waters’, being an obvious example.

As for most of recorded, rather than mythological, history, the Aristotelian philosophy of positiveness held sway. It is generally acknowledged that it was the English Civil War philosopher Thomas Hobbes (1588-1679), who espoused the diametrically opposite view (Jørgensen & Nafstad 2004, p19).

Hobbes lived during a period of history characterised by much social turmoil and unrest. He formulated the theory of psychological egoism, which is a deeply negative view of human nature, believing that men in a state of nature, that is a state without civil government, are in a war of all against all in which life is hardly worth living (Hobbes 1651/1968; see also Jørgensen & Nafstad 2004).

However, within a hundred years of Hobbes, Jean-Jacques Rousseau (1712-1778) was supporting the Aristotelian position by contending that humans were born moral and with the potential for good. In psychology, both Spencer (1871-1939) and McDougall (1820-1903) also tried to oppose the negative position, the latter declaring that humans had an empathic instinct. Nevertheless, these were voices that were in the minority.

However, Sigmund Freud belonged to the Hobbesian school when in 1918, after another period of intense social and political unrest – World War 1, he declared:

“I have found little that is good in human beings on the whole. In my experience most of them are trash…”
(Freud 1918)

Scheff (1966) warned that a categorisation such as mental illness becomes an identity thus stabilising the role and reinforcing adoption of the negative human view. It is hardly surprising therefore that Held (1991) took the view that therapy itself is based on psychopathology.

So despite efforts to the contrary, the negative view of humans and self-interest in particular, remained the “primary and true motivation” (Jørgensen & Nafstad 2004, p.19), even accounting for moral and unselfish behaviour.

The fall of the negative approach was to herald a change to the positive. There were early pioneers of the positive approach, these included Carl Rogers, Abraham Maslow and Viktor Frankl, but the mid 20th century was not quite the right time for change. Negativity had arguably not fallen quite sufficiently. Hegel’s first law - the Law of the Transformation of Quantity into Quality (see Woodfin & Zarate 2004) predicts that events will eventually precipitate “…a sudden leap into a different state.” (Ibid, p.24).

Indeed, events finally reached a ‘critical point’ when, in 1999, Martin Seligman devoted his Presidential Address to the American Psychological Association, and declared his aim to utilise his Presidency to catalyse change away from a preoccupation with negativity in psychology (Seligman 1999; Seligman & Csikszentmihalyi 2000). The rest, so to speak, is history.

Positive psychology is now well established, and is aimed at studying all that is positive, and, in its applied form is the application of positive psychology to facilitate optimal functioning (Linley & Joseph 2004).

This then is the context for the rebirth – rather than discovery - of positiveness during the last years of the 20th century.

References:

DoH (Department of Health) (1992)
The health of the nation. London: HMSO

Dubos, R. (1959)
The mirage of health: Utopian progress and biological change. New York: Anchor Books

Fitzpatrick, M. (2001)
The tyranny of health: doctors and the regulation of lifestyle. Abingdon, Oxon: Routledge

Freud, S. (1918)
Letter from Sigmund Freud to Pastor Oskar Pfister, 9th October 1918. The International Psychoanalytical Library, 59:61-63. The Internet: www.pep-web.org/document.php?id=ipl.059.0061a

Held, B.S. (1991)
The process/content distinction revisited. Psychotherapy, 28, 207-18

Hobbes, T. (1651/1968)
Leviathan. London: Penguin (originally published 1651)

Illich, I. (1975/ 1995)
Limits to Medicine - Medical Nemesis: The expropriation of health. London: Marion Boyars

Jørgensen, I.S., & Nafstad, H.E. (2004)
Positive psychology: Historical, philosophical, and epistemological perspectives. In P.A. Linley & S. Joseph (Eds.), Positive psychology in practice (pp. 15-34). Hoboken, NJ: John Wiley

Le Fanu, J. (1999)
The rise and fall of modern medicine. London: Abacus

Linley, P.A., & Joseph, S. (2004)
Applied positive psychology: A new perspective for professional practice. In P.A. Linley & S. Joseph (Eds.), Positive psychology in practice (pp. 3-12). Hoboken, NJ: John Wiley

Little, D. (1989)
Human suffering in comparative perspective. In R. Taylor & J. Watson (Eds.), They shall not hurt (pp.53-72). Boulder, CO: Colorado Associated University Press

McGrath, J.C. (2006)
Posttraumatic growth and the origins of early Christianity. Mental Health, Religion & Culture, 9, 291-306

OED (Oxford English Dictionary) (2001)
Oxford Concise Dictionary (10th edition revised). Oxford: Oxford University Press

Poole, A. (2005)
Tragedy: A very short introduction. Oxford: Oxford University Press

Scheff, T. (1966)
Being mentally ill: A sociological theory. Chicago, IL: Aldine

Schopenhauer, A. (1850/2004)
On the suffering of the world. London: Penguin (originally published as Parerga and Paralipomena, 1850)

Seligman, M.E.P. (1999)
The president’s address. American Psychologist, 54, 559-62

Seligman, M.E.P., & Csikszentmihalyi, M. (2000)
Positive psychology: An introduction. American Psychologist, 55, 5-14

Tedeschi, R.G. & Calhoun, L.G. (1995)
Trauma & Transformation: Growing in the Aftermath of Suffering. Thousand Oaks, Ca: Sage

Woodfin, R., & Zarate, O. (2004)
Introducing Marxism. Royston, Herts, UK: Icon Books