Throughout our shared human history, there are always stories of people undergoing powerful and profound changes following exposure to unprecedented events and after confrontation with new realities.
In literature, the humanities, and throughout religious traditions, we as a species seem particularly struck by the significance of the change that happens in response to transformative experience.
We see this most clearly in the example of religious conversion experiences. Abraham and the burning bush, Saul (Paul) on the road to Damascus, Muhammed's visit from Gabriel in the cave, are all examples of ways in which exposure to powerful realities serve to transform an individual.
In these and other cases, the changing of the individual also can have a profound impact upon the arc of human history. The conversion of Emperor Constantine on his death bed would serve to influence the dissemination of the Christian faith throughout what would be Europe and the entire world, contributing to a transference of state power onto the church and into private religious life. In another vein, Roosevelt's crippling experience with polio would to be an unlikely catalyst for a political career that would make him the champion of a nation crippled by the great depression and isolationism, only for the nation to emerge as the largest global power in the free world.
In literature, too, we see circumstances that impact upon characters that alter the course of the story and impact upon the story's outcome. Romeo's chance meeting with Juliet would send the Montagues and Capulets headlong into a feud that would cost both protagonists their life and utterly transform both families. In Dickens' Christmas Carol, the miserly, cold-hearted Scrooge is transformed into a generous and loving ambassador of goodwill and Christmas cheer through his encounter with four spirits. In fact, the presence of profound change agents in both sacred and secular stories is so prominent that mythologist Joseph Campbell viewed it as one of the constant components of myth and necessary to the infrastructure of the hero story.
Medical Science and Experiences of Change
So how does this idea of outside forces impacting upon the individual relate to our everyday existence, and what might the medical sciences say about the idea of internal change being mitigated by external factors? To answer this question, let's go back in time for a moment to the first World War.
The circumstances of World War I provided a profound, unprecedented condition of mass warfare, made possible through mechanistic advances turned quickly toward vaguely defined objectives almost arbitrarily constructed along nationalistic lines. To solider and civilian alike, these new conditions offered an objectifying and alienating experience in which the fragility of the human condition was carried in stark juxtaposition against the armored machinery mauling out the invisible decree issued out from a string of command, taking orders from a chance assassination of an unknown aristocrat.
That the irrevocable fortitude of a happenstance war would stake it's claim on the lives of people unlikely to profit directly from it's outcome was no new thing. However, what was significant now was the advances made in medical science which would be equipped with the capacity to observe and measure the myriad of consequences of warfare carried out in the personhood and self of the surviving casualties of the war. As with the detection of the soldier's heart syndrome identified in the civil war, medical experts would begin to catalogue medical outcomes of warfare through the benefits of systemic observation that were part and parcel to priorities of rehabilitation and treatment.
In World War I, the term War Neurosis would be applied to a category of symptoms that emerged as consequences of war exposure. This would include both physiological and psychological reactions to warfare that would have a profound debilitating effect upon the individual, rendering the soldier incapacitated in warfare and civilian life alike.
Film documentation from this condition offers a haunting depiction of a curious and distinctive precursor to what we would come to define as Post Traumatic Stress Disorder.
For the purpose of this discussion, the concept of War Neurosis offers particular significance because is emulates how circumstances of experience itself might serve as the causal role in conditions requiring medical support and care, impacting as it does upon changes occurring on physical and material levels. What happens to us, can change us.
Although this may seem to be somewhat intuitive to our experiences as humans, this is an insight that often is evaded by medical sciences which seek pathology in the functioning of organs and systems within organisms. What happens within an individual is generally considered more so than what happens to the individual when it comes to medical research pertaining to both medical and psychiatric conditions. Ultimately, it wouldn't be until after the Vietnam War, in the completion of the DSM-III that the term Post Traumatic Stress Disorder would enter into formal diagnostic nosology, cannonizing the condition as a distinctive psychiatric conditions such as schizophrenia.
The research that has now developed regarding trauma has solidly substantiated the notion that experience alone can and does profoundly change us. What is most alarming about the findings, is that the change that is experienced appears to occur at a level far beyond the subjective perspective of belief sets and basic assumptions. Although change of course happens on this level as well, results of research have now shown that in the case of profound trauma, changes occur to the brain at the level of brain structure and functioning.
And changes that occur through trauma do not stop at the brain. Due to the brain's central role in orchestrating the entirety of bodily functioning, changes that impact upon the brain influence other bodily systems, including those that mitigate sleeping, eating/digesting, metabolism, immunology, attention, and growth. We thereby can quite literally come out of a circumstance a new person. The sooner in life that a traumatic experience occurs, the more profoundly it can shape the individual.
Over the past couple decades, a body of research has developed to offer perspective on early exposure to adversity, and its consequences on quality of life. Beginning in 1995, managed care consortium Kaiser Permanente working along side the Center for Disease Control and Prevention have taken a considered look into certain adverse experiences that demonstrate negative outcomes upon life subsequently. A total of 10 adverse experiences were ultimately identified and found to have negative health outcomes upon the lives of persons exposed to them. Not surprisingly, this body of research has also found that negative risks increased with the number of respective adversities a subject was subjected to. The 10 adverse experiences consist of: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect, mother treated violently, household substance abuse, household mental illness, parental separation or divorce, and having a parent incarcerated in prison. The study, popularly referred to as the ACEs Study (Adverse Childhood Experiences) adds weight to the idea that life experience changes us.
Things can also be different...
Even as the evidence would seem to confirm the idea that particular experiences can be harmful to us, research findings also support a broad variability in exactly how these occurrences affect us on an individual basis. One particularly intriguing area of research is on the area of what has been coined Post Traumatic Growth.
Post Traumatic Growth is an outcrop of the positive psychology movement and was a term introduced by Richard Tedeschi and Lawrence Calhoun also in 1995. Drawing from research on the emerging research on trauma, Tedeschi observed that up to 90% of trauma survivors identified at least one aspect of Post Traumatic Growth following the trauma. Post Traumatic Growth relates to the somewhat paradoxical finding that many trauma victims describe certain positive outcomes of traumas that very often also left them with some clearly negative life outcome. Included are "favorable" experiences such identifying greater satisfaction with life, a changed set of priorities, warmer, more intimate relationships, greater sense of personal strength, and recognition of one's new possibilities or paths to one's spiritual development. It is important to note that these occurrences did not necessarily occur in place of the negative developments that are associated with PTSD and trauma disorders, but that somehow the experience also served to deepen or enrich other aspects of life, that the individual may have not been able to appreciate or fully comprehend prior to the trauma.
Another consideration that is important to keep in mind is the human variability that seems to exist between individuals when it comes to trauma exposure. As the ACEs research makes clear, exposure to trauma can be debilitating to the individual. Still, research suggests that the majority of people who are exposed to potentially traumatizing incident, do not manifest a disordered response or psychiatric condition from the occurrence. Likewise, it would be inappropriate and potentially harmful to develop a perspective that persons who have endured trauma or adversity to be endowed with some special type of life perspective or insight because of their experience. Traumas by definition are awful experiences, and if anything good can come out of them it would be in spite of the pain and suffering or as some sort of secondary byproduct of it. Healthy societies thereby work to diminish avoidable hardships. Just as no two people are exactly alike, no two people are likely to interpret a singular event in identical ways, with identical outcomes.
But what, if anything can account for differences in how people experience different circumstances, and what determines if and how we are to be changed by life's unexpected occurrences? Again, let us turn to the theory of Individual Psychology to consider this.
Exogenous Factors and Individual Psychology
The significance of change and it's relevance to symptoms and the need people have to seek out treatment was built into the theory of Individual Psychology. As a fundamentally contextual psychology, Individual Psychology was uniquely equipped to deal with the experience of trauma and with the concept of changes that occur to us in response to life circumstances in general. As the originator of Individual Psychology, it is important to recall that Alfred Adler was an enlisted medical provider during World War I and was exposed to the debilitating outcomes of war including unique set of symptoms associated with War Neurosis depicted above. This exposure would shape Adler's views on human condition, both in understanding human dysfunction but also in discerning the role that social concern in and for others would play in healthy responding and in the growth that can occur through hardship.
One construct in particular that was referenced by Adler offers special relevance to the idea of change as it relates to the onset of symptoms and the need to seek out help. Exogenous Factors refer quite literally to the external cause of a symptom or problem. Typically, these constitute experiences that represent a new set of demands for the individual to respond to, which he or she was not properly or adequately prepared for.
Being a socially oriented psychologist, Adler viewed exogenous factors as being circumstances that demand from the individual a greater degree of cooperation and fellowship in resolving a new situation. When we meet our own personal limits, our capacity to overcome then relies on our ability to elicit the support and involvement of others.
This premium Adler placed on coopertation offers profound significance when we stop and consider the ten types of childhood adversities identified to be of particular concern in the ACEs study. Experiencing abuse or exposure to various forms of familial discord and dysfunction offers a uniquely distressing situation in which a child's would-be source of support in a loving and stable care provider is in someway diminished in their capacity to protect the child or when the parent/care giver themselves are transformed for a period of time into the source of threat itself from which protection is required. Under such circumstances, who is the child to turn to in search of safety, support, and guidance? How can a child be expected to develop an outwardly oriented and cooperative stance in life, when unable trust others in the world around them. As such, the child learns early in life not to count on others, and that situations that require outside help are thereby unsolvable. Thus, a tendency throughout later life of responding to subsequent difficulties through futile displays of distress or related problematic coping replace more functional approaches.
As such, some persons may find themselves particularly vulnerable with regards to a certain type of future stressor or trauma. In fact for some individuals, an outwardly "positive" development may prove subjectively distressing, launching them into unscripted regions for which their former strengths or capacities no longer offer the same advantages or where they may no longer be able to rest upon the comforts of familiarity and routine. In this way, exogenous factors are highly individual experiences, revealing hidden needs and propensities that may have never before been made clear.
Of course, in the face of any new and unexpected situations, new lessons can be learned. New adversities drive some to develop unfound strengths or capacities, a deeper appreciation for life, or strengthened relations. However, this requires that the responder finds a way to adapt and develop to the new circumstance. It is only from the sidelines of life where we can observe what new challenges confront others in the world around us and learn from these in safety and security. When the unexpected happens to us, we are at the mercy of our own limited and scripted intuitions.
Individual Psychology seeks to account for unprecedented changes and the emergence of symptoms through identification of the exogenous factor that may have prompted the manifestation of problem behavior. In a manner of speaking, symptoms always point to an exogenous factor, often unseen and under-considered by earnest treatment providers who look too closely at disorder presumed to exist within the individual. "When did the problem begin?" serves as a potentially powerful and revealing clinical question from the Adlerian lexicon where we can consider the significance of the circumstances surrounding and imbuing meaning to the presentation of the symptom.
However, just as the symptom references back to those external forces that remained outside of the individual's capacity to anticipate or account for, the exogenous factor when properly identified and accounted for points back to the individual and to the hidden and invisible private vulnerability or need area that could only be reveled in the light of this exogenous factor.
So what is it that changes us?
If we take into consideration the basic assumptions of Individual Psychology and the ever emerging research on trauma, growth, and adversity, changes represent the embodiment of new realties. Change from this standpoint is an artifact of a profound form of learning. It is the outcome of objective realities resonating throughout our subjective experience visa vi the biomechanics of our own internal physiology.
Who we become at this point in time will require us to adopt a brave and confident type of ignorance that allows us to open our hands to experience. As we assume this role in cooperative movement with the world and others arounds us, may we permit ourselves to live life in a new reality, no longer fettered to the habits and assumptions that have come to define us up until this imminent waking point.
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| Blogger Ben Rader w/ wife Melissa |
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