Why do some people suffer after a traumatic event while others do not?
This is an important question in the world of trauma psychology, one that is being extensively researched. We know, both anecdotally and empirically, that, given exposure to a critical incident, some people will be negatively affected by it, while others will move on and be essentially fine. For example, several young people of similar age and background can be deployed on the ground in the same unit in Iraq or Afghanistan, be exposed to roughly similar experiences, and some will return stateside, move ahead with happy and fulfilling lives and be fine, while others will experience some level of disruption associated with their service.
Why is that?
The answer to this appears to be largely the same as the answer to so many other quandaries in the field of psychology: the unique combination of genetic constitution and set of life experiences for any given individual. It’s the old “nature vs. nurture” question, and, as is typically the case, the answer seems to be “yes, both influence outcome significantly.”
As with so many things, it seems clear that we inherit a genetic constitution that may leave us more or less at risk of developing lasting problems after trauma exposure. Recent studies indicate that, with similar levels of trauma exposure, individuals who have close family members who have struggled with trauma-related problems are more likely than those without such a connection to struggle after trauma. This link seems fairly strong.
However, one generally does not experience trauma-related problems without … trauma. Life experiences do not occur in a vacuum, and trauma-related concerns are certainly no exception. Sometimes when we talk about trauma, we talk about a “dose-response relationship,” which simply means that a person’s response to trauma is directly related to the amount of exposure he or she has. Because of the differing “doses,” a person who experiences a single-incident trauma of brief duration (a car accident, for example) is at less risk of lasting problems than a person who experiences chronic exposure to ongoing traumatizing events for a lengthy period of time (such as child abuse or neglect).
Life experiences do not occur in a vacuum, and trauma-related concerns are certainly no exception.
This is not to say that people who experience a single car accident do not develop significant problems; they can and, unfortunately, sometimes do. However, the likelihood of ongoing struggles increases as the amount and severity of exposure to trauma increases. So, a person’s history of trauma and learned coping skills combines with his or her genetic constitution to create that person’s level of risk and resilience.
Sometimes when we talk about trauma-related struggles, we talk about trying to find ways that we might “inoculate” people against developing serious negative outcomes after a traumatic event. Of course, there is no shot or medicine that will achieve this; what we mean when we say this is that we hope to create a set of life experiences that will reduce a person’s vulnerability to troubles by increasing his or her resilience level. Essentially, we want to start to establish—prior to trauma exposures—habits and ways of being and relating to the world that seem to be associated with better outcomes after trauma exposures. For example, habits of thought are important in structuring how we perceive the world. A tendency to blame extensively or to personalize others’ behaviors may reduce resilience, so, with an eye toward increasing resilience, we may try to shift habits of thought in a different direction.
Of course, unlike “inoculation” in the true sense of the world, none of these will provide any real immunity. At present, there is no such thing—bad things happen to good people unexpectedly, and sometimes, in spite of everything, that person will encounter struggles associated with that. But we know that some habits can and do increase the chances that, upon exposure, the individual will be able to incorporate the experience and continue living life without major disruption.
Our knowledge about this grows every day, and we continue to work toward a more complete understanding of how to assist survivors of trauma. Both before and after traumatic incidents, there are interventions that we have identified that we know can meaningfully reduce suffering; this being so, it seems worth the effort to continue pursuing them as best we can, in spite of the imperfect state of our knowledge.
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