Emotions and trauma

Adrian: Hi.

Jamie: How are you going?

Adrian: I'm good. We're talking about post-traumatic growth.

What is it? And why is it? I guess.

Jamie: I think the first thing to understand about it is the word trauma. A lot of people use the word trauma these days, but it's important to have an understanding of what that is.

Trauma is any life experience where the person might subjectively experience a state of psychological distress after the event.

And it's normally defined as an experience where there's either loss or a perceived loss of life or serious injury.

So that can include things like mass tragedies like bushfires and floods and so on. But it can also include personal trauma situations where people feel as though their life was at risk. So stroke, road traffic accidents, loss of a loved one.

So that's what trauma is. And obviously part of the definition of trauma is that it can cause distress and so people can go on, have an ongoing sense of psychological distress, and we would call that post-traumatic stress.

And there's a DSM, diagnostic and statistical manual diagnosis, called post-traumatic stress disorder. And we understand trauma mostly in the context of trying to understand that condition.

So post-traumatic growth is a much more recent idea. And it emerged from evidence in studies that showed that even when people are exposed to traumatic situations, there are some of them who go on to experience growth rather than ongoing psychological distress, and that's simply labeled post-traumatic growth.

So it's a situation where a person experiences a traumatic event and then not only bounces back to where they were before, but bounce back to a higher level in some way.

Adrian: And so you and I both love language. And the stupid thing about stroke is that it historically was, you were struck down by God. So I have this vision of the finger coming out of the sky and there you go, Adrian, you've had a stroke. Something bad has happened.

I don't know that I ever really processed trauma per se. I just thought, you know, you have a stroke. I didn't know anything about stroke. You have a stroke, you get better and you get on with life.

But actually, no, you're left with lifelong disability in my case. And, you know, loss of independence because I don't have a license anymore, for example. Which really sucks.

Jamie: Yeah.

Adrian: But if I look at the trajectory with a pregnant wife and a kid on the way, I didn't want that kid to come into the world and have a depressed, angry dad who was, you know, on a disability pension and angry at the world.

So I kind of shook myself together. And, and that was an internal and an external factor that made me look after my world around me. So that kid didn't come into the world with an angry man.

So it's unlike resilience, which you may as we know, you know, you've had it before and after. You may have been resilient before the finger came out of the sky and you're still resilient after. Post-traumatic growth, is that defined event. And then your trajectory goes upwards.

Jamie: That's right. So it's a, it’s a defined event that changes you as a person in some way.

And I suppose you speak about you made the choice of not being a bitter man because you were struck. The processing of what had happened to you is part of the post-traumatic growth experience, right? You'd processed it in such a way and you made a choice that you wanted to be the best father and provider you possibly could be. And that led you down a certain path.

Not everyone processes events like that in a similar fashion. Some people hold on to their pre-stroke situation or condition or life or lifestyle. And have significant difficulties shifting their mindset, shifting their behaviours, shifting their thoughts and attitudes to adjust to the new way things have to be. And then making the most of that.

So all of that for me is encompassed by post-traumatic growth. The choices you made necessarily required you to grow because if you didn't grow, if you didn't process what had happened to you in that very meaningful way, well, it could have turned out very differently for you.

Adrian: The other thing I did, and this was sort of from day dot in hospital, was I made a conscious decision. I kind of felt anger was a waste of energy. I needed to get as well as I could because I had heart surgery coming up and then I needed to get out of hospital as quick as I could because there was a child on the way. You can't put it back in.

So, I needed to get well quickly. And I just felt there was no point in having a pity party and rolling around and wallowing in anger and sadness when I had to, you know, get walking again, get moving again. And so, anger for me was not part of the equation.

And I didn't, I kind of felt like anger was something that you gave yourself. Post-Traumatic stress was different. But anger is something that you kind of give yourself and you see that and you let it run around. And I just, I didn't want to be dragged down by my anger as well.

So, reflecting back on when you introduced the concept of post-traumatic growth to me it is, it was more about appreciating the fact that I'm still here, I'm still alive. Konnie doesn't have a life as a single mother ahead of her. So I've got to get well. And anger to me was, I think you would know me well enough to know that anger doesn't really come into the equation for me.

Jamie: Yeah, Yeah.

Having said that, anger can be a very normal part of a grieving process. And anger itself can be a healthy emotion, if used correctly. And anger is the emotion that gives us energy to do something about something that we perceive as being unjust.

The fact that you didn't even go there possibly means that you came to acceptance a lot quicker than most might have in a situation such as yours. You didn't, in your terms, didn't want to waste your energy on the anger.

So you probably, very quickly, moved through the process of processing what had happened to you and you immediately focused on the future, the near term future and the long term future. And asked yourself the question, what do I have to do to match this vision of the future that I have? Again, of being a father, provider, a husband, and ...

Adrian: Get back to work.

Jamie: Get back to work. Do all those things.

Adrian: I think in some ways I was naive because I just thought you have a stroke, you get better, you go back to work. But actually there was months and months and months and months of rehabilitation ahead of me.

And I got back to work, but not in the way that I did previously because, hey, there's an arm that doesn't work and you no longer have a license. You can't jump in a ute and can go from site to site, etc.

But it was, I think luckily my employer at the time said "Mate, when you're ready to come back to work, there's a job there for you."

In hindsight, entering or trying to get into the workforce with disabilities is bloody hard. And that was luckily one less complication that didn't enter the equation.

I just thought, yep, I'll just go back to work.

Jamie: Right.

Adrian: And that took seven months of intensive rehabilitation. But employment as a goal is vital, I think.

Jamie: Absolutely. So, so you were keen to re-engage with life and get back to it as quickly as possible. And that's part of post-traumatic growth. It's about being connected to others, looking for meaning, for new possibilities and so on.

And my understanding is you returned to a different form of work. Did you? Then what you'd been accustomed to?

Adrian: I ... pre-stroke I was running a site, running a garden, and then overseeing several other teams and several other gardens.

You can't do that when you can't drive anymore. So I was luckily, you know, I got to work in my favourite garden, which overlooked Sydney Harbour and Rose Bay and the Harbour Bridge and the Opera House.

And you know that wasn't a bad place to be. But I wouldn't have chose it, I mean. I stupidly and I think this is an example of growth. I stupidly applied, when I stupidly, I saw a job, I'd been out of hospital five weeks. I still had dressings on my wound from heart surgery and I applied for and got my dream job.

And then had the reality check of going ... My cousins are optometrists, so I went and saw my cousins. And they said "Look, based on these tests, you won't have your license."

I had to turn down my dream job and that really, it was a kick in the pants. It was uplifting to, you know, this would have set up my horticulture career at 34 to go on to bigger and better things.

I would have been running a 400 acre Arboretum in central west New South Wales, native plants, etc. etc.

Dream job, dream job and it still, yesterday was the 16th anniversary of my stroke. I didn't tell you that before we started filming and it's still 16 years later that loss of opportunity. I will never, it will never sit right with me. It will never, that for me, that lack of independence and loss of opportunity, because of, I would have had a pretty good horticulture career.

I've still got a pretty good career, but it's one thrust upon me rather than one chosen for myself. But I think, yeah, maybe I shouldn't have been looking for jobs, 5 weeks out of hospital.

Jamie: Well, I mean, that speaks to your willingness to just get back to it and soldier on and do the best you can. And in some ways that might have given you that motivation to keep going and eventually find another job, even though it's not the one that you would have chosen, but something that's still fulfilling and it helps you achieve those other life roles.

Adrian: If I hadn't done that job, you and I wouldn't be talking because would never have met.

Jamie: Exactly. Exactly.

Adrian: So from bad, good.

Jamie: From bad, good. Exactly.

Adrian: Is my take home message of post-traumatic growth. Is that, you know, finger comes out of the sky and your trajectory can be that, or that, or that. It doesn't have to be that.

Jamie: That's right.

Adrian: Which is hard in the context of stroke, because stroke is life changing. And, you know, I've been in hospital, I've watched people dying, I've watched families grieve and I've seen lives shattered.

So perhaps when ... when should you tell someone, if you think you can. I mean, we can't go to the DSM five and look it up, can we?

Jamie: No, no. It's not a condition in the DSM five. DSM five ... the full title of that is the Diagnostic and Statistical Manual of Mental Disorders. And there's nothing disordered about post-traumatic growth, so you're not going to find it in there.

Adrian: Right.

Jamie: It's a concept that is independent of that taxonomy. And when should you tell someone?

Well, whenever you notice any signs that they might be growing as a direct result of the major life event that otherwise might have caused an ongoing traumatic response.

Adrian: Is there, can you be too early?

Jamie: I don't know the answer to that question. I'm not sure. I'm not sure that the literature has actually looked at that. But my sense would be no. And your story is a really good example of that, right?

You were looking, you had accepted your dream job within five weeks of the stroke. Is that what you said? Well, that's pretty early days Adrian.

Adrian: I was five weeks of being out of hospital.

Jamie: Right. It's still early, so it's probably not too early.

Adrian: Right. It's not, yeah. It's that looking to the horizon rather than looking at your feet because your feet are shuffling because you're learning to re-walk.

Jamie: Yeah.

Adrian: I mean I was again this is, it sounds silly to say it, but my best mate when I had my stroke, he rang me the first morning in hospital and we were supposed to go on a bushwalk and I said, I guess we won't be going on that walk now.

He said, no probably not. I said to him and I clearly remember well, I want to be bushwalking again within 12 months. And at that point I was completely hemiplegic. I was in the bed, I'd been in a bed ... I was going to be in that bed for about another week because this side of my body was not moving.

And, and he said "Yeah, alright, we'll go walking in 12 months."

And I did. 12 months to the day. From discharge from hospital we went on a five day bushwalk and, and I said to Pat "Did you say yes to dangle the carrot or to shut me up or to gee me up?"

And he said well I'd seen your MRI. So I kind of figured you'd get your walking back. So it was a bit of all of that.

Jamie: Yeah.

Adrian: And that, that again, it set me on a trajectory of, okay, well, I've got to get walking because I'm going bushwalking in 12 months time.

Jamie: Great. What a lovely story.

Adrian: What are the, sort of, four or five pillars of post-traumatic growth?

Jamie: So one is an enhanced appreciation of life where a person generally has a sense of gratitude and appreciation for what life holds.

An increased perception of personal strength. So that requires a person to draw deep on their character strengths and enhance some of them perhaps.

There's the identification of new possibilities in life. Which fit in your story, was a necessary requirement because you had to look at new ways of working, new ways of navigating your environment and so on.

Improved relationships with others, and a sense of connectedness with others.

Spiritual growth is an aspect of post-traumatic growth as well.

So they're, they're the five domains that are generally included in this constructed post-traumatic growth.

And if you do the post-traumatic growth questionnaire, it will give you a score across those five domains.

Adrian: Can a person like ... will a person perhaps not get all five? They'll cherry pick, but still experience growth even if they only got, you know, spirituality and strength, for example.

That's still going to be better than none at all.

Jamie: Correct. Yeah, that's right. So you don't have to have all five, but usually two or three would be the minimum for someone to be experiencing post-traumatic growth.

Adrian: And once you've got it, my understanding is you can't shake it off.

Jamie: Yeah. I mean, why would you want to shake it off?

Adrian: Yeah.

Jamie: It's part of you. It actually becomes part of your character or it's intimately at least related to your character.

Adrian: And can you cultivate it? Can you get more? Or is enough enough?

Jamie: Yeah, it's a really good question. And I get asked that quite a bit, particularly when I give presentations about it.

I don't know that we've got a perfect science for how to cultivate post-traumatic growth. I suppose, seeking those things. So, reflecting on one's life situation and thinking about whether there are any possibilities for growth as a result of this generally negative thing that's happened.

So reflecting on what's happened in the most positive way. And that necessarily requires some future oriented thinking because as in your story, you were forecasting, what, 15, 20 years into the future at least, and you were imagining the life that you could have in spite of what's happened.

And you had to come to terms with the vision of how life would have been if what happened didn't happen, if you hadn't had the stroke.

And you had to resolve that in some way, you had to process it and make meaning of it. And I think that's probably. I know it's very vague and very general. But that would be my suggestion about how to best cultivate it. Process it deeply, look into the future, look for a meaningful life. Imagine the most meaningful life you can have, and then work backwards from there.

Adrian: Ruminate.

Jamie: Yeah. Interesting that you mentioned that. Rumination is interesting because it's usually used in a negative sense where people go over and over something, usually something that bothers them more or a problem or something like that.

Rumination serves a purpose, and the purpose is to solve a problem. So I would say yes, ruminate so long as you're solving a problem and not just going over ...

Adrian: This sucks. This sucks. This sucks.

Jamie: That's right.

Adrian: Okay. And I mean, I still clearly remember when you first mentioned we were in a, we'd exchanged emails, we had spoken on the phone, but we were in a room together doing training about brain injury and you were presenting the clinical and 20 minutes into the presentation you said and Adrian here is a good example of post-traumatic growth.

And I thought, what the hell is that? And I'm looking on my phone, looking at it, and I read those things and I you know, those underlying concepts. And I just I was reflecting "Oh, yeah, I get that." I could clearly draw upon my personal strength.

So I'm a warm, friendly guy, but I realise as a result of what's happened to me that I am as hard as granite.

Jamie: Yeah.

Adrian: Something, whatever happened, you know, a meteor comes through the roof right now. I'm on an aeroplane and it's crashing. Whatever. I know that everyone around me will be going to hell in a handbasket, but I know that I'll be doing higher order thinking and I'll be really okay with myself.

And I think that inner strength, certainly in terms of people who've had a stroke, I would wish that for anybody if I could pick or choose because stroke is going to throw challenges constantly.

You know, if you're going to be living a life, if you've had a stroke when you're young, 30, 40, 50 years of living with a shitty situation, having that recognition that you are a tough M.O.F.O, is a good thing to have.

And yeah, I love that idea of I don't come across particularly macho, you know, I'm not going to, you know, talk about the footy or whatever, but you place me in an awkward situation and I know that I'll be okay.

Jamie: Yeah.

Adrian: I think inner strength is a great thing to have.

Jamie: Absolutely. And for you that probably pre-existed the stroke did it?

Adrian: I don't know. I mean, I think as a teenager watching my dad die, you know, he had a series of brain tumors and finally decided after the third not to have more surgery because at this point, he wasn't, you know, medical science was not prolonging life.

They were just keeping, you know, staving off death. And that. You know. So at 17, I watched Dad die and I closed his eyes.

Two days later, I was doing, you know, I buried him. And then the day after that, I started the HSC with a hangover.

So I don't know that I ever thought about post-traumatic growth in reflecting back on watching Dad die, but I certainly I think that probably set me up without reflecting on it for further on down the track.

Jamie: Yeah.

Adrian: Once stroke happened and then, you know, you introduced the concept. I reflected on that and that interconnectedness. I love the interconnectedness that you get from it also of my situation is not your situation, but we have a commonality. So we have a connection. And I love connection now.

I mean, I'm the youngest of nine kids, so I'm used to, as, you know, studies around birth order. When you get to me, you're adept at dealing with people from 8 to 88 because you're exposed from a very young age to lots of people.

So I had that to draw upon. But then you've got that interconnectedness of not quite the same situation, but similarity. So I can kind of walk in your shoes a bit, but you can kind of walk in my shoes a bit.

And I think I think again, stroke brings that out in people. Which are, you know, I don't know anybody. I have no friends that have disability. I'm not a ... I'm in that community but it's not my community.

My community is you and I going bushwalking or, you know, going to an orchid show or whatever. It's not disability. So you can kind of dabble in it and not but, you know, you're not bullshitting, I guess.

Jamie: Yeah, I wonder whether you know, your positioning in the family and your early life exposure to lots of different people from different walks of life and different ages. I wonder whether a certain flexibility emerges from that life experience that may or may not be relevant to post-traumatic growth, but may be relevant to sort of problem solving. We do know that problem solving is affected by cognitive flexibility.

And if you can fairly rapidly shift your perspective or shift your direction when a problem occurs, such as a meteorite coming through the roof, well, you're going to be a good problem solver.

And to some extent, I wonder now whether problem solving might be part of that, the whole post-traumatic growth experience. Right?

Because it's about looking for new ways to do old things or and that includes defining who you are and what your next 20, 30, 50, 70 years is going to look like.

So I'm just sort of riffing here on some ideas. And this is not based on any sort of empirical studies I've read, but I do wonder whether that's an important part of it. And your story would be a really good example of that, again.

Adrian: It's like a Teflon coating.

Jamie: Yeah.

Adrian: Okay, life, bring it on. And it is that, you know, I've been through this and I remember, I told you. When it appeared that I'd had another stroke and this you describe that as very high order thinking. I was left in a in a room in a wheelchair waiting for an MRI with no windows, no social worker, or a psychologist to help me process it. And I was just like, okay.

And I just wanted to lie in the fetal position and ball my eyes out. Because it certainly appeared, my blood pressure was through the roof. I was hemiplegic.

I'd had another stroke. My neurologist thought I'd had another stroke. And I remember sitting there going, okay, well, you've been through this and you've rehabilitated, so you know you can do that again.

It's fortunately, it's your right side again. So at least you've got your left side again. And I was just lining up my ducks. I was lining up my ducks.

Okay, so you know what to do for rehab. It's your right side. I'd told Konnie, don't call anyone. I would rather have answers and give people answers rather than because when you're one of nine kids, you know, you make a phone call, Ade's in hospital. It looks like he's had another stroke.

Lots of movement happens. But I just wanted to get answers and proceed on the basis of, okay, you've had another stroke, now you can lie on the floor in the fetal position and ball your eyes out.

Jamie: Right.

Adrian: But I pulled myself together and I clearly remember, literally and figuratively put myself together and went, okay, let's go have an MRI and not cry.

And it is that intestinal fortitude to pull yourself together, which I just think thank God for that, if I'm honest, because. Oh, thank Buddha. Thank whoever.

You know, there's that spirituality thing. Thank your lucky stars that you can draw upon those reserves for the whatever's next.

Jamie: Yeah.

Adrian: Because sitting in a wheelchair in a soulless, windowless room waiting for an MRI is not a happy place to be.

Jamie: No.

Jamie: So that was quite a remarkable story about discovering that you had that inner strength, that intestinal fortitude, as you'd put it, to get through some pretty significant challenges.

And that's one domain, one sphere, if you like, of post-traumatic growth.

Another one is appreciation of life. How has that resonated for you since you've had the stroke?

Adrian: Looking out a hospital window, it was springtime, and I just wanted to be out there. I've always been a nature boy and as a career I've worked outside, rain, hail or shine, for, you know, 14, 15 years. I love interacting with nature.

It's on the walls. It's in the garden. And stroke, not having a license has shortened my horizons.

So I kind of have a gilded cage here in the backyard where I still get to interact with nature. And I love, I've acquired a reasonable orchid collection, which is good for me to interact and keep my horticultural skills. I get to use my horticultural skills to cultivate and enjoy growing orchids.

I will always think of myself as a horticulturist, even if I ... Screw you stroke. That's what I did and that's what I do. And that's how I think of myself.

And I'm still going to do it and I still get to do it.

Jamie: That's amazing. Is it alright if we go and have a look?

Adrian: Of course.

Jamie: Sounds good.

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Jamie: So what does this place mean to you?

Adrian: It means a lot of things, Jamie. It means joy, peace.

It means for me, I still get to practice my horticulture skills because I don't work in a garden, you know, four or five days a week.

It means joy, sorrow, anger, frustration. There's an orchid up the back that after eight years it was going to flower for the first time for me. And two days before the flower opens, I was rather frustrated because an insect ate the flower. I went, oh, well, there's always next year.

And it's that peace. It's, you know, post-traumatic growth means that acceptance, I guess.

But in 12 square meters, I get life lessons that I can take out of this place into the real world. And it makes me a better human.

Jamie: Yeah. Wow. So what are some of those life lessons?

Adrian: Stuffs out of my control.

Jamie: Yeah.

Adrian: I can put all my horticultural skills to use. And plants will thrive. Plants will sulk, plants will die. Plants will flower, plants will not flower. And ultimately, I can do everything within my control, but I have zero control.

And that was the same with my experience, certainly within the hospital. And then moving on from that. The only thing I had control of as an inpatient in hospital, doctors telling me stuff, physiotherapist making me do stuff. The only thing I had control of was what was going on between my ears. And everything else in life, in hospital, in here is out of control.

So I can only control my emotions. So I really screwed my emotions down tight.

Jamie: Yeah.

Adrian: And outwardly projected a guy that was calm and in control and friendly and polite. In hospital I was all those things in a bloody hard place.

But those life lessons, I guess, are a good ... You're in hospital for nine, ten weeks, but then you re-enter the world with disability and you have to process that.

I didn't want to be … I didn't want to be that angry guy that I mentioned before. I don't wanna be an angry guy in here. I wanna be a happy guy in here. It's springtime at the moment.

I mean, how can you ... Ultimately the end game, growing orchids, is to have them flower. And I'm going to be surrounded by thousands of flowers in the next couple of weeks. And that's just unbridled joy. That's just, that's just ...

You and I've talked about, I remember, what is it? Instant dopamine and low level dopamine. There's a lot of low level dopamine going on here.

And right at the moment "ding, ding, ding". It's all just going off, you know, the synapses are firing. It's joyous.

How can you not be happy when you're surrounded by the scent?

I mean, you can describe a flower, but you can't describe the scent. And I think the scent is ... You can take a photo of a flower. But you can't take a photo of a scent.

So I've only got that, you know, 4 to 6 weeks of a year. I just get to come up and go. And that heady smell, you know, makes me dizzy and giddy. And I love it. So you can see the look on my face.

This place here represents a lot of things to me. But unbridled joy, I think is probably the main one.

Jamie: I'm really fascinated by that mixture of emotions you mentioned earlier that you also associate with this place.

So it's unbridled joy for six weeks in the year because you see the fruits of your labour, if you like, and you get to enjoy it in that ephemeral sense, particularly using your olfactory sense.

But to enjoy that six weeks of the year takes a lot of grit, a lot of hard work, a lot of persistence and perseverance and challenges and disappointments and all the rest of it.

And I wonder now whether your horticultural background and knowing that fact of life for plants, which is you can't control everything, you can't control the weather, you can't control a lot of external factors. All you can control is give these plants the best environment, the best support necessary to achieve the best possible outcome.

Even though you realise that the best possible outcome won't always be achieved. And I wonder whether that is interwoven in your character and whether that in some way has actually helped, helped you foster some post-traumatic growth.

Adrian: Cultivation.

Jamie: Yeah, Yeah, exactly.

Adrian: As I cultivate them, I cultivate me, you reckon. Yeh, possibly. I've never really thought about it that way. I mean, I look at, you're a scientist, I look at this unemotionally.

But the end result is purely emotion. It's a scientific process. You know, feed them this at this time. Water them, you know, more in summer. Give them as much life as you can. And all that sort of stuff.

So give them optimal opportunity to do what they want.

Jamie: Yes.

Adrian: Is all higher order thinking. The end result is "Yay, yay." Lots of brain chemicals going "Happy, happy. Joy, joy".

So yeah, that's an interesting, interesting ... I'm gonna have to ponder that now.

Jamie: Well, it's not dissimilar to the story you were telling me earlier, which is, you know, you'd had another stroke or thought you'd had another stroke.

All you felt like doing was curling into a ball and crying. But you pulled yourself together to to say, okay, what do I need to do here? What are the next steps?

And that's similar to, you know, that's very thoughtful, very rational, so that you could have ultimately an emotional experience.

And in the context of post-traumatic growth, the emotional experience is living a meaningful life. Living a good life. Being happy. Being authentically happy.

And that requires cultivation, requires work, it requires dedication. It requires strength and commitment.

And yeah, I think it's not too much of a stretch of the analogy of this world pretty much being a microcosm for the world of the, the person, the soul, the psyche.

Adrian: It's interesting, we haven't really touched on happiness, but I love to be happy.

Jamie: Yeah.

Adrian: I could be really unhappy because at 34 I had a stroke and lost, you know, opportunity etc. etc.

But I'm fundamentally motivated by happiness. And you talked about authentic happiness and I'm not bullshitting it.

Yeah, it's ... I love to be happy regardless of, of, you know, stuff happens externally, that again, happiness is totally within.

You know, I've got the keys to it. I can be the driver. So it's that sense of control that planning that we sort of touched on without ... I mean, yesterday was the 16th anniversary of my stroke and yesterday wasn't a great day.

But I'm allowed to have one day a year where things are, you know, are a little bit rough around the edges. I want to be happy the other 364 days of the year. And that takes effort.

Jamie: Yeah.

Adrian: And post-traumatic growth for me is the driver of that. Post-traumatic growth makes me happy.

Growth on this makes me happy. Growth within myself makes me happy. Seeing growth in other people makes me happy.

And I just think it's a lovely idea. And I think you, as I said, you know, when I was there Googling, looking up at you and Googling, I thought it was a gift. You gave me a gift.

And I think what I hope we achieve is that we give people a gift also.

Because I think it's a good thing to have. It's a good thing to cultivate. It's a good thing to have more of. And as we've touched on, once you've got it, you can't shake it off. You know, I'm going to be this guy for the rest of my life and I wouldn't want to be anybody else.

Jamie: That's lovely. Well, I'm deepening my own knowledge anecdotally through your story about the power and the importance of trying to cultivate post-traumatic growth after a traumatic experience, and I think you're still one of the best examples of that that I've ever come across.

And it's just nice to, to see the connections and see how the rest of your world and outlook and interests kind of weigh in on that post-traumatic growth process. And I think it's wonderful and thanks for sharing it.

Adrian: I'm not going to give you a hug, but it's lovely hearing from a friend who also has a clinical background to say that.

I mean, that's like, you know, literally there's goose bumps here, Dave. I've got goose bumps, man. To be an exemplar of something be it an orchid grower or whatever, is not a bad place to be and somebody's gotta do it. Well, you know, sure, I'm going to put my hand up and, you know, the Commonwealth Games are on and I'm a gold medalist in post-traumatic growth.

Cool. Thank you.

Jamie: You're very welcome. We're done.

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Jamie: So welcome to my world, Adrian. In our previous conversation, we mentioned trauma in the context of defining post-traumatic growth.

So what's a traumatic event?

It's essentially an event that threatens the integrity of an individual. And the DSM defines trauma as exposure to actual or threatened death, serious injury or sexual violence.

The person might encounter trauma in being exposed to war, sudden and unexpected death of loved ones, natural disasters, threatened or actual physical assaults, threatened or actual sexual assaults, serious accidents and being diagnosed with a life-threatening illness such as stroke.

There are some trauma statistics you might find interesting. 57 to 75% of Australians will actually experience a potentially traumatic event at some point in their lives. So the majority. PTSD is characterised by enduring symptoms of intrusive memories of the event, avoidance of all of the reminders of the event, a negative thoughts or feelings and changes in arousal or reactivity.

So that's post-traumatic stress disorder. And it's estimated that 12% of Australians will experience PTSD in their lifetime. The one year prevalence is about 6% in Australia. And approximately 20% of people who are exposed to a traumatic event experienced PTSD.

So there's some statistics about trauma.

Now your question when we had our discussion was what is post-traumatic growth? And that is most commonly defined as positive psychological change experienced as the result of the struggle with highly challenging life circumstances.

This is the definition that was offered by Tedeschi and Calhoun, who developed the PTG literature.

There are some other definitions and similar concepts. Another definition is the success with which individuals cope or strengthen their perceptions of self, others and the meaning of events after a traumatic event. And some of the other terms or concepts that overlap with or are sometimes synonymously used with post-traumatic growth are adversarial growth, benefit finding and stress related growth.

Importantly, post-traumatic growth is to be distinguished from resilience.

We often use the term resilience within a mental health context and in everyday language. And what resilience means is basically bouncing back to your baseline after you've experienced some adversity or challenge.

Post-traumatic growth is different in that the person bounces back to a higher level compared to their baseline.

And a very common saying that's often cited in this respect is that which doesn't kill me makes me stronger by Nietzsche.

Adrian: But Jamie, we're not talking about being happier. We're not talking about happiness, per se, are we? It's different.

Jamie: It's very different to happiness. One can experience post-traumatic growth independent of their levels of happiness. It's more about developing a sense of purpose, meaning and autonomy in life.

So consider the person who's lost his or her child to leukemia. Very sad experience, obviously. And because of that experience, they've become committed to helping other children with leukemia or parents of children with leukemia. They set up a charity. And they help develop awareness and raise funds for this worthy cause.

Now, that person won't necessarily say that they feel happier as a result of what they've been through, but they will often report a stronger sense of purpose and meaning as a result of the event.

They've re-evaluated their life where their life trajectory was, and they've made a significant change and look for new opportunities in this case.

So the positive changes, the new found meaning and the clarity of life priorities would be considered forms of growth, even if the person's not reporting feeling happier or more satisfied with life.

So you asked about the five areas of post-traumatic growth. They are an enhanced appreciation of life, increased perception of personal strengths, identification of new possibilities for one's life, spiritual growth and improved relations with others.

Why does post-traumatic growth occur?

One reason is people are intrinsically motivated towards growth. We all aim to grow. If you ... If I cite one of the more popular and well founded theories in psychology, which is self-determination theory, we all strive for competence, connection and autonomy.

And competence is about growing, learning new things, being productive, being helpful, being able to be of service.

So we're all intrinsically motivated for that.

When someone experiences a traumatic event, their world shatters. It ... Their world views are questioned and they need to, in a sense, pick up the pieces and reassemble their model of the world.

And so if a person is intrinsically motivated to grow and their world shatters around them, that obviously leads to this third element, which is reconstructing the world and the model of the world.

And this requires the person to make meaning of things. Often in different ways to their understanding prior to the traumatic event.

Adrian: So I grew up in the country. I know cows ruminate. But why are we talking about rumination? I think it's an interesting idea.

Jamie: Yeah, rumination probably deserves more research than it's attracted to date. Rumination is the idea of mulling over concepts, ideas, what's happened, what's to happen.

So people can ruminate about what's happened in the past. But people can also ruminate about what they're concerned about in the future.

And rumination is a really important part of the process of making sense or making meaning of things. So rumination about a traumatic event involves thinking about how and why the event occurred, and it's accompanied by high levels of distress, often at least in the early stages, and it can be characterised by intrusive thoughts.

So thoughts you don't want to have at that particular time or intrusive memories and counterfactual thinking about how the incident could have been avoided.

Now, this is very common for people who have experienced trauma. Now at a more general level. We ruminate to solve problems. And the problem here to solve is my world has shattered.

How can I make sense of what's happened? So Todeschi and Calhoun have proposed that rumination is one of the mechanisms that facilitates post-traumatic growth.

Another one is deriving meaning from the event. So an individual starts to derive meaning from the trauma by contemplating why it happened and what can be learned from the experience.

And then thirdly, social support. Other people, particularly those who have experienced similar circumstances themselves, will be able to help survivors make sense of the events and devise new narratives to tell different stories about how and why they got to that point.

Adrian: And so passive rumination, not good.  But active rumination, actively engaging and thinking about these circumstances is going to be helpful in the long run?

Jamie: I would say active and helpful rumination. There is unhelpful rumination. There is a form of rumination where a person gets stuck in a loop in a repeat pattern, and by definition there's no problem solving going on there.

Person's getting stuck. And that could be due to a flexibility issue or a habit of thinking.

So I would say active, helpful or positive rumination, I suppose, is the way out.

Adrian: So for me it was I'm in hospital, I need to get out of hospital. I need to learn to walk, I need to problem solve. And I was, I suppose, ruminating on not what was but what is and working, dealing with the consequences rather than mulling over why has this happened?

Jamie: Yep. Yep. Precisely. So you went straight into problem solving mode and obviously that ultimately helped.

So thanks for joining me in my world for a little moment Adrian. I hope you've taken some notes and that you find that helpful.

Adrian: Thank you for having me. Is there going to be a test Jamie?

Jamie: Of course.