The Trauma Script

22:20And many mental health experts were assuming we need to do something to take care of this looming disaster, this looming mental health disaster. And what happened eventually? What happened eventually was that the pandemic did not have nearly the psychological impact that people thought it would have. There were a lot of studies done, and I don't know if I can call to mind all of these different kinds of studies, but one of the best examples is suicide. People thought suicides would skyrocket during the pandemic. And in fact, suicide stayed the same or declined globally. In my own research, you know, we tracked people over time, and we found that people were as resilient and as healthy as they always had been.

23:06And this has been seen also all over the world.

23:11George, many people believe that we respond to difficult or traumatic experiences by going through a series of stages. This idea was popularized by Elizabeth Kubler-Ross, who said, we go through denial, followed by anger, followed by bargaining, followed by depression, and finally, acceptance. Talk about how this theory has gained widespread traction and whether there's much evidence supporting it in scientific circles. Well, initially the theory, Kubler-Ross had proposed the theory to account for how people face their own death. And there's hardly any data on that, any research on that for obvious reasons.

23:52people are not interested in participating in research as they face their own death. But then it got foisted onto how people deal with the loss of a loved one. And she didn't actually do that. That was really other people that did that, other theorists. And it became very popular. I think the reason that it became popular, because it's sort of a roadmap. You know, something like grief has got lots of existential threat involved in it. We don't think about death very much. life and death, and suddenly we've lost somebody, we don't know where they are, what that means. And this theory provided very clear answers.

24:32Unfortunately, it's far too neat and tidy to actually be true, and the research has never supported it. There's not really been any evidence that it's actually what people go through. And a lot of research contradicts it. I understand that one of the tenets of the theory is that you have to go through each stage in order to get to the next stage. So if you try and skip a stage, you'll end up suffering for a longer period of time. So in some ways, the theory is surprisingly prescriptive, if you will. It says that you have to go through stage one before you get to stage two, or stage three comes before stage four.

25:07And again, this doesn't quite match the scientific evidence on loss and bereavement, right? It does not match the evidence at all. You know, many people don't go through any of these experiences. There's a lot of idiosyncrasies to how people cope, how they react to things like the death of a loved one. And this precision, this sort of sequential perfection, in a sense, doesn't really accommodate it. And it's ended up, I think, for all the comfort it might give some people at being a kind of a roadmap, it also causes a lot of harm. because when people don't experience those stages, other people then argue that perhaps there's something wrong with them.

25:49They're not doing the grief properly, and they're going to suffer more if they don't straighten up and do the stages in sequence. And in some ways, this matches your own experience. You experienced this deep silence after your dad passed away, which is not really reflected in the stages of grief. Julia's mom was really upset that she was not grieving enough. Jed was surprised that he was not reacting with trauma to what had happened to him. And in some ways, all of you were basically saying, here's the model of how we're supposed to respond to something terrible. And what's wrong with me that I'm not fitting this model?

26:25Yes, absolutely. I actually recall in my own experience that after my father died, I returned to Colorado where I was living and went back to work right away. And the people at work kept telling me, you know, you don't have to work. It's okay. You can take some time off. And I think they were worried that I was, you know, inappropriately coming back to work when it's really all I wanted to do. I wanted to, you know, and it makes sense because when people come back to work, come back to something that's rewarding to them, they're telling themselves and showing themselves they still have a role in life.

26:59They still have an identity that's not lost.

27:10You found that there are many trajectories that characterize how people respond to adversity and loss. One of these patterns is, in fact, marked by what you call chronic grief. What is this, George? Chronic grief is, simply put, the inability to get over the loss. We measure it in very clear ways, having a lot of the kind of symptoms we associate with grieving, but struggling to function, struggling to think, to concentrate, to be close to other people. And it just simply can't get past that. So they're suffering and suffering for months and often years. How many people experience this kind of chronic grief, George?

27:51Best estimates, I would say, are at the most about 10 % and usually less.

28:02A second trajectory that you've identified is what you call the recovery pattern. What is the recovery pattern? The recovery pattern is very interesting. It's a pattern that begins with a lot of difficulty, struggle, difficulty, high levels of symptoms and distress. And then gradually over the course of a year or two, the symptoms and the distress diminish and the person moves back toward their baseline, where they were before. It takes time, but they're steadily getting better. A third pattern that you've noticed is characterized by a delayed onset of symptoms. What do you mean by this? Well, delayed symptoms, first of all, we don't really see that with grief.

28:45There is really no evidence for something called delayed grief. We do see this when there's a trauma, a potentially traumatic event, but we don't see the classic idea of delayed PTSD. Classically, it was a thought that people would be functioning just fine, and maybe this would be connected to the idea that perhaps they're in denial. And then out of nowhere, they would suddenly develop PTSD. And the same thing was said for grief as well. If people aren't grieving, like Julia perhaps, her mother might have thought she's going to have a full-blown grief reaction. It's just going to take up on her.

29:21It's a dwelling inside her as if it's a thing. It's dwelling inside her and is going to come out and grab her and then she's going to really be suffering. But the mind and the body don't work that way. The grief and emotions are not dwelling inside us as things. And when we have seen those patterns, they're not quite as dramatic as that. We see with delayed PTSD, for example, people are struggling, not doing very well, but they're barely getting by, and they get a little bit worse. Their level of distress, their symptoms increase slowly, and they cross a line to where they're now sort of officially really suffering.

29:58but they've actually been struggling all along. That's the pattern we see. You say that the most surprising pattern is also the most common pattern in how people respond to setbacks and tragedy and grief. What is this pattern, George? Well, this pattern we call the resilience trajectory. Initially, when I began my career, it's very interesting. It was assumed that very few people would show this kind of pattern of They might struggle for a week or two, maybe a little bit longer, have some upheaval in their life, they're kind of preoccupied. And then that kind of dissipates and they're more or less functioning normally.

30:40We call this a stable trajectory of healthy functioning. And when I first began my career, it was assumed that hardly anybody would show that pattern. And if they did show that pattern, there was something wrong with them. That was the denial idea. When we began to actually look, is what I did in my research, which was the only novel thing about this research was that we just looked and measured the range of possible responses to see how many people were showing these responses. When we actually did that, we found that the majority, it's almost always the majority that's showing that pattern. Most people experience short-term distress, upheaval, and then they continue to function normally after that.

31:20It's not that they don't care. It's not that they're not saddened or upset by the event, but they move on with their lives. Do we see these different patterns in all manner of setbacks, people getting divorced, people suffering physical losses, people with injuries or ailments, people losing a loved one? Do we see these different patterns of response for all manner of different setbacks, George? Yes, absolutely. We've now done this. My team has done a lot of this, but other research teams are also doing this. We've seen these patterns in now about 100 different studies, actually, for everything from the worst kinds of events like traumatic injury, mass shooting, spinal cord injury, to things that are like loss and relationship divorce.

32:11We've seen it for financial problems, losing a job, et cetera. So it's the range of anything that's sort of a serious event that somebody's going to go through that's going to upheave them, cause upheaval in their life for a while. We'll see these same patterns.

32:32I want to spend a few moments talking about why the popular understanding of loss and grief has come to be at odds with what the scientific data is showing. How do people respond when you share your findings about resilience with them, George? Well, I've been doing this for a long time, Shankar. I've been doing this for about 35 years now. So initially, it was difficult. We began to report these findings in scientific journals, and they were more or less ignored. And I was young, and I'm told that I had kind of an extremely young face. So it was easy to dismiss, this is just some young guy doing this research.

33:11But over time, as we began to pile up the evidence, the negative reactions began to happen, and particularly from the trauma world. People in the trauma world would tell me, you're a good researcher, but there's something wrong about what you're doing. And therapists would come up to me if I'd given a public lecture and tell me, I'm sure you're a good scientist, but you're just wrong about this. It's just wrong. I know, and you're wrong. And that happened for quite some years. I'd say 15, maybe 20 years even, and it's slowed down a bit. But oddly, there's been a revival of this idea in recent years, a revival of the idea that everybody is traumatized.

33:51Where do you think that comes from, George? Well, it took me by surprise. I think it's mostly in younger people, probably has something to do with the internet. it. I know there are a lot of these cultural phenomenon, like on TikTok, there's something called trauma dumping, where people go on TikTok and tell their trauma stories. And those are very popular sites when people do that. So I don't know really, besides that, how this has come about, how this has been revived. Now, it's certainly possible, George, that some of the people who come up and disagree with you are, in fact, people who have experienced chronic grief.

34:28You told me that about 1 in 10 people do experience long-term trauma from these experiences. So it's perhaps understandable why someone with long-term problems might generalize from their own experiences. But we don't see this with many other medical conditions. People who have terminal stage 4 cancer don't say the only form of cancer is metastatic end-stage cancer. In fact, for most medical conditions, if we must have the problem, all of us would want to have the mildest form of the problem. But somehow people seem resistant to the idea of mild grief or grief that passes by quickly. Something about that seems wrong.

35:05Yeah, grief, I think, has a different element to it. That element that somehow you are not honoring the person that had died if you move on too quickly. But there's another element to it also, which is that we are wired, if I can use that word, we're wired for threat, for danger. We pay attention when something bad happens. The internet knows this, all media know this, that the clicks online come from really bad things that are attention-getting things, ugly, disastrous things. In the modern era, just around the time of when the internet was really taking off was when also these diagnoses for grief and trauma really came to the fore.

35:52And lots of books are written about how bad these things can be. And the books were well-meant and they were accurate books about the disorder itself when people can't recover. But those books got a lot of attention and I think led to the idea in the popular culture that these events are going to really harm us when they happen. I've argued actually that one reason why therapists tend to think that trauma is more common than it is, and therapists do overestimate the prevalence of trauma typically, is if they see traumatized people, they see traumatized people in their practice, and they see a lot more than is in the normal populations, in the base rates.

36:34So they tend to then overgeneralize that to the general population. It's a very human thing to do. It's not evil or dumb. It's a very human thing that therapists do because they are humans. It's also the case that I think after mass tragedies, if you think about the 9-11 attacks or if you think about, you know, disasters like the COVID pandemic or a natural disaster, in some ways, if I come and tell you, look, things are going to be really bad, a lot of people are going to be affected, we should do a lot, and it turns out I'm wrong, people will just say, okay, you know, his intentions were in the right place, but he made a mistake.

37:09But if I come and tell you after an event like this, you know, most people are going to be fine. You know, even if I turn out to be right, I can come across as callous. Yeah. There's something I call the resilience blind spot, which is that right in the middle of, particularly in a disaster, but when we're in the middle of, in the throes of our initial reaction to a seriously aversive event, you know, we do get upset. We have a very good stress response. Our mind-body system has a very well-honed stress response. It's been honed by millions and millions of years of evolution. And you can't activate that response without first feeling stress.

37:48So you have to be upset in order for that response to kick in. So that initial upset we have tends to blind us to the idea that we'll ever not feel that way. We have a hard time as humans with that. Our minds have a hard time with that. And when there's a disaster, something large scale, there's a kind of a contagion that happens as well. Other people are upset too. And so they're upset and I should be upset and I am upset and now you're upset. You know, and that's kind of happens quite fast. When we come back, how the popular understanding of trauma, even if well-intentioned, can sometimes inadvertently create new forms of suffering.

38:31You're listening to Hidden Brain I'm Shankar Vedanta

38:45This is Hidden Brain I'm Shankar Vedanta What are your experiences with grief and tragedy? How have you coped with setbacks in your life? What advice have you shared with others who are dealing with loss? If you have thoughts or questions that you would be willing to share with the Hidden Brain audience, please record a voice memo on your phone and email it to us at ideas at hiddenbrain.org. Use the subject line trauma. Two or three minutes is plenty. And again, that's ideas at hiddenbrain.org. George Bonanno is a psychologist at Teachers College, Columbia University. He is the author of The End of Trauma, How the New Science of Resilience is Changing How We Think About PTSD.

39:31Some of our conversation today, George, has been about how the work you've done, the scientific findings, are at odds with how our culture says we should respond or ought to respond to setbacks or tragedy or potentially traumatic events. Can you talk about some of the ways in which our culture offers what you might call unhelpful ideas about how we should respond to these events? Yes. I think that there's been a tendency in the last decade in particular of focusing far too much on human frailty, I think, as if people are easily breakable. And there's been a sense of not wanting people to suffer in any way.

40:10There's a Greek concept called eudaimonia, which many people might know about, which is the kind of companion to happiness. But it's not happiness in the sense of joy and hedonic pleasure. It's a sense of reward from achieving something, and that isn't always fun. So I think a lot of what's valuable in life requires a little bit of struggle, and there's a tendency right now to avoid any and all signs of that.

40:42One implication of this idea, George says, is to not assume that painful and unpleasant life events will lead to prolonged mental suffering. That could be the case, of course, and if it is, it should be taken seriously, and people who are suffering should seek help. But it's not useful to assume that everyone, or even most people, will have prolonged grief or long-term trauma. I've had many experiences like this. I recall once when my children were smaller, and there was the preschool they were going to, And one of the teachers told me that one of the children's parents had lost a parent over the summer break.

41:22And she didn't know what to do when the child came back to the class. She asked me if she could talk with me about it. And she said, what should I do? And I said, maybe nothing. And she was quite taken aback by that. But the point I made to her was, you know, maybe this child doesn't want a lot of attention called to him. Maybe he wants to just be a normal kid in the class. Let it play out and see what happens. Can you talk a moment about the widespread use of trigger warnings? Many schools and media organizations are worried about the mental health impacts of sharing negative information with students, with listeners, with viewers.

42:01Do these warnings work? And how do you think they're connected with the conversation we're having about trauma and resilience? Trigger warnings were born out of the idea that everybody's, well, there's a widespread idea that people have hidden traumas lurking inside them or past traumas that were unresolved and they're kind of somehow raw inside people. That's a very common, became a very common assumption. And the trigger warning idea emerged from that as a kind of a way to say, you know, if anybody's got a trauma here in this room or has a trauma lurking inside them, we're going to show some content here, you're going to experience something if you stay for this presentation that might trigger that.

42:43And it was based on the idea that everybody is kind of walking around with these barely below the surface traumas that can explode at any point. And that's really not accurate in any sense of the word. I think we couldn't function as human beings if we were actually built like that. And the research on trigger warnings has shown fairly convincingly that they either don't help or they cause harm. People who are given trigger warnings often are more anxious than people who didn't give trigger warnings, didn't receive them. In research George has done with former Hidden Brain guest Dakar Keltner, he's found that our mistaken beliefs about human fragility cause people to walk on eggshells around those who have suffered losses.

43:27In fact, research finds that even people in acute grief can smile and laugh, and smiling and laughter are correlated with positive long-term mental health. The research shows quite clearly that most people, even people who've recently lost a spouse within the last few months, when we did interviews, we found that the majority of people were showing genuine laughter and smiling during the interview. And that's because these are very social processes. Most of the time when we laugh and smile, almost all the time, it's with other people. And they're very pro-social. They're contagious. They connect us to other people.

44:03And what we've seen in our research with grief is that people kind of go in and out of these phases. You might see somebody crying and holding their head and shaking their head because they're so upset. And then 30 seconds later, they're laughing. They still have tears on their face and they're laughing about something they remembered. And that laughter, we posited, is laughter is a kind of a way to reconnect with the person and almost reward the person for listening, but also rewarding ourselves, letting us feel connected to somebody else. It's a very, very human process. There's been a kind of a prohibition about it for a number of years because somehow it's not respectful or it means you don't care.

44:43But in fact, it actually does mean you care enough to live your life.

44:51When we start by assuming most people will display resilience in the face of setbacks, George says we can discover new ways to cope. Years after his father's death, George found himself conversing aloud with his dad. Someone who was watching him might have thought that long-standing, unresolved traumas were rearing their head. George says it was just the opposite. He was developing a relationship with his father that he did not have while his father was alive. What I had done in my own life was I began to talk with my father. And I would talk with him, and this is primarily when I had my own children.

45:28and so I was now a father and being a father, being a parent is not easy. And there were times when I just thought I wished that my father was alive despite the difficulties we had when he was alive. I felt this would be different now. I'm a different person. He would undoubtedly be a different person as well. And so I began to talk with him in the elevator in my building. I live in an old building in New York and the elevator is quite slow. So I felt safe in the elevator because nobody would see me. And I knew when that door was going to open because the elevator would stop slowly and there was a pause before the door opened.

46:02So I began to talk with my father. And I found this very comforting to have these conversations with him. I'm wondering what you asked your father, George, and whether he said anything in response? You know, I might be asking about one of my children or how having children changes the way you think. or I was noticing things say I would have been much more carefree until I became a parent and I was worrying about money. And I would say something, Dad, I know you were very concerned about money. This is really hard. And I would really just talk with him about it. Obviously, he'd never answered back.

46:41But it was more like I would imagine how he was responding and just be able to tell him this.

46:53There is a great deal of variability in how people respond to difficult life events. What causes one person to suffer endlessly after a loss or setback, while others bounce back? What are the drivers of human resilience? For a long time, researchers have wrestled with the question. Many different factors, like courage or patience or social ties, can shape whether we are resilient. But George Bonanno has found that there is one central orientation that is absolutely crucial. It's a matter of really working out what is the right way to behave in this situation, what's the right way to cope in that situation.

47:32And that led me to this idea of what we call behavioral flexibility. It's a set of skills that we see in people that solve this problem. What do I need to do now? What's the problem I'm facing now and what do I need to do about it? What can I do about it?

48:13go to apple.co slash hiddenbrain. You'll have access to a free one-week trial in both places, and your support will go a long way to helping us build the show. Again, that's support.hiddenbrain.org and apple.co slash hiddenbrain.

48:35George Bonanno is a psychologist at Teachers College, Columbia University. He is the author of The End of Trauma, how the new science of resilience is changing how we think about PTSD, and the other side of sadness, what the new science of bereavement tells us about life after loss. George, thank you so much for joining me today on Hidden Brain. It's been absolutely my pleasure, Shankar.

49:02Have you had experiences with tragedy that match or contradict the ideas you've heard on the show today? Have you experienced difficulty aligning how you felt about a terrible life event with how those around you expected you to behave? If you have thoughts or questions for George Bonanno that you would be willing to share with the Hidden Brain audience, please record a voice memo on your phone and email it to us at ideasathiddenbrain.org. Use the subject line, trauma. Two or three minutes is plenty. Again, that's ideasathiddenbrain.org. Hidden Brain is produced by Hidden Brain Media. Our audio production team includes Annie Murphy-Paul, Kristen Wong, Laura Querell, Ryan Katz, Autumn Barnes, Andrew Chadwick, and Nick Woodbury.

49:52Tara Boyle is our executive producer. I'm Hidden Brain's executive editor. I'm Shankar Vedantam. See you soon.

50:08Thank you.