Monday, October 3, 2016

On Finding Meaning in Adversity

I spent this past weekend at a conference for the Society for Research on Psychopathology (SRP). During the Presidential Address, my brilliant research advisor articulated complexities of understanding the etiology, course, and treatment of bipolar disorder. Voicing incredible vulnerability, she shared a personal story about a friend of hers, who was a determined and passionate woman with multiple graduate degrees and an internationally acclaimed career. While she was seeking treatment during a period of sickness, her doctor told her that her ambition was fueling her illness, and she needed to reduce her commitments and reassess her lifestyle. The following day, she committed suicide. Life was not worth living if she could not embrace her ambition. My advisor compassionately explained that for many experiencing bipolar disorder, aspects related to periods of illness, such as high ambition, are also cherished aspects of identity.

I share this to portray the dialectic of mental illness, disability, and adversity. In so many ways it is a source of struggle and of pain. And yet, it is often what makes us who we are.

Before delving deeper into my thoughts on this theme, I wanted to share a brief anecdote depicting my own experience. After writing my last blog post, my dad emailed me saying, “I know there is nothing I can or could do, but I still can’t help but feel like I wish there was some way I could have prevented this or that I could fix your vision disability.  It is only my nature.”

I responded, “I wouldn't change it, frankly. I think I've learned so much - about myself, about the world. I appreciate the sentiment, but I don't know that I'd be where I am if I hadn't experienced vision loss.” I hoped to reassure my dad, who I think feels guilt for not being able to protect my brother and me from the challenges we face, as well as to articulate the ways in which this experience shapes my perspective on the world and pushes me to grow in unexpected ways.

I have been thinking about related research on resiliency, some of which I saw at SRP (i.e. George Bonanno). A trauma, illness, or other stressor can feel excruciating and insurmountable in the moment, and yet afterwards, we can find meaning that enhances wellbeing. This response to trauma is referred to as post-traumatic growth, characterized by feeling more gratitude for life or greater appreciation of loved ones (i.e. as described by Lawrence Calhoun). Trauma, though inherently tragic, can bring us together and help us reconnect with what is important to us. I take away from this that not all adversity is all bad all the time; there are positive outcomes that result from challenge. To me the important questions then become how to facilitate this post-traumatic growth, and what is it that enables one to find meaning in adversity.

As a clinical psychology graduate student, I often consider how this relates to mental health. In the personal story shared by my mentor, it is clear that ambition is a common thread both in illness and in strength for many people experiencing bipolar disorder. There is fabulous work showing myriad adaptive functions accompanying depression, autism, and the like. Depression has been related to increased empathy, and has been experienced by inspirational leaders like Martin Luther King, Jr., and Mahatma Ghandi.  Autism leads to attending to detail and thinking in pictures or patterns, and advocates such as Temple Grandin have described this as an asset in her career. Importantly, this movement towards recognizing the adaptive functions and meaning that can be gained from otherwise exceptionally difficult experiences offers promise to de-stigmatize mental illness. I also wonder if the ability to find meaning results from framing adversity and illness both as a source of potential suffering but also as a source of perspective, strength, and insight.

My belief in the importance of finding a broader meaning in these experiences makes me disappointed by how little this notion is emphasized by the healthcare community. The medical model views challenges to health – both physical and mental – as diseases that need to be treated, ideally cured. The obvious goal of this model is to eradicate disease. I see a discrepancy between this model and my fundamental belief in viewing diseases (and other forms of adversity) as challenges to face, and as opportunities from which we can learn about ourselves and others. That is not to say I would wish illness, disability, or other adversities on anyone. But, these adversities are an inevitable aspect of life. I wonder to what extent treatment could be improved by taking an approach that encourages pride and ownership of illness and disability, striving to build an identity that includes but is not defined by the illness or disability. This approach is not meant to minimize the extensive acute or prolonged suffering that result from adversity; instead this approach provides a way to cope and find meaning. Shifting schemas held by the healthcare community to emphasize this challenge-oriented mindset would likely foster resilience and reduce suffering.

One of my favorite quotes is by Andrew Solomon, “forge meaning, build identity.” This message resonates with me deeply. Often, we cannot change the struggles we face – whether it be in the form of illness, disability, discrimination, or bullying. What we can command is our narrative. And that narrative can be a source of strength, identity, and meaning.

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