The secrets of extraordinary survivors

It’s true that a good proportion of people suffering trauma do carry mental illness. On average, around 25% of people exposed to a life-threatening or violent event develop post-traumatic stress disorder, or related disorders that don’t meet its strict diagnostic criteria. Their lives can revolve around their symptoms, which include nightmares, flashbacks, intrusive thoughts, disrupted moods or cognition, hypervigilance and irritability. Usually they harbour irrational fears that cause them to avoid situations that remind them of what happened.

Traumatised survivors of war crimes, and victims of torture and rape – such as Eugenie – typically fear sleeping in the dark. They have difficulty watching anything violent on TV. If they are women they are usually afraid of men and may choose to miss their bus or train if it carries a preponderance of men. Eugenie dreaded being in crowds, yet she also couldn’t bear spending even five minutes on her own. At night, she says, “I would see the soldiers in my mind and all they did to me.”

“Post-traumatic growth”

Left untreated, those symptoms can persist for years. In 2004, Greek psychiatrists discovered that survivors of the 1953 earthquake on the island of Cephalonia, which killed 455 and left many homeless, were still experiencing flashbacks and nightmares, more than half a century later.

Yet it’s still striking that the majority of people who live through an earthquake, terrorist attack or physical abuse do not experience lasting psychiatric symptoms. “People are more resilient than we give them credit for,” says Simon Wessely, professor of psychological medicine at the Institute of Psychiatry, King’s College London. When Wessely’s team asked 1,000 Londoners about their emotional state in the days following the suicide bombings on 7 July 2005, only one in 100 said they felt they needed professional help. A similar survey among residents of New York City after 9/11 by George Bonanno at Columbia University found that a large majority suffered no trauma symptoms at all during the six months that followed (though PTSD rates among those living or working near Ground Zero were around 20%). This rather undermines the received wisdom that everyone in the vicinity of a disaster needs help.

Such extreme differences in the way people cope are striking, and puzzling. What makes some people more resilient, so they require less help and can pull through quicker than others? And why do a minority even manage what psychologists call “post-traumatic growth”, living deeper, more meaningful lives than before?

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Some clues come from the High Valley Resilience Study at Harvard Medical School, which followed a group of young people who had been hospitalised in their early teens due to severe psychosis. Following patients from the late 70s to the early 90s, it found that a minority surprised everyone by going on to lead normal lives in adulthood. These survivors did not appear to possess any remarkable innate attributes. Instead, what set them apart was the way they framed the story of their illness and how they integrated it into their personal narratives.