It was coined "shell shock" during the First World War and "combat fatigue" after the Second. But what psychology today calls post-traumatic stress disorder (PTSD) has been with us since we first faced extreme adversity -- in other words, since evolution delivered us.

And with 225 million confirmed cases in 221 countries, some 4.6 million deaths to-date, over seven hundred thousand in the U.S. alone, and the deepest global recession since World War II, the trauma of our time has been the global COVID-19 pandemic. Untold numbers have suffered acute stress and PTSD.

But, is it possible that many have also grown from the trauma, and even our businesses have benefitted?

Our Response to Stress

When faced with trauma and life-threatening tragedy, PTSD is not the norm but rather the exceptional psychological response. Following trauma, most of the time we undergo a homeostatic, restorative outcome, the so-called bounce-back to our pre-trauma psyche. But we may also experience a negative transformation that succumbs to the strain or even a positive transformation that grows from it. Nor are the negative and positive transformations mutually exclusive, according to the research. In fact, the stress that aggravates the Yin of fear and painful memories in its victim may concurrently heighten the Yang of compassion and tolerance.

Acute Stress and PTSD

Negative transformation from distress may become persistent and even acute. The latter is the most common of the general categories of severe trauma. An estimated 20% to 50% of assault, rape and mass shooting victims experience it.

PTSD is the severe form of acute stress, the stuff of nightmares, or perhaps more accurately, living a nightmare. Clinically, it is diagnosed by intrusive thoughts, behavioral changes and avoidance of the trauma-inducing event. But viscerally, persistent fear, extreme irritability with angry outbursts, reckless, self-destructive behavior, involuntary memories and vivid flashbacks of traumatic events may occur. Even persistent cognitive disorientation and reality distortion characterize the neurological disorder.

Approximately 50% to 60% of the U.S. population has been exposed to some type of trauma-inducing stress. In the aggregate, only about 5% to 10% develop PTSD, though granular studies reveal the types of events and levels of exposure can vary rates substantially. For example, personally threatening events from the 1992 LA riots found levels from 7% to 10%, Gulf War veterans neared 13%, while accident survivors and assault victims ranged from 17% to 18%.

The Potential

At 16 billion neurons, we are a species bound only by our nervous system -- intelligent, gregarious animals defined by our social interrelationships and ability to create and grow. With roughly the same gray matter, a species that once drew in caves and used stone tools to capture prey now uses space telescopes to explore the recesses of the cosmos and questions our own place in it. It stands to reason that severe distress to our minds far exceeds even physical pain.

Analogously, the potential for resilience and growth from post-trauma impact should leave us yearning for new opportunities. Moreover, the new spotlight on growth-oriented aspects from trauma have revealed a surprising result: Incidents of positive outcomes far outnumber psychiatric disorders.

Resilience to Trauma

Resilience is the roly-poly toy of psychological functioning, returning the individual to equilibrium post-crisis. Surprisingly, except perhaps to field experts, the majority of people respond to disruptive events, from the death of loved ones to life threatening situations, with relatively healthy psychological and physical function. Resilience is characterized by an evolving, dynamic process, adaptability to change and a return to homeostasis or even growth beyond it.

The phenomenon does not necessarily mean emotional flat lines, as sporadic mood swings and restless sleep over the course of several weeks, often longer, are common. In other words, some "rolys" and "polys" are par for the course. However, disruption in normal functioning rarely exceeds mild levels, and incapacitation and debilitation are extremely rare.

Resilience also defies traditional counseling methods. Active grief work has recently been shown ineffective or possibly even harmful, while physical causality has gained prominence. The emerging field of psychoneuroendocrinology is exploring the linkage to biological factors, which themselves are bearing fruit for resistive benefit; studies reveal inflammation a resistance-reducing culprit. Indeed, the impact of sleep quality and certain steroids on reducing inflammation have shown great promise for the resilience benefit.

The Value of the Positive & the Known

On the psychology front, building positive neural pathways greatly enhances our resilience. There are active adaptation techniques we can employ, such as benefit finding, focusing on good things and learning experiences, and expressing gratitude for what we already have.

Rituals and habits have proven helpful in dealing with trauma, especially grief. Whether a religious observance to honor someone's passing, a graduation ceremony to mark a life achievement or a routine shared with a loved one, they symbolically give meaning and connection to events and people. Moreover, they give us the perception of restoring our pre-trauma control and balance.

We can also proactively seek out helpful emotions. Positive feelings release endorphins that act on the opiate receptors in our brains to bring a sense of euphoria and serve as natural elixirs to trauma. Pursuing that which brings us love, joy, humor, self-pride, peace of mind and inspiration, however seemingly minor the reason, speeds the healing process and acceptance of life situations.   

Post-Trauma Growth

In the mid-1990s, Tedeschi and Calhoun advanced the budding theory of post-traumatic growth (PTG) and also coined the term. Finding narratives of growth induced by suffering in all major world religions, they traced its roots in scientific study to mid-20th century work in clinical psychology and narrated their own extensive research.

In large part, however, despite that growth is more prevalent than its opposite, it had been overlooked clinically and has yet to receive the common notoriety of PTSD. Indeed, it is the injured, not the healthy, who avail themselves to treatment and research.

Another unexpected finding was that distress and growth are not mutually exclusive and in fact, often coexist; the same PTSD patient may also experience concomitant benefits from the trauma. While neither trauma nor beneficial stress-induced results are inevitable, this finding is quite the opposite of resilience, where the trauma is more like a bump on the highway of life. Growth is less autonomic, more conscious, than resilience.

New Meaning

Perhaps the true pioneer of growth-based research was the brilliant Austrian psychiatrist, Viktor Frankl. To Frankl, giving meaning to his suffering allowed him to survive the horrors of Auschwitz where he also lost his family.

For the person experiencing growth, tragedy and meaning are oft intertwined. If she had her druthers, the cancer survivor would not have chosen her frightful ordeal; but the experience might have made her grow both personally and in her relationships.

The trauma itself is a disruption to our core belief systems. But the person who experiences growth redraws the coordinate system of what she gives meaning to and how she spends her time and energy. She might now spend more quality time with her children, listen more closely to her direct reports at work, get to know her neighbors, and volunteer at the children’s cancer ward of her local hospital on weekends.

Growth for Business

Aside from the tragic death toll, the COVID-19 impact on the economy has been a once-in-a-generation struggle. U.S. unemployment surged from 3.5% to 14.7% from February to April of 2020, while 70% of small businesses viewed modest or grave negative impact. Some $5 trillion in stimulus money was needed to stem the tide, yet the Delta variant and an anti-vaccination wave still chills the trajectory forward.

Nevertheless, on individual and group bases, entrepreneurs have employed positive self-change techniques that would make Dr. Frankl proud.

Necessity, for instance, has yielded paradigm shifts. Businesses from dance instruction for kids, to fitness workers and family jewelry stores have pivoted online since they could not work face-to-face.

Mental well-being has taken a spotlight. With a third of Americans experiencing high stress levels, U.S. companies have come to view mindfulness and mediation no longer a fad, but rather a business necessity.

Entrepreneurs have engaged in seemingly endless ways of supporting one another, retaining their workers and helping their communities. A social entrepreneur in Philadelphia rescued and delivered 30,000 pounds of food to those in need in just two weeks.

And support networks have grown. For instance, the Black Innovation Alliance (BIA) was formed to foster African American tech founders and creatives experiencing hardships in the pandemic. Charitable donations, health and child care support, cleaning supplies, IT support and even car repair have been freely offered for help. One founder even started a financial support site for new pet owners, since pet adoptions have soared as locked-in families have sought companionship.

May our enduring spirit continue.

"When we are no longer able to change a situation, we are challenged to change ourselves.”

     ~ Viktor Frankl