A thesis in psychology presented by Hannah Klaas at the University of Lausanne on 24 September 2018 shows that many people who have suffered from mental illness have also found that aspects of their experience have been positive for their personal development and their relationships with others. This takes time, and stigmatisation certainly doesn’t help. But do not we say that what doesn’t kill us makes us stronger?
Research in psychology rarely deals with large samples of "normal" populations. However, Hannah Klaas had this opportunity at the National Centre of Competence in Research LIVES. Using data from the Swiss Household Panel, which tracks thousands of households longitudinally right across Switzerland year after year, she was able to extract a sub-sample of 682 people who have had a serious health problem during their lifetimes, half of whom suffered from a physical ailment, while the other half was made up of people who have suffered from a mental health problem: mainly depression, burn-out or anxiety.
In writing her thesis she had several objectives: to determine the place that the illness had taken in the identity of these people, to observe how social context, social support and stigmatisation influence recovery and development, and finally to compare the lived experiences depending on whether the ailment had affected the body or the mind. Indeed, it has been known for around thirty years that traumatic experiences such as disasters, interpersonal violence or physical health problems can ultimately have a positive impact on personal development. However, apart from a few poorly disseminated, mainly qualitative, studies, the consequences of mental illness on what is called adversarial growth has never been observed quantitatively.
Personal growth and relationships with others
The thesis by Hannah Klaas clearly demonstrates that various positive aspects can come from mental health problems such as depression, burn-out or anxiety, both in terms of personal fulfilment and in changes in relationships with other people. 60% of those taking part in the study reported a significant or moderate degree of personal growth, and 35% had experienced some positive changes since the illness.
Those for whom the disease has become an inherent part of their identity exhibit more signs of adversarial growth. They consider that they have become more understanding, more tolerant and stronger after having gone through this hardship, and claim to have a greater appreciation of life. Many remark that the situation has allowed them to arrange their lives better, for example by ending relationships seen as unhealthy, or by becoming more aware of problem areas in their lives.
“This effect is most evident in people who have had psychotherapy,” notes Hannah Klaas. On the other hand, whether or not an individual has received drug medication has no connection, either positive or negative, with this personal development. In this study, those people who state that they have grown through the adversity that they have experienced are in no way differentiated by their socio-demographic characteristics. "We are talking about the development of intra-personal and social skills, which has no connection with the level of education", the researcher notes in order to explain this broad representation of different social backgrounds.
Is it a question of resilience? "It's not a question of going back to a pre-illness state, but rather of a personal development which goes far beyond that," explains Hannah Klaas. Moreover, her thesis indicates that the link between centrality of identity and personal growth is becoming increasingly apparent over time, particularly when the symptoms and the direct impacts of the illness have ceased.
The age at which the psychological problems started also counts, but only to a moderate extent. For certain aspects, adversarial growth seems to be more prevalent among people aged 40 or older. “For some also earlier, but when you're in the middle of your life and you have more experience, it might be easier to find meaning or a reason for your illness, to accept it and to take positive aspects from it for your relationships with others. Or perhaps at this stage you are more ready to make changes in your life?”, suggests the doctoral student.
Discrimination and recovery
Her thesis also shows that people who have suffered severe discrimination because of their state of health find it harder to see themselves as cured. However, and very interestingly, adversarial growth helps people to cope with stigmatisation. People who have experienced some form of stigmatisation benefit more from their personal fulfilment: when they have managed to transcend these problems and have “grown” as a result, they show high levels of subjective recovery. This personal development therefore contributes more to the recovery of persons discriminated against for a mental illness, compared to victims of physical illnesses discriminated against or to other patients who have not been stigmatised. However, it is not essential to have experienced personal development in the face of adversity to feel cured, because 25% of the people questioned felt that they had recovered without noticing any significant progress in their personal development.
Social support is crucial. Joining a support group, being part of an association or joining a club all encourage adversarial growth. On the other hand, people who suffer from loneliness and isolation find it harder to make sense of their difficulties, even if they lie in the past.
It should be noted that the sample consisted mainly of people who have already had their health problem for at least two years, for whom the direct impacts of the condition have ceased or who have become used to managing the problem, and who have come to accept their illness and are willing to talk about it. In addition, these people have a higher than average level of trust in others. Swiss nationals and academics are also over-represented in the sample, although their rating of adversarial growth is no higher than in other social categories.
There is hence a high probability that the most vulnerable individuals have not been adequately represented in the study, either because they hide their illness or because they have not been diagnosed. Moreover, the analysis of a sub-group showing low cure rates shows that these people (10%) are more afraid of talking about their illness and report a lower level of adversarial growth. These are also people who indicate more instances of being stigmatised, who receive less social support, and less often belong to groups.
For Hannah Klaas, the most important message of her thesis is that mental illness should not be a taboo, and that "positive things can even come out of it, such as gaining a better understanding of one's strengths or being able to put an end to a toxic relationship." She recommends that the creation of support groups be encouraged, with the particular aim of developing a positive identity in people with illnesses, and of fighting stigma even more, because “people are more than their health problem.”
According to the researcher, more on-line information is needed on recovery and the opportunities for adversarial growth aimed at those affected and their close ones, and even campaigns in schools to gain a better understanding of these phenomena: “We learn what cancer is, but never depression. For example, it is a little known fact that half of the people who suffer from depression experience only one episode during their lifetimes.”
>> Hannah Klaas(2018). Identity, adversarial growth and recovery from mental and physical health problems. Under the supervision of Dario Spini. Université de Lausanne