Ronnie Janoff-Bulman (e.g. Janoff-Bulman and Frieze, 1983; Janoff-Bulman, 1992) has written extensively on the subject of trauma, expounding an influential theoretical perspective for understanding responses to traumatic events. She proposes that the psychological distress experienced in response to trauma is due, in large part, to the shattering of basic assumptions held about oneself and the world. A traumatic experience challenges three basic, previously unquestioned, assumptions: the world is benevolent, the world is meaningful, and the self is worthy. The assumptions follow Lemer’s “just world” principle (1975, 1980) which states that events do not occur by chance alone but people get what they deserve in life. These assumptions lead to an ‘illusion’ of personal invulnerability which is dramatically shattered after confrontation
' * This was not found to be the case in the representative case studies by Heinemann and Shontz (1984), although the nature of the study was to look at adjustment in two participants only (see section 1.3.2)
Chapter 1_______________________________________ INTRODUCTION
with serious injury or threat to survival forcing victims “to confront their own fragility” (1992). Support for this theory was shown in the study by Parkes (1972) described above (see section 1.3.2) where feelings of personal vulnerability arose following the loss of a limb.
Janoff-Bulman asserts that coping is a process of rebuilding one’s “assumptive world”; a process which may incorporate apparently maladaptive strategies such as self-blame, denial, and intrusive ideation. In fact, she argues, these strategies aim to restore the psychological equilibrium maintained by the assumptions of meaning, justice and personal control, and are driven by a need to make sense of what has happened. Janoff-Bulman stresses the importance of recognising the adaptive value of denial, emotional numbing and intrusive recollections, framing them as automatic efforts to come to terms with and integrate traumatic experiences (1992). Within this theory, denial permits an individual to maintain their old assumptions unchanged. In fact denial has been shown to be associated with good adjustment (e.g. Dinardo, 1971). Other strategies facilitate the coping process by rebuilding shattered assumptions in a way that maximises the possibility of perceiving self-worth and benevolence and meaning in the world. For example, the strategy of comparing oneself with (real or hypothetical) less fortunate others preserves a favourable self- concept. Young adults with spinal cord injuries have been found to compare themselves with others who have suffered a greater degree of paralysis (Bulman and Wortman, 1977). Self-blame (as discussed in section 1.6.3) may reflect a need to minimise the apparent meaningless nature of the event and the possibility of
randomness in the world*'. Believing that one’s behaviour might have prevented the outcome invokes beliefs in personal control, and the perception that one can positively affect future outcomes. The representative case studies by Heinemann and Shontz (1984)’^ for example, found that the participant who continued to show little acceptance of injury at over two years post-injury, attributed his accident to chance, denying any personal responsibility. He attempted to restore a sense of control over his life through attempting suicide. A further coping strategy put forward by Janoff- Bulman (1992), is for individuals to find positive elements and benefits in the outcome of trauma in order to “find meaning in their suffering” (p. 135), and thus attempt to recover their fundamental assumptions.
Janoff-Bulman has stated that “the adjustment of survivors rests largely on whether they experience profound disillusionment and despair, or ultimately, minimal disillusionment and hope” (1992, p.70). The outcome of trauma is thus seen to depend upon the ability to see beyond loss and vulnerability to transform or reinterpret the experience in terms of appreciation of life itself and of one’s personal strengths (Janoff-Bulman and Berger, 2000; Janoff-Bulman and Berg, 1998):
“It is not simply that some trauma survivors cope well and perceive benefits in spite o/their
losses, but rather that the creation of value and meaning occurs because o f their losses,
particularly the loss of deeply held illusions. In the end survivors often feel both more vulnerable and more appreciative, two states that are fundamentally linked.” (Janoff- Bulman and Berg, 1998 p. 35 - original emphasis)
MacLeod (1999) has challenged the widely-accepted relationship between self-blame attributions and psychological adjustment, proposing alternatively that attributions following a traumatic episode may actually be driven or influenced by the level of distress experienced.
Chapter 1________________________________________________ INTRODUCTION
In summary, the way in which individuals see themselves and the world in which they live is influenced by trauma. The adjustment process involves an adaptation of these constructions of the self and the world, and will be mediated by factors including self esteem, personal values, social stigma, flexibility in roles, social support, previous coping skills, and attributional style. A proportion of individuals sustaining physical injury do not display signs of maladjustment as evidenced by psychological morbidity, and appear to recover well (e.g. Purry and Hannon, 1989). However, little clinical research has accounted for the meaning of the injury in the life of the individual or personal definitions of good outcome. Nor has much research been undertaken in exploring how the self-concept is affected following severe physical injury, and the way in which changes in the self-concept promote or impede adjustment. The present study aims to address these areas, and is introduced in the following sections.