Denial Healthy? Not Necessarily

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Five academics have challenged the conventional wisdom that silence in the face of emotional trauma is an unhealthy reaction. “Contrary to common assumption, this study demonstrates that individuals who choose not to express their thoughts and feelings in the immediate aftermath of collective trauma are capable of coping successfully and in fact are more likely to do so than individuals who do express,” write five professors who hail from the University of California at Irvine, the University of Buffalo, and the University of California at Santa Barbara.

Their research tracked the emotional responses of an impressive 1,779 U.S. citizens for two years following the September 11, 2001 attacks. Professor Roxane C. Silver, UCI, funded the web-orchestrated study using a National Science Foundation grant. Knowledge Networks, Inc., an online survey research company, collected the data mere hours after the attacks, thereby gauging Americans’ immediate responses to the horrific event.

In their article for the Journal of Consulting and Clinical Psychology, the professors sought to address what they see as misplaced media coverage following the attacks. The Professors, Mark D. Seery, Roxane C. Silver, E. Alison Holman, Whitney A. Ence, and Thai Q. Chu, point to psychologist Keith Ablow’s Virginia Tech comments on the NBC Today show as an example:

“The more they [Virginia Tech Students] can talk about what they’ve lived through, the more they can be encouraged to emote, that gives them some security and insulation against burying those feelings and then having them surprise them later in life,” the authors quote Ablow.

“Statements like this, which ostensibly represent the state of scientific knowledge, are likely to garner media attention, especially in the wake of a collective trauma,” write the academics. They later add, “Even brief soundbites could guide the public’s expectations for how they and those around them should be responding, including expressing thoughts and feelings” (emphasis original).

The five professors argue that the clinical use of early intervention methods—pushing victims to emote immediately following collective traumas—has “outpaced rigorous research.” In addition, they argue that such approaches carry a common reverse assumption that “choosing not to express in the early aftermath of a trauma is actively harmful, if not pathological.”

Their research, which shows that Americans who chose not to emote immediately following 9/11 demonstrated more psychological resilience, directly contradicts this assumption.

But a Los Angeles Times article by Susan Brink uses the study to substantiate other medical theories about post-trauma coping mechanisms, theories which the data can neither refute nor support. Her article, “After the tragedy: Vent? Not necessarily,” weaves the results of this study together with comments from several other psychologists and co-researcher Professor Seery.

“Some people have periods of what psychologists call ‘healthy denial.’ Like Scarlett O’Hara, they cope by promising themselves to think about it tomorrow,” writes Brink.

Brink’s writing seems to insinuate that, like Scarlett O’Hara, people can healthily bottle up extreme trauma and deal with it later. This is not necessarily what the study demonstrates. She writes,

“The new study is in line with other mental health research that suggests some things are better left unsaid—at least for some people. Those who immediately talk about the trauma of an attack or a hurricane can find as often as not, that airing it doesn’t change the memory and fails to bring relief. Seery found that those who responded quickly to prompts to write online about the attacks had higher levels of stress two weeks later. Months later, they were more likely to have symptoms of post-traumatic stress disorder.”

The trauma study was correlational in nature and not designed to establish which factors contributed to the post-traumatic stress of some individuals, or whether expression determined the mental health outcomes of respondents. In addition, it was designed to gauge whether avoiding expression following a collective trauma was a sign of pathology; it was not designed to gauge whether an individual’s silence was explicitly healthy.

In fact, the researchers list denial as one of the coping mechanisms used by those who expressed their distress, along with

• active coping,
• seeking instrumental social support,
• behavioral disengagement,
• positive reframing,
• planning, and
• religion.

Those who responded to the prompt—and who responded at greater length—had higher instances of “lifetime traumatic events,” were older, and had more pre-9/11 physical illnesses.

Brink takes considerable liberty in creatively hypothesizing about non-responder’s coping mechanisms. “Seery found that those who didn’t want to talk about the trauma remained healthy, no doubt using a variety of coping skills—spit-shining the house, working around the clock, or heading to the shopping mall or golf course to get their minds off it,” writes Brink. “They may be doing more than distracting themselves. They may be putting pain on hold until they muster up more strength or gain perspective.”

But could it be that those who chose not to respond were simply less affected by the events of September 11, 2001?

One of the study’s authors, Professor Seery, seems to think so. He told this correspondent in an email that he believed those who chose not to respond demonstrated more mental “resilience.” He wrote,

“To answer your first question, yes, we argue that a likely explanation for our results is that people who were initially more distressed by the attacks were more likely to express their thoughts and feelings about it. Given exposure to the same potentially traumatic event, experiencing less distress is in turn consistent with resilience. Resilience would have thus contributed to both choosing not to express (or not expressing very much) and better outcomes over time.”

Assuming those who didn’t respond suffered less stress following the 9/11 attacks, they wouldn’t necessarily have much pain to put on hold in the first place, contrary to what Brink suggests. The authors describe expression as a “proxy for initial stress” within the study.

Political scientists and other sociologists usually adopt the approach that a hypothesis cannot be proven, it can only fail to be disproven. This assumes that, since the universe is so complex, humans can never truly account for every variable in a situation. Therefore, scientists can only cross off individual variables one at a time.

The researchers acknowledged several limitations of their data, including

1. that the study was not optimally sensitive to pre- and post- health measurements;
2. health diagnoses were self-reported;
3. “the current investigation does not resolve if the respondents who chose to express actually could have benefited from that or subsequent expression;” and
4. “our findings may not generalize to other social contexts of expression” such as “socially rewarding” environments.

As the third limitation indicates, this research cannot determine whether those who chose to talk about their trauma benefited or were hurt by their choice to express. It can only show that they suffered post-traumatic stress in the long-term, not what caused it.

Bethany Stotts is a staff writer at Accuracy in Academia.