Post-Traumatic Growth: Philippine President Elpidio
JESUS SALVADOR A. LIGOT, JR., M.D. Clinical Assistant Professor of Psychiatry State University of New York at Buffalo POST-TRAUMATIC GROWTH NO FINANCIAL DISCLOSURES. POST-TRAUMATIC STRESS DISORDER Exposure to actual or threatened death, serious injury, physical and sexual violence Intrusive symptoms: Nightmares, flashbacks, intense psychological distress Avoidance of stimuli Negative alterations in cognition and mood (detachment and isolation) Hyperarousal and hypervigilance Self destructive behaviors > alcohol & substance abuse Negative sequelae: Depression, suicidal ideations and attempts, homicidal ideations, attempts and aggression
Source: DSM –V, American Psychiatric Association NEURAL CIRCUITRY OF FEAR
NEURAL CIRCUITRY OF FEAR Threat Thalamus Amygdala & visual cortex Amygdala – receives threat; initiates the “fight or flight” response, sends signals to the hypothalamus and activates the sympathetic nervous system releasing adrenaline, cortisol and NE causing increased HR, RR, increased blood flow to muscles, pupils dilate, fat mobilized Concurrently, detailed information sent to the visual cortex -> contextual info to hippocampus NEURAL CIRCUITRY OF FEAR Hippocampus relays info back to amygdala and the amygdala determines whether there is an actual threat or not fight or flight response gets turned off if no threat. PTSD > overactive amygdala > impaired hippocampus (helps in the contextual understanding of fear). > decreased volumes of the frontal cortex – impairs the extinction of fear responses “ The brain enters a vicious cycle of emotional and cognitive excitement, and like a runaway train just keeps on picking up speed.” (Le Doux, 1996) NEURAL CIRCUITRY OF FEAR PTSD State of high alert Systems are still responding to a trauma that happened months or years ago. Amygdala is overactive – sympathetic overdrive – > CRH & NE increase fear conditioning, enhance arousal and vigilance. Parts of the brain that should be overriding amygdala– hippocampus and frontal cortex are dysfunctional Brain unable to differentiate things that should trigger a fear response and things that should not. Nemeroff, Post-traumatic stress disorder: the neurobiological impact of psychological trauma, Dialogues in Clinical Neurosccienses, 2011 FOUR OUTCOMES OF PTSD Actively symptomatic , at times with self-medication with drugs and/or alcohol Recovery with some residual impairment Full Recovery /Resilience Post-traumatic growth - positive psychological change resulting in above baseline functioning (Tedeschi, 2011). Trauma becomes the catalyst for positive change
Warner, 2013, Promoting Post-traumatic growth RESILIENCE Ability to adapt successfully to acute stress, trauma or more chronic forms of adversity Psychosocial factors: Optimism and positive emotionality Ability to harness social support Spirituality : ability to find meaning Use of active coping strategies such as problem solving and planning • Lower levels of denial and avoidant coping behavior
Nestler et al, Psychobiology and Molecular Genetics of Resilience, Nat. Rev. Neurosci., 2009 NEUROBIOLOGY OF RESILIENCE The H-P-A Axis: Resilience associated with less stress induced increase in CRH (corticotropin- releasing hormone) and cortisol. Neuropeptide Y – counteracts anxiogenic effects of CRH in amygdala, hippocampus, hypothalamus. In people who are resilient, NPY balances out CRH • BDNF (brain-derived neurotrophic factor) > promotes functioning of the hippocampus
Nestler et al, Psychobiology and Molecular Genetics of Resilience, Nat. Rev. Neurosci., 2009 H-P-A Axis NEUROBIOLOGY OF RESILIENCE • BDNF (brain-derived neurotrophic factor) > promotes functioning of the hippocampus
GENETICS: 1.) CHR1 receptor gene – regulation of H-P-A axis. 2.) Serotonin transporter gene – short allele (5 HTTLPR) 3.) COMT gene – low functioning allele increases NE and dopamine – increases anxiety 4.) NPY gene 5.) SNP in gene encoding BDNF – reduced hippocampal
Nestler et al, Psychobiology and Molecular Genetics of Resilience, Nat. Rev. Neurosci., 2009 NEUROBIOLOGY OF RESILIENCE EPIGENETICS : • Meaney and colleagues Compared offspring of high nurturing and low nurturing maternal rats (i.e. licking) Offspring of high nurturing rats – less anxious, attenuated responses to stress Offspring of less nurturing rats - epigenetic changes affecting the hippocampus resulting in behavioral
deficits Nestler et al, Psychobiology and Molecular Genetics of Resilience, Nat. Rev. Neurosci., 2009 POST-TRAUMATIC GROWTH • Change beyond the ability to resist and not be damaged by stressful events • Seismic – shaking one’s foundation to the core • Beyond pre-trauma levels of adaptation • Ironically, those who score highest on dimensions of coping will report relatively little growth • Struggle with trauma is crucial for post-traumatic growth but PTSD is not a pre-requisite
Tedeschi, Interview, November 2016 POST-TRAUMATIC GROWTH Positive psychological change (Tedeschi, 2004) Attempt to find meaning and resolve (Morris, 2007) Human capacity for resilience & potential growth Recovery from trauma is not about putting the shattered world back together as it was but rebuilding the shattered world in a way that is better(Dorotik-Nana, 2016)
Tedeschi and Calhoun, 2004. Psychiatric Times POST-TRAUMATIC GROWTH Implication: We are capable of growth experiences in the context of suffering and struggle as well in the aftermath of traumatic events, losses, abuse and betrayal. (Ferentz, 2016)
Not everybody ends up with learned helplessness but some come out of it with learned optimism. (Seligman, Positive Psychology, 1998)
In order to reach a place of transformation, there has to be a place of struggle (Ferentz, 2016. Helping people move from heartache to healing.)
POST-TRAUMATIC GROWTH HISTORICAL CONTEXT
Victor Frankl: “Man’s Search for Meaning” William Sledge: Study of POWs by Vietnamese > showed that the POWS who were held captive longest and had been subjected to harshest treatment reported most positive changes’ Richard Tedeschi, Ph.D. and Lawrence Calhoun, Ph.D. of UNCC (University of North Carolina at Charlotte) > pioneers in the field of post-traumatic growth
Upside, Rendon, 2015 POST-TRAUMATIC GROWTH 5 Dimensions of Posttraumatic growth (Tedeschi and Calhoun) 1.) Rediscovering personal strengths 2.) Belief in new possibilities 3.) Improvement in relationship with others 4.) Spiritual growth 5.) A newfound appreciation of life
Post Traumatic Growth Inventory: tool to measure PTG
Tedeschi and Calhoun, 1996 PTG Inventory (Tedeschi & Calhoun) 21-item standardized questionnaire 5 Research Validated PTG Factors Relating to Others New Possibilities New Personal Strengths Newfound appreciation of life Spiritual Change
Tedeschi and Calhoun, 1996 , PTG Inventory (Tedeschi & Calhoun) PTG Inventory (Tedeschi & Calhoun) POST-TRAUMATIC GROWTH Writing a new life narrative Challenging one’s assumptive world-view i.e. “ Good things happen to good people and bad things happen only to bad people.” (Why me ?) • Assimilation: Person wishes to maintain or retain pre- existing assumptions. Person fits the new trauma related information into his world view (maladaptive) • Accomodation: Reconstructing world view to achieve congruence with the new trauma-related information
, POST-TRAUMATIC GROWTH Deliberative rumination/Reflective pondering : Intrusive thoughts must not be avoided. It is the catalayst to rethinking the meaning attached to event. This will allow survivors to construct a new view of themselves. Cognitive reframing of one’s story from that of mental defeat and hopelessness to one that is hopeful and optimistic (Narrative reframing)
Upside, Rendon, 2015. FACILITATING PTG Cognitive Behavioral Therapy – CPT (Cognitive Processing Therapy)- reappraisal, reviewing of cognitive styles, assumptions
Mindfulness-based therapy – promotes direct reduction of intense and inappropriate emotional states , e.g. relaxation training
Upside, Rendon, 2015 FACILITATING PTG • Expressive writing : writing forces people to break ideas and events into smaller units; also facilitates deliberative rumination
Study of Smyth (2008) comparing group of veterans with PTSD who wrote about time management vs trauma – the ones who wrote and reflected about their trauma showed improvement in severity and decrease in stress indicators (cortisol).
Upside, Rendon, 2015 FACILITATING PTG Art therapy : including music and dance >Process of deliberate rumination – creative process > Subjects who scored high in openness to new possibilities have usually high creativity.
• Spirituality /Spiritual counseling In 103 studies of PTG, religious coping often correlated with growth more than community support and enthusiasm His Excellency President Elpidio Quirino • Birth: Vigan, Ilocos Sur • 2nd child among 8 • Father: jail warden • Mother: school teacher • Modest and humble beginnings
President Elpidio Quirino Foundation Vigan, Ilocos Sur UNESCO World Heritage Site • Taught grade school students in a village/barrio school while in high school • Walked 10 kilometers everyday to earn money • Made sketches of Filipino heroes and won prizes for them • Saved up money to be able to transfer to Manila High School Supported himself to go to school by working as a clerk in the Manila Police Department
He did sketches and illustrations for some publications
President Elpidio Quirino Foundation • Captain of the debating team in Manila High School and debated with another future president • University of the Philippines College of Law • Topnotcher in the 1915 Bar Examinations • Dean, Adamson University Law School
The President Elpidio Quirino Foundation • Congressman at the age of 29 • Senator at the age of 35 • Secretary of Finance • Secretary of Interior • Secretary of Foreign Affairs • Senate President Pro-Tempore • Vice President
The President Elpidio Quirino Foundation Married Alicia Syquia, scion and heiress of the Syquia clan in 1921 5 Children: Tomas, Armando, Norma, Victoria and Fe Angela
President Elpidio Quirino Foundation Quirino Family Portrait
Armando, Dona Alicia Syquia Quirino Norma Victoria Tomas Fe Angela (not yet born)
The President Elpidio Quirino Foundation THE SYQUIA MANSION THE SYQUIA MANSION . Japanese occupation of the Philippines . General McArthur and the US government had to leave the Philippines . President Quezon in exile in Saranac Lake, New York . Senator Quirino imprisoned for two weeks in Fort Santiago for refusing to collaborate with the Japanese
, • One of the most devastating events that happened to a country in World War II • Whole city of Manila torn down to pieces and burned • Gruesome death of 100,000 Filipinos
C, THE BATTLE OF MANILA
Credit: The Shambles that was Manila, Daily Mail.co.uk THE BATTLE OF MANILA
Credit: The Shambles that was Manila, Daily Mail.Co.UK THE BATTLE OF MANILA
Credit: The Shambles that was Manila, Daily Mail.co.UK QUIRINO FAMILY TRAGEDY
Credit: The Shambles that was Manila, TRAGEDY OF ELPIDIO QUIRINO
Family caught between American shells and Japanese machine guns Mrs. Quirino and three children were killed – daughter bayoneted Mother-in-law and brother killed as well Carried the dead bodies of his family to cemetery Single-handedly dug a grave for each of them Never spoke about this again.
Laya, 2015. The Calvary of Elpidio Quirino POST WORLD WAR Won the elections as Vice President of President Manuel Roxas Premier post of Secretary of Foreign Affairs First Filipino Diplomat – established requisite embassies and consulates abroad President Roxas died of heart attack and he assumed presidency in 1948 Won the succeeding election in 1949
The President Elpidio Quirino Foundation MALACANANG PALACE THE QUIRINO ROOM MALACANANG PALACE
With daughter Victoria who became the First Lady at 16 years old.
The President Elpidio Quirino Foundation THE FIRST FAMILY
Victoria, Elpidio, Conchita, and Tomas
The President Elpidio Quirino Foundation PERSONAL STRENGTHS Resilience and fortitude Born in provincial jail – Ilocos Sur Humble beginnings – barrio school teacher Walked 10 kms each day to teach children Hardship and adversity > burning desire and firm determination to succeed SPIRITUAL GROWTH Man of unwavering faith Speech to the Catholic Women’s League in 1948: “ There is an Unseen Hand that subtly guides and directs our national conscience in moments of peril and adversity. What we need to rebuild is our spirit and soul, our morale as a people. The tenets and teachings of Christ must be revived and revitalized or society will perish. The rock of ages should still be our rock of strength.” SPIRITUAL GROWTH Japanese occupation: Imprisoned for several months at Fort Santiago for refusing to collaborate with the Japanese. Man of integrity and uncompromising principles Exemplified the adage , courage is fear conquered by faith and love. DEFENSE MECHANISMS People when faced with difficult and challenging circumstances regress to more primitive defense mechanisms such as denial, repression, splitting President Quirino > Mature & advanced defense defense mechanisms Altruism: When faced with an emotional conflict, an individual deals with it by dedicating himself to the needs of others IMPROVEMENT IN RELATIONSHIP WITH OTHERS President Quirino looked beyond himself and empathized with the rest of the Filipino nation Showed compassion and initiative in accepting the White Russian refugees fleeing communism from China Provided a “beacon of hope” to the White Russian refugees Establishing diplomatic ties with other countries and fostering goodwill BELIEF IN NEW POSSIBILITIES President Quirino was a teacher, painter and orator. Reinvented himself as a statesman and diplomat. Achieved economic growth of GDP of 9 percent Mass housing for low and middle income families Initiated the creation of the Social Security System Initiated serious land reform Minimum wage act
, NEWFOUND APPRECIATION OF LIFE Sublimation – Channeling negative and unacceptable impulses into more positive outcomes Pardoned and repatriated the Japanese prisoners of war in an unprecedented act of compassion and reconciliation Benevolent gesture received initially with criticism and anger He did not want his people and his children and grandchildren to inherit hatred and anger
C CLEMENCY STATEMENT PRINCIPLES AND VALUES Forgiveness and compassion Benevolence and magnanimity Tolerance, good will and love
“ With the passage of time, Elpidio Quirino stands still in the Pantheon of Philippine presidents. He deserves to be enshrined in the hearts of the Filipino people not only as the First Diplomat and eminent president of the Republic of the Philippines, but in the sober judgment of many as the greatest and the best.” UP President Salvador Lopez Reburial (February 29,2016)
Credit: The President Elpidio Quirino Foundation Reburial (February 29,2016) The tomb of President Quirino
, The grandchildren of PEQ
Mrs. Ruby Quirino Gonzalez-Meyer, Ms. Cory Quirino and Mr.Elpidio “Butch” Quirino