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American Journal of Orthopsychiatry
Positive Growth From Adversity and Beyond: Insights
Gained From Cross-Examination of Clinical and Nonclinical
Samples
Pninit Russo-Netzer and Galia Moran
Online First Publication, November 7, 2016. http://dx.doi.org/10.1037/ort0000224
CITATION
Russo-Netzer, P., & Moran, G. (2016, November 7). Positive Growth From Adversity and Beyond:
Insights Gained From Cross-Examination of Clinical and Nonclinical Samples. American Journal of
Orthopsychiatry. Advance online publication. http://dx.doi.org/10.1037/ort0000224
Positive Growth From Adversity and Beyond:
Insights Gained From Cross-Examination of Clinical
and Nonclinical Samples
Pninit Russo-Netzer
University of Haifa Galia Moran
Ben-Gurion University of the Negev
Growth following adversity is a well-known phenomenon. Yet studies often focus on specific
populations and/or specific types of adversities, thus limiting opportunities to identify underlying
common processes of growth. The present study sought to identify shared positive change
processes in different samples of individuals each of whom faced life adversities (clinical/
nonclinical) and experienced growth as a result. We conducted a secondary analysis comparing
in-depth interviews from 2 independent study samples including 27 Israeli adults that experi-
enced spiritual growth and 31 American mental health peer-providers in recovery. Using the
grounded theory approach (Strauss & Corbin, 1998), the findings point to existing shared
transformative positive change pertaining to one’s way of being and adhering to a generative
orientation (Erikson, 1963) in the world. These changes were conceptualized under 3 growth
dimensions: (a) strengthened sense of self, manifested in self-integration, self-acceptance, and
enhanced ability to face further adversity; (b) development of compassion, acceptance of others,
and a deep sense of connection to others; and (c) a prosocial commitment characterized by
generativity and active contribution. These findings point to shared growth processes among
individuals with a different backgrounds and different kinds of adversities. This change goes
beyond mere coping, to an inner transformation in one’s self, connection to others, and
development of a proactive-prosocial approach in the world. The implications for health care
practitioners and the importance of acknowledging the potential for growth following adversity
and supporting such growth are discussed.
Supplemental materials: http://dx.doi.org/10.1037/ort0000224.supp
Despite economic prosperity in past decades, individuals
are increasingly experiencing higher levels of mental
distress (Diener & Seligman, 2004; Twenge, 2000). For
example, depression and anxiety are rising among university stu-
dents (Eisenberg, Gollust, Golberstein, & Hefner, 2007). Accord-
ing to the World Health Organization (WHO), it is anticipated that
by 2020 depression and related mental health problems will rank
second among the leading causes of the global burden of disease,
and reach first place by 2030 (WHO, 2012). Such disconcerting
figures pose major challenges to the field of mental health (Collins
et al., 2011).
Commonly, a discrete approach is taken in diagnoses of mental
health, involving identification of specific types of pathologies and
differentiated treatment plans which can be useful for targeting
specific symptoms. However, such an approach eliminates the
identification of a more holistic view of human growth potential
beyond symptom relief. This holistic approach has been demon-
strated empirically by the “complete mental health” model and
conceptualizes mental health states as part of a continuum rather
than discrete healthy versus pathological conditions (Keyes, 2002,
2007). Mental health states therefore range from the possibility of
flourishing at one end to languishing at the other (Keyes, 2002,
2007). According to this model, mental health is defined not only
as the absence of mental illness but also as the presence of “a state
of well-being in which the individual realizes his or her own
abilities, can cope with the normal stresses of life, can work
productively and fruitfully, and is able to make a contribution to
his or her community” (WHO, 2004, p. 12). Thus, well-being and
wellness are seen as fundamental to our understanding of mental
health states (e.g., Myers, 1992; Roscoe, 2009), particularly eu-
daimonic orientation to well-being which emphasizes human ful-
fillment and growth (Ryff, 1989; Ryff & Singer, 2008). This study
seeks to explore the common growth processes following adversity
which integrate a holistic approach to the understanding of growth
irrespective of discrete characteristics.
Pninit Russo-Netzer, Department of Counseling and Human Develop-
ment, University of Haifa; Galia Moran, Department of Social Work,
Ben-Gurion University of the Negev.
Correspondence concerning this article should be addressed to Pninit
Russo-Netzer, University of Haifa, Mount Carmel, Haifa 31905, Israel.
E-mail: pninit.russonetzer@gmail.com
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
American Journal of Orthopsychiatry © 2016 American Orthopsychiatric Association
2016, Vol. 86, No. 6, 000 http://dx.doi.org/10.1037/ort0000224
1
From Mental Illness to Recovery:
A Holistic Approach
Similar to the complete mental health model, a new approach
has been developed by the field of psychiatric rehabilitation and
recovery. Through the accumulation of personal anecdotes, empir-
ical evidence, and longitudinal studies, it has been found that
long-held, pessimistic, deteriorating, and debilitating prognoses of
severe mental illnesses (e.g., schizophrenia, bipolar, major depres-
sion, etc.) have shifted to a more hopeful and optimistic view of
recovery (Anthony, 1993; Deegan, 1997). In addition, accumulat-
ing efforts have been made to empirically validate the complex and
individual experience of recovery (Andresen, Caputi, & Oades,
2010; Leamy, Slade, LeBoutillier, Williams, & Bird, 2011). Sim-
ilar to Keyes (2002, 2007), these more recent studies showed only
a loose connection between psychiatric symptoms and one’s abil-
ity to regain meaningful roles and reintegrate into the community.
Thus, knowledge of psychiatric diagnosis and treatment may only
partially help in one’s journey back to a meaningful and function-
ing life. As a result, the holistic definition of recovery in the
context of mental illnesses has been defined as “a way of living a
satisfying, hopeful, and contributing life” even with the limitations
caused by illness (Anthony, 1993). The term “recovery” in relation
to mental illness is also used to denote the potential for positive
psychological processes of identity transformation, developing
purpose and meaning in life, empowerment, and community inte-
gration (Deegan, 1997; Onken, Craig, Ridgway, Ralph, & Cook,
2007). Thus, similar to the complete mental health model, a more
holistic view which takes into account sociopsychological aspects
of human mental health and well-being is emphasized in order to
achieve recovery in mental illnesses.
A Growth Orientation for the Study of Holistic
and Complete Mental Health and Recovery
The broader perspective of mental health, human flourishing,
and well-being can be framed under positive psychology (Selig-
man & Csikszentmihalyi, 2000; Seligman, Steen, Park, & Peter-
son, 2005). In essence, it calls for a broader understanding of
human potential through “the study of the conditions and processes
that contribute to the flourishing or optimal functioning of people,
groups, and institutions” (Gable & Haidt, 2005; p. 104). Both the
model of complete mental health (Keyes, 2002, 2007) and the
recovery-oriented approach for mental illness (Anthony, 1993)
highlight a strength perspective of human growth, involving well-
being and life-flourishing as primary focal points, rather than
attending to stress, trauma, dysfunction, and diagnoses (Andresen
et al., 2010; Keyes & Haidt, 2003; Leamy et al., 2011; Ryff &
Singer, 2008). In addition, both fields aim to advance knowledge
and scientific endeavors to the betterment of individuals, institu-
tions, and society (Anthony, 1993; Seligman & Csikszentmihalyi,
2000) and challenge and broaden traditional conceptions of psy-
chological wellness and illness.
In particular, the relevance of positive psychology to recovery
from serious mental illnesses has gained increasing recognition
(Moran & Nemec, 2013; Resnick & Rosenheck, 2006; Slade,
2010) calling for an investigation of mental health recovery in
terms of positive psychological processes generic to all humans,
such as meaning (e.g., Andresen, Caputi, & Oades, 2006) and
well-being (e.g., Clarke, Oades, & Crowe, 2012). Furthermore,
given the challenges of the human mental condition and increasing
rates of mental distress and illness, the present study aims to
understand the underlying positive human processes that may arise
from exploring different types of adversities in a holistic and a
growth- oriented approach. Based on this, our natural starting point
for analysis was through the concept of posttraumatic growth
(PTG; Tedeschi & Calhoun, 1996, 2004).
Post-Traumatic Growth (PTG)
Described and studied by Tedeschi and Calhoun (1996, 2004),
PTG reflects an experience of positive psychological change fol-
lowing a struggle with challenging life circumstances. According
to the theory, adversity and crisis can provide a unique opportunity
for growth and personal development that would not otherwise
occur. PTG has been demonstrated following a range of adver-
sarial events, for example, survivors of multiple natural disasters
(e.g., Marshall, Frazier, Frankfurt, & Kuijer, 2015), severe and
terminal illness (e.g., Hefferon, Grealy, & Mutrie, 2009; Tallman,
Shaw, Schultz, & Altmaier, 2010), violence (e.g., Williams, 2007),
and among war veteran populations (e.g., Aldwin, Levenson, &
Spiro, 1994; Feder et al., 2008), to name a few.
Irrespective of the type of adversity, such experiences challenge
and destabilize the individual’s inner psychological orienting
structures. The traumatic event inherently poses a threat to indi-
viduals’ core beliefs and assumptions regarding the self and the
world. PTG is positively associated with well-being (e.g., Triplett,
Tedeschi, Cann, Calhoun, & Reeve, 2012) and can increase one’s
sense of meaning and purpose in life as reflected in reconstructed
life narratives (McAdams, 2006; Neimeyer, 2001; Tedeschi &
Calhoun, 1995). PTG can develop in forms of increased appreci-
ation of life, improved relationships with others, new possibilities,
an enhanced sense of personal strength, and spiritual change and
development (Marshall et al., 2015; Tallman et al., 2010).
Spirituality is viewed as a personal quest for understanding
ultimate questions concerning meaning and the relationship with
the sacred or transcendent (Koeing, McCullough, & Larson, 2001).
Previous research has shown that dealing with trauma and adver-
sity may initiate a greater engagement with fundamental existential
questions (Tedeschi & Calhoun, 2004) that lead to an increased
interest in spiritual issues (Shaw, Joseph, & Linley, 2005). Ac-
cessing spiritual resources facilitates meaning-making of trauma
and adversity, as well as reconstruction of worldview (Vis &
Boynton, 2008). Spirituality is positively associated with greater
mental and physical well-being (e.g., Van Dierendonck & Mohan,
2006) and serves as a protective factor in psychological adjustment
to negative life experiences (e.g., Young, Cashwell, & Shcherba-
kova, 2000). Thus, spiritual change serves as a unique, multidi-
mensional, and volitional form of individual change considered a
core, universal facet of human development (Wulff, 1997) that
functions as a discrete aspect of positive growth process (Shaw et
al., 2005). Because not all who suffer from a mental illness engage
in peer work, and not all who experience adverse life events
undergo spiritual growth, these samples represent distinct exam-
ples of individuals who thrived and flourished amid salient nega-
tive life experiences.
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2RUSSO-NETZER AND MORAN
The Present Study
Studies from both clinical and nonclinical populations suggest
that regardless of the debilitating negative effects of crisis, trauma,
and human languishing, the potential for human growth and flour-
ishing remains (e.g., Calhoun & Tedeschi, 2006; Keyes, 2002,
2007; Slade, 2010; Vaillant, 2012).Yet, most studies focused on
exploring distinct, homogenous sample characteristics and adver-
sities (e.g., survivors of multiple natural disasters, survivors of
cancer, war veterans) leaving the question of commonalities of
growth processes unattended. Understanding common processes
across types of adversity and populations can contribute to the
identification of generic positive change processes, thus informing
not just the “what” of positive growth, but also the “how.” To this
end, this study focuses on in-depth life story narrative descriptions
of two diverse populations both clinically as well as nationally: a
sample of individuals who reported on a spiritual growth process
(for purposes of the current study they will be named: the spiritual
growth nonclinical sample) and a sample of individuals diagnosed
with severe mental illnesses who are in processes of recovery and
working as mental health peer supporters (named for the purpose
of the current study: the peer providers sample). These particular
samples were selected for investigation because in both positive
growth processes following adverse life events were salient, de-
spite their different life stories and distinct individual characteris-
tics. These aspects enhanced our confidence that much can be
learned about common human growth processes from cross-
comparing these two populations.
Specifically, we were interested in examining the inner psycho-
logical positive change processes that individuals experienced
across the clinical and nonclinical samples. We asked, can we
identify shared processes of positive growth? And if so, what is the
nature of these psychological inner growth processes?
Method
The study employed a secondary qualitative analysis of two
independent sample narratives derived from different studies: a
sample of American mental health peer providers who were inter-
viewed about their recovery experiences and life stories, and an
Israeli sample who were interviewed about their spiritual growth
processes. Cognizant of the limitations that the assessment will be
conducted in retrospect and despite the fact that the interviews
were based on different original research questions, it was decided
to employ secondary analysis to the data sets in order to system-
atically explore and identify commonalities in the positive change
processes across these samples. The rationale for comparing these
samples stemmed from the authors’ recognition of a salient char-
acteristic in both samples—rich descriptions of growth following
difficult and adverse life events.
Secondary analysis in qualitative studies is a known technique
often used to pursue a new research question from data previously
collected to study a different research question or purpose (Hinds,
Vogel, & Clarke-Steffen, 1997). The cross-examination of the two
distinct samples provides an opportunity for a metaview, allowing
a broad and rich understanding of a specific phenomenon as
manifested through the diversity of settings, participants, and
qualitative traditions (Aguirre & Bolton, 2014; McCormick, Rod-
ney, & Varcoe, 2003). In the present study, this method enabled us
to discern and further understand shared growth pertaining to
universal human positive processes. Each sample and its original
study design is briefly described next.
Spiritual Growth Sample
Twenty-seven Israeli individuals were interviewed in a study
exploring processes of spiritual change (i.e., fundamental change
in life views, attitudes, priorities, and behavior). This sample
represents a wide variety of gender, ethnic origins, and socioeco-
nomic status and residence across the country. All participants
were Jewish Israeli, from various ethnic origins (52% “Ashke-
nazi,” i.e., of European American origin, 33% “Mizrahi,” i.e., of
Asian-African origin, and 15% mixed origin). Ages ranged be-
tween 25 and 66 years (M⫽45; SD ⫽11). Fourteen participants
were married, six divorced, six single, and one widowed. Interest-
ingly, all participants of the sample had experienced either nega-
tive life events or adversities which accounted for the positive
growth they experienced in the form of spiritual change. Adver-
sities experienced by the sample ranged from the loss of loved
ones, dealing with terminal illnesses and domestic abuse, to so-
cioeconomic hardships, as well as a loss of meaning and existential
concerns with no apparent external crisis (Russo-Netzer & May-
seless, 2014).
Mental Health Peer Providers
Thirty-one mental health peer providers from the United States
were interviewed twice in a study examining accounts of personal
recovery benefits and life stories of peer workers. Their ages
ranged between 26 and 63 (M⫽45, SD ⫽12), 17 (55%) were
women, 30 (97%) identified as White; 20 (64%) were single, eight
(26%) were married/cohabiting with a significant other, and three
were divorced. Participants had diverse diagnoses—about two
thirds affective (i.e., depression and bipolar disorders) and the rest
had schizophrenia and/or psychotic- related disorders. Participants
were relatively well educated and mostly Caucasian (Moran,
Russinova, Gidugu, Yim, & Sprauge, 2012).
Procedure
In both samples, semistructured, face-to-face in depth inter-
views were conducted, lasting between 1 and 3.5 hr. All interviews
were audio-recorded and transcribed verbatim. For both studies,
institutional ethics committees granted approval and participants
signed informed-consent forms before participating. Both studies
provided rich accounts of processes of positive change in the
aftermath of varying types of life stressors/crises and displayed the
participants’ own voices regarding the phenomenon. For example,
the mental health peer providers were asked: “Was there a signif-
icant time or event in your work as a peer provider that contributed
to your recovery?” the Israeli interviewees were asked, “What
made this change possible?” Both samples were asked open ques-
tions in order to identify idiographic, subjective experience, “Can
you describe that particular experience/incident in more detail?”;
“What was it like?”; or “Can you give an example?” (van Manen,
1990). The transcriptions of the interviews with Israeli participants
were translated from Hebrew by the first author who was the
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3
POSITIVE GROWTH AND BEYOND
interviewer and is fluent in English and Hebrew, and a native
English speaker who was bilingual in Hebrew verified correspon-
dence with the original version of the transcriptions.
Data Analysis
Data analysis unfolded in stages. First, as both authors were the
original principal investigator researchers of the studies, we had
access to the raw data and were well versed in the contexts of the
narratives allowing in depth acquaintance with each life story
narrative. The authors could thus approach the narratives while
examining them from the perspective of a new research question
while maintaining contextual and nuanced understanding. Al-
though coming from different fields of study (counseling and
positive psychology, and clinical psychology with a focus on
psychiatric rehabilitation, respectively), both researchers are white,
female, and interested in positive human development processes.
Both are secular with no specific spiritual practice, and maintain
Israeli nationality. This stance sensitizes them to detect subtle
positive processes even amid negative life events, which can be
valuable and enhance the quality of analysis. At the same time, this
very same stance renders the researchers to potential biases
thereby attributing overly positive processes in the participants’
interview descriptions. Authors were aware of this potential bias,
and strived to minimize this risk as much as possible, by reading
and rereading the interviews while conducting critical inquiries of
specific takes on parts of the analysis between the researchers. This
process of recurring discussions involving in-depth clarifications,
going back to the texts to verify insights and then reconvening,
enhanced the credibility of the qualitative examination. Further-
more, it was ensured that interpretations and findings were
grounded in direct and rich excerpts from the interviews, providing
a thick description of the phenomenon in the participants’ own
words (Lincoln & Guba, 1985; Stiles, 1993).
Second, following these informal discussions and brief reassess-
ments of the interview data in each sample, the researchers grew
confident in the existence of shared positive human growth expe-
riences in these two distinct samples worth further exploration. To
compare the samples, the interview data were analyzed using
procedures consistent with the grounded theory approach (Corbin
& Strauss, 1990; Patton, 2002). The process of data analysis was
spiral and iterative, engaging both within-case analysis of each
account as a stand-alone entity and cross-case comparisons to
identify common experiences (Strauss & Corbin, 1990) synergis-
tically (Ayres, Kavanaugh, & Knafl, 2003). The authors each
reread their interview transcripts from an open, fresh perspective,
guided by the question: are there shared positive change processes
in the diverse samples? And if so, what do they involve? They
identified meaning units—significant parts in the narratives that
provided an understanding related to the study question—and
established an initial list of codes. Through a series of repeated
meetings and rereadings of the interviews, the authors further
searched for interrelations, similarities, and dissimilarities across
samples, which involved a conceptual process of clustering and
breaking of categories and themes. Thus, coding was an iterative
process of conceptual development involving a series of intensive
discussion meetings between the researchers, followed by return-
ing to the respective texts, verifying the conceptual developments,
and returning with further modification and clarification of emerg-
ing shared codes. In this process, meaning units were integrated
into core themes, reflecting a higher level of abstraction and
allowing for comparison between the different texts (Strauss &
Corbin, 1998), resulting in solidification and conceptualization of
higher-order categories and relations between concepts (e.g.,
Strauss & Corbin, 1998).
Findings
Both samples demonstrated positive change and growth follow-
ing adversity, which largely relate to meaning-making and en-
hancement of one’s sense of self. A transformative experience in
one’s way of being in the world is conceptualized across three
broad categories: (a) a strengthened sense of self—self-integration
and enhanced ability to face further adversity; (b) a deepened
relational approach— enhanced compassion, acceptance, and a
sense of deep connection with others; and (c) commitment to
generativity and contribution.
The first domain was described by participants from both sam-
ples as a strengthened sense of self that permeates their existence
and way of being in the world. This inner development was
manifested in two complementary processes: (a) holistic self-
integration and self-acceptance of contradicting and/or hurt aspects
of the self, and (b) enhanced capability to face adversity and life
challenges by employing a new way of interpreting reality. The
second domain appears to transcend close and intimate relation-
ships, reflecting a profound transformation in one’s basic percep-
tions manifested in a decentralized ego and gained wisdom result-
ing in enhanced compassion, acceptancem and sense of connection
with others. Finally, the participants voiced commitment to gen-
erativity and contribution emphasizing an active prosocial ap-
proach. As can be learned from the participants’ own words, they
evolved from self-centered processes into a strong drive and desire
to benefit others. Commitment to be of service to others is de-
scribed by participants in both samples as providing them with a
sense of meaning and purpose. The results involve rich and elab-
orate narrative excerpts from both samples which can be fully
appreciated in the integral supplemental material. Here we present
a summary table of the findings with demonstrative quotes for
each domain across samples (Table 1).
Discussion
This study sought to identify common processes of positive
change following adversity, using an in-depth life stories inter-
views from two different samples experiencing growth from ad-
versities. The findings elucidate similar powerful positive trans-
formations, despite diverse sample characteristics (mental health
condition, cultural background, demographics etc.) and diverse
types of adverse life experiences. These findings highlight the
value of exploring positive processes with populations experienc-
ing psychiatric disorders. While often the focus of study with this
population is on pathology, this study supports the possibility to
identify positive aspects of growth that can promote thinking and
practice related to recovery (Moran & Nemec, 2013; Resnick &
Rosenheck, 2006). Overall, this study illuminates underlying psy-
chological growth processes and a generic capacity to not only
cope well in response to a given adverse condition, but also to
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4RUSSO-NETZER AND MORAN
Table 1. Demonstrative Quotes of the Three Growth Domains
Themes Spiritual growth sample Mental health peer provider sample
Theme I: Strengthened sense of self
I.1. Holistic self-integration and
self-acceptance
I have had so many parts within me that I refused
to acknowledge . . . like my anger, my
aggression, even my cruelty. These things were
the most difficult to encounter, but once I did,
so much space cleared up. All those weights
that I carried, I’ve learned to treat them as part
of reality, as my growth space and not as my
enemy . . . I let go of control and met these
parts within me of hard feelings, of my
weaknesses, of death wishes, and it is a
corrective experience because once you validate
these parts within you, when you accept them
rather than struggle, you finally feel whole.
[Amit, 51]
I’ve gotten to a place where I know where to put them
[psychotic experiences], I know how to understand
them, I see what they do to my being, and I know
the proper place in my being for that. The metaphor
that I use is when Jesus says that the stone that the
builders rejected was the most important one of all.
It’s like, I don’t want to just get rid of this
[psychiatric illness]. I find the right place in my
being for it, and it’s okay. It’s good. It’s part of me.
[Charles, 24]
I.2. Ability to better face adversity
and life challenges by
employing a new way of
interpreting reality
I’ve learned through this process that what
matters most in life is the way you interpret
what happens to you. I see people that
whenever something bad happens to them, they
interpret that as ’I have no luck in life, I am
miserable, life is horrible’, and a spiritual
perspective allows a different interpretation, of
viewing something that happens to you as a
lesson, an opportunity, a space for growth, and
when you treat things that way they really
change in reality, not just in the way you
experience them. It gives you more strength to
deal with that. Whenever I fall, I am more able
to make something meaningful out of it, to
gather all the pieces and create something new
out of that [Ziva, 44]
By putting me through all that [the symptoms of her
mental illness], has taught me a lot about resilience
. . . resiliency is one of the attributes that comes
with this illness. You’re a bouncy ball, and you just
keep bouncing . . . this illness has been the biggest
challenge because I’ve been able to approach it and
decide how I’m going to deal with it. It’s going to
flatten me or I’m going to recover. I’m going to
move on. I’m going to learn from it. Or I’m going
to be bitter and resentful and hate everything. That’s
been an option, too. And, of late, it has become an
asset. It’s really become something that I’m proud
of [Sally, 41]
Theme II: Enhanced compassion,
acceptance and sense of
connection with others
First and foremost it is about being a human
being . . . to remember that the person in front
of you is a human being, who has feelings and
thoughts and dreams, who is scared and sad
and happy, who loves and hates and sometimes
depressed like you . . . when I face another
person then we can really be in a dialogue as
equals, because what happens in many
relationships is that we think we are better or
not as good as the other person and that has a
lot of impact on the dialogue. I am more open
to others, I have more patience [Shay, 34]
. . . I learned so much from others. And the mutuality,
I look for it in my relationships with my peers. And
also with other humans . . . I guess I’ve taken it a
step further to recognize that as human beings, we
all have some suffering. We all have obstacles to
overcome. I guess it helps me look for what I have
in common with others, as opposed to differences
[Mark, 35]
Theme III: Commitment to
generativity and contribution
There is no bigger happiness than touching other
people’s lives and to be a living proof that
there is hope and that there is something to
strive for . . . there is a meaning to life. My
whole life has changed and I want to give
back, I want to do things that matter. Things
that have meaning and can help as many
people as possible . . . That makes my life
meaningful, that I know I have a role here that
I can’t take for granted. We all have limited
time in this world and if I won’t use it for
doing things that can benefit other people, the
world, then I am wasting it [Rachel, 56]
You walk around with these skeletons rattling in your
closet for all these years, and then here comes an
opportunity where I’m able to come out of the
closet and then to help other people in their
recovery. So that, to me, was more meaningful than
anything I’ve ever done in the past. This was
meaningful because it encompassed me as a person.
It’s like my life experience was being used. [John,
52]
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5
POSITIVE GROWTH AND BEYOND
thrive (e.g., Deci & Ryan, 2000; Keyes, 2002, 2007; Seligman &
Csikszentmihalyi, 2000).
The current findings reveal transformational processes of
growth which penetrate one’s basic sense of being and experiential
outlook on the world. Some of these processes are similar to PTG,
demonstrating increased appreciation for life, more meaningful
interpersonal relationships, and an increased sense of personal
strength (Tedeschi & Calhoun, 1996, 2004). Distinct from PTG
and other growth-related phenomena (e.g., Davis, Nolen-
Hoeksema, & Larson, 1998; Masten, 2001; Tedeschi & Calhoun,
1996), the current study emphasizes holistic, experiential dynamic
intrapersonal multifaceted processes which account for growth.
Participants’ processes involved transformational changes includ-
ing: a transformed sense of self, view of the other, and a devel-
opment of a generative active stance. While these processes are
often interrelated, and sometimes may seem to unfold in a linear
fashion (from “self” to “other” to “generativity”), they could also
at times be described as occurring independently, or concurringly.
In the “self’ domain individuals evolved from having shattered and
fragmented selves into developing an integrated and strengthened
sense of self. This positive change in the self involved an increas-
ing ability to interpret negative events in multiple perspectives
while employing positive reinterpretations. Such a reappraisal is
crucial for the development of agency and ego-resiliency against
subsequent stressors that the individual may be exposed to (Bauer,
McAdams, & Pals, 2008; Tugade & Fredrickson, 2004).
Humanistic conceptualizations of the self, and particularly those
identified with Maslow and Rogers, emphasize the self as being or
becoming (Polkinghorne, 2001), and existential thought further
added the inherent responsibility to create, transform, and re-create
the self embedded in one’s involved in this dynamic process
(Schneider & May, 1995). The findings of the present study appear
to provide a clear embodiment of such humanistic and existential
perspectives: the participants’ self is experienced by them as
dynamic and unfolding, yet stable and coherent, involving per-
sonal responsibility (Hoffman, Stewart, Warren, & Meek, 2009).
Such a process is accompanied with an ongoing reflectivity that
appears to yield self-acceptance of both personal strengths and
weaknesses as integral of being whole, which contributes to de-
veloping a sense of ego integrity (Erikson, 1963).
Furthermore, both samples illustrate the development of a eude-
monic orientation (rather than toward hedonic pleasure or mere
comfort; Lent, 2004; Ryan & Deci, 2001). This is reflected in
participants’ developed attentiveness to their authentic inner voice,
which is experienced as independent to external stimuli, rewards,
and/or gratifications. Eudaimonic individuals are able to postpone
immediate gratification for the attainment of more distal goals
(e.g., Maslow, 1962; Ryan & Deci, 2001), which signifies a shift
from mere survival mode to reconstruction of one’s self identity
and life meaning with regard to greater purpose. Once equipped
with this intensified sense of purpose and meaning, Frankl (1985)
claimed that a person would be able to withstand any life situation,
irrespective of the suffering it may present. This is evident in the
participants’ openness to embracing life’s challenges once under-
standing the growth and meaning that resulted from their adverse
experiences.
Alongside psychological transformational growth, participants
also reported development of the “other domain,” where partici-
pants showed a growing capability of acceptance of and compas-
sion toward others, and enhanced sense of interconnectedness with
others. Such developments appeared to further support partici-
pants’ meaning-making processes and contributed to their
strengthened sense of self. In this sense, the inner psychological
realm of the self can be understood as cocreated through the
process of self-other reference (Becker, 1992). Such inner deep
connection to other human beings is recognized in therapeutic and
additional healing contexts where relationships between two
equivalent partners are acknowledged as engaged in making sense
together (Auerbach & Blatt, 2001; Buirski & Haglund, 2001).
Finally, participants’ compassionate worldview and active en-
gagement in voluntary or help-giving roles reveal commitment to
contribute to the greater good and humanity as a whole. Thus, one
grows by developing personal meaning, which extends to one’s
deep understanding of others as equals and elicits the desire to give
back. The commitment to others that was present in both samples
suggests it to be a significant component of positive growth in
diverse populations. Such adoption of generative roles is in line
with previous research recognizing the value of help-giving to the
giver themselves (e.g., Ratzlaff, McDiarmid, Marty, & Rapp,
2006; Salzer & Shear, 2002). Indeed, altruistic acts have been
associated with increased levels of mental health, above and be-
yond the benefits of receiving help (Schwartz, Meisenhelder, Ma,
& Reed, 2003). By extending self-interest, one may deepen self-
discovery (Post, 2005). Erikson (1950)’s theory of generativity (vs.
stagnation) further elaborates this view, defining it as a psychos-
ocial development stage involving a shift from self-focus to others
with “a concern for establishing and guiding the next generation.”
Mansfield and McAdams (1996) suggested that highly generative
adults combine orientations toward agency and communion, as
they exhibit an ability to generate outputs which extend the self in
a powerful way (agency) and to contribute to others with the
purpose of assisting and benefiting them (communion).
Table 1 (continued)
Themes Spiritual growth sample Mental health peer provider sample
I have been given a gift, and within this
experience things that used to be at the center
of your life become insignificant and something
else occupies the stage. This is the essence of
why this gift is so great. It teaches you that
giving, being kind to others is the most
fulfilling thing. It is a blessed commitment to
make humanity better. [Mira, 57]
Eventually I guess my dream would be to carry the
message of hope and try to inspire people to get
what they want out of life and share whatever skills,
resources, and supports that I have in my own life
[Mark, 35]
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6RUSSO-NETZER AND MORAN
The eudemonic generative orientation identified in the current
study was manifested not only cognitively (i.e., viewing challeng-
ing situations as opportunities, endorsing certain values) and emo-
tionally (i.e., deep compassion and acceptance) but also in action,
thereby providing participants with a sense of direction and overall
purpose (i.e., implementing prosocial values in reality, as a peer-
provider or a volunteer). In this sense, we agree that generativity
may function as a pathway from suffering to meaning (de St.
Aubin, 2013). Moreover, this engagement in generative action
seems to lead to further enhancement of one’s sense of self.
Accumulating studies demonstrate that generative strivings are
positively associated with personal well-being (e.g., Keyes & Ryff,
1998) and meaning in life (e.g., Emmons, 2003; Nielsen, 2014).
More specifically, in the context of mental illness, this can also be
understood as a unique type of vocational recovery (Dunn,
Wewiorski, & Rogers, 2010). In this sense, it is suggested that by
being a contributive member of society, persons in recovery work-
ing as peer providers may cultivate their “internal strength” and
reconstruct a sense of self which further promotes their recovery
process (Auerbach & Richardson, 2005). Similar processes are
evident among the nonclinical sample which demonstrate the
versatility of human capability to grow above and beyond given
adverse circumstances and develop a sense of meaning, efficacy,
fulfillment, and self-worth (e.g., Baum & Neuberger, 2014; Bond,
2004).
Overall, the findings of the present study contribute to the
understanding of the possibilities to thrive and attain a meaningful
life in the face of life’s challenges. This is reflected first and
foremost in the participants’ intentional choice to acknowledge the
possibility embedded in experienced adversity to create something
new and beneficial, rather than succumbing to the conditions that
encompassed them at the time. The insights gained in the study are
thus in line with current calls advocating an integrated view of
positive mental health (Keyes, 2007; Vaillant, 2012) as well as in
mental illnesses (Thornicroft & Slade, 2014).
Limitations and Suggestions for
Further Research
The study findings are preliminary and involve several limita-
tions. First, secondary qualitative analysis, while allowing us to
examine new and fresh research questions, is, at the same time,
limited by the nature of the participants who were recruited for
different research questions and purposes (Hinds et al., 1997).
Thus, we are cautious that the original study questions may have
constrained the scope of population sampling, limiting access to
the breadth of positive growth processes following adversity. Spe-
cifically, it is possible that individuals in the spirituality sample
represent a subgroup who have experienced adversities and thrived
through meaning-making processes related to spirituality. How-
ever, other individuals from the general population who face
adversities may thrive in other ways. In a similar vein, the mental
health peer provider sample consisted only of peer providers.
Other individuals with mental illnesses may find other channels
through which they recover a meaningful life and thrive. Finally,
this study illuminated a specific kind of growth which, although
cross-cultural, is still represented by samples from two Western-
oriented cultures. Future studies may address a broader spectrum
of cultures and nationalities. For example, given that generativity
rests more on collectivist values, we may assume that this pattern
of growth may be even more pronounced in Eastern cultures.
Summary and Practical Implications
Overall, the current findings convey the richness and multidi-
mensionality of individuals’ lived experiences of positive growth
following diverse adversities as shared human phenomena. To-
gether, the findings suggest a personal growth process that em-
braces self-integration and resiliency, allowing the development of
a mature identity which transcends self-focus to caring for others.
These findings highlight the value of exploring possibilities of
individuals with mental illnesses to thrive despite having a psy-
chiatric disorder, and thus point to a new potential direction of
hypotheses that are driven by a positive approach. Furthermore,
systems, professionals, and nonprofessionals providing services to
individuals with serious mental illness (SMI) can benefit service
users by addressing the potential of growth processes and enabling
conditions (e.g., constructive meaningful roles) to thrive and fulfill
one’s human potential despite mental illness. Similar to nonclinical
populations, eliciting awareness and self-reflection in mental
health service users may facilitate discourse related to the three
growth domains (self, other, and generativity).
In practicality, this means attending to subjective ways in which
individuals conceptualize their coping and meaning-making re-
lated to adverse events and processes. In addition, enabling op-
portunities for help-giving support positive change processes fol-
lowing adversity. In particular, for people with psychiatric
disabilities, identifying structured generative roles (not just as peer
providers) that are meaningful to them could serve as a spring-
board for their rehabilitation, recovery, and, ultimately, growth
processes.
Keywords: positive change and growth; qualitative study; sense
of self; mental health recovery; spirituality
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