WE CHANGE continually from birth to death, but the process is not always steady.. Sometimes it is a leap forward or a devastating setback: Almost overnight, it seems, a pleasant, self-assured housewife suffers a complete breakdown; a confused, rebellious teen-ager becomes a civilized young man: a competent, reliable worker goes to pieces at his job; a disorderly, childish young woman turns out to be a splendid mother.
How can we explain these abrupt changes for better or
worse? What is it that suddenly sets us on a better p.ath—or
makes us lose our way?
For some time, psychiatrists, delving into the histories of people suffering from mental disorders, have beçn struck by the fact that the beginning of long-range illness followed a crisis in the life of the patient. In some cases, the crisis was a misfortune or a catastrophe that might be expected to cause trouble: the death of a child, the loss of a job, major surgery. But in others, the event that preceded the downturn was not a disaster or even a piece of ill fortune. The birth of a baby. a promotion, the first year of college often appeared as the forerunner of the plunge into illness. Some people cracked under the strain of even supposedly joyful transitions.
While psychiatrists observed the apparent connection between crisis and mental illness, they could not help noticing that the very same crises that defeat some people call forth the most amazing and unexpected strengths in others. And it is not necessarily the “strong” person who reacts well; often it is someone who hitherto has been relatively weak and ineffectual. ft seems, then, that a crisis can produce a real growth of personality.
A person in the midst of a crisis is in unfamiliar territory. He is disoriented and confused. His thinking and feeling are flooded with memories of past crises that filled him with similar anxiety or fear. The older person facing surgery may be haunted by the vague terrors of a childhood tonsillectomy; the new schoolboy bidding his mother good-by is reliving all the separations he has ever known.
Caught in the grip of a situation that seems insoluble,’ a person becomes tense and irritable, hostile to those closest to him, or depressed and moody. He doesn’t eat; he can’t sleep; he feels exhausted. His symptoms may resemble those of impending nervous breakdown, but they are the normal reactions of a person in crisis. Eventually he “solves” the problem one way or another, And, according to the way in which he has handled himself during the crisis, he comes out mentally stronger and more in tune with reality—or weaker and more susceptible to trouble in future times of stress. What makes the difference?
For more than a decade, at Harvard University Medical School and the Harvard School of Public Health, as well as at a few other centers, researchers studied the “acidencal” crises that beset us and the “developmental” crises that punctuate our growth. They watched the way iri;which people respond to the death of a loved one; the &actions of patients awaiting operations; the responses of men ‘women and children to disasters such as tornadoes and fires; the behavior of women who have given birth to premature babies; the adjustment of couples to the early months of marriage. Their studies show us how our handling of these critical turning points molds our personalities and shapes our lives.
Athong women who gave birth to premature babies, for example, there were two quite distinct ways of reacting to the crisis. Some responded ‘with grief and an acute awareness of the danger to the baby. They poured out their fears to their husbands nd family, badgered dxiors and nurses for information. They insisted on seeing the baby, even though they were warned that it might be an unpleasant experience. When the danger of the baby’s dying had passed and they returned home, they embarked on a campaign of preparations for the baby’s homecoming. They visited him regularly, and collected facts from all possible surces about ways to handle him. They corralled a mother or aunt to help.
Another group of v,c)rnen faced with the same crisis, behaved in many ways more considerately to family, friends and hospital personnel. They accepted the first reassurance of a husband or a doctor that “everything will be all right.” Occasionally they speculated on why this thing had happened and who was to blame for it, but they didn’t lament about it. When the baby was out of danger, they were confirmed in their belief that there had been no crisis. They visited the, infant rarely and took no steps tcr learn about his special needs.
Six to ten weeks after the babies’ release from the hospital, the mental-health workers who had followed the behavior of the mothers reported that the women’s different reactions to the same crisis were associated with two very different outcomes.
The women who had been most upset, most vocal in their concern, most aware of the real problems of the crisis had survived it well. They seemed strengthened. Effective problem- solving had been learned, which seemed to make the mothers and their families more capable of adjusting to other crises. Family relationships were often better than they had been before the birth of the baby. But the women who had denied the importance of the crisis, rather than confront it in all its unpleasantness. were the center of deteriorating family relationships. The household was beset with bickering and blame; everyday problems were bypassed, and the baby was often either neglected or spoiled by an oversolicitude that impeded his development.
The patterns of response to the crisis of premature birth were repeated with subtle differences in all the studies of crisis. To the extent that a person faced the realities of the problem and actively grappled with them, he emerged stronger or at’ least as strong. To the extent that he fled from the realities of the crisis, he set the stage for a worsening pattern of adjustment to life.
The latter type evaded the issues that the crisis presented by belittling the problem and pretending that he was not upset. He had not sought the help of others and refused help when it was offered. He shifted his energies away from trying to solve the problems that the crisis posed and focused them instead on blaming individuals or groups of people for his plight. Or he developed neurotic symptoms—excessive sleep, headaches, muscle pains or stomach trouble—which replaced the crisis itself as his main concern.
In a sense, none of us can be educated in advance to deal constructively with a crisis. Yet to some extent we can anticipate certain life crises and rehearse, as it were, our role in them.
For the key to healthy adaptation is the ability to face up to a situation, despite its stress and unpleasantness and despite the inevitable tensions that afflict us when a problem has no ready solution.
People who weather a crisis well are those who actively search for a solution. They thirst for helpful information. They want to know in advance exactly what surgery is like, or how to care for a premature baby. They avoid blaming themselves or others, realizing that this is a distraction from the real problem. They are not ashamed to express fears and anxieties. They learn how to rest when theirefficiency falls because of fatigue, and how to discipline themselves to return to the painful struggle when they have been replenished. They can accept, even enlist, help, considering this not a sign of weakness but of maturity.
What we know about healthy and unhealthy paths during a crisis not only gives us tools for self-help but also provides us with ways of aiding those we Jove. Consider the normal crises of early married life.
Exciting and gratifying as they are, the first months of marriage also involve many physical and psychological demands. which many people experience as a series of crises. A young couple must set up a home and work out complementary patterns of the division of labor and decision-making. They must weaken their ties to parents and direct their emotional energy to the new relationship. Each must extend the boundaries of personal privacy to include the other in all the apparently minor aspects of living which hitherto have been private—and this may be very unsettling. They must achieve a satisfactory sexual adjustment, which is complicated Lfl our culture both by the excessive romanticizing and sentimentalizing of sex and the breakdown of premarital sexual prohbitions. If the young couple fail to deal with these problems, if they turn away from unpleasantness and postpone adjustment, they set the stage for a marriage in which future crises, the birth of a baby, illness or the loss of a job, may be more poorly handled. But if they do their crisis work properly, they will have taken crucial step toward a relationship of mutual trust, respect, ;upport and love. And to the extent that each person has contributed to. the realistic solution of each crisis, he will have enhanced his own personality and strengthened his individual problem-solving skills.
In every life crisis, then, there are both the danger and the opportunity, the threat and the promise, the specter of deterioration and the hope of growth and enrichment. For we arc not the prisoners of a’pcrsonality forged once and for all in childhood or adolescence. If we can learn to avoid the ways of evasion, and to make healthful choices during the critical turning points of our lives, we may change the whole quality and direction of our existence.

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