But an emerging field called “posttraumatic growth” takes a different approach. It is about changing the way we see ourselves and finding new meaning in life.

A friend with a severely autistic son once said: “I spent the first seven years trying to change his life, never realizing how profoundly he was changing me.”

Many of us could tell similar stories about the effects of trauma. And I suspect that more people experience posttraumatic growth than posttraumatic stress (although it is possible to have both).

I recently raised the question of posttraumatic growth on my blog, and here is one amazing response from a woman named Carla:

I remember vividly hearing my physicians and attorneys discussing my “catastrophic” injury. “Catastrophic… hmmm. What are they talking about?" I recall thinking. To the people uttering these words, my spinal cord injury was the only part of my life in their awareness.

Only I knew about the troubled, thirty-two-year marriage that I left behind four years before my accident; My husband’s nearly successful suicide/homicide attempt the day after I asked for a divorce; my grandson's birth while my then-husband was in the hospital recovering from his injuries; This grandson’s untimely death at seven weeks of age from SIDS; my ex-husband's second suicide attempt; my daughter's spiraling-down bipolar psychopathology after her son's death; two home break-ins, four moves and three job changes.

What have been the take-aways from losing everything, and almost my life, during this protracted eight-year period?

My life is not easy and often I feel overwhelmed. I am often disgusted by what is involved in my bowel and bladder care. My morning routine seems to last forever. I've lost my old identity, roles, expectations, independence and dreams.

But despite, or because of these difficulties, I am aware of how my life has changed — for the better.

Faith. I now know that I will be cared for regardless of where life's circumstances place me. From the moment I realized that I was going to be crashed into, as I prayed out loud, I knew I would be taken care of. I remember hearing the words “it doesn't matter.” My interpretation of that was that whatever happened  would be ok… and it was.

Life. It is precious and can end at any moment. Because of that, I say “I love you” much more frequently than before my accident.

Kindness of others. My family and friends were treated with unbelievable care and kindness by total strangers. For every difficult situation, it was there.

Patience. Waiting has become a way of life for me until recently when I resumed driving. I still wait for appointments, return calls, new or needed equipment, and lessons for how to do new things with my often uncooperative body.

Compassion. I have gained a deeper understanding of how disabilities impact those who have them. I also feel compassion for those who do not really understand the full impact of disability and can see life only through their own eyes.

Forgiveness. I don't believe most people awaken with an intention to kill or injure others. Bad things happen in every life and forgiving those who may have caused an accident or injury frees up personal energy for healing. Remaining in the past or becoming bitter hurts the grudge holder rather than punishing others.

Gratitude. I feel this every day for the recovery I have been blessed with, and for friends and family who love me and whom I love.

Expression of Grief and Sadness. These may follow massive emotional and physical adjustments and they’re a blessing in disguise. They open up space for necessary change. To quote the 70s production, Free To Be… You and Me: “it's ok to cry, crying gets the sad out of you.”

Love. Life is unpredictable and fragile. It is important to let others know what they mean to you at every chance.

Resilience and Persistence. Giving up is not an option even when it seems attractive. Turning the impossible into the possible is only accomplished by bouncing back and working hard to overcome, accept, or adapt to continuous change.

Mindfulness. Focusing on the present and appreciating your surroundings is a blessing that I often overlooked in my former, hurried, multitasking life. I am able to take the time to hear and appreciate others' life stories more fully since my accident.

Certainly not everyone who experiences trauma grows as a result. And it is important to know that trauma disturbs everything in the emotional system and most people need a good deal of time to begin to heal.  Growth in the wake of trauma can take months or years to gain perspective.  But for many of us, trauma steals old identities and forces us to take a fresh look at our lives and our priorities.  Most of us who have experienced emotional growth after trauma say that once they stopped fighting and opened up to the new truth of their lives, they were able  to take a fresh look at who they really are at core and what it really means to be alive.

A follow up question to your column on harsh self judgment: how do we learn to differentiate between inappropriate self criticism and the genuine need for self evaluation. I have never been able to find a satisfactory way to do a quick review of how I handled a certain situation without being extremely critical of myself.
Ardmore, PA

there are no hard rules about this, but if you find that you are beating yourself up when you evaluate your behavior, it's pretty safe to say you are on the wrong track.  Any review of your behavior should be done with compassion.  You must trust that you are a good person and performing best you can.  And that if you are not performing best you can, there are very real reasons why you have not.  So a self-evaluation should not feel harsh, it should feel constructive.

Son's PSTD from Iraq
Q: Dear Dr. Gottlieb,
May I say how much I admire and respect you. My son is an Iraq Vet. He is suffering from PSTD and was diagnosed like the lady in this weeks forum in 45 mins. as having ADD. My son is 27 and is married but having difficulties. Andrew is very bright, charismatic and gets along with a lot of people. He is very depressed and unmotivated and is currently separated from his wife. I am helpless to assist him. The VA has let him down and he did get a Dr.s name but has not called him. Andrew is difficult since he is sometimes brighter and intuitive about the person who is treating him. On two occasions he quit because of his sense that the Dr. was inept. I can only pray, love, and support him. I would love if you could see him since I truly respect your common sense approach and deep empathy with your patients. Or if you could recommend a therapist who is strong in PSTD and the issues that surround it like social, marriage,etc. The person has to be strong because Andrew is one of the most strong willed humans I have ever encountered.

Respectfully,
Mary Colket
Glen Mills, PA

Mary I don't know anyone in Glen Mills who specializes in PTSD with veterans, and that is exactly who I would want him to see.  I am posting this in hopes that some mental health professionals who have this specialty will comment so that we can get your son the help he needs and deserves

During today's chat, Dan Gottlieb and a guest will discuss loneliness and a sense of belonging. They will discuss the topic first, then invite others to join. Chat now!

Dear Dr. Dan:

I know many people who, like me, have been adopted. And many of us have a driving need to meet their birth parents. I don't.

But I do suffer from a lifelong sense of not belonging and wonder if you could suggest some possible ways to cope with this.

My adoptive parents did not reveal my birth circumstances until I was 17 and heading to college. Naturally, I was shocked and saddened, but not completely surprised.

The entire family, including cousins in my own age group, had known this all along, and it became clear that the nagging sense of not being a true member of the group had a real basis.

Had the term “Identity Theft” been used way back then, it would certainly described the situation.

The result for me has been a continuing sense of not belonging to any group, and the related feelings of not being good enough, attractive enough, or smart enough to be included.

At this late stage of life (60+), is it too late to finally overcome this crippling fear of not being wanted? Obviously, many people face tragedies in life that change their circumstances and cause them to experience these same feelings. I would so appreciate your comments.

Feeling Alone

Dear Alone,

Some of what you talk about is common to many, if not most, people who have been adopted. And this business of feeling alone and different from everyone else is also very universal.

I believe this struggle about wanting to repair feelings of being alone is the main roadblock to finding genuine peace and security.

But let's start with your story and then talk about the universal one.

Many who have been adopted struggle with low self-esteem, a sense of being rejected by their parents and an ongoing fear that people will leave them again. 

We all fear rejection, but with adoptees, there is always a question of why their birth parents put them up for adoption. It's almost inevitable for them to wonder if there flaws caused this rejection. And because of this, many adoptees have difficulty maintaining intimate relationships.

You haven't said anything about intimate relationships in your life, but we will explore that on our web chat tomorrow. 

Don't get me wrong. Many who are adopted do very well in life. They feel loved and secure, knowing their adoptive parents made a choice and love them fully.

Likewise, many adoptive parents are comfortable with the adoption issue and are open with their children from the beginning. Many even help their children reconnect with their biological parents, knowing that that is what their children need to shape their identity.

It doesn't sound as if your adoptive parents were very comfortable with the adoption issue. Secrets are almost always about anxiety or shame. So not only did you have to wonder about this yourself, you were raised by anxious parents.

Their decision to tell you at age 17 came at a terrible time in your development. All children this age struggle with identity questions such as, “who am I? How am I the same/different from my family?” So here you are nearly 50 years later, and perhaps struggling with the same questions. And underneath it all is the longing for something you've never had.

Here is where it gets universal. We are hardwired to be social animals. We feel more comfortable with people who look and act as we do. But something I've never quite been able to figure out about our hardwiring— we all want to be part of the clan, to be understood completely and accepted for who we are. But at the same time our drive to be unique is just as strong!

So, like many minorities, you already feel unique but, that doesn't feel very good. Your great fear of being unwanted is not a fear, but a fact. It may or may not be true externally, but it is a truth you have been living with most of your life. And if there was a way we could look directly into your mind, we would probably see that you’re a person who feels unwanted. So, like the rest of us, your crippling fear is really about facing feelings that already live inside you.

I don't want you to overcome this fear of not being wanted. I want you to sit with it and let yourself feel what you feel.

Your anxiety has been protecting you from deeper, more painful feelings. The fact that you have this fear of being rejected tells me that deep down, you hope that one day you will be accepted (whatever that means to you).

Sometimes hope keeps us stuck. It’s the hope that we can undo something that happened to us, that we will get what we think we need, and avoid what we fear.

What would happen if you no longer had hope?Underneath that hopelessness lies a great grief. Perhaps you will be able to finally mourn all the losses you have carried your whole life.

The process won't be easy and it won't be quick. But if you work on it, you might discover a woman who is comfortable with who she is and has found inside the acceptance and compassion she always wished for.

One of my least favorite sports clichés, and there are many, is "there is no I in team."  As I think about it, there is also no U in team.  So if there is no I and there is no U, maybe the whole team thing is an illusion.

So that got me thinking about identity.  Not only is there an I in identity, there is no U. now of course identity is only about the self, but maybe that's an illusion also.  I was thinking about that on a recent meditation retreat when I was supposed to be thinking about other things, but that's the way minds work, they never do what you want them to do, the little rascals.

But maybe all our identities really are an illusion.  Or, at the very least, not completely true.  We tell ourselves who we are : the good girl, the workaholic, the martyr, the caregiver, or even the blogger.  One woman told me when we first met socially that she is and anxious person.  Well, she might have more anxiety and she wants, and it might be so uncomfortable that it is sometimes disabling, but is she and anxious person?  No more so than I am a quadriplegic or a blogger or even a nice guy.  All of the labels we give ourselves still don't add up to who we are.  And all of those labels are connected only to the way we see experience ourselves intermittently.  And then to make matters more complicated, those minds of ours create stories about why we are the people we think we are: neglectful parents, childhood trauma, illness of a loved one, recent breakup, spiritual calling or just plain unlucky.  So we have our identity, our explanations and we are ready for life.  Maybe. 

What if what we tell ourselves is only a shadow of the truth.  Then maybe identity is a kind of illusion.

This chat will be about learning disabilities in children.

Dan will begin his chat with invited guest, Richard Selznick of the Cooper University Hospital Learning Center and author of "The Shutdown Learner" before inviting all others to join.

Dear Dr. Gottlieb,
 
My son has been anxious and distractible since he was about five years old.  So of course he had difficulty in school as he just couldn't pay attention to his work.  In addition, he was quite shy and didn't make friends easily but we thought all of this would improve with time. 

We never thought he had any kind of learning disability because he was not hyperactive. 

On the contrary, he was always a very sweet kid and did what he was told. Except with homework.  That was always a struggle as he would go to his room and emerge later having accomplished nothing. 

Eventually, he would argue with us and say that he was stupid and couldn't get it right anyway.  

Thinking the problem was primarily anxiety, he saw a therapist for two years. 

It was primarily talk therapy and he liked going, so I think it helped a bit.  But the following year when he got into middle school, things got worse.  He had more difficulty in school and became more withdrawn and started to behave like he just didn't care. 

That's when the arguing started.  I guess held of fear and frustration, I began to push him harder thinking that maybe he was being lazy. 

Of course deep down I knew this was the worst thing to do, but I felt out of control.  When his seventh grade teacher said he might be depressed, we grew very concerned and took him to the pediatric neurologist she recommended. 

After a 45 minute interview the doctor said that he had ADD and should take medication.  We were shocked at how quickly he made the diagnosis.  By now, the symptoms have been so disruptive to our family life that there is constant tension. 

My son is against medicine, yet I need to help my child focus and help him to be a successful student. I'm very hesitant to believe my son has ADD since it wasn't diagnosed until 7th grade.

Dear worried Mom,

My heart goes out to you and your son. 

I can understand your fear and frustration as it must have looked like your precious child was slipping away.  And I can certainly understand your sons feelings. 

Like your son, I was inattentive in school and began to see failing grades in elementary school.  And because I received no help, I continued to do poorly in school straight through college. 

But worse than that was the great shame I felt as a child.  Like your son, my parents called me lazy.  

Yet I knew I was trying as hard as I could, so I figured that if I'm not lazy I must be stupid.  I suffered with those feelings of shame and inferiority for many years. 

Fortunately, you realize there is a problem and have been trying to do something about it for a long time.Unfortunately, like many parents, you have been unable to find a clear understanding of what's happening and what to do about. 

First, nobody can diagnose ADD or any other learning disability in a 45 minute evaluation.  And before ADD is diagnosed, other things have to be ruled out if possible. 

Like anxiety, depression, food allergies, family conflict and dozens of other things.  In addition, not every mental health professional is trained in the diagnosis and treatment of ADD, so before you make an appointment, find out there background. 

Once other things are ruled out and you have a competent professional working with you, this evaluation should include family history, interviews with parents and school officials in addition to spending time with the child. Putting that label on any child after 45 minutes is, frankly, ridiculous.

Medication is another issue. 

For children with severe ADD and ADHD it can be life altering. 

But as we all know our children are overdiagnosed and overmedicated.  If you were to decide to give him medication, one of the side effects could be increased anxiety. 

On the other hand, there is a possibility that medication could help with his inattentiveness.  

There is even a possibility that the stimulant medication could calm him down internally and he might feel more comfortable with himself. 

But that doesn't mean he has ADD, nor does it mean he should take medication. All it means is that the medication could help with some of his symptoms but we have yet to figure out what the problem is.

When I spoke with you on the telephone, you told me that you finally took him to psychologist Richard Selznick who is director of the Cooper University Hospital learning Center in Cherry Hill who did a thorough assessment of your son and family. 

And I am thrilled with what you have told me. 

First, after getting the results of the assessment, all of you are learning more about what your son really needs to be successful. 

Many kids are not good at communicating their real needs, but kids with learning disabilities have even more difficulty.

So now that you are understanding one another better, you can all begin to plan constructive strategies including communication with school, help at home and other interventions. 

There is a very real possibility that once he gets the help he needs, you might find that his anxiety and insecurity diminishes.  If not, psychotherapy could also be included in the treatment plan at a later time. 

Richard Selznick, author of "The Shutdown Learner" will be joining me on my web chat Tuesday

This chat will be an open discussion about what it takes to make changes in our lives and how we can begin letting go of the assumptions we have been making for years.