Why are life events troubling?
Ruth Spence, Lisa Kagan and Antonia Bifulco find it’s not a straightforward question…
30 April 2019
Life happens. In Kipling’s words, the twin impostors of ‘triumph and disaster’, the best and worst the world can throw at us. Not all ‘life events’ are life-changing. At face value, many appear benign (leaving school, getting a job, moving in with a partner); whilst others seem inherently damaging (the death of someone close, a life-threatening illness, relationship break-up). Yet the extent to which a life event is ‘good’ or ‘bad’ is not necessarily intuitive, and it may surprise you to know that psychologists often continue to act as if it is.
This matters. Negative life events are critical in understanding psychological disorder. Clinicians look to life events as the precipitating factor when creating formulations of client symptoms. ‘Ask not what is wrong with a person, ask them what happened’ has become something of a mantra for psychologists. Likewise, life-events research is based on the idea that severe (very negative) life events coupled with prior vulnerabilities (e.g. childhood experiences, genetic predispositions, negative cognitions of self or the world) are important in explaining the onset of mental health problems.
So what is it that makes an event negative? Given the rich volume of research around life events, that question should be easy to answer. Yet when you move beyond events that are obviously tragic – and even here there’s room for some subjectivity – most people falter in explaining why something is negative or troubling. Looking at the way life events have been studied can help explain the complexity involved.
From checklists to context
Traditionally, life events have been measured by checklists, which take an event category, such as a divorce, and give everyone who endorses it the same rating. The stress experienced is then calculated by adding together the number of life events that have occurred. A good example of this is the Holmes and Rahe stress scale, from 1967.
But not everyone experiences life events similarly. Let’s use the example of a divorce – most people will agree this will usually be negative. Reflecting this, it gets a whopping 73 out of 100 from Holmes and Rahe. But what if the formal divorce proceedings happen after a long separation? Or after a short marriage? With or without children? In a traditional cultural or religious setting? What if the relationship was abusive? Given the variety of factors that could be involved, can all divorce events really be rated in the same way? Whilst there would always be some negative element of loss, some divorce situations could clearly be far more troubling than others. Or consider pregnancy. It might indeed be very positive if the pregnancy is planned and wanted, and in the context of a good relationship. But if the context is changed, the valence can immediately become stressful, negative and troubling.
We believe all these contextual issues influence the severity of the event, sometimes radically. When checklist measures ignore what is going on around the life event, they are actually ignoring key factors in what it is that makes it negative. They miss the clues to how it is damaging to psychological wellbeing. The life impact of a life event helps define what makes it negative. This has been borne out by studies that use in-depth interviews of life events, such as the Life Events and Difficulties Schedule (LEDS: Brown & Harris, 1978). Events measured in such detail predict psychological disorder such as depression with far more precision than self-report checklists.
Based on the analysis of numerous narrative accounts of life events and their surrounding contexts, we have developed a conceptual model that explains why life events may be experienced as more or less severe and troubling. We uncovered four key areas of psychological need that, when threatened, tend to make an event negative:
- Attachment – events that involve negative changes in close relationships often involving loss or rejection.
- Achievement – events that prevent or hinder reaching a desired goal.
- Security – events that jeopardise physical or mental safety and uncertainty of possession, routine or physical existence.
- Identity – events that compromise how we and others view the self, involving stigma, belonging or physical deterioration.
We believe that how a life event impacts on these four underlying areas is more important than its category, whether, for example, it’s exam failure, mugging, financial loss or relationship break-up. And within these key areas there are important features that increase the likely damage to wellbeing. One is the degree of impact – from mild to marked levels depending on intensity, threat, finality and change involved. For example, an event threatening attachment can be on a continuum from ‘hassle’ (minor argument with partner) to serious negative event (major row), to life-changing (threatened divorce) or trauma (violent attack).
How does this model fit with previous work? Studies have illustrated that other features typify events that are highest on severity and provoke depressions. These include loss (with more or less finality) and danger (threat of future loss), entrapment/defeat (the event underlines lack of escape from a punishing situation) and humiliation (the event is stigmatising) (Brown et al., 1995; Kendler et al., 2003; Harkness & Monroe 2016). So let’s now turn to some examples of how the dimensions of loss, danger, entrapment, humiliation and impact can act to increase negativity in our four key areas of psychological need.
Think of an individual having fertility treatment and the needs that might be affected by this – identity (as parent) and perhaps achievement (i.e. not being able to reach the goal of having a baby). An unsuccessful round of IVF would be considered to have aspects of immediate loss but still contain some hope – the next treatment might be successful. Compare this with being told that after many years of entrapping failed fertility treatments there is nothing left to try. Here, there is a sense of final loss and futility.
Another example, paralysis following a stroke, could involve features of loss, danger and entrapment. This may also affect identity (self as functioning agent). On a closer analysis security may be affected if the person gives up their job and earning capacity, and attachment may be affected if it leads to deterioration in a close relationship due to caring responsibilities or hospitalisation.
So on a simplistic level a person could experience loss in attachment (bereavement), achievement (failing a key exam), security (eviction) or identity (confirmation of infertility).
Yet the most damaging events are those that hit at a number of areas of our core functioning. They have an impact on the very meaning of our lives.
We believe that the conceptual model developed helps explains not only why intuitively negative events are seen as such (death, divorce, destitution), but also why lesser events under certain conditions are so negative. Breaking a finger or wrist might seem inconvenient, painful but relatively minor. But if it stops the individual doing their job, performing their parenting role or having contact with close others, it may involve greater hardship. Suppose the breakage was due to an attack – either from someone close or randomly in the street – this would have greater impact on felt security and the belief in a benign world. Events can also escalate: the individual may be told they will never recover full mobility in their hand and then lose not only functioning but also their livelihood and future goals. Conversely, such context also points to the availability of ‘safety nets’ or available resources that reduce negativity (e.g. another household wage earner cushioning the impact of job loss or parenting demands).
The average reader might be finding it hard to believe that this is still an issue, in a science that has arguably moved consistently from nomothetic to idiographic understanding. We can assure you that it is. We believe it’s hampering research, for example producing inconsistent results in genetic studies that often still use a checklist approach. We continue to argue that all negative events are likely to affect one of our core psychological needs (attachment, achievement, security, identity) and that furthermore, the dimensions of loss, danger, entrapment, humiliation and life impact enable us to understand further aspects of events, how they are experienced and how they affect our lives – its meaning and enjoyment.
We are currently testing this model using a new online measurement of life events: the Computerised Life Events and Assessment Record (CLEAR: Bifulco et al., 2018). The measure not only gathers data regarding event type and context but also allows individuals to include information about various event attributes. Such detail allows for more meaningful analysis. The online system means events can be gathered on a wide scale and prospectively. We have used the data to quantitatively check whether the attributes we have identified truly are important in helping to differentiate between severe and non-severe life events. At the very least, we hope that by outlining this model researchers using life events should be inspired to think more critically about the measurement tools they use.
What about in the realm of applied psychology? Often a client’s vulnerability and maintenance factors will be examined more closely than the life events that have precipitated their symptoms. And although sometimes it will be obvious why a certain life event might have contributed to a client’s symptomatology, at other times it will be less so. It may be that the client does not spontaneously describe all the events and their accumulation, or outline all the relevant context. They may not see such factors themselves as important. Our approach could serve as a way of thinking further about events that may appear at first glance to have had a disproportionate effect on the client’s wellbeing. It could also enable links between predisposing events and cognitive or historical vulnerabilities to be clearly drawn out during formulation (e.g. a history of rejection or a fearful attachment style, may sensitise to events involving humiliation). Thus, we can devise notions of matching of event to vulnerability.
We hope that having a more sophisticated framework for estimating negative life events will mark a new phase for life events in psychological research and related clinical practice. Much like the ongoing debate between a dimensional rather than categorical approach to mental health, perhaps a better understanding of the complex features of life events on a continuum of negativity – rather than as discrete identical categories – would further our understanding of how environments impact individuals. It may also serve to avert stigmatising inferences of weakness in relation to mental health. Let’s seek to better understand the true extent of the damage inflicted by life’s ‘slings and arrows of outrageous fortune’.
- Ruth Spence, Lisa Kagan and Antonia Bifulco are at the Centre for Abuse and Trauma Studies, Middlesex University
Illustration: Dominique Duong
Bifulco, A., Spence, R., Nunn, S., et al. (2018). Computerized Life Events and Assessment Record web-based measure of life events: A preliminary study of reliability, validity, and association with depression. JMIR Mental Health.
Brown, G.W. & Harris, T. (1978). Social origins of depression: A study of psychiatric disorder in women. London: Tavistock Publications.
Brown, G.W., Harris, T.O. & Hepworth C. (1995). Loss, humiliation and entrapment among women developing depression: A patient and non-patient comparison. Psychological Medicine, 25(1), 7–21.
Harkness, K.L. & Monroe, S.M. (2016). The assessment and measurement of adult life stress: Basic premises, operational principles, and design requirements. Journal of Abnormal Psychology, 125(5), 727–745.
Kendler, K.S., Hettema, J.M., Butera, F., et al. (2003). Life event dimensions of loss, humiliation, entrapment, and danger in the prediction of onsets of major depression and generalised anxiety. Archives of General Psychiatry, 60, 789–796.