Abstract
Introduction
What it implies to experience that life is meaningful is a growing research field in psychology internationally. A number of studies have shown that the experience of meaning in life is of great importance for motivation and coping in the face of crises and highly stressful events (Breitbart et al., 2018; Greenstein & Breitbart, 2000; LeMay & Wilson, 2008; Schnell, 2021). There has been considerable research into meaningfulness in relation to different patient groups, including those at risk of suicide (Søberg et al., 2018) and in palliative care (Breitbart et al., 2015). Population studies mainly include adult participants (Sørensen et al., 2019). There has been little research that specifically explores traumatized adolescents’ experiences of meaningfulness, and crises of meaning. From a treatment perspective, it may be useful to gain knowledge of the experiences of this group in relation to meaning and sources of meaning, and the significance they attach to these experiences.
We know that many children and young people with early childhood trauma have a high disease burden (Nordanger & Braarud, 2017; Van der Kolk, 2017), but less is known about their experience of meaningfulness after the traumatic events. In this study, in a Norwegian sample, the purpose has been to explore how developmentally traumatized young people in treatment in a Child and Adolescent Mental Health Outpatient Clinic (CAMHS) experienced meaning in life, specified as meaningfulness, crises of meaning and sources of meaning.
Developmental trauma
Childhood traumatic experiences that complicate and disrupt a child’s development in many areas are described as developmental trauma (Nordanger et al., 2011; Van der Kolk, 2010). Developmental trauma is understood as trauma related to the child’s experiences over time and includes neglect and domestic sexual, physical, and emotional abuse, as well as frequent separations or violence involving the child’s caregivers (Spinazzola et al., 2021; Stien & Kendall, 2004). The term developmental trauma is debated, especially in relation to its inclusion as a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) (Bremness & Polzin, 2014; van der Kolk et al., 2009). In this study, we draw on Nordanger and Braarud (2017, p. 73) who describe developmental trauma as a stressful situation where two negative factors, traumatic stress and poor regulatory support, occur simultaneously. In this way, children are subjected to traumatic stress at the time as they lack regulatory support from caregivers. The term “developmental trauma” reflects how stress can interfere with the child’s development over time. Examples of potential developmental trauma can be care situations where the caregiver and the abuser are the same person, or where the caregivers are incapable of intervening to help an abused child due to their own problems (Anstorp & Benum, 2014, p. 46). Traumas can affect a child for many years, often for life (Felitti et al., 2019; van der Kolk, 2014, pp. 149–150). Children and adolescents exposed to domestic violence and abuse find that their fundamental feelings of attachment and security are disrupted (Braarud & Nordanger, 2011; Crittenden, 2017; Hjemdal, 2014; Siegel & Solomon, 2003; Treisman, 2016). Children and adolescents with developmental trauma make considerable efforts to adapt to various demands and expectations, whether at school or in contact and relationships with others (Holt & Hafstad, 2016).
Many adolescents referred for treatment to a CAMHS may have developmental trauma (Ormhaug et al., 2012). In 2019, more than 56 000 patients were treated in CAMHS in Norway (Norwegian Directorate of Health, 2019), which corresponds to five percent of the population under 18 years of age. Studies show that a high proportion of children and adolescents treated in a CAMHS report serious events that could potentially lead to post-traumatic stress disorder (Davis & Siegel, 2000; Fagermoen et al., 2017). There are no corresponding figures for developmental trauma, as this is not a diagnostic term used in the statistics.
Previous studies have shown that young people in mental health care can ponder existential questions about the meaning in life, death and feelings of belonging (Schnell et al., 2018). It has also been reported that crises of meaning can be a contributing factor to suicidality in adolescents (Gerstner & Hautzinger, 2012; Schnell et al., 2018). Adolescents with developmental trauma have experiences which for many have resulted in basic mistrust to the world (Hickle & Lefevre, 2022), which can disturb their experience of meaning in life in which an (often unconscious) trust in life as worth living is fundamental (Schnell, 2015, p. 161). Further knowledge of the importance and understandings of experiences of meaning in children and youth with developmental trauma receiving mental health therapy is needed.
A psychological approach to meaning in life
Various definitions of meaning in life are used in research (Battista & Almond, 1973; Lambert et al., 2013; Leontiev, 2013; Reker & Wong, 1988; Schnell, 2021, pp. 5–9). Meaning in life can be studied empirically using psychological methods. Schnell and colleagues (Damásio et al., 2013; la Cour & Schnell, 2020; Pedersen et al., 2018) base their research on population studies using the comprehensive tool Sources of Meaning and Meaning in Life Questionnaire (SoMe) (Schnell, 2009; Sørensen et al., 2019) as well as qualitative studies (Sørensen et al., 2015).
The extensive research that underlies the development of SoMe and understandings of meaning in life (Schnell, 2021, pp. 14, 25) implies that the model can be considered relevant to the majority of the population with its natural variations. In Schnell’s model, meaning in life is an umbrella concept that encompasses and distinguishes between meaningfulness, crises of meaning and sources of meaning (Schnell, 2009). An experience that life is meaningful is based on a mostly unconscious appraisal of life as coherent, significant, directed and belonging (Schnell, 2009). A crisis of meaning may imply a feeling that life is frustratingly empty and meaningless (Schnell, 2021, p. 8; Schnell et al., 2018) and can manifest itself as disorientation, a sense of emptiness, and doubts about one’s understanding of self and reality. This can be an emotionally painful and paralyzing experience (Schnell et al., 2018). A life without meaning can cause stress and in some cases increase the risk of suicide (Schnell et al., 2018).
A number of sources of meaning have been identified that affect meaningfulness, some to a greater degree than others (la Cour & Schnell, 2020; Schnell, 2021, pp. 60–62; Schnell & Becker, 2007). Among the most notable sources of meaning are generativity, care, religiosity, spirituality, harmony, development, social engagement, attention, close contact with nature, creativity and a feeling of belonging in social relations (Schnell, 2021, p. 60).
The experience of meaning in life is associated with good mental health (Kleiman & Beaver, 2013; Steger, 2013). Positive associations between the experience of meaning and quality of life and psychological well-being are also found (Damásio et al., 2013; Pedersen et al., 2018; Sørensen et al., 2019; Vötter & Schnell, 2019). Similar findings, showing a strong association between personal meaning and subjective and psychological well-being are seen among adolescents (Brassai et al., 2011; De Vogler & Ebersole, 1983; Jiang et al., 2019; Krok, 2018). Furthermore, meaning in life has been found to moderate the relationship between stress exposure and depressive symptoms among adolescents (Dulaney et al., 2018), as well as to be a protective factor against suicidal behavior (Lew et al., 2020). Despite a growing research interest in meaning in life among adolescents, most of the studies still include adults. It has been shown that when comparing with youth of college age, the same percentage of younger adolescents seem to understand what meaning in life is and are able to coherently discuss this on their own (De Vogler & Ebersole, 1983). However, there is a gap of knowledge regarding the reflections and experiences of adolescents with developmental trauma on meaning in life issues.
Meaning making has been described by some as a key concept in the treatment of complex trauma (Abraham, 2017). Despite this, we see that experiences of meaningfulness, crises of meaning, sources of meaning and the importance of finding meaning in life have been little addressed in child and adolescent mental health treatment of developmental trauma.
Against this background, the aim of the present study was to explore how developmentally traumatized adolescents treated in CAMHS describe their experiences of meaning in life, specified as meaningfulness, crises of meaning, and sources of meaning.
Materials and methods
Ethics
The study was assessed and approved by the privacy officer of Innlandet Hospital Trust (ref. 13313). It forms part of a larger project involving interviews of both therapists and patients, which was also assessed and approved by the same privacy officer. Participants received written and oral information about the study and signed a consent form prior to the interviews. Participation was voluntary and participants could withdraw from the study at any time without stating a reason. During the interviews, it was repeatedly pointed out by the interviewer that the participants were free to decide not to talk about sensitive experiences if they felt uncomfortable by doing so. It was also emphasized that not participating or withdrawing would have no consequences for treatment. Parental consent was obtained for the two participants who were under 16 years of age. Prior to each interview, an agreement was made that the participant’s therapist would be available if the participant needed a follow-up consultation after the interview.
Sampling
We considered that the research topic would be best illuminated with a strategic sample (Malterud et al., 2016) of adolescents with developmental trauma in treatment in CAMHS. The participants were recruited through their therapists. The therapists were asked to assess whether there was concurrent traumatic stress and poor regulatory support on the basis of the referral and screening interview. The main selection criterion was the age of 14–18 years with symptoms of developmental trauma. Furthermore, those in active substance use or psychosis were excluded. The therapists assessed the adolescents’ suitability for participation in the study as having mild enough symptoms to cope with an interview. This study does not describe the participants’ diagnosis or treatment approach. However, they all had developmental trauma as a complex backdrop.
Interviews were conducted with eight adolescents aged 14–18 years. For reasons of privacy, we do not provide specific information about individual participants, only an overall picture of who they were. They were all in an early stage of outpatient treatment for their trauma at a CAMHS in Norway, and they were all receiving the same treatment. We do not have information about any medication they may have been given as supplementary treatment to psychological therapy. The participants were all born and grew up in Norway and were attending school. At the time of the interview, five of them lived at home with their mother, father or both parents. One lived with a boyfriend, while two lived in foster homes. Two had been inpatients in a psychiatric ward for adolescents. Most of the participants had moved several times, either with their family or to various forms of emergency accommodation before moving to a foster home or back to their parents’ home. Several of them reported having had quite strong suicidal thoughts, but none were at risk of suicide during the period of the interviews. Although an even gender distribution was sought, most participants were female.
Due to anonymity we do not specify individual traumatic experiences, but the following types were mentioned: a high level of family conflict, rape, several broken relationships, violence, violations, and parental alcohol and drug use. The common feature was a very insecure childhood coupled with little or no regulatory support from caregivers.
Data collection
Given the limited research in this field, we conducted a qualitative study to explore the participants’ experiences. We used semi-structured individual interviews, which are well suited when the purpose is to have an open exploratory approach, but still ensure a focus on the specific aim of the study in similar ways for all interviews (Malterud et al., 2016; Whitehead & Whitehead, 2016). Semi-structured interviews allow for exploring individual differences and follow-up questions. Adolescents with developmental trauma might be vulnerable and feel uncomfortable and stressed in an interview situation. Our experience was that the semi-structured approach enabled fruitful dialogues where the participants could express their experiences. We found semi-structured interviews suitable in this study where the aim was to explore and understand participants’ subjective experiences, identify meaningful aspects of their stories, and achieve a deeper understanding of a field that has previously been little studied (Creswell & Creswell, 2017, p. 104; Malterud et al., 2016).
In the interviews, an interview guide with open, thematic questions was used. Specificity was high, but there was also room for the participants’ own stories, whereby we aimed to obtain data with high information power (Malterud et al., 2016). Participants were informed by their therapist that they were going to be interviewed by a researcher doing a PhD degree and with experience from working as a therapist in CAMHS. They also received advance information that meaning in life was the main theme of the study. The interview guide included themes and open questions considering meaning in life, self-experience, everyday life, and relationships. Emotions and feelings regarding these experiences were also asked for. Examples of such open questions were: What do you think about when I say “meaning in life,” what does that mean to you? How do you experience meaning in your everyday life? What gives you strength in life? Where or whom do you get strength from? Is there anything in particular you do to gain strength? Follow-up questions were used to elucidate on the different themes discussed during the conversations. Five interviews took place at a CAMHS, while the other three were telephone interviews due to the COVID-19 situation. The interviews were conducted by the first author and lasted from 40 to 60 min. They were audio recorded and transcribed verbatim by the first author. Before each interview, the previous interview was read through in order to facilitate planning and preparation for the new interview. However, a complete analysis was not conducted until all the interviews had been transcribed.
Analysis
An explicit aim of this study was to explore the participants’ own descriptions of their experiences of meaning in life and to determine the most important sources of meaning for this group. The basis for the analysis was thus their descriptions of how they experienced meaning in life following their traumatic experiences. The interviews were analyzed using systematic text condensation (Malterud, 2012). This is a cross-case analysis specially developed for qualitative research in medicine and health sciences consisting of four steps. First, the research team read through the entire material with an open mind to gain a general idea of it and identify preliminary themes. We then read the text closely to identify and code meaning units that represented the participants’ experiences and reflections. Next, we summarized and condensed the content of each code group and sorted the different meaning units in each group into subgroups (condensates). During this process, we identified suitable quotes from the material that would illustrate the themes. Finally, an objectified summary description of the content was created, illustrated with individual stories and quotations typical of the topics and findings of the study (Malterud, 2017). The research team discussed the results during the four steps. The coding process continued until a high level of agreement was reached in the team (Malterud, 2017). The first author was responsible for the final analysis as it appears in the present text. In the discussion, the findings are discussed in the light of theoretical concepts of meaning related to this study context.
Results
When the participants unfolded their experiences of meaning in life, their stories were grouped into several themes: relationships with others, persevering and making progress, maintaining routines and structure in daily life, religiosity and spirituality, and experiencing good moments and finding space free from pressure. These themes were sometimes explained separately, sometimes intertwined and in combinations.
The importance of relationships
The adolescents described relationships with others as very important for experiencing meaning in life. One said, reflecting on what gave her meaning: “. . . maybe all the people you meet, get to know, and their stories in a way. I don’t really know.”
They often talked with friends, including boyfriends, girlfriends, and relatives. Several of them had at times had strong suicidal thoughts. However, the support provided by family and friends made them think twice about taking their life. Some of them said that they were pleased that someone knew about their suicidal thoughts, and it was reassuring to have someone to talk to when the destructive thoughts returned. One said: I often think about what the meaning really is, but when I talk to my friends, that becomes a reason to keep going.
Many associated a secure relationship with the feeling of meaning in life, but there were also descriptions of unsafe and unreliable relationships. Many had experienced broken parental relationships several times and other negative events due to their parents. Some were afraid of one or both of their parents, but at the same time they could tell about moments of closeness and familiarity, displaying a double and ambivalent relationship.
Some explained that experience of meaning in relationships also included some kind of mutuality. “Meaning is to help others,” one said. Another described how he got strength and a sense of meaning from his family, but his father was violent and unpredictable. He said: . . . most often (I’m) thinking about protecting the little ones (younger siblings), or my mum, if my father comes back and tries something (to hurt them).
An important meaningful purpose for him was to stand up for those in his family who needed protection.
Due to lack of adequate care, some participants no longer lived at home with their parents. Some lived in foster homes, and some had stayed in an adolescent psychiatric facility before being transferred to foster care. Most of them said they felt safe living where they currently lived. However, many of these adolescents described feeling no sense of coherence in life. Their lives had involved moving house and changing school many times. Most of the participants had a relationship with adults outside their family. Adults perceived as safe were e.g. the staff of the mental health facility where they had stayed, teachers or therapists. However, several of them stated that it could be difficult to trust adults in general. They were afraid of trusting others. One said: I never really feel safe. There’ll probably never be a day when I don’t think: “That man might kill me any time” or “She might run over me with her car.”
A key factor here was the experience of being listened to, for example, by their therapists. They then felt that the therapists supported and cared about them. It was a positive experience to enter therapy and be listened to. One of them said: That’s been one of the nice things about coming here (to therapy). I’m not interrupted, and I can say what I need to say.
Several of the adolescents said they liked going to school because of the social aspect. At school, they could meet their friends and be with other people. The teacher was important to many of them because they were pleased to have an adult they could talk to. Many said they felt included in a community at school. One explained: I’m really happy when I go to school . . . having a place where people are waiting for me . . . where people make room for me. It makes me really happy to fit in, you know.
The participants also reported mistrusting other adults. They often felt insecure and alone even though they were with others. Most of them described a poor relationship with their mother. They felt that she had not been there for them. Although they all had a father, the fathers were little mentioned. In general, they felt that it was unsafe to have relationships with others. Bad memories and experiences related to parents were notable in many of their stories. Nevertheless, some said that they could gain strength from their parents through individual incidents where they had found that their parents had listened to them or said something positive.
Family and friends were also important as an ideal picture of what a meaningful life is about, and were thus expressed as a key aspect of their future expectations: “Starting a family, love, experiencing life with some friends, having strong ties to people, I think perhaps those things can be a meaning in life.” They wanted to establish a better family than their parents had been able to.
Structure and routines
All participants stated that routines and structure in their lives provided a sense of security. One said: There’s not much that gives my life meaning, really. [. . .] Well, routines and so on, that’s something I remember from the childcare institution, that’s something I remember I liked very much.
Almost all said that these factors were lacking in the families that had brought them up. They now made an effort to have routines in their lives. They got up at regular times, had breakfast, and got ready for school. Many said that they slept poorly, although they all thought sleep was important. They often had nightmares that disturbed their sleep. It was unusual to sleep through the whole night, but when they did eventually have a good night’s sleep over time, they felt rested and refreshed, which made it easier to feel happy. They felt that their childhood had been chaotic and incoherent. However, several of them reported feeling better now that they had everyday routines. One participant emphasized that her stay in an adolescent mental health facility had been of great help. There she had experienced routines over time. She said: Routines are something I remember from where I stayed. I remember I liked that a lot. I think it was maybe mostly because when I was a child, I didn’t really have that many routines in my life. But where I stayed there were only fixed times, like when we had to do things, like routines for everything, going to school at the same time, having breakfast at the same time, all the regular shifts, everyone who worked there, that’s what it was like to live there, fixed mealtimes and so on, I really liked that. I don’t really understand why, but it was kind of reassuring because when we never had routines like that at home, it didn’t take long before everything was screwed up, whether it was something I’d done, or we suddenly had to move to somewhere else.
School was a place that provided structure in the participants’ lives. School gave them routines and security. For many, their everyday lives were chaotic, with little structure at home and in their spare time. Some described school as a safe haven and an escape from everyday life. For these adolescents, education was a driving force to get on with their lives after their traumatic experiences. They said that they wanted to go to school every day, but also that it could be difficult to concentrate or keep going on days that often seemed long and demanding.
Meaningful moments of well-being and escape from pressure
Most of the participants felt better when they had something to do in their leisure time. They found this a meaningful experience. Furthermore, it was important for many of them to exercise and eat healthy food, and they participated in various activities to avoid being alone. Examples mentioned were involvement in the community and in politics, which was felt to be important. One of the participants had a horse, and when life was too challenging, she spent time with her horse. Many of them were keen on computer games, which some of them used to escape from mental pressure. One said: When I play games, I escape from reality when things get difficult. I sit down and play, talk to my friends from around here or farther away. Then I disappear for a bit from the world and my problems and focus on the game instead. That’s been a good thing. I get away from mom and dad if things have been difficult.
Others painted, listened to music, or engaged in sports activities. But also immediate experiences of silence and finding peace in nature were described. To the question “What do you feel gives you meaning?” one answered: Being able to wake up completely undisturbed, have a cup of coffee, sit outside relatively early in the morning and just have peace around me, have a smoke, listen to the birds chirping.
Later, the same person explained that nice little things that happened, often unexpectedly, gave meaning and inspiration in life: Generally just little things that are nice, that make it worth living. Go to school one day and then find out that I don’t have lunch money with me, and then out of the blue one of the people I can call my friends says “that’s okay” and buys me something I like. Or I get a short phone call from a friend if we’re going to play video games. Wake up to ready-made breakfast. Things like that.
Another also underlined the significance of the “few happy moments now and then” when pressure is hard: Yes, many times I wonder how I can still have hope when I’m treated so badly by my family. It’s the few happy moments I get every now and then that help and keep my hope up.
These moments of escape from pressure, joy, hope and feeling part of nature, and being seen in a friendly way by others, seemed to give hope and well-being and were associated with experiences of meaning in life.
Making progress
Among the participants we found hopes and wishes for the future, as well as indifference and low expectations. One attitude could be to persevere day by day in self-encouraging ways, as was the case for this girl: The meaning is to persevere in a way, just take each day as it comes. A bit like thinking that tomorrow will be a good day, having a final positive thought before falling asleep, or standing at the mirror and giving yourself a smile. It helps a lot just to have that smile on your face.
Some pointed out that their previous traumatic experiences had affected their view of and attitude toward the world around them. Indifference to the world was often mentioned. It was difficult for many to feel happy about anything after they had been let down and had other negative experiences. Several of them said they were afraid of planning things. It could be difficult enough just to get through 1 day at a time. One explained: I just try to get through the day, really. It’s not like I’m looking forward to the next day.
However, the adolescents also reported making plans for an education and a job. One wanted to be an architect and build her own house far out in the forest where she could live in peace with her own family. A common wish was to be able to decide about their own lives and not be dependent on others, but rather live in more ideal relationships with others, as mentioned above. This future goal gave them the strength and the will to continue living. One of the participants expressed this in the following way: The idea of getting an education, having my own family, giving my children a much better childhood than I had . . . I think a lot about doing pretty well for myself, so I can pass it on to my children if something happens . . . That gives me the hope and strength to want to move on.
They all wanted a different life than their current one; they felt that life now was tough. However, one of them stated that he had no thoughts about the future: I really don’t have any dreams or thoughts about what’s in store for me, I’ve never had any real vision of the future.
Persevering and making progress were nourished both by positive future expectations and the daily struggle to keep life going as well as possible. One said: Meaning here and now is actually staying alive, quite simply. This scar is where I cut my arm. I regret doing it, but it took the pain away there and then. If you take your life and die, you cannot change it, so meaning is staying alive, really.
Meaning in life was associated with persevering through challenges and not giving up or giving in to the urge to self-harm. However, the scars on arms and the stories told of emotional pain and indifference to life showed the fragile side of this.
Religiosity and spirituality
Some participants had had a religious upbringing, but not all. Some had stopped believing in God, and others expressed a more undefined spirituality or belief in fate.
One explained how his Christianity had been important to him in this way: Faith has played a big role throughout my life ever since I was a child. I am a baptized Christian, I grew up with many Christian traditions, focused on the reason why we celebrate the various holidays, on why we celebrate Christmas—not just the presents. (My faith) has also helped me at times when I tried to commit suicide. [. . .] That’s one of the main rules I remember, that you’re not allowed to kill yourself, then you can end up in hell because you’re wasting the most precious gift you’ve been given. That helped me a couple of times.
What this boy considered as Christian ethics regarding suicide helped him in critical situations. He did not mention anything about a personally active religious life, but underlined his belonging to the Church and the importance of the various holidays. Another participant described her personal religious practice and how she had found that religion had let her down: I believed in God before, ironically. I prayed to God several times a day until secondary school, to get rid of my illness, for mum and dad to get back together, for them at school to stop bullying me, for me to become what they wanted me to be. Nothing worked, I didn't feel right anywhere. “Why do you (God) exist if you do nothing?” After that I never believed in God. I believe more in science, I define myself as an atheist.
For her, a belief in God did not make sense anymore. It did not work, so she had turned her back on religion and gone for science and atheism as more meaningful alternatives. However, some other participants were pleased to have something such as religion to rely on and turn to when things were difficult. One of them recalled an experience where she thought she was going to die. She said she believed in God when she was in that situation: When you’re close to death, you believe in something . . . I think there’s more between heaven and earth . . .
Some had read a great deal about the spirit world and about belief in destiny. Several of them believed in life after death. One said: I believe there’s something between heaven and earth . . . people who . . . like a soul and spirit world . . . everything’s connected. I’ve read a lot about this to understand it better . . .
A clear belief in fate was also expressed: I believe in fate, which is one of the meanings . . . I believe that everything happens for a reason, that something good will happen after something bad has happened.
This kind of belief in fate included an element of hope and trust, which also seems to have been the common theme running through the participants’ stories of religiosity and spirituality. However, for some participants, this trust had been broken and replaced by non-belief.
Discussion
The adolescents in this study were able to reflect on what meaning in life is about. In that way, these young people did not differ from what is found in other research (De Vogler & Ebersole, 1983). However, their stories were colored by their particular situations of being developmentally traumatized and were closely connected to their ways of dealing with their stress.
We found that meaning in life was related to everyday factors of importance for most aspects of life, such as relationships, structures, progress, moments of well-being, and religiosity and spirituality. These factors presented by the participants are also of vital importance to most other people in relation to experiencing meaningfulness (Schnell, 2021, p. 7). Thus, the developmentally traumatized adolescents associated meaning in life with similar factors to very many other people. However, their experiences of and reflections on meaning in life were challenged by the core conflict of developmental trauma involving two co-occurring negative factors, namely traumatic stress and poor regulatory support (Nordanger & Braarud, 2017, s.73). This implied that meaning in life experiences were not actually given, but something they had to negotiate in ongoing stressful dynamics of ambivalence between elements such as trust and mistrust, security and insecurity, belonging and isolation, significance and worthlessness, perseverance and resignation, directedness and indifference.
Many of the study participants had experienced broken relationships and negative experiences with caregivers that could not provide regulatory support. Children come into the world with an expectation of close ties to others (Bowlby, 1958/1986) and are dependent on safe and predictable relationships with significant adults (Crittenden, 2017; Siegel & Solomon, 2003). Winnicott (1970) referred to this as a “blueprint for normality.” People need to reflect themselves in others and to gain strength, acknowledgment, and support from the “significant other” in order to develop (Binder, 2002). However, a close relationship can be felt to be threatening, as ambivalence about closeness may be part of one’s psychopathology following traumatic events (Braarud & Nordanger, 2011). Consequently, relationships with therapists or teachers or a belief in God can be challenging and ambivalent.
As mentioned initially, meaning in life concerns trust in life as worth living. Meaningfulness comprises an often unconscious appraisal of one’s life as coherent, significant, directed, and belonging (Schnell, 2009), while a crisis of meaning implies a feeling of life as frustratingly empty and not worth living. A crisis of meaning presupposes a desire for life to be meaningful. To a certain extent, we can see examples of crises of meaning among the participants in our study. However, these adolescents do not articulate meaningfulness as a goal they are chasing. Rather, they wish their lives could be better and more manageable. They set proximate and more distant goals, and they draw on both internal and external resources to be able to handle their daily life situations and keep their life on track toward future expectations.
For many, the developmental trauma experiences had broken their life stories into pieces, and they lacked a coherent experience of being themselves. Their traumas had also deeply violated their capacity to appraise themselves as significant persons in their contexts. Forms of abuse, neglect and violation had undermined their positive self-perception. Furthermore, directedness, another important facet of meaningfulness, was challenged by their situations. This also applied to the notion of belonging, and withdrawal and shame seemed to be common reactions to trauma. All these aspects are seen in the literature on developmental trauma (Nordanger & Braarud, 2017; Van der Kolk, 2010).
However, a key finding was that these adolescents gave examples of how they understood meaning in life, and in what ways meaning was of importance in their situations. Here, follow some reflections on these points. When dealing with their fractured horizontal coherence (life story), they emphasized a vertical equivalent by trying to construct an integral notion of who they were, including their life experiences, challenges and ways of handling these, and what they wanted to do and achieve, longed for, and how they took on new roles of significance and belonging.
This was not without much frustration. Many mentioned that they wanted to take higher education to get a good job and have a well-functioning family, but such expectations were often broken by poor performance at school, concentration problems and intrusive memories and emotional pain. However, they found life worth living, and associated meaning with the elements we have pinpointed under the section “Results.”
Religiosity and spirituality were mentioned in different ways. One participant explained that she had identified with Christianity since her childhood. She felt a sense of belonging religious holidays and draw on what she understood as ethical principles from her religion. However, she did not mention her personal religious practices. In this way, she expressed what might be seen as a typical “folk church” way of being Christian. In her area of Norway most of the inhabitants belong to the Church of Norway (Lutheran). Only a few go to church on regular basis (3%–4%), but many have some kind of relationship to the religious holidays and use the church for important life events, particularly funerals. Many people make use of pastoral care in their local communities, particularly in relation to profound life experiences (Danbolt et al., 2021).
Another example showed how the religious practice of praying for help in dealing with traumatic situations had failed, and the adolescent concerned had turned her back on religion, become an atheist and established another life orientation. These examples show different ways of being religious in this particular area, such as religion as belonging without expecting any particular effect from it, and religion as a tool that can be expected to be helpful. In addition, some had more spiritual ways of understanding life: life is “more,” or there is a “purpose.” They did not explain further whether these ways of thinking were helpful or not, but perhaps the belief in fate regarding a purpose provided an expectation that life would be better after all. These elements of a belief in fate also reflect currents in Norwegian society, particularly in popular media.
The adolescents in this study had positive experiences of being seen and listened to by adults. They found that a meaningful life was possible despite their previous traumatic experiences. It appears that the path toward experiencing a meaningful life for this group is more demanding than for the general population, since a meaningful life is easier to achieve for those who have developed a basic trust in the world through early childhood attachment (Schnell, 2015, p. 161).
Children and young people with developmental trauma may be functionally impaired in several areas (Holt & Hafstad, 2016; van der Kolk, 2003). They have greater difficulty than others in coping with school (Nordanger & Braarud, 2017, p. 90). Despite this, the adolescents in the present study described school as providing structure and security, and a place where they are seen and listened to. School was referred to as a safe haven in contrast to their home situation, which had been marked by negative experiences such as violence and abuse. Their experiences from home may have led to a lack of coherence and meaningfulness in their lives. Generally, school can be experienced as a place with order and structure and thus provides these adolescents with a sense of coherence, which again enhances new experiences of meaningfulness (Schnell, 2021, s.7). School is a vital, inclusive element in their lives. Life is meaningful when it is seen to be coherent and have a clear direction. A further key factor is the sense of belonging (Schnell, 2009, 2021, p. 7), and a feeling of belonging will strengthen the experience of meaning (Lambert et al., 2013). In institutional settings such as mental health therapy and school, adolescents can find that they not only gain something from others but are also able to contribute to the community. This can in turn create an experience of meaning (Aron & Aron, 2012; Schnell, 2021, p. 7; Wong, 1998).
Many of the participants stated that they wanted a different life. Their dream of a better life was focused on education, employment, and giving their children a better childhood than they had had themselves. In this way, they created meaning by setting goals in life (Park & Ai, 2006). They thus appeared to be striking out new paths for themselves. However, this can also be understood as a longing or expectation for the future as a safe place where the trauma sufferers will be important fathers or mothers for a new generation who will have better lives than their parents had. In our data, such generational expectations for the future motivated the adolescents to make greater efforts at school and fight their way through challenges. There is reason to assume that such future expectations are fragile, and perhaps also vaguely expressed. Nevertheless, they are highlighted as key factors in what these adolescents associated with meaning in life.
Several of the young people talked about various activities which they found gave them a break or a space of freedom from their mental pressure. Such things as computer games, riding and grooming a horse, contact with nature, or drawing and painting were mentioned. These were all described as opportunities to escape from everyday life and have a break from all kinds of pressure. These expressions of getting away from everything and taking a break can be understood from a trauma therapy perspective as dissociation. Dissociation means that the person with complex trauma reacts when the trauma is overwhelming by disconnecting from the world in order to survive (Anstorp et al., 2006). The connection is broken and the self is no longer coherent; the person can thus experience a lack of control through poor integration between the various action systems in the brain and the processing of information (Hart, 2011; Lyons-Ruth et al., 2006).
In the present study, such dissociative ways of escaping might also be understood from a meaning-making perspective, as long as they were mentioned in association with the notion of meaning. For this group, it might make sense to escape from unbearable mental pressure, and experience tranquility and peace with oneself. Such dissociative behavior might then have a positive function. For the purposes of treatment it is important not to regard dissociation as solely pathological, but also possibly beneficial, as opportunities to find meaning in life. In our study, the participants seemed to gain new strength and willpower to fight on, not only flee from their challenges. However, this suggests the importance of therapists adopting an exploratory approach to traumatized adolescents’ stories about experiences that can be understood as dissociative (Van Der Hart et al., 2005). It is a question of being curious about what adolescents’ activities and escape gives them, and furthermore, exploring meaning in life as a possible counterbalance, which makes life tempting enough for adolescents to work on the trauma and the integration of their split self.
Several participants reported feeling insecure. Based on clinical experience and current research, we know that developmental trauma leads to fundamental insecurity. Although the participants often found relationships challenging, it was important for them to have close contact with someone. The basic human need of belonging and having valuable relationships with others is also a key aspect of Joiner’s (2005) interpersonal theory, which emphasizes that if this need is not met, it can cause mental anguish that can again lead to suicidal thoughts. Some of the adolescents in this study reported having had strong suicidal thoughts. One of the participants said that her belief in God had prevented her from taking her life. God had been her support in a crisis situation. The experience of trauma can make a person appreciate alternative aspects of life and, as in this case, turn to religion and find peace there (Feder et al., 2008). Belief in a god can be linked to the person’s experiences of attachment and can be understood as seeking security, hope and a safe haven in God (Granqvist & Kirkpatrick, 2008, 2013). However, another participant had stopped believing in God when she had not recovered from an illness. She did not find that faith helped her. Faith can also be related to unreliable parental figures where the adolescent feels let down and therefore stops believing in God (Granqvist & Kirkpatrick, 2008). Traumatic events and psychological defense mechanisms can have an impact on a person’s relationship with God. In her book “The Birth of the Living God—A Psychoanalytic Study,” Rizzuto (1979) showed how people may associate God with a power or with nature, or they may distance themselves completely if they have experienced very negative parenting.
Based on the present study, we suggest that mental health care for adolescents could include a greater focus on meaning in life, in terms of meaningfulness, crises of meaning and particularly sources of meaning. However, we see that our findings coincide with what people in general consider to be meaning in life and sources of meaning (Schnell, 2009; Sørensen et al., 2019). We may thus assume that the preferences of the adolescents in these areas do not differ from those of the general population. Although their basic insecurity and anxiety due to their traumatic experiences may have diminished their capacity to focus on the topics of meaning in life or sources of meaning (Holt & Hafstad, 2016), we must emphasize the importance of trust (Schnell, 2015). The good relationships that these adolescents appeared to have with their therapists can form a sound basis for increased focus on meaning in life in therapy, which can strengthen their positive, trust-based experiences of relationships, routines, structure, development, belonging, and other key factors in meaning in life.
Strengths and weaknesses of the study
The main strengths of the study are its clear theoretical framework, rigorous methodological design, and high specificity (Malterud, 2012; Malterud et al., 2016). A further strength is that an experienced research team has collaborated on the design and analysis. However, it can be argued that even though the interviewer made an effort not to ask leading questions, there may have been power asymmetry between an experienced adult interviewer and an adolescent who may have felt insecure and had a strong (unconscious) desire to adapt to the other. This was discussed in the analysis phase. Some of the interviews had to be conducted by telephone due to the COVID-19 pandemic. The sample was selected based on the therapists’ assessments of whether the adolescents had developmental trauma and other symptoms, as well as their suitability to be interviewed. The suitability assessment in particular may have resulted in adolescents of above-average socioeconomic status being invited and agreeing to join the study, which may have influenced the results. Furthermore, it could be objected that the analysis is too broad and thus little related to the participants’ very specific traumatic experiences. In this sense, the study may not have revealed specific links between developmental trauma and meaning in life to any great extent.
Conclusion
This study presents knowledge and experience of the importance of meaning in life for developmentally traumatized adolescents in treatment in a child and adolescent mental health outpatient clinic. Our analysis indicated that the participants associated meaning in life with those aspects of their life experiences that we from a professional perspective also understand as key experiences of meaningfulness in the general population. Of particular importance in this context were positive relationships with significant others, structure and routines, moments of well-being, future goals such as education, work and one’s own family, and activities such as politics, being with animals, belief in God, being outdoors or playing computer games with others. The adolescents in this study seemed to benefit from many different sources of meaning. At the same time, a key challenge was the significant ambivalence associated with forming trusting relationships with others as a result of the participants’ traumatic experiences. Further studies should examine more deeply the factors that adolescents with developmental trauma associate with meaningfulness and sources of meaning, and the importance of meaning in life for their ability to cope with challenges and stress and to receive and benefit from treatment. One hypothesis that would be interesting to test further in a quantitative research design, using the SoMe questionnaire, could be that experiencing meaning in life reduces the negative consequences of developmental trauma. A further key question is how meaning-related topics can be addressed in therapy in child and adolescent mental health clinics.
Footnotes
Acknowledgements
Many thanks to the Innlandet Hospital Trust for permitting us to carry out this study and to the participants for giving of their time to share their reflections, experiences and knowledge in relation to this study.
Author contributions
K.O. and L.D. designed the study. K.O. and L.D. wrote the interview guides. K.O. collected data and conducted interviews. K.O., T.S., L.L., and L.D. performed the analysis. K.O. wrote the manuscript. All authors contributed to the analysis and participated in revision of the manuscript. All authors read and approved the final manuscript.
Availability of data and materials
Anonymized data are available from the corresponding author on request.
Consent for publication
Not applicable.
Ethics approval and consent to participate
The study was assessed and approved by the privacy officer of Innlandet Hospital Trust (#113313). Informed written consent was obtained from all participants. All names and personal identification were removed during transcription. Communication of information about the participants and the results is kept to a minimum to ensure anonymity.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was financed by Innlandet Hospital, Brumunddal, Norway (#150614).
