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Abstract

Disappointment is an under-studied concept in the field of PTSD; it is nevertheless apparent in testimonies of individuals diagnosed with PTSD. Self-disappointment, disappointment with others, and disappointment with the Sublime are mentioned in the literature yet were not studied and described in the context of PTSD and spiritual recovery. This study aims to fill this gap; 50 individuals of varying backgrounds who recovered from PTSD and attributed their recovery to spirituality were interviewed. Participants underwent a variety of traumas, had different piety levels, and used different recovery methods. Findings revealed a mechanism where individuals diagnosed with PTSD experience three-dimensional disappointment (TDD) with self, others, and the Sublime, and that this disappointment breeds a sense of disconnection and helplessness. Findings suggest also that disappointment plays a significant role in both creating PTSD and intensifying the suffering from it. Implications for caregivers, therapists, and individuals with PTSD are discussed.

Keywords

spirituality trauma PTSD disappointment self-disappointment recovery

Individuals who have undergone traumatic event(s) may also suffer from post-traumatic stress disorder (PTSD) (American Psychiatric Association, 2013). Trauma victims diagnosed with PTSD experience clusters of symptoms: avoidance, intrusive thoughts, hyperarousal, and decreased ability in cognitive and academic tasks and social connections (Van der Kolk, 2014). PTSD can also result in spiritual struggle: tensions, conflicts, and strains over what is sacred to the individual (Abu-Raiya et al., 2015). Spiritual struggles include reducing victims’ connection with their spirituality, spiritual community, spiritual resources, and what they consider sacred (McCoubrie & Davies, 2006). Spiritual decline is also connected to disappointment with the Sublime (Strelan et al., 2009) and spiritual disappointment (SD) (Sandage et al., 2010). In this qualitative study, we aim to describe the various facets of disappointment experienced by recovered individuals diagnosed with PTSD who attribute their recovery to spirituality.

Fowler and Dell (2006) describe spirituality as a developing and changing dimension of human existence that evolves throughout an individual’s life. Spirituality is also considered the connection with “The Sublime” (Ronel, 2008) and finding global, humanistic, spiritual, or religious meaning in life events (Galanter et al., 2020). The connection between spirituality and religion is debatable, Hill et al. (2000) suggest that religion is an institutional method for gaining access to the Sublime, whereas spirituality is an integrative voyage toward connection with the Sublime regardless of denomination and piety. Shults and Sandage (2006, p. 161) describe spirituality, as a “search for the sacred,” suggesting spirituality constitutes “ways of relating to the sacred”; they see spirituality as a movement between dwelling in and seeking out a connection to the sacred through religious and non-religious means. Shults & Sandage’s relational spirituality model is dialectical and flexible, differing from Fowler and Dell's (2006) linear progression model.

Spirituality plays a role in recovery from extreme and traumatic events. Aten et al. (2019) showed in a meta-analysis study that religious and spiritual engagement improved recovery from disasters. Barrett (2009) showed that spirituality could promote healing from relational trauma, and Paredes and Pereira (2018), who studied cancer patients, found that spirituality improved recovery and promoted post-traumatic growth (Tedeschi & Calhoun, 2004). Spirituality was also found to reduce recidivism: those who used spirituality in their recovery were less likely to re-commit crimes (Whiteley & Polson, 2021). Exline et al. (2021) studied four behavior patterns toward God and tied spiritual decline with disappointment toward God. Shults and Sandage (2006) showed that recovery and spiritual growth could follow SD when given proper attention.

Disappointment is a common human emotion connected to an individual’s expectations of the outcome of actions or events (Zeelenberg et al., 1998). Zeelenberg et al. showed a difference between regret and disappointment. They suggested that disappointment is connected to events perceived as outside the individuals’ sphere of influence. There are several arenas where people can experience disappointment: self-disappointment (Baumeister, 1990), disappointment with others (Sandage et al., 2015), disappointment with the Sublime (Strelan et al., 2009), and spiritual disappointment (SD) (Paine, 2017). Self-disappointment occurs when individuals are confronted with undesirable outcomes of situations, events, and actions which they attribute to faults in their own being (Baumeister, 1990). Self-disappointment is connected to mental pain and is regarded as a significant factor in an individual’s suffering. Orbach (2003) and Tossani (2013) see self-disappointment as a factor in mental pain, creating mental-health problems and suicide risk.

Disappointment with others consists of disappointment with community and congregation members (Paine & Sandage, 2023) and significant idealized others such as parents, teachers, community leaders, and religious/spiritual leaders (Eytan & Ronel, 2023; Sandage et al., 2015). Exline and Grubbs (2011) describe the fear of telling others about disappointment with the Sublime: they show a connection between the other’s response to the disappointment with God to individuals’ levels of spiritual struggle and decline. Shults and Sandage (2006) also connect SD with significant others as a factor in spiritual decline. SD is described as an experience of a let-down, anger, and negative feelings toward the sacred or the Sublime because of what the individual perceives as abandonment and neglect (Paine & Sandage, 2023). Strelan et al. (2009) showed that disappointment with God was connected to poorer spiritual maturity and may result in mental health problems such as depression, low spiritual well-being, and stress. Sandage et al. (2010) suggest that overcoming SD can also result in spiritual transformation and growth.

As shown in the literature review, individuals who go through extreme and traumatic events are affected by various kinds of disappointment; however, to the best of our knowledge, there has yet been no attempt to describe fully the role of disappointment in the experience of individuals diagnosed with PTSD. The current study aims to cover this gap and to describe the various facets of disappointment in the experience of individuals who have gone through traumatic events and recovered via spirituality. The study is part of a larger study aiming to describe the role of spirituality in recovering from PTSD.

Method

A qualitative-phenomenological method was used to obtain an authentic first-hand description from participants (Arcury & Quandt, 1999; Maxwell, 2008), thus allowing the identification of the components, and processes, of participants’ personal experiences of their disappointment, and its role in spiritually-based recovery.

Participants

The participant group consisted of 26 men and 24 women diagnosed with PTSD who self-attested as having recovered via spirituality. Participants’ ages ranged between 28 and 69 (average = 45). Participants came from four recovery methods: spontaneous remission (n = 13), group therapy (n = 13), 12-step spiritual therapy (n = 12), and trauma-focused therapy (n = 13). Participants came from Israel (n = 16), USA and Canada (n = 12), Palestine (n = 6), Europe (n = 6), South Africa (n = 5), and Arab countries (n = 6). Twenty-one participants were observant or part of a congregation: 10 Jewish, 4 Muslim, 7 Christian. Of the non-observant, 25 said they were non-observant but affiliated to their religion of birth: 6 Christian, 6 Muslim, 13 Jewish. Four participants said they were non-observant and saw their religion of birth as irrelevant. PTSD causes: war and terror (n = 24), sexual abuse (n = 18), childhood trauma (n = 17), cults (n = 8), assaults (n = 16), bereavement (n = 10). Some suffered multiple traumas.

Procedure

Criterion sampling was used in this research. Criterion sampling involves reviewing and studying “cases that meet a predetermined criterion of importance” (Suri, 2011). The criterion we used was “individuals diagnosed with PTSD by a mental health professional, self- attested as having recovered, and are attributing their recovery to spirituality.” Interviewees defined spirituality according to their idiosyncratic definitions. Recruiting was done by a mixed method of maximum-variation approach (Sandelowski, 1995), snowball sampling (Noy, 2008), and direct recruiting (Arcury & Quandt, 1999). Using multiple recruiting methods serves to expose diverse facets of a phenomenon (Suri, 2011). Invitation to participate in the study was published in centers for PTSD treatment and in social media groups for PTSD, in English, Hebrew, and Arabic, in Israel, Palestine, the USA, and South Africa. Recruiting via social media is a valid way to obtain participants from a variety of backgrounds (Weiner et al., 2017). In addition, people who publicly presented themselves as recovering from PTSD via spirituality were approached (n = 6) (Suri, 2011). Seventy-two people responded, and 51 participated in the study. Ten did not meet the PTSD criterion, eight were not interviewed due to saturation, and three did not come to the interview.

The sample size of sub-groups aimed at avoiding saturation while obtaining high information-power data (Guest et al., 2006). High variability of participants in sub-group and dialog quality between researcher and participants determined sample size of sub-group. The first author conducted semi-structured open-ended interviews 1.5 to 2 hr long; an interview guide was constructed and approved by the university ethics committee (IRB). To avoid re-traumatization and risk of causing unnecessary suffering (Duckworth & Follette, 2012), the interview guide focused on participants’ recovery process and its spiritual component, rather than the traumatic event(s), for example: “Please describe to me, if you can, your experience in recovery: how did this affect the spiritual path you found?” or: “Please tell me, if you can, about experiences, feelings, thoughts, or actions that you consider helped you in recovery, whether in or out of the therapy sessions you had.”

Because participants were individuals diagnosed with PTSD, Interviews were held in person; the first author traveled to various countries during the research period and invited people to participate in the study in those coumtries. Participants signed a consent form and were able to withdraw at any time. Interviews were held in a trauma-informed therapeutic manner (Schulman & Menschner, 2018). Information about PTSD treatment centers was given to the participants should they need it. The researcher introduced himself as having been involved in trauma and recovery for many years at a professional and personal level, thus producing a trauma-informed safe environment (Abell et al., 2006). Participants chose the interview language; the first author is fluent in Hebrew, English, and Arabic a translator was used in comprehension of difficult dialects and words in anonymously recorded extracts in Arabic. The transcripts were kept separated from the encoded name list; interviewees’ backgrounds were changed when needed to prevent identification.

Data Analysis

The data analysis process included transcribing each interview, thus acquiring an initial impression and sense of continuity (Patton, 2002). Initial reading led to a text-subject- focused analysis process, identifying themes, categories, and meta-categories and constructing an overall view of the subject of study. To validate categories and themes, anonymous excerpts, themes, and categories were shared with five trauma therapists, two women and three men, all with 10 or more years of experience in the field of trauma therapy. Validation by peer experts allowed another examination of the analysis, themes, categories, and processes identified by the researcher, and gave additional credibility and validity to the findings (Sousa, 2014). In addition, the first author performed the fieldwork and analysis of the results, and the second author provided an overview of the research and its results.

Results

Analysis revealed two major themes. The first three-dimensional disappointment (TDD), divided into sub-themes of disappointment with self, others, and the Sublime, and the second was disconnection resulting from TDD. The disconnection theme consisted of active disconnection, passive disconnection, and disconnection as a sense of helplessness. Those defining themselves as non-spiritual prior to the trauma(s) also experienced the spiritual components of the TDD and disconnection.

Three-Dimensional Disappointment (TDD)

TDD was present in all sub-groups. Participants experienced self-disappointment, disappointment with others, and disappointment with the Sublime.

Self-Disappointment

Three types of self-disappointment were apparent: from experiencing the traumatic event(s); from not seeking help on time and suffering from PTSD, and spiritual-self-disappointment.

Self-disappointment with the incident: Participants described their self-disappointment their inability to defend themselves or avoid the harm they experienced. This self-disappointment was related to their perception that they should have been stronger or smarter; thus, the event(s) and PTSD were partially their responsibility and even their fault. Tzila, a secular Jewish Israeli and sexual assault survivor, said, “I should have known not to go there; I let myself down by going.” Ahmed, a paramilitary Palestinian Muslim with combat and prison trauma, said: “I let myself down and was disappointed with myself for the violence I used and for not protecting myself better.” Eran, a religious Jewish Israeli man whom a family member sexually assaulted, was aware of the absurdity of self-disappointment in his case and still experienced it: “I know and was told I’m not guilty, that I was a small child, yet I was still very much disappointed with myself.”

Veterans diagnosed with combat PTSD, and victims of repetitive sexual assault, spoke of the self-disappointment they felt for going through multiple traumatic events; they felt they “returned to the scene of the injury” which they should have avoided after the first event. Boaz, an American Jew, and Israeli veteran, said: “ I knew it was not good for me - I already had combat experience - but I still entered Gaza. I should’ve known better.” Elian, an Israeli Jewish woman, and childhood abuse survivor said: “Time after time I returned to that room. Why (. . .)? I let myself down.”

Self-disappointment for not seeking help: Participants felt they should have asked for help earlier than they did, thus intensifying their pain and suffering. The self-disappointment in this case, was for ignoring the need for help. Yael, an Israeli Jewish woman, survived an abusive cult: “I cannot believe that I did not tell my mother about what happened, (. . .) I waited so many years.” Olga, an American Mormon who experienced domestic violence, said: “It took me so long to get out of this relationship. It’s unbelievable (. . .) I let down myself, my kids, and my friends.”

Veterans who sought treatment only years after the event(s) also experienced self-disappointed. Eyal, a Jewish Israeli combatant, told. “It took me 10 years of suffering until I realized I had PTSD. It wasn’t like there was no info around me, (. . .); what an idiot. I let down myself and many others.” Jamil, a paramilitary Palestinian Muslim, was injured: “I did not seek help and did not talk to anyone, (. . .) I am still a bit disappointed with myself that I did not ask for anyone’s help. I let myself down by losing hope.”

Spiritual self-disappointment: Participants from spiritual/religious backgrounds were disappointed that their spirituality, whether religious or not, failed to protect them as they thought it should have.

Ben, an Israeli yoga instructor, suffered from combat PTSD: “I went to war thinking I was very much resourced; connected to myself and to yoga and such. When I experienced trauma and especially PTSD symptoms, I was really angry with myself: I wasn’t supposed to go through that.” John, an American Catholic, returned from war with PTSD: “I am a believer, I went to church and went to war, I knew where and why. When the PTSD symptoms started, I was ashamed and disappointed: me having PTSD? Me, hurt?.” Shoshana, South African Jewish woman, was assaulted; she said: “I was told am I strong because of our faith, so when I did not recover immediately, I was disappointed with myself.” Jamil felt his faith was too weak: “When I realized it was because of what happened, I was really disappointed with myself and with Allah. I felt the nightmares were inappropriate.” Fatma, a South African secular Muslim and mindfulness teacher, was abducted and robbed: “I was sure that I’m prepared for everything. I’m Buddhist and mindful, so bring it on. . . when it did not help, I was devastated, angry and disappointed.”

Spiritual self-disappointment of the non-spiritual: Individuals who defined themselves as non-spiritual prior to the traumatic event(s) and PTSD were nevertheless self-disappointed with their lack of spiritual connection which, they felt, could have helped them. Ben said:

I was there, under the bridge waiting for the Syrian snipers to find me, hoping they wouldn’t. and, there and then, I told myself, if only I had faith in something, anything, I would not be suffering so much now. I was angry with myself that I let myself down by not having something to believe in.

Ahmed said, “I did not consider myself spiritual, then when the horror of what I did hit me, I was disappointed that I didn’t have any God, that I didn’t believe in the universe enough.” Henry, an American atheist veteran with combat PTSD, said, “I wanted to have a spiritual-something, anything. I was looking for something and felt I let myself down for not having any; I just knew it could help me.” Jaqueline, an American Christian cult survivor, said: “I was self-disappointed that I did not have any spirituality or faith in my life. I felt that if I had it would have helped me, but I didn’t have it. It was heartbreaking, painful.”

Disappointment With Others

Participants talked about two kinds of disappointment with others: being hurt by the actions or neglect of others; and disappointment with others’ failure to help them when they were suffering from PTSD symptoms.

How come they let it happen? Participants described disappointment with people whom they felt were aware of the event(s) but did not prevent it. Gina, an American Jew, and a survivor of an abusive cult, said: “People around me, neighbors and such, could see that the house, (sigh), was not OK at all. They didn’t; it was devastating and heartbreaking.” Gal, an Israeli Jewish recovered addict and childhood abuse survivor, said, “Many people came into our house, including important ones like the Rabbi and such; they only spoke with my parents. I hoped that someone would talk to me; they never did.”

Hooda, a Palestinian Muslim, saw her brother killed: “I was furious with my parents and brothers, and the imam. They let me down, they let him down. They sent him to die. How could they?” Dalit, an Israeli Jewish bereaved sister to an older brother, was disappointed by the authorities. Her testimony represents many others disappointed by what they felt was authorities’ neglect: “My brother volunteered to be a fighter and they sent him into battle without the right gear. They let him down; they let all of us down.” Karen, a South African Catholic, daughter of a mixed couple, said: “Teachers, and social workers, and others: they all saw what happened, they deserted me, they did nothing. I was just a kid.”

Why didn’t they help me afterward? Participants shared their disappointment with their community, significant others, and authority figures for not helping them overcome their PTSD symptoms.

Ben said: “I came back suffering flashbacks, rages. They locked me in a room. They didn’t even try.” Jamil said: “I came back as a hero, but no one tried to listen and help me with the things that were going through my mind. I felt lonely. disappointed.” Miriam, an Israeli Jewish and abuse victim, said: “They took my testimony but then left me. How could they? They knew what I must be going through.” Jaquelin said: “.. .they saw the suffering and did nothing to help. When your own parents disappoint you like that, you just give up.” Yochai, an Israeli nonobservant Jew who recovered from combat PTSD, said: “I was obviously suffering, roaming the streets like a ghost, lonely; I was angry and disappointed that they didn’t care, that no one cared, not my comrades nor my commanders and not God or whatever you call him.”

Disappointment With the Sublime

Participants talked about a sense of being disappointed with the Sublime and felt neglected and lonely. Findings also show that participants who said they were non-spiritual prior to their trauma felt similar disappointment.

Sense of neglect: Religious participants missed their sense of spiritual connection. They felt that the Sublime’s presence they used to feel was lost; they felt neglected and angry. Ido, an American religious Jew and victim of domestic violence, said: “I looked for answers, I didn’t find any (.) It made me ignore everything, disbelieving God, disappointed with God.” Bella, an American religious Christian and sexual assault victim, said: “God was inaccessible because He allowed it, He neglected me.” Malik, a Lebanese Muslim refugee, said: “I felt Allah was not here anymore. He deserted me; this took my hope away. Khab-Amali [Arabic for disappointment] as they say.”

Non-religious spiritually connected participants also experienced disappointment with the Sublime. Cherry, a secular Israeli Jew, practiced yoga and mindfulness: “I felt anger and disappointment toward the universe. Here I was practicing yoga and caring for others, and I was assaulted?! I felt insulted by the powers.” Dalit, a secular Israeli Jewish woman and a believer in the power of nature, was assaulted on a nature trail: “This was so disappointing, devastating. . . it ruined my sense of connection to the universe and mother nature and creation. All around me is the beautiful earth and I’m in hell! God of the universe neglected me, disappointed me!” C. J., an American Christian veteran, said: “Seeing the suffering, I felt- this can’t be, there isn’t any God.”

Sense of loneliness. The perception of neglect also created a sense of loneliness directed toward the self and others or the Sublime. Nir, an Israeli “independent Jewish believer” as he defined himself, with combat PTSD, said: “I didn’t feel His presence. I longed for it, then and after.” Musa, a Palestinian paramilitary combatant who recovered from combat PTSD, said: “When the flashbacks came I had no one. I prayed and called for anyone: Allah, Jesus, and even Moses. When there was no answer, I was so lonely.” Debora, a secular Israeli Jewish and cult survivor, said: “I felt I could not trust God. He left me alone in their hands. Loneliness was what I felt.” Sam, an American Catholic chaplain with combat PTSD, said: “I made an appointment with God and felt that he had failed to keep it. I felt abandoned (. . .) He dis-appointed me if you see what I mean.”

I didn’t have faith, and still, I was disappointed with Him: Interestingly, the participants who defined themselves as non-spiritual prior to the event(s) also felt disappointment with the Sublime; these participants were surprised by this spiritual disappointment because they did not see themselves as having any spiritual connection.

Shani, an Israeli atheist and a bereaved sister to an older brother, said: “God? I was angry with Him and angrily refused to relate to Him. Even though I didn’t believe in Him I still felt He let me down; Lonely, disconnected.” Tal, an American reform Jew, was sexually assaulted; said: “I didn’t want anything from God; still when I was attacked I called Him and was angry and disappointed when EVEN He didn’t answer.” Sandra, an American Christian, lost her brother in a car accident and was attacked by the other driver’s family, told: “I didn’t have any kind of connection to the Almighty; still when I was attacked, I asked, God where are you, how can you let this happen?” Moran, an Israeli atheist cult survivor, said: “I didn’t want any connection with the entity that neglected me. I was angry with Him and with myself for expecting Him to help.” Ahmed said: “I looked for God. (. . .) In my youth I rejected Him; nevertheless, I was disappointed He didn’t save me.”

Disappointment Breeds Disconnection

Participants described how their disappointment made them disconnect from themselves, others, and the Sublime. Some participants described the disconnection as an active choice resulting from anger; others felt it was a passive process they had no control over.

Active disconnection. Participants who actively disconnected felt anger and sometimes even rage at what they perceived as betrayal, or at least negligence, by others and the Sublime. These participants cut themselves off from any stimulus other than their sense of disconnection and disappointment.

Jamila, a Palestinian-American Muslim and terror victim, said: “I was so angry and disappointed with Allah that I disconnected myself from the world, from myself; I didn’t wash and ate forbidden food and didn’t see my family. I punished Allah and my family.” Olga’s: “It disconnected me from God and church for a long time. I didn’t want anything to do with them.” Abraham, an Israeli observant Jewish with Combat PTSD, talked about his active disconnection after being disappointed with “institutions”: “A gap opened between them and me: me and the clergy, government, parents, and God - I felt that He and they didn’t deserve my love anymore, so I took my love away from them all. From myself also.”

Passive disconnection: The passively disconnected participants felt they had no other option, as if they were forced to disconnect. Participants described the disconnection as a natural and inevitable outcome of the vicious cycle of trauma-PTSD-disappointment.

Tamar, an Israeli Jewish and a cult survivor: “I was so angry and disappointed with myself and everyone else (. . .) I couldn’t . . . be in touch, not with myself, nor others, nor God.” Eyal said: “I felt unforgivable and untouchable. I felt I was not allowed to be in touch with anyone. I went to the desert, not to connect with God, but to make sure He wouldn’t find me, neither Him, myself, or anyone else.” Jack, an American Christian and a veteran, said: “I felt I have no choice, it was beyond me. It wasn’t that I disconnected myself from God: I drifted away.” Musa’s words encapsulate the many passive disconnection testimonies:

I felt betrayed. Everything disappointed me and felt tasteless. I could not connect to them or to my religious and spiritual practices. I tried but it was of no use; I had to come up with new ways to connect to God; the old ones were not for me anymore. I didn’t want to disconnect; I just couldn’t connect.

Disconnection as helplessness: Participants felt that the disconnection added a sense of helplessness to their suffering. The sense of helplessness created a spiral down to despair and to what was felt as the nadir of unbearable suffering.

Eyal said: “When I was disconnected, I felt there was no one out there to help me. I couldn’t help myself, and He, and no one else, was there to help or assist if I needed it; So I’m down in the pit.” Participants described the sense of disconnection as a frightening sense of helplessness and suffering that they could not endure. Avichay, an Israeli Jewish veteran, said: “It was like no one could do or wanted to do anything to help me. Here I am, disconnected, lonely, begging for connection and getting no help. An unbearable experience.” Sandra said: “I cried for help, I longed for help, but I was so far out that there wasn’t any.” Jenny, an American Christian, who was a nurse during the Balkan war, said: “The pain and suffering I saw made me feel that I am alone; there isn’t and cannot be any help. I am deserted here and no one up or down, in heaven or earth, can and wants to help me. I felt despair.”

Discussion

The current study aimed at describing and widening our understanding of disappointments’ role in the experience of individuals diagnosed with PTSD. Analysis revealed that participants experienced three main dimensions of disappointment: self-disappointment, disappointment with others, and disappointment with the Sublime or spiritual disappointment (SD). Disappointment was related to the traumatic event(s) and the PTSD symptoms resulting from it. We suggest disappointment plays a central role both in the onset of PTSD and in worsening of the symptoms associated with the disorder. The TDD created active and passive disconnection that was experienced as helplessness.

As some of the components of TDD: self-disappointment - disappointment with others and disappointment with the Sublime - were already described by other researchers, we will focus on current study’s unique findings: self-disappointment from delayed help-seeking, spiritual self-disappointment, disappointment with the Sublime, and the mechanism of the TDD creating disconnection, helplessness, and despair.

The word disappointment in all three languages study participants used means perceiving that something went wrong with the expected results or the course of events in an individual’s life. In English it comes from the French word disappointier, meaning ‘to cancel a meeting’ (Soukhanov et al., 1992). In Hebrew, akhzava ( אכזבה ) derives from the word kazab, meaning ‘a lie’; in the Bible it meant going to a river only to discover it has run dry (Ruvik, 2014). In Arabic, the word kheibat al-amal (خيبة الامل) adds to these definitions the end of hope (Almany, 2022). We find it interesting and significant that these definitions correspond with the descriptions given by the participants in the current study of their experiences when struggling with trauma and PTSD.

Self-disappointment

Participants sense of self-disappointment revolved around three main themes: event(s), delays in seeking help, and spiritual self-disappointment. Interestingly, the third theme, spiritual self-disappointment, also appeared among those who defined themselves as “non-spiritual” prior to the traumatic event(s). Baumeister (1990) connected self-disappointment to mental health problems, depression, and suicide risk. Orbach (2003) suggested that the self-disappointment Baumeister described is the basis of mental pain and mental health issues. Tossani (2013) connected mental pain and self-disappointment to traumatic events in individuals’ lives, yet he did not connect mental pain and self-disappointment to PTSD.

We suggest looking at the various dimensions of self-disappointment described as an important factor in the suffering evoked by traumatic events. Thus we see disappointment and self-disappointment, as part of the mechanism leading to victimization, self-centeredness (Ronel, 2008), and PTSD. We add to Tossani (2013) and suggest that the three types of self-disappointment described create an accumulation of mental pain intensifying the suffering of trauma victims with PTSD.

Self-disappointment about life event(s) was already described (Baumeister, 1990; Zeelenberg et al., 1998), however, the self-disappointment with the delay in seeking help and spiritual self-disappointment are unique findings to this study. A delay in help-seeking is a well-known phenomenon in PTSD (Murphy & Busuttil, 2015), yet it was not connected to an individual’s sense of self-disappointment and the suffering derived from it. We suggest that self-disappointment with delayed help-seeking intensifies the suffering of individuals who were traumatized and contributed to the development of PTSD. Monteith et al. (2021) studied women veterans who suffered sexual abuse in the army; their study revealed a connection between the fear of institutional betrayal and a delay in help seeking.

We suggest that the combination of the fear of institutional betrayal described by Monteith et al. (2021), and the self-disappointment with one’s help-seeking patterns we described, widens and deepens our understanding about the suffering experienced by individuals with PTSD and the origins of their problematic help-seeking patterns.

The third type of self-disappointment spiritual self-disappointment is unique to this study. Spiritual disappointment was described by Sandage et al. (2010) and by Paine (2017); however, they described disappointment with clergy, others, and the Sublime. Spiritual self-disappointment, where individuals are disappointed with themselves for the weakness of their spirituality, is a new type that was not yet described. We suggest spiritual self-disappointment is connected to victimization, self- centeredness, and control-seeking behavior. By regarding themselves as the main cause of events, individuals with PTSD gain a false sense of control and are trapped in self-centeredness (NAWS, 1993). Ronel (2008) described initial powerlessness over the trauma, and secondary powerlessness over one’s own reaction to it, when individuals try to control the uncontrollable.

We suggest that when participants choose to see themselves as “not strong enough” in their spirituality they earn a false sense of control and avoid the pains of accepting their powerlessness over what happened to them and their reactions. We suggest spiritual- self-disappointment is a unique form of secondary powerlessness connected to PTSD development and to victims’ futile efforts to regain control.

The findings about non-spiritual participants who also experienced spiritual self-disappointment are especially interesting and important. These participants described spiritual self-disappointment despite having no previous spiritual connection. Shults and Sandage (2006) suggest that individuals move between dwelling and seeking in their spirituality and connection to the sacred. We suggest that spiritual self-disappointment among the nonspiritual is a good example of the seeking phase of traumatized individuals. It shows how trauma can be a catalyst for a spiritual quest. Studies of German soldiers (Büssing & Recchia, 2016) and patients with chronic pain among the general society (Büssing et al., 2013) showed a connection between high levels of stress and increased spiritual need.

We suggest that the increased spiritual need among the non-spiritual in our study is the result of spiritual deprivation (Flint & Ronel, 2023) intensified by spiritual self-disappointment. Spiritual self-disappointment we suggest, is an element of spiritual need and is a form of victimization and self-centeredness for religious/spiritual participants and the non-spiritual alike.

Disappointment With Others

As previously mentioned, disappointment with others is a well-known phenomenon in trauma and PTSD. Pargament et al. (2008) described the spiritual trauma of being abused by clergy, and Faver (2004) showed a direct linear connection between the presence of supportive others and resiliency in mental health providers. Smith and Freyd (2017) showed how institutional betrayal was linked to poorer mental health. Two types of disappointment with others were found: 1. Disappointment that others did not prevent the event; 2. Disappointment that others, including family, friends, clergy, and institutions, did not help afterward. These two types are both connected with feelings of betrayal and are part of the structure of TDD, leading to disconnection, helplessness, and despair as described above.

Disappointment With the Sublime

Strelan et al. (2009) and Exline (2013) connected disappointment with the Sublime to spiritual connection’s maturity and spiritual struggles. Our findings suggest differentiating between the sense of neglect by the Sublime and the loneliness that comes from perceiving the Sublime’s obliviousness. The neglect and loneliness in participant descriptions were interwoven, strengthened each other, and were experienced by religious, secular, spiritual, and non-spiritual alike. Study participants were disappointed with the Sublime in accordance with their spiritual/religious practice: this accords with Abu-Raiya et al.’s (2015) description of spiritual struggles.

Current study findings show that the intense experience of a traumatic event and the PTSD symptoms that follow challenge the spiritual maturity and spiritual connection even of individuals that are well established in spiritual/religious practice, such as spiritual/religious leaders. When looking at the relational-spirituality structure suggested by Hall (2004) and Tomlinson et al. (2016) we see disappointment with the Sublime as a painful part of seeking in a seeking-dwelling for the sacred process.

Interestingly, individuals who were non-spiritual when experiencing the trauma(s) also felt disappointment with the Sublime. These findings suggest that the search for the sacred described by Shults and Sandage (2006) is relevant for the non-spiritual and for the spiritual/religious individuals. We suggest non-spiritual participants sought a connection with the sacred without defining it as spiritual practice at the time.

Disappointment with the Sublime in the suffering of individuals with PTSD is part of the spiritual struggle described by Abu-Raiya et al. (2015); nevertheless, we suggest adding TDD to their descriptions of spiritual struggle. The TDD we described uncovers a new and less-known facet in the mechanism of PTSD development, and its exploration may help professionals and victims in the struggle for recovery after trauma(s).

Disconnection and Helplessness

TDD brought participants to a state of disconnection from themselves, others, and their spiritual resources. Some experienced this disconnection as a conscious and active action they took to protect and distance themselves from the pain inflicted by the trauma and PTSD symptoms, while others felt disconnection was forced upon them without their control. Active disconnection was accompanied by anger, and rebellion against, and punishment of, self, others, and the Sublime. We suggest looking at active disconnection as part of the hyperarousal symptom cluster suffered by individuals with PTSD, whereas passive disconnection is part of the avoidance cluster (Asmundson et al., 2004) and of the decline in the ability of individuals with PTSD to maintain relationships also with the Sublime (Van der Kolk, 2014).

Both active and passive disconnection created a sense of helplessness that was described by the participants as intense suffering. Milberg et al. (2004) showed that when the sense of helplessness is combined with powerlessness it creates despair. Considering PTSD is an experience of powerlessness (Ronel, 2008) we suggest that trauma and TDD also activated a mechanism of an intensified sense of helplessness, which in its turn evoked despair.

The Role of Disappointment and Disconnection in Spiritual Recovery

Since all participants presented themselves as being in the process of spiritual recovery, and disappointment was a central factor in their narratives, we assume that TDD is indeed a key component in the process of developing and recovering from PTSD. However, a detailed description of the process goes beyond the scope of this article, and we have described it elsewhere (Flint & Ronel, 2023, unpublished manuscript). Shults and Sandage (2006) suggest that spirituality can flourish and grow after a spiritual-seeking period. We propose looking at TDD and the disconnection described here ignited a spiritual-seeking phase which led to spiritual growth. We suggest TDD and disconnection are unavoidable parts of spiritual growth after trauma and PTSD, and can promote traumatized individuals’ spiritual recovery.

To be disappointed one needs to have had expectations (Zeelenberg et al., 1998). We suggest that TDD and the subsequent disconnection are evidence that individuals with PTSD have a sense of spiritual expectation that, when unmet, leads to TDD, disconnection, helplessness, and despair. Sandage et al. (2010) showed that spiritually disappointed individuals fail to accept reality and focus on the loss they experience while accepting reality is connected to better spiritual health growth.

We add that TDD and disconnection is a phase when individuals with PTSD are at the self-centered end of the axis described by Ronel (2008) and have not yet moved toward recovery and connection with the Sublime. The TDD and disconnection created by traumatic events can lead to spiritual experiences (Walach, 2017), and to the quest for the sacred (Shults & Sandage, 2006). We suggest that the traumatic event(s) and PTSD lead to TDD, disconnection and perceived helplessness and can serve as a catalyst for seeking the sacred, setting individuals - whether spiritual or not - on a path of spiritually based recovery.

Conclusion, Limitations, and Implications

Our findings show that disappointment plays an important role in the development of the pain and suffering caused by trauma(s) and contributes to the development of PTSD. Participants experienced three dimensions of disappointment with self, others, and the Sublime. This led them to painful disconnection, perceived helplessness, and despair. Nevertheless, as the study participants have all recovered, and attributed their recovery to spirituality; the findings and analysis thus suggest that disappointment, when dealt with appropriately, can serve as a recovery vehicle after traumatic events. These findings are important for all who care about the outcomes of traumatic events among individuals with PTSD and can assist therapists, family, caregivers, and victims to better understand survivors’ suffering and promote recovery.

The study is limited by the fact that participants were picked following their self-description as having recovered from PTSD attributing their recovery to spirituality. The role of three-dimensional disappointment, disconnection, and helplessness in other individuals with PTSD is yet to be studied. The self-testimonies of recovery might also be a limitation, as participants might still be suffering from PTSD if tested by conventional psychiatric measures; however, Hart et al. (2020) showed that the self-reporting of recovery indicates a valid recovery.

Further research should focus on the role of spirituality in the recovery process of non-spiritual participants. Findings suggest that by understanding spirituality’s role in the broader community of individuals with PTSD, we might be able to promote recovery. Disappointment is very much connected with regret (Loomes & Sugden, 1986); we suggest that regret might be connected to moral injury (Drescher et al., 2011) and should be studied in the context of TDD, disconnection, and spirituality.

As PTSD is a grievous outcome of warfare, terror, and daily life, knowledge about the cause of suffering and recovery is crucial. We suggest therapists and family members should look at disappointment with a fresh insight, seeing it as a step on the long and challenging path to recovery. Familiarity with processes enables effective coping (Levine, 1997). Clinicians and the community alike should assist individuals struggling with PTSD to come out with their disappointment, overcome it, and transform it into re-connection.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Tuly Flint

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Post-Traumatic Stress Disappointment: Disappointment and Its Role in PTSD

Abstract

Keywords

Method

Participants

Procedure

Data Analysis

Results

Three-Dimensional Disappointment (TDD)

Self-Disappointment

Disappointment With Others

Disappointment With the Sublime

Disappointment Breeds Disconnection

Discussion

Self-disappointment

Disappointment With Others

Disappointment With the Sublime

Disconnection and Helplessness

The Role of Disappointment and Disconnection in Spiritual Recovery

Conclusion, Limitations, and Implications

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

References