Altruism Born of Suffering and Prosocial Behavior ... - Springer Link

Soc Just Res (2009) 22:53–97 DOI 10.1007/s11211-009-0088-1

Altruism Born of Suffering and Prosocial Behavior Following Adverse Life Events: A Review and Conceptualization Johanna Ray Vollhardt

Published online: 24 February 2009 Springer Science+Business Media, LLC 2009

Abstract This paper introduces the concept of ‘‘altruism born of suffering,’’ and provides a review and integration of relevant research and theories from various disciplines. In contrast to the well-supported notion that prosocial behavior is rooted in positive experiences, whereas violence and adversity often contribute to further violence and antisocial behavior, it is proposed that suffering may actually enhance the motivation to help other disadvantaged members of society, including outgroups. A motivational process model is presented that includes a typology of altruism born of suffering, integrates clinical and social psychological perspectives on underlying processes, and proposes potential mediators and moderators. Relevant empirical studies are reviewed that provide initial support for this model. A particular emphasis is placed on victims of group-based violence, and implications for intergroup relations and social justice. Keywords Altruism Prosocial behavior Suffering Collective violence Intergroup relations

A commonly held view is that altruism and prosocial behavior originate in positive experiences and processes, whereas antisocial behavior is often rooted in negative conditions and life experiences. Indeed, social psychological theories of altruism and prosocial behavior tend to study the phenomenon in the general population and have focused on positive factors, whereas most research on traumatic events and adverse life experiences is centered in the field of clinical psychology and has focused on negative, psychopathological effects.

J. R. Vollhardt (&) Department of Psychology, University of Massachusetts, Amherst, 135 Hicks Way, Tobin Hall, Amherst, MA 01003, USA e-mail: [email protected]

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Nonetheless, emerging perspectives in clinical and social psychological research provide evidence to support an alternative phenomenon. Staub (2003, 2005) has coined the term ‘‘altruism born of suffering’’ to describe how individuals who have suffered may become particularly motivated to help others—not only despite their difficult experiences but precisely because of them: ‘‘Many people who have been neglected, physically or sexually abused, survived persecution, torture or genocide against their group, rather than becoming hostile or vengeful against the world devote themselves in significant ways to helping others’’ (Staub, 2003, p. 540). He has also proposed that this depends on additional experiences that transform the meaning of past suffering and promote psychological change, leading people to turn toward and care for, rather than turning against others (Staub, 2005; Staub & Vollhardt, 2008). Within clinical psychology, altruism has been mentioned as one possible manifestation of ‘‘posttraumatic growth’’ (e.g., Tedeschi, Park, & Calhoun, 1998), an area in trauma studies that has increased over the last decade (see reviews in Linley & Joseph, 2004; Zoellner & Maercker, 2006; meta-analysis in Helgeson, Reynolds, & Tomich, 2006). However, as of yet systematic research on what can be referred to as altruism born of suffering does not exist. Moreover, in general social psychological research on altruism and prosocial behavior, this perspective has not been addressed explicitly. Nevertheless, both within the areas of altruism and prosocial behavior and in other social psychological domains, extant research offers a wealth of theoretical perspectives that can contribute valuably to understanding altruism born of suffering. The study of altruism in the context of adversity can also enrich existing social psychological theory regarding the different paths that lead to prosocial behavior. In order to provide the rationale for studying altruism born of suffering, the paper begins with a brief overview of the main directions and research findings on effects of traumatic life events on the one hand, and on altruism and prosocial behavior on the other hand. The overview illustrates the underlying theme of these two bodies of research: namely, that negative, adverse conditions lead primarily to negative psychological outcomes, whereas positive (prosocial) behavior results from positive psychological conditions (see Staub, 2005). In contrast to these well-supported findings, a motivational model is then developed that explains and organizes empirical evidence of altruistic and prosocial behavior among individuals who have suffered.1 The starting point for this model is a typology of altruism born of suffering that distinguishes relevant dimensions of suffering and of prosocial behavior. Given that the experience of collective violence, caused with human agency and intention (e.g., 1

A major debate in the literature has been whether certain acts can be defined as altruistic or not. In this paper, Batson’s position that altruism applies to all acts that are primarily motivated by the desire to improve others’ well-being will be followed. This does not exclude internal or external rewards, as long as the ‘‘ultimate goal of increasing another’s welfare’’ (Batson, 1991, p. 6) is given. However, since it is difficult to measure or observe a person’s motivational state, it is impossible to say for many studies whether the reported prosocial act was altruistic or not (see Schroeder et al., 1995, p. 19). Moreover, in many studies reviewed in this paper, this conceptual distinction is not made, and some examples will be referred to as altruistic, although other scholars could dispute such an interpretation (see, e.g., Cialdini et al., 1987).

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genocide or other ethnic violence), carries a particular risk of perpetuating suffering through defensive violence and large-scale cycles of revenge (Staub, 1998; Staub & Pearlman, 2006), I argue that an alternative response to this type of violence is an important manifestation of altruism born of suffering that has significant implications for the prevention of violence. Similarly, while altruism born of suffering has important benefits both on the interpersonal and on the societal level, collective helping and helping of outgroup members is less common, and poses a particular challenge to social justice. Therefore, the review places a particular emphasis on intergroup relations and collective violence, while only briefly touching on prosocial behavior after suffering that has not been experienced collectively or caused with human intention. In order to define a prosocial act in the context of trauma or adversity as ‘‘altruism born of suffering,’’ it is necessary to consider the underlying processes and motivation(s). Thus, drawing on existing theories in clinical psychology (coping, posttraumatic growth), motivational processes are specified in the model, and extended by applying general social psychological theories and constructs— such as empathy, perspective taking, perceived similarity, social identity, and common fate—to altruism born of suffering. Still, the question remains why prosocial behavior often does not occur, despite motivational tendencies that may arise from the experience of suffering. This problem is addressed in a third part of the model, proposing volitional processes that inhibit or enhance prosocial motivation among those who have suffered. In sum, a model of altruism born of suffering is presented that distinguishes (1) categories of the traumatic event (predictor variable) and prosocial behavior (outcome variable); (2) motivational processes that may explain the phenomenon (mediators); and (3) volitional variables which inhibit or reinforce it (moderators). On the basis of this model, a review of existing empirical evidence of altruism born of suffering and its underlying motivations is then provided. Comparing this initial empirical evidence with the theoretical possibilities specified in the model, several hypotheses for future research are derived; and finally procedures for testing these hypotheses that would overcome methodological limitations of prior work are discussed. Such future work would not only contribute to the field’s knowledge about the psychology of victimization and of prosocial behavior, but may also have implications for the alleviation and prevention of violence by which our societies are plagued.

Negative Psychological Effects of Suffering The long-lasting, negative psychological effects of human suffering are well documented. They include symptoms that decrease individual well-being (e.g., posttraumatic stress disorder (PTSD), depression, anxiety disorders, suicidal tendencies, somatic complaints, eating or sleep disorders, substance abuse), and symptoms that have destructive consequences for interpersonal and societal relations (e.g., increased family conflict, delinquency, or aggressive and violent behavior; see Norris et al., 2002; WHO, 2002). These negative outcomes have been

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documented similarly for different types of human suffering, ranging from suffering caused without human agency (natural disasters: review in Briere & Elliott, 2000) or without human intention (technological disasters: reviews in Ursano, McCaughey, & Fullerton, 1994) to suffering caused intentionally, by human agency—which is defined as violence (WHO, 2002). Direct violence can be further differentiated into interpersonal forms (family/ domestic or community violence) and collective violence. The latter is carried out between groups within a society or between nations, and includes wars, ethnic conflict, terrorism, genocide, repression and disappearances, torture, and other forms of human rights abuses (WHO, 2002). Structural violence is defined as the unequal distribution of power and resources between groups, resulting in (sometimes drastically) decreased life chances for those who are disadvantaged (Galtung, 1969; Høivik, 1977; see review in Heggenhougen, 1999). Structural violence also often contributes to various forms of direct violence, including domestic violence (Benson, Wooldredge, Thistlethwaite, & Fox, 2004), homicide (Peterson & Krivo, 1999), and ethnic conflict (Gurr, 1993). Negative effects on individual well-being and interpersonal relations as described above have been documented for all of these forms of violence. On the level of interpersonal violence, research has examined these effects, for example, following abuse by partners (Roberts, Williams, Lawrence, & Raphael, 1998), childhood abuse (Springer, Sheridan, Kuo, & Carnes, 2003), sexual abuse (Whiffen & MacIntosh, 2005), and social exclusion and ostracism (Twenge, Baumeister, Tice, & Stucke, 2001). On the collective level, research has demonstrated similar negative effects among survivors of the 09/11 attacks (Bonanno & Jost, 2006; Miller & Heldring, 2004), civilians in war (Karam & Bou Ghosn, 2003), refugees (Lavik, Hauff, Skrondal, & Solberg, 1996), victims of racist incident-based trauma (BryantDavis & Ocamo, 2005), as well as structural violence (e.g., poverty: Anooshian, 2005). Violence Begets Violence: Affective and Cognitive Processes The link between violence directed toward oneself, and acts of violence or aggression directed toward others (the latter being included among the symptoms of PTSD), is often bi-directional (Begic & Jokic-Begic, 2002). For example, childhood abuse is generally associated with hostility, aggression, and antisocial personality disorders in adulthood (Horowitz, Widom, McLaughlin, & White, 2001; Springer et al., 2003); and more specifically physical abuse in early childhood is a risk factor for aggression toward one’s own children (Black, Heyman, & Slep, 2001) and intimate partners (Schumacher, Feldbau-Kohn, Slep, & Heyman, 2001), even when controlling for other environmental and biological factors (Dodge, Bates, & Pettit, 1990). Similarly, high level of violence, crime, and discrimination in one’s neighborhood is a risk factor for aggressive behavior (Valois, MacDonald, Bretous, Fischer, & Drane, 2002). These reactions could be explained by mediating affective and cognitive processes that are likely to arise in response to other human beings causing harm to the self, close others, or one’s social group. For example, heightened suspicion and

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mistrust are prevalent symptoms among refugees (Lavik et al., 1996); anger and the desire for revenge was a widespread reaction after the 09/11 attacks (Lerner, Gonzalez, Small, & Fischhoff, 2003; Skitka, Bauman, & Mullen, 2004), mediated by increased distress among those who have higher beliefs in a just world (Kaiser, Vick, & Major, 2004) and associated with a conservative shift (Bonanno & Jost, 2006); and hatred is among the most commonly reported psychological effects of war on civilians (Lopes Cardozo et al., 2004). These processes can give rise to defensive violence or revenge on the interpersonal and on the collective level. The resulting cycle of violence is illustrated, for example, in archival research on school shootings in the United States, which reportedly have often been preceded by ostracism or bullying (Leary, Kowalski, Smith, & Phillips, 2003). Past experiences of childhood abuse have even been regarded as an explanation for the Oklahoma City bombing (Gallimore, 2004). On the intergroup level, revenge has also been studied as one of the underlying causes of war (see Moerk, 2002) as well as terrorism (e.g., Hafez, 2006). The literature on intergroup conflict also describes how affective and cognitive responses to past victimization that has not been experienced personally or even in one’s life-time can generate cycles of violence. For example, shared societal beliefs about the group’s victimization can contribute to an ‘‘ethos of conflict’’ (Bar-Tal, 2000). Through narratives of violence against one’s group in the past, historical trauma is relived. This may give rise to shame, rage, and entrenched intergroup violence (Rice & Benson, 2005). Collective narratives of trauma are often instrumentalized by politicians or militant group leaders to instigate new violence, which is then perpetrated by former victim groups (Ramanathapillai, 2006). These narratives can even refer to victimization that occurred centuries ago, yet still arouse intense feelings of anger and humiliation that fuel cycles of revenge and ethnopolitical conflict in the present (Baumeister & Bratslavsky, 2000; Lickel, Miller, Stenstrom, Denson, & Schmader, 2006; Pick, 2001). To summarize, the commonly held belief that harm and violence perpetuates suffering in a cycle of violence (Dodge et al., 1990) is empirically well supported. As Nelson Mandela states, ‘‘suffering (…) is a legacy that reproduces itself, as new generations learn from the violence of generations past, as victims learn from victimizers’’ (WHO, 2002, p. 12). Therefore, the possibility of breaking cycles of violence through altruism born of suffering is of particular importance, and theory and research on this phenomenon is much needed.

Altruism and Prosocial Behavior as a Consequence of Positive Factors Supplementing the large body of research on cycles of violence, theories of altruism and prosocial behavior have primarily focused on benevolent cycles, examining positive factors and processes leading to the motivation to help others (see Batson, 1991; Penner, Dovidio, Piliavin, & Schroeder, 2005; Schroeder, Penner, Dovidio, & Piliavin, 1995). This positive focus is consistent across research on the effects of socialization, individual differences, and situational factors on prosocial behavior.

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In the developmental literature, positive socialization experiences have been identified as key factors for the development of altruism and prosocial behavior (Staub, 2004, 2005). This includes a positive parenting style, responsiveness, empathic caretaking, and secure attachment (Eisenberg, 1992; Mikulincer, Shaver, Gillath, & Nitzberg, 2005; Staub, 2004). Parental warmth has even been associated with prosocial behavior among adults, including collective action for outgroup members (Franz & McClelland, 1994; London, 1970) and heroic acts such as rescuing Jews during the Holocaust (Oliner & Oliner, 1988). Caring parents and other prosocial role models such as siblings, peers, teachers, and even behaviors modeled in the media have been shown to predict prosocial behavior in all stages of development, even adulthood (Grusec, 1991; Mussen & Eisenberg, 2001; Piliavin & Callero, 1991). Parallel to the focus on positive learning experiences during childhood, social psychological literature on individual and situational influences also highlights primarily positive factors that predict prosocial behavior. Above all, positive personal and social standards (norms and needs) as well as affective processes have been studied (Penner et al., 2005). For example, prosocial activities fulfill personal needs such as the expression of values, maintenance of social relationships, and enhancement of self (Clary & Snyder, 1999); and a prosocial value orientation, which is the concern for other human beings and perceived responsibility for their welfare, is a personal norm that predicts helping behavior (Staub, 2005). Theories of prosocial behavior have also focused on positive social norms such as the social responsibility norm (Berkowitz & Daniels, 1964) or the reciprocity norm (Gouldner, 1960) that explains why individuals who received help are more likely to help others subsequently (Wilke & Lanzetta, 1970). The most prominently studied affective source of altruism has been empathy, both as a trait and state variable (e.g., Batson & Oleson, 1991; Eisenberg & Miller, 1987; for a critical discussion see Batson, 2002; Cialdini, Schaller, Houlihan, & Arps, 1987). Similarly, perspective taking, the cognitive aspect of and precursor to empathy, increases helping behavior (Davis, 1994; Eisenberg & Miller, 1987), as does sympathy (Eisenberg, Fabes, Miller, & Fultz, 1989). Both states can occur in response to perceived positive characteristics of the victim, including similarity (Dovidio, 1984; Eisenberg & Miller, 1987) and attractiveness (Benson, Karabenick, & Lerner, 1976). The latter is also likely to enhance positive mood, another predictor of helping behavior (Salovey, Mayer, & Rosenhan, 1991). In contrast, inward-focused distress has been shown to decrease prosocial behavior, including support for disadvantaged members of society (Carlson & Miller, 1987; Wakslak, Jost, Tyler, & Chen, 2007). The considerable amount of research examining positive effects of negative affect on prosocial behavior has focused primarily on how the motivation to avoid and reduce these states results in prosocial behavior and thereby the achievement of a more positive state (Cialdini, Darby, & Vincent, 1973). Therefore, this theory is in line with the hedonistic perspective of research on altruism and prosocial behavior, which emphasizes its gratifying and positive functions and processes (see also Schroeder et al., 1995). In sum, the literature on altruism and prosocial behavior has focused on a variety of positive influences, whereas the literature on trauma and violence has primarily

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studied a host of negative consequences (as noted, e.g., by Bonanno, Galea, Bucchiarelli, & Vlahov, 2006). Overall, both bodies of research reveal the underlying notion that positive outcomes will develop from good experiences and, conversely, that negative outcomes will arise from adverse experiences. This outlook is supported by a large body of empirical evidence that cannot be disregarded. Obviously, positive conditions are conducive to prosocial behavior, and violence creates a serious societal problem. However, the complexity of human behavior cannot be fully accounted for by this linear perspective. People who experience adversity and trauma are not always negatively impacted, and resilience may in fact be more common than often assumed (Bonanno, 2004; Bonanno et al., 2006). Moreover, the research on thriving, benefit-finding, post-traumatic, stressrelated, or adversarial growth shows that extremely negative events may even lead to positive changes and perceived personal growth (e.g., Helgeson et al., 2006; Linley & Joseph, 2004; Park, 1998; Tedeschi et al., 1998). Importantly, some of these benefits can also extend beyond the self and to other individuals who are in need—such as when prosocial behavior is motivated by negative experiences, and victims help others who are suffering (Staub, 2003; Staub & Vollhardt, 2008).

Altruism Born of Suffering: Introduction of a Concept Cases of prosocial behavior arising from negative experiences have been observed by psychologists working with victims of mass violence such as war, genocide, and other severe human rights violations. As Martıń-Baro´ (1994, p. 128) writes: although researchers have not paid much attention to the possibility that war might have a positive impact on people’s development, undoubtedly, like any ‘extreme situation’, war offers the possibility that some people, and even whole groups, may develop virtues that would not have arisen under other circumstances. (…) situations generated by war offer opportunities for people to bring out the best in themselves through altruistic behavior [italics added], and to develop the virtues of solidarity that get so little stimulation from the dominant system’s values in times of peace. In other words, among the positive consequences that can evolve in the aftermath of (mass) violence is empathy for other victims and prosocial behavior on their behalf. This positive ‘‘survivor mission’’ that is aimed at ameliorating or preventing further suffering has been described by Lifton (e.g., 1967, 2003), arising from his psychiatric work with survivors of the Holocaust, Hiroshima, and other events of mass violence. Helping others has also been suggested by Janoff-Bulman (1992) as one way of rebuilding shattered assumptions of the world and finding new meaning in life after trauma. Likewise, Suedfeld (1997) has described the ‘‘ability that people have not only to survive extremely bad experiences but in fact to build upon them for greater strength, understanding, and purpose’’ (p. 329), and he has identified ‘‘altruism’’, ‘‘charitable and educational activities’’, and ‘‘more sensitiv[ity] to others’’ (pp. 329 and 335) as possible outgrowths of these experiences. In a similar vein, in the literature on posttraumatic growth, increased altruism and prosocial

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behavior are considered together as one of the possible areas of growth after traumatic life events (Tedeschi et al., 1998; Vazquez, Perez-Sales, & Hervas, 2008). It has been theorized that experiencing traumatic events ‘‘may be a kind of empathy training’’ (Tedeschi et al., 1998, p. 12) that motivates helping. However, although considered theoretically, to date altruism and prosocial behavior have not been the focus of studies in this field,2 leaving a lot of unexplored potential for future research (see Shakespeare-Finch & Copping, 2006). Thus, although recognition and descriptions of this phenomenon have increased in recent years, a unified conceptualization and research program on what may be called ‘‘altruism born of suffering’’ (Staub, 2003, 2005) have yet to emerge. Central to this concept is that altruism and prosocial behavior might not only be maintained despite suffering, which can be explained with theories of resilience (e.g., Bonanno, 2004; Charney, 2004), hardiness (Kobasa, 1979), and salutogenesis (Antonovsky, 1987), but even develop precisely because of suffering. In other words, it is possible that something about the experience of suffering—either the situation itself, the psychological processes that accompany it, or additional experiences that transform the meaning of suffering (see Staub, 2005; Staub & Vollhardt, 2008)—may give rise to altruism and prosocial behavior. This idea is further explored in the following, and provides the basis for the proposed motivational model of altruism born of suffering.

Toward the Development of a Model: Theoretical Dimensions of Altruism Born of Suffering On its most basic level, the concept of altruism born of suffering captures the observation that suffering can lead to (increased) helping behavior. A more differentiated analysis and explanation must consider, in a first step, whether altruism born of suffering occurs for all forms of suffering and prosocial behavior, or whether there are limitations with respect to the generalizability of the phenomenon. This requires a systematic classification of altruism born of suffering along its relevant observable dimensions. Therefore, the first step of the model provides a classification of suffering experienced by the potential provider of help (dimensions of the predictor variable) as well as characteristics of the performed helping behavior (outcome variable). To put it simply, this part of the model looks at who is being helped in which context. The empirical relation between suffering and prosocial behavior, however, can only be understood when motivational processes are taken into account that mediate this effect. Therefore, in the second step of the model the underlying motivations are specified that lead to altruism born of suffering—rather than to destructive consequences—and differ from motivations that predict and explain general 2

A search in PsycInfo (in June 2008) with ‘‘post-traumatic growth’’, ‘‘stress-related growth’’, ‘‘adversarial growth’’, ‘‘benefit-finding’’, and ‘‘thriving’’ as keywords returned in total only two entries for the following search terms: helping, prosocial, altruism, altruistic, and compassion. One of these sources is a review article (Vazquez et al., 2008) and the other an exploratory, qualitative study with a small sample size (Shakespeare-Finch & Copping, 2006).

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prosocial behavior. These specific motivations are conceptualized as mediating processes and are the centerpiece of the theoretical explanations for altruism born of suffering in the proposed model. Given that suffering does not always lead to prosocial behavior, in the third and last step it is necessary to investigate under which circumstances these motivations are more (or less) likely to lead to actual prosocial behavior. These moderating factors are incorporated in a theoretical framework based on Kuhl’s (1987) actioncontrol model, which distinguishes motivational from volitional factors that strengthen (or hinder) motivations as they are translated into action. Following the theoretical elaboration of this model, a review of empirical studies is presented that shows which evidence of altruism born of suffering exists to date in support of the proposed model, and which future research is needed. Dimensions of Suffering and Prosocial Behavior Empirical examples of altruism born of suffering encompass a broad range of prosocial behaviors exhibited by victims of different types of adverse and traumatic events in various contexts (see Table 1). Important distinctions for suffering are (a) whether it was experienced individually or collectively, and (b) whether the harm was inflicted intentionally, or without intention or even human agency. These two dimensions jointly determine the potential psychological and societal impacts of the experienced harm, and the scope of its effects. While the number of individuals enduring a harmful event determines its (visible) societal impact, intentionality of harm increases the likelihood of cycles of revenge.3 Because of this potential danger and its large scale, the review will focus primarily on intergroup violence as a central case of collectively experienced, intentionally caused harm. In order to determine the scope of helping behaviors performed by those who have suffered, prosocial actions can be classified according to relevant aspects of the situation (see Fig. 1). Above all, this involves (a) the time point: whether prosocial behavior arises in response to the immediate situation, or as a long-term effect in the aftermath of the events. Furthermore, one can distinguish between (b) the level of helping: interpersonal versus collective helping, (c) group membership: helping ingroup versus outgroup members (defined by socially relevant categories), and (d) similarity of fate: helping those experiencing the same versus other adverse event types than the provider of help, that is, different fate. The first two dimensions concern the type of helping and range from interpersonal helping during an adverse event to collective helping among those who suffered in the past. The last two dimensions concern the recipient of help and range from a narrow focus on helping ingroup members experiencing the same fate to outgroup members experiencing different fate (‘‘inclusive caring’’, Staub, 2005). Thus, based on these four dimensions (time point and level of helping, group membership and similarity of fate), theoretically altruism born of suffering can occur on a continuum of 3

However, as one reviewer pointed out, in some cases the desire for revenge also occurs after industrial accidents and even natural disasters, where no human intention or perpetrator is involved (see, e.g., Goenjian et al., 2001, for revenge thoughts after Hurricane Mitch).

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Sample

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275 Holocaust survivors, U.S.

100 Holocaust survivors

20 Holocaust survivors (concentration camp and control group of refugees)

3 Israeli victims of attack by terrorist Terrorist attack organization

100 male Vietnam Veterans

Combatants and civilians in war

224 Lebanese children, age 10–16; with control group

605,454 people in the United States, signing up online to volunteer

346 college students, U.S.

Kahana et al. (1988)

Kahana et al. (1985)

Kay (1998)

Kleinman (1989)

Kishon-Barash et al. (1999)

Leaning and Briton (2004)

Macksoud and Aber (1996)

Penner et al. (2005)

Piferi et al. (2006) Raboteg-Sˇaric et al. (1994)

529 children (age 5 and 6) in Croatia War

Terrorist attack (09/11)


War

War

War (soldiers)

Helping others, volunteering, engaging in Holocaust education

Holocaust

In-depth interviews, TAT, quantitative measures of generativity (LGS and GBC)

Qualitative in-depth interviews

Survey study

Qualitative interviews

Methodology

Prosocial behavior (sharing, comforting, helping others)

Donating money and blood

Volunteering for various organizations, including crises-related organizations

Prosocial behavior (self-report scale), e.g. helping other children

Longitudinal study, behavioral observations

Survey study

Archival analysis of longitudinal data

Structured interview study (standardized measures)

Helping outgroup members (enemies) in war Qualitative interview study

Altruistic intention to help (scale) and PTSD Survey study inversely related

Case studies, semi-structured During attack: comforting and aiding wounded; after: helping families of interviews disabled children, helping victims to gain compensation

In concentration camps: sharing food and clothing; helping avoiding harm; socioemotional support

Altruism most highly correlated with wellbeing

Human rights activism, support of other community members

Type of prosocial behavior

Holocaust

Holocaust

8 human rights activists, Columbia

Political violence

Event

Hernandez (2001, 2002)

Collective suffering with human intentionality (mass violence)

Reference

Table 1 Empirical evidence of altruism and prosocial behavior during or after traumatic life events, classified by type of suffering

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314 White college students, U.S.

121 college students, U.S.

Wayment (2004)

Yum and SchenckHamlin (2005)



Holocaust


Holocaust

1000 adults, victims and control group

Natural disaster (Hurricane)

27 adults

16 male survivors, age 24–61

Grossman et al. (2006)

London (1970)

8 Canadian outgroup activists

Borshuk (2004)

Social marginality

Childhood sexual abuse

Marginality within ingroup

Individual suffering with human intentionality (interpersonal violence)

Kaniasty and Norris (1995b)

Collective suffering without human intentionality (natural disasters)

51 women (age 35–60), U.S.

Case study (Holocaust survivor Primo Levi)

Volpato and Contarello (1999)

93 Holocaust survivors (1946 and 1979–1996)

Suedfeld et al. (2005)

Thomas (2003)

Random nationally representative U.S. sample, N = 768

Schuster et al. (2001)


Combat soldiers, psychiatric patients War and mental illness

Rachman (1979)

Event

Sample

Reference

Table 1 continued

Telephone interviews, structured

Case studies, observational data

Methodology

Qualitative interviews

Structured interviews (standardized measures)

Survey, content analysis of open-ended questions

Longitudinal survey study

Rescuers of Jews during Holocaust

Helping ostracized children, mental health profession, volunteering

Semi-structured interviews

In-depth qualitative interviews

Social justice activism on behalf of outgroup Qualitative interviews members

Tangible and instrumental support

Donating, comforting, empathy, helping behaviors

Donating blood, clothes, money, food; volunteering; charity efforts

Cooperation, sharing, mutual aid, support Document analysis, between fellow prisoners in concentration quantitative content camp analysis

Volunteering and donating, comforting

Generativity, including altruism (e.g., raising Content analysis of prosocial children; Holocaust education; videotaped guided life volunteering for community work) history interviews and archived interviews

Donating blood or money, volunteering

Dangerous or difficult acts to help others experiencing harm


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15 Australian adults, age 24–15

Leaders of SPSSI and APA

Shakespeare-Finch and Copping (2006)

Unger (2000)

16 stroke survivors, mean age = 61

100 siblings of children with or without retardation, mean age = 11.62

62 children, age 8–14, with disabled sibling or without

42 adults, mean age = 43.29, U.S.

300 adults, mean age = 40.79, U.S. convenience sample

18 HIV-positive individuals, mean age = 34.7

69 children with cancer, 77 control; age 7–15

24 hospitalized children, 51 school children (control), mean age = 10

Gillen (2005)

Hannah and Midlarsky (2005)

McHale and Gamble (1989)

McMillen and Cook (2003)

McMillen and Fisher (1998)

Reeves et al. (1999)

Reiter-Purtill (2003)

Seagle et al. (2002)

Chronically ill children

Cancer

HIV

Negative life events, e.g. bereavement

Spinal cord injury

Siblings of disabled children

Siblings of disabled children

Stroke

180 females and 25 males, mean age Bereaved spouses = 76.5 years, U.S.

Social stigma and marginality

Interpersonal violence (rape, armed attack)

Event

Brown et al. (2008)

Individual suffering without human intentionality

Sample

Reference

Table 1 continued Methodology

Case studies; document analysis

Case series methodology, qualitative content analysis

Altruistic choices in drawing task (behavioral intentions)

Prosocial behavior in a classroom-setting (helping other children)

Altruism as coping strategy, especially helping others with HIV

‘‘Increased compassion’’ (subscale of Perceived Benefits Measure)

‘‘Increased compassion’’ (subscale of Perceived Benefits Measure)

Household chores, caregiving

Drawing task

Peer-, teacher- and selfreports; Revised Class Play measure

Semi-structured interviews, constant comparison method

Survey, standardized measures

Structured interviews (standardized measures)

Structured phone and home interviews with children and mothers

Emotional support and custodial care Structured interviews with (Sibling Helping Scale of Family Helping standardized measures; self Inventory) and other report (mother)

Helping other stroke patients, teaching others about illness

Interpersonal, instrumental helping behavior Longitudinal analysis of (e.g., errands, housework, childcare) structured interviews

Social activism, outgroup activism

Compassion (desire to help others, empathy) Semi-structured interview with those who have experienced similar and grounded theory events


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Experienced Individually • not caused intentionally (e.g., illness, death of close others) • caused intentionally (e.g., domestic violence, sexual abuse, ostracism) Experienced Collectively • not caused intentionally (e.g., natural disasters) • caused intentionally (e.g., genocide, war, terrorism)

Dimensions of prosocial behavior (towards others in need):

Increasing inclusiveness and scope

Dimensions of suffering (experienced by provider of help):

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Type of helping: Time point • during situation vs. aftermath Level • interpersonal vs. collective helping

Recipient of help: Group membership • ingroup vs. outgroup members Similarity of fate • similar vs. different fate Increasing inclusiveness and scope

Fig. 1 Basic model of altruism born of suffering: dimensions of suffering and prosocial behavior

increasing inclusiveness and scope—ranging from short-term interpersonal helping of ingroup members experiencing the same fate to long-term, collective prosocial behavior benefiting outgroup members suffering from different experiences than the provider of help has in the past. These distinctions are not only important for reasons of classification, but also for theoretical reasons. Specifically, they are grounded in several theories and bodies of literature—such as posttraumatic growth, social identity theory and common ingroup identity, and research on the effects of similarity on helping—that shed light on possible explanations for altruism born of suffering. This involves motivations that are elaborated in the next part of the model. Motivational Processes as Mediators of Altruism Born of Suffering The core assumption of ‘‘altruism born of suffering’’ is that prosocial behavior among individuals who have suffered may actually be motivated by their adverse experiences—and not (only) by universal processes that apply to the general population and have been documented in the literature on altruism and helping behavior. Therefore, a model of altruism born of suffering must explain how the motivation to help others potentially differs between those who have suffered and those who have not. Resilience theories explain how individuals who are at risk for the negative effects of violence may nevertheless develop or maintain levels of altruism and prosocial behavior comparable to those who are not at risk (Southwick, Vythilingam, & Charney, 2005). However, these theories do not explain why an individual who has suffered could potentially be even more motivated to help than before his or her adverse experiences, or compared to someone who has not suffered. In other words, a central question to be addressed in this model is what the specific cognitive and affective processes are that may arise from the experience of suffering, and additionally strengthen the motivation to help others in need. These variables can

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Suffering (experienced by provider of help)

Experienced Individually Experienced Collectively

Motivational Processes Coping and Post-traumatic Growth By helping others in need: • relieving negative affect related to own suffering • increased self-efficacy • social integration • regaining meaning Situational Demands and Norms • required helpfulness in situations of need • reciprocity norm of helping

Prosocial behavior (towards others in need) Type of Helping Recipient of Helping

Positive Affect and Categorization • increased empathy and perspectivetaking with others in need • identification with other victims, perceived common fate

Fig. 2 Motivations as mediators of altruism born of suffering

be derived from relevant work in clinical and social psychology, and integrated in a theoretical framework that is based on a general motivational model (see Fig. 2). Importantly, the motivations presented in the following vary in their level of selfversus other focus. Therefore, a number of scholars would not regard some of them as altruism (see, e.g., Cialdini et al., 1987). However, it can also be argued that positive consequences for the actor do not necessarily mean that an action is not altruistic. As long as the immediate and direct intention is focused on helping the other, it can be considered altruistic even when positive consequences for the actor arise from the action as well (see footnote 1). The Clinical Perspective: Helping as Coping and Posttraumatic Growth Given the nature of the events that give rise to altruism born of suffering, it is not surprising that the only explicit theoretical explanations which exist for this phenomenon so far are within the field of clinical psychology. These perspectives include helping as a coping mechanism, rebuilding meaning after trauma, and posttraumatic growth. Midlarsky (1991) has argued that helping is an effective coping mechanism for victims or individuals under high stress, and provided five categories of theoretical explanations for this effect. First, helping others may distract from own troubles and self-directed negative emotional reactions due to the other orientation that is inherent in altruism and prosocial behavior. Through a ‘‘downward social comparison with those who are still struggling’’ (Tedeschi et al., 1998, p. 13), own suffering may appear in a different light, and be perceived as less distressing. Experimental research also has shown that helping decreases the strength of self-focused moods, while increasing the strength of other-focused moods (Millar, Millar, & Tesser, 1988). Second, mood tone is generally improved by helping (Salovey et al., 1991), and may effectively enhance well-being of individuals who have suffered and are under continued distress. Third, in addition to this affective process, helping others could

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affect coping through cognitive processes, such as increasing victims’ perceptions of competence and self-efficacy, which are associated with prosocial behavior (Bandura, Vittorio Caprara, Barbaranelli, Pastorelli, & Regalia, 2001). Fourth, in some cases helping may promote social integration. This occurs because of positive attitudes toward people who provide help, reciprocity norms, and mutual social support (Gouldner, 1960), all of which positively contribute to coping and well-being after adversity. However, since people may react negatively to received help that threatens their self-esteem (Nadler, 2002), social integration may be less influential for coping than the improvement of the help-providers’ mood and self-esteem. Finally, Midlarsky also emphasizes that altruism and prosocial behavior can create or enhance meaning in life. This perspective is in line with the writings of psychiatrist and Holocaust survivor Viktor Frankl, who identified meaning as the perhaps most crucial element in surviving extreme situations such as torture and genocide. In order to survive, an individual must be able to make larger sense of the otherwise senseless suffering (Frankl, 1984). Trauma is characterized by a loss of previous meaning systems, and a central task for individuals healing from trauma is to restore ‘‘shattered assumptions’’ of the world, and find new meaning and value in their lives (Janoff-Bulman, 1992). This can occur when people engage in altruistic acts, and prevent others from suffering. Finding meaning is also often discussed in the posttraumatic growth literature, which examines positive changes after trauma (see Linley & Joseph, 2004; Tedeschi et al., 1998; Zoellner & Maercker, 2006); and it is a central concept in theories of hardiness (Kobasa, 1979) and salutogenesis that is based on the ‘‘sense of coherence’’ (Antonovsky, 1987; for integration of these theories see Almedom, 2005). However, the search for meaning through altruism is a very mature response to traumatic events, and it seems unlikely that many would develop it. Therefore, this explanation can only be seen as one possible hypothesis among others, with limited explanatory and predictive power. For example, it does not explain why different forms of altruism born of suffering occur, on various levels (interpersonal or collective) and benefiting different recipient groups. In order to gain a more complex understanding of possible underlying processes as well as different forms of altruism born of suffering, additional cognitive and affective processes must be considered. These can be derived from general theories in social psychology. Applying Social Psychological Theories to Altruism Born of Suffering A social psychological perspective can contribute theories that explain the interaction of personal and situational factors giving rise to altruism born of suffering. This includes motivations for short-term helping in the situation of suffering, as well as differences regarding the recipient of help (in- versus outgroup member, similar versus different fate) and the level of helping behavior (interpersonal versus collective helping). Required Helpfulness and Reciprocity Norms In extreme situations of high stress and danger, the motivation to help may be caused primarily by situational demands.

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Specifically, suffering may entail situations in which an individual is required to help other victims. This has been described as ‘‘required helpfulness’’ (Rachman, 1979; see also Southwick et al., 2005). It can increase with reciprocity and other social norms of helping, explicit requests from others, or because of the perceived ability to help relative to those suffering more (Kaniasty & Norris, 1995b). Individuals who experience harm collectively, or in a family setting, witness others in need and are exposed to more opportunities to help (see McHale & Gamble, 1989). This may give rise to long-term effects that generalize beyond the immediate situation, since prosocial behavior is often acquired in a process of ‘‘learning by doing’’ (Staub, 1979). Moreover, an important process is presumably the acquired competence and perceived self-efficacy that is experienced as individuals provide help (Midlarsky, 1991). Required helpfulness would therefore primarily predict domain-specific helping with problems the provider of help knows how to handle due to the own experience of suffering. Negative State-relief, Empathy, and Perspective-taking Two of the most influential social psychological theories of altruism and prosocial behavior concern the roles of negative state relief and empathy as underlying motivations. These general theories can both be extended to explain why individuals who have suffered might be particularly inclined to help other victims. The negative state relief hypothesis argues that individuals generally experience distress when witnessing others’ suffering, which can be relieved by engaging in helping behavior (Cialdini et al., 1987). This personal distress may be enhanced among those who have suffered in the past. Particularly when observed suffering resembles one’s own experiences, it is likely that memories of these experiences will be activated, giving rise to more distress and subsequent prosocial behavior than among individuals who have not suffered. However, since overarousal may reduce helpfulness when it is not regulated (Fabes, Eisenberg, & Eisenbud, 1993), inward-focused distress due to associations with one’s past may also become so intense that helping behavior is not possible and the situation is avoided instead (see also Carlson & Miller, 1987; Wakslak et al., 2007). Similarity to the victim is also relevant for the empathy-altruism hypothesis of helping behavior, which has received a considerable amount of empirical support (Batson & Oleson, 1991). Empathy and, in turn, helping behavior increases with perceived similarity to the victim (Dovidio, 1984; Eisenberg & Miller, 1987; Krebs, 1975). The few studies that have examined similarity in terms of experienced victimization reveal the same effect. For example, women with rape experiences express higher levels of empathy in response to descriptions of other rape victims than women who do not share this experience (Barnett, Tetreault, Esper, & Bristow, 1986; Barnett, Tetreault, & Masbad, 1987). Perspective-taking, the cognitive aspect of empathy, also influences helping behavior (Levy, Freitas, & Salovey, 2002). However, perspective-taking is often difficult to achieve, especially when it involves experiences such as collective violence that are for many beyond the realm of everyday life, and perhaps even one’s imagination. Therefore, it seems likely that perspective-taking with victims

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will occur more easily for individuals who themselves have experienced harm, especially when the event type is similar. This is supported by experimental research showing that perspective-taking is anchored in one’s own experiences, which are gradually adjusted to adopt others’ perspectives (Epley, Keysar, van Boven, & Gilovich, 2004). In other words, one’s own experiences of suffering can make other victims’ experiences more comprehensible, and enhance the likelihood of helping through increased empathy and perspective-taking. The more similar the experiences of the provider and recipient are, the stronger these processes are likely to be. Social Categorization/Identity and Cognitive Construal Social categorization theory (Turner, 1987) predicts that the salience of shared group membership will give rise to altruism and prosocial behavior, such that ingroup members are more likely to receive help (Stu¨rmer, Snyder, Kropp, & Siem, 2006; Stu¨rmer, Snyder, & Omoto, 2005). According to Campbell (1958), two of the factors that determine whether a social aggregate is perceived as a group are similarity and common fate (see Castano, Yzerbyt, & Bourguignon, 2003). The term ‘‘common fate’’ refers to the same, shared experience (or anticipation) of harm. It has been shown experimentally that threat creates the perception of interdependence that facilitates ingroup-formation (Flippen, Hornstein, Siegal, & Weitzman, 1996). Similarly, it has been suggested that common fate gives rise to a sense of ‘‘we-ness’’, which in turn predicts prosocial behavior (Dovidio, Gaertner, Validzic, & Matoka, 1997; Sole, Marton, & Hornstein, 1975). Indeed, common fate of highly stressful conditions has been shown to increase helping of others (Dovidio & Morris, 1975). Since common fate and threat characterize situations of collective violence, this process might explain findings of increased prosocial behavior during war, terrorist attacks, and other traumatic events—most of which are experienced with members of the same social category. Thus, common fate and similarity on other social dimensions are often confounded. Although in most studies similarity has been operationalized in terms of dress, ethnicity, or shared attitudes (Dovidio, 1984), and studies examining the effect of similarity based generally on suffering (rather than a specific event type) are scarce (see Westmaas & Silver, 2006), it seems plausible that similarity related to experienced adversity may be particularly salient in situations of witnessed suffering and need, providing a relevant category for the perception of the other as an ingroup member. However, initial perceptions of similarity on other dimensions may be necessary in order to increase helping behavior in situations of threat instead of expressing limited concern for one’s own safety (Batson, 1979; Flippen et al., 1996). This could explain why increased helping behavior after natural disasters does not always include outgroup members (Kaniasty & Norris, 1995b; Norris et al., 2002), and that instead negative phenomena such as stereotyping and victim blaming can occur (Napier, Mandisodza, Anderson, & Jost, 2006). Likewise, perceptions of similarity with victims of events that differ from own experiences will probably not occur as readily, and may depend on the cognitive

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representation or construal of one’s own and the other victim’s suffering. Specifically, depending on the level of abstractness with which suffering is construed, other types of adverse experiences can still be perceived as similar, and understood as common fate. Rather than focusing on the specific details of the events, which is characteristic of low-level construals (Trope & Liberman, 2003), the potential provider of help may focus on the essence of suffering (high-level construal) that is shared with victims of other types of events. This broader construal of suffering can then even serve as the basis for including outgroup members with different experiences in a common ingroup (Gaertner & Dovidio, 2000), which could explain more specifically how altruism born of suffering toward outgroup members occurs. Because such abstract conceptualizations are not the most common perception, recategorization and means of making these similarities salient may be necessary in order to achieve the effect. For example, in a laboratory study, help for former outgroup members increased after merging two separate groups into one common ingroup with a superordinate identity (Dovidio et al., 1997). Studies using real group memberships demonstrate similar effects. For example, salience of a superordinate identity as soccer fans (rather than as fans of a specific team) increased helping behavior toward fans of the rival team (Levine, Prosser, Evans, & Reicher, 2005), and salience of superordinate identities as EU citizens (rather than the national identity) increased helping behavior after natural disasters in other countries (Levine & Thompson, 2004). Based on these trends, it is plausible that salience of victimization may create the perception of a shared group membership among individuals who suffered, giving rise to increased motivations to help other victims. This will likely be facilitated when they suffered from the same event or event type. However, this effect may also be possible to achieve among victims of different event types when the suffering is cognitively represented on a high level of construal. Future research is needed in order to examine under which conditions ingroup-categorization based on experiences of suffering occurs, and whether it may also lead to the inclusion of outgroup members with distinct experiences in a common ingroup. In sum, the motivational explanations for altruism born of suffering that are summarized in Fig. 2 involve a clinical perspective, namely helping as coping with adversity, finding meaning after suffering, and posttraumatic growth; as well as a social psychological perspective that involves norms and situational demands to help, perceived similarity that can lead to increased empathy/perspective-taking with other victims, as well as perceptions of common fate or shared experiences of adversity that may result in the categorization of others as part of a common ingroup. Moderating Volitional Factors A lingering question is that while motivational tendencies may be present that can result in altruism born of suffering, obviously it does not always occur among those who have suffered. Instead, inhibiting factors that are also linked to the experiences of suffering may prevent this motivational tendency from developing or—when it arises—from being translated into action. As the reviewed research on cycles of

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violence shows, negative consequences of suffering are widespread, and seem more prevalent than the positive response. Therefore, any adequate model of altruism born of suffering must also take inhibiting factors into account. However, the literature already has documented these negative factors in great detail, whereas very little research has been dedicated to the alternative, prosocial response. Thus, the proposed model focuses on the positive and facilitating factors that may outweigh inhibiting factors and reinforce a prosocial response, while their absence may undermine this positive reaction (see Fig. 3). The relation between motivation and facilitating versus competing inhibiting factors is addressed in Kuhl’s (1987) general action-control model of motivation and volition (see also review in Eccles & Wigfield, 2002). Kuhl distinguishes motivational processes, which lead to the intention to act, from volitional processes that strengthen this intention in light of distracting or inhibiting factors. According to this distinction, motivational processes are based on cognitive and affective factors (such as attitudes, values, but also competencies) that interact with facilitating situational stimuli and give rise to the intention to act. However, they can also be inhibited by pragmatic and situational constraints (such as effort or conflicting goals). For this reason, additional volitional processes are necessary in order to overcome these constraints and allow the initial action tendencies to be carried out. Kuhl (1987) describes several strategies that can help to maintain and protect an activated motivation, and can be applied to altruism born of suffering as follows: (1) selective attention, meaning a focus on information that supports the motivation to help, (2) encoding control, that is recognizing characteristics of the situation that are relevant to the motivation to help other victims, (3) emotion Motivational Processes • Coping and post-traumatic growth • Situational demands and norms

Experienced Collectively

OR

in absence: - weaken, hinder -

Experienced Individually

in presence: + strengthen, facilitate +

• Positive affect and categorization Suffering experienced by provider of help

Prosocial behavior towards others in need Type of Helping Recipient of Helping

Volitional Factors • Selective attention +/- (e.g., heightened awareness of injustice or focus on own problems) • Encoding control +/- (e.g., perceived common fate or not) • Emotion control +/- (e.g., regulation of distress or not) • Motivational control +/- (e.g., therapeutic interventions or lack of) • Environmental control +/- (e.g., altruistic community, reciprocity or unsupportive environment)

Fig. 3 Volitional processes that strengthen and facilitate motivations for altruism born of suffering

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control, which is the regulation of negative affect that would otherwise undermine the intention to help, (4) motivation control, which entails a reassurance of the motivation to help in light of competing intentions and goals (such as the individual’s own recovery), and (5) environmental control, that is the search for surroundings that support the intention to help other victims. Such ‘‘volitional shielding’’, as it has been termed in work by Koole building on this model (e.g., Koole, 2004; Koole & Jostmann, 2004), seems particularly important among those who have suffered. Prosocial motivations are likely weakened by the ‘‘aversive affect that arises as a result of demoralizing circumstances’’ (Koole & Jostmann, 2004, p. 974), and they must be strengthened and maintained when psychological and material resources that are needed for helping are impacted through stressful or traumatic life events (Hobfoll, 1991). Therefore, volitional factors are important to include as moderators in the proposed model (see also Kuhl, 1981), as they can explain when prosocial motivations among those who have suffered will lead to actual helping behavior and when they will not (see Fig. 3). Summary: Theoretical Model of Altruism Born of Suffering In sum, several theoretical arguments exist suggesting how and why prosocial motivations may be particularly pronounced among individuals who have suffered. The proposed model uses Kuhl’s general motivational framework to organize and integrate theoretical explanations of altruism born of suffering. This necessarily involves relevant dimensions of suffering and prosocial behavior, motivational (mediating) processes as well as facilitating (moderating) factors that can strengthen and reinforce motivations of altruism born of suffering in light of hindering circumstances (see Fig. 4). This model lays out the basic relations between relevant

Suffering of the potential provider of help: • Caused intentionally or not intentionally • Experienced individually or collectively

Motivational processes when confronted with others in need: • Coping and post-traumatic growth (less negative affect, increased self-efficacy, can lead to finding meaning)

Prosocial Behavior on behalf of other victims: and result in:

• Situational demands and norms to help (required helpfulness, reciprocity norm) • Positive affect and ingroup categorization (empathy and perspective taking, common fate and identification)

if strengthened by the presence and not hindered by the absence of: Internal and external volitional factors: • Selective attention • Encoding control • Emotion control • Motivational control • Environmental control

Fig. 4 Schematic model of altruism born of suffering: summary of all elements

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variables, and illustrates how they may jointly contribute to the occurrence, scope, and inclusiveness of prosocial behavior among individuals who have suffered. Obviously, not all factors and processes may be present in every case, but presumably vary depending on the type of event, situational or environmental factors, and individual differences. Also, while the proposed model focuses on underlying processes and constructive dynamics, obviously conditions and individual difference variables that predict positive versus negative responses to trauma and adversity (such as social support, optimism, cognitive flexibility, e.g., Bonanno, 2004; Zoellner & Maercker, 2006) are important to integrate in future, extended models.

Empirical Evidence of Altruism Born of Suffering Although altruism and prosocial behavior among victims and survivors has not yet been the object of systematic study (as pointed out by Martıń-Baro´, 1994; Shakespeare-Finch & Copping, 2006; Tedeschi et al., 1998), the literature does provide some initial empirical evidence of the phenomenon. These findings also support basic tenets of the proposed theoretical model, which is used in the following to organize existing empirical examples of altruism born of suffering. As noted earlier, these studies usually do not examine the phenomenon explicitly, but rather report findings of prosocial behavior and altruism as a by-product of other investigated questions. The motivations and underlying processes are, in most cases, not explicitly tested but can be inferred from some studies. Therefore, the studies are presented along the observable dimensions of the phenomenon, suffering and prosocial behavior, while motivations that provide initial support for the model are pointed out throughout the review and summarized at the end. Last but not least, the degree of elaboration for each reviewed study will vary depending on its methodological quality, such that studies with a control group and other features that strengthen the findings’ validity are described in greater detail. Altruism Born of Suffering from Collectively Experienced, Intentional Harm The experience of collective violence is usually characterized by a strong limitation of psychological and material resources (Dekel & Hobfoll, 2007), which restricts the possibility to help others. Yet, even in such extreme situations as imprisonment in concentration camps during the Holocaust, helping behavior has been reported as a common occurrence. Interpersonal Helping in the Immediate Situation For example, in an interview study of 100 Holocaust survivors in the United States (Kahana, Kahana, Harel, & Segal, 1985), providing help to other victims in concentration camps was indicated by an overwhelming majority (82%) of the sample. The most frequent ways in which victims helped others in this situation was by assisting in avoiding harm (reported by almost half of the sample), sharing life

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necessities with others such as food and clothing (in over one-third of the sample), and providing socio-emotional support (in one-fifth of the sample). Whereas food was shared most frequently with family members, survivors reported having performed the other two helping activities equally often for non-family. The finding that helping was a prevalent aspect of the survivors’ experience, and a necessity arising from their situation, is in line with other analyses of Holocaust survivors’ reports. This includes the content analysis of a published testimony, revealing that cooperation, sharing, mutual aid and support were among the most frequent social behaviors toward fellow prisoners in concentration camps (Volpato & Contarello, 1999). Most participants of the study conducted by Kahana et al. (1985) indicated an altruistic sense of responsibility for each other as the primary motivation to help other prisoners. Other survivors reported that helping others was also a way of maintaining humanity amidst atrocity (Kahana, Harel, & Kahana, 1988). However, as these are retrospective self-reports, alternative interpretations are possible. For example, mutual helping in this situation also could have been a survival strategy. On the other hand, antisocial behavior (e.g., stealing food from dying prisoners) was not an uncommon way of trying to survive this situation (see Frankl, 1984). This gives rise to an important question that should be addressed in future research, namely which factors predict a prosocial rather than antisocial response to the same objective situation of suffering. Interpersonal altruistic actions during an extreme situation, such as comforting or aiding those who were wounded, were also mentioned in case studies of survivors of terrorist attacks in Israel (Kleinman, 1989). Similarly, Rachman (1979) reports prosocial acts among combat soldiers in response to situational demands of suffering during war, referring to this phenomenon as ‘‘required helpfulness.’’ Although these acts are performed to help and reduce harm of others, reportedly helping also reduces the helper’s fear in these situations (Rachman, 1979). A more extreme case of altruistic behavior among soldiers is self-sacrifice, or what has been described as ‘‘altruistic suicide’’ in combat, and it was found more frequently in cohesive groups (Blake, 1978). However, soldiers are not always victims, but also potential perpetrators, and therefore these cases are only partially relevant for altruism born of suffering. Collective Helping in the Situation Collective prosocial behavior describes actions that are directed toward a social group, such as a community or nation (Schroeder et al., 1995). This kind of prosocial behavior benefiting the ingroup is often stimulated by mass violence. For example, several studies have documented widespread solidarity after the 09/11 attacks in the United States (see review in Vazquez et al., 2008). Specifically, altruistic and prosocial behavior such as donating money or blood, comforting, or volunteering were among the most frequent responses to these events (Yum & Schenck-Hamlin, 2005; see also Piferi, Jobe, & Jones, 2006; Skitka et al., 2004; Thomas, 2003). Using archival, longitudinal data from a volunteering website, Penner et al. (2005) found that volunteering significantly increased for three weeks

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after 09/11. Additionally, while the greatest increase occurred for crisis-related causes, volunteering on behalf of stigmatized and disadvantaged groups in society (e.g., gays and lesbians, homeless individuals, immigrants) also increased. In this specific case of altruism born of suffering, most of those engaging in prosocial behavior were not physically affected themselves. However, through identification with the national ingroup, collective violence can have a psychological impact on all members of society, leading to the perception of shared vulnerability and victimization. Accordingly, the relief of personal distress related to the perception of common threat may be an underlying and non-altruistic motive for the observed helping behavior (Penner et al., 2005). Several studies found that disaster-focused emotions such as survivor guilt and grief predicted helping behavior after 09/11 (Wayment, 2004). Similarly, an interview study with a large, nationally representative sample revealed that collective helping in the days immediately after the attacks was higher among those who experienced greater stress reactions (Schuster et al., 2001). Other theories that have been discussed as possible explanations for increased helping behavior after 09/11 are terror management theory (Pyszcynski, Solomon, & Greenberg, 2002; Yum & Schenck-Hamlin, 2005) and the belief in the just world motive that may have been activated through the death of innocent victims in the attacks (Lerner & Miller, 1978; see also Penner et al., 2005). Helping and volunteering in this context can both serve to reduce death anxiety by engaging in culturally valued activities (Jonas, Schimel, Greenberg, & Pyszcynski, 2002), and to re-establish a just world (DePalma, Madey, Tillman, & Wheeler, 1999). However, these explanations could also explain increased prosocial behavior among individuals who are not directly impacted by the events, but witnessing them through the media in other parts of the world. Therefore, these explanations are regarded as less central for altruism born of suffering than explanations that are based on social categorization and social identity. It should also be noted that the same constructs that could explain prosocial behavior after 09/11 also predicted destructive, negative responses; for example, in a different study increased distress associated with a belief in the just world predicted the desire for revenge (Kaiser et al., 2004; see also Bonanno & Jost, 2006). Therefore, future research needs to clarify when distress has constructive versus destructive effects; and explore the possibility that altruism born of suffering toward ingroup members does not necessarily exclude destructive attitudes and behaviors toward outgroup members (e.g., interpersonal forms of prosocial behavior after 09/11 were correlated with moral outrage and revenge: Skitka et al., 2004). Therefore, altruism born of suffering that is directed toward outgroup members seems particularly important to examine. Helping Outgroup Members with Common Fate The prevalence of prosocial behavior benefiting ingroup members (as defined by meaningful social categories in society) in the studies discussed so far is not surprising, given that under conditions of extreme suffering from collective violence, helping will naturally be focused on those who are present, experiencing common

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fate. Because mass violence is so often based on distinctions between ethnic, national, religious or other social groups, common fate is usually experienced with other members of the specified ingroup. However, depending on the context of suffering, this ingroup based on common fate can also include members of other social categories. In situations that are as strong as the experience of mass violence, the salience of shared suffering may provide the basis for a perceived ingroup of fellow sufferers with individuals who would otherwise be categorized as outgroup members (see Penner et al., 2005). In an analysis of a large-scale qualitative interview study with combatants and civilians in 12 war-torn countries (‘‘People on War Project’’), Leaning and Briton (2004) even found instances of prosocial behavior toward members of the group that was defined as an enemy in the war, and thereby as the ultimate outgroup. In most of these cases, a common group affiliation such as shared religion, or common fate such as refugee status was perceived, and reported as a crucial determinant of the decision to help (see also Marsh, 2004). Helping Beyond the Immediate Situation of Suffering In addition to extensions of helping behavior to the collective level and to outgroup members, prosocial behavior among those who have suffered can also generalize beyond the situation and over time. For example, both in studies with Vietnam Veterans (Kishon-Barash, Midlarsky, & Johnson, 1999) and Holocaust survivors (Kahana et al., 1988), altruism and interpersonal prosocial behavior were common, and highly associated with psychological well-being and decreased levels of PTSD. Similarly, generativity, a concept that goes back to Erikson and refers to providing and caring for future generations (see McAdams & de St. Aubin, 1998), was found to be a prevalent characteristic among Holocaust survivors (Kay, 1998; Suedfeld et al., 2005). Specifically, this involved the desire to be productive members of society by volunteering and helping (Kay, 1998), and teaching one’s children to help others and ‘‘repay society for every kind thing done for them,’’ for example by engaging in community work (Suedfeld et al., 2005, p. 243). Although these studies did not include control groups of people who did not personally experience the Holocaust, Kay (1998) compared survivors of concentration camps with Jews who had managed to escape from Europe early, and found that the camp survivors scored higher in generativity than the refugees. A different context of suffering and age group is examined in studies of prosocial behavior among children in the aftermath of war. A longitudinal study, conducted in the early 1990s among 5- and 6-year-old children in Zagreb, Croatia, revealed that prosocial behaviors rated by teachers, such as sharing sweets and toys or feeling sorry for other children in need, were significantly increased after the experience of war, whereas aggressive behavior remained the same (Raboteg-Sˇaric, Zˇuzˇul, & Kerestesˇ, 1994). This study controlled for developmental effects. Similarly, a crosssectional study revealed increased prosocial behavior among children from age 10–16 in a war-torn region in Lebanon (Macksoud & Aber, 1996). Against their expectations, the authors found that those children who had suffered more—by being separated from their parents and having witnessed violent acts such as the

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intimidation of family members by militia forces, or seeing people in their communities killed or injured under artillery fire—scored higher on a general scale of interpersonal prosocial behavior than a control group of children who had not been directly affected by the violence. Among children who had suffered, the authors also observed a general sensitivity toward injustice and protecting or helping those in need. Such heightened or ‘‘precocious moral sensibility’’ also has been described in other studies of children growing up under conditions of political crisis (Coles, 2000; Garbarino, Kostelny, & Dubrow, 1991). Among adults, this sensitivity can give rise to prosocial behavior benefiting a larger group, such as collective action aimed at positive social change (Penner et al., 2005). For example, a qualitative interview study with human rights activists in Colombia revealed that the motivation to engage in activism on behalf of the community, and show solidarity with those who had suffered from the same fate, was grounded in personal experiences of adversity (Hernandez, 2001, 2002). Another constructive response to extreme political violence is the strong commitment to positive societal change observed among some survivors of the Cambodian killing fields, which has been referred to as ‘‘positive revenge’’ (Garbarino, Dubrow, Kostelny, & Pardo, 1992). Similarly, many Hiroshima survivors became very involved in peace activism and the movement for nuclear disarmament (Lifton, 1967); and one aspect of generativity that was found among Holocaust survivors was their strong engagement in Holocaust education (Kay, 1998; Suedfeld et al., 2005). Phenomena like these can also occur at the macro level, involving larger groups within traumatized societies, and resulting in the ‘‘social transformation of trauma’’ to prosocial movements that benefit the entire society (Bloom, 1998, p. 179). This has been described for several post-conflict societies, including South Africa (Tedeschi, 1999; see also Gibson, 2004). Helping Others with Different Fate The examples so far have described prosocial behavior directed toward ingroup members and those who experienced the same event or event type. However, helping can also be directed toward people who have experienced different traumatic events than oneself. For example, survivors of terrorists’ highjacking of a bus in Israel reported that the altruistic activities they engaged in following the attacks included assisting families of children with birth defects, helping other victims to gain compensation, and in general to ‘‘help those who feel pain like I do’’ (Kleinman, 1989, p. 53). With temporal and/or physical distance from the situation, psychological and material resources as well as exposure to victims of other events may increase, providing more possibilities to help those with different experiences from one’s own. Furthermore, with temporal distance a higher construal level of one’s own suffering may become more likely (see Trope & Liberman, 2003), allowing one to perceive similarities with other forms of suffering. In other words, a more universal and inclusive perception of one’s suffering may require distance from the events (Kay, 1998). Additionally, psychological closure may increase over time and

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facilitate the ability to attend to other concerns—that is, not only the ingroup’s suffering, but also outgroups’ well-being (Skitka et al., 2004). Thus, temporal distance and psychological closure may predict more frequent occurrences of altruism born of suffering that benefits other social groups who are presently suffering in similar (yet, not the exact same) ways as one’s own group has in the past. Using Jews as only one example of a group that has suffered in the past, their helping of outgroup members includes the Sarajevo Jewish community’s aiding of Muslims and Christians during the war in the Balkans (Serotta, 1994), the high participation of Jews in the Civil Rights movement acting on behalf of AfricanAmericans (Weiss, 1997), and the disproportionally high involvement of Jews in social justice movements (Franz & McClelland, 1994; see also Brodkin, 2003). Similarly, Jewish Holocaust survivors demonstrated against the slaughter of Vietnamese civilians by American soldiers (Lifton, 2003), and many Jewish organizations and individuals have urged the international community to intervene in the genocide in Darfur, referring to parallels with the Holocaust (see Messinger, 2004). In all of these cases, perceived similarities with the persecution of Jews in Europe were often mentioned as the motivational basis for the perceived responsibility to help. For example, in decisions to grant citizenship to refugees from Vietnam (in the 1970s), Bosnia (in the 1990s) and Darfur in the present, Israeli politicians reminded of Jewish refugees during the Holocaust who were rejected from several countries, arguing that Israel therefore had a moral obligation to prevent this situation from happening again (Haaretz, 2007a, b; Serotta, 1994). Of course, further research is needed in order to examine this observed phenomenon systematically, including replications with other ethnic and religious groups to rule out the possibility that the findings are related to specific historical, religious, and cultural influences. In many of these examples, not only the immediate survivors have become involved in helping others, but also members of the next generations who have not experienced the events personally, but grew up with family and community narratives of violence. Thus, altruism born of suffering may include transgenerational effects, as the legacy of suffering can become part of the group’s collective identity (Alexander, Eyerman, Giesen, Smelser, & Sztompka, 2004). Nonetheless, whereas there are historical case studies and other anecdotal evidence of this important phenomenon, social psychological research has not yet investigated the ways in which a groups’ history of victimization may positively influence prosocial attitudes and behavior toward outgroup members. Altruism Born of Suffering from Individually Experienced, Intentional Harm Examples of altruism born of suffering among those who experienced intentional harmdoing individually are also found for all dimensions of prosocial behavior specified in the model. For example, on the interpersonal level, ‘‘increased compassion’’ was the second most frequently reported growth outcome among patients interviewed after a traumatic spinal cord injury resulting from car accidents or shootings (McMillen & Cook, 2003). However, this study does not specify toward whom increased compassion is directed. In an interview study with resilient

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male survivors of childhood sexual abuse, ‘‘making meaning through altruism’’ was identified as a frequent coping strategy (Grossman, Sorsoli, & Kia-Keating, 2006). This involved particularly helping others who were underdogs or vulnerable in some way—as children, others in school who were ostracized, weak, or minority group members; and later as adults people who were homeless or HIV-positive. Several participants of this study had even made helping their profession, most frequently in mental health professions. Similarly, in an interview study with victims of various forms of interpersonal violence, the desire to help others was also often apparent in the participants’ professional plans, for example in the case of a male survivor of an armed hold-up who wanted to start a center for traumatized men (ShakespeareFinch & Copping, 2006). In both studies, empathy and perspective-taking with others who suffer were also perceived as a consequence of the individual’s own victimization, for example being able to understand what the social outcaste is feeling (Grossman et al., 2006), and immediately noticing when someone is depressed (Shakespeare-Finch & Copping, 2006). An example that illustrates collective prosocial behavior based on the idea of (anticipated) common fate is the organization ‘‘Mothers Against Drunk Driving,’’ founded by a mother who lost her child in an accident caused by a drunk driver. This organization provides support for those who were bereaved and victimized by drunk drivers and also advocates in order to prevent more people from being killed in such accidents (see, e.g., Bloom, 1998). Some empirical examples suggest that collective prosocial behavior benefiting outgroup members may be particularly likely after suffering caused by members of the social ingroup. For example, rescuers of Jews during the Holocaust who were interviewed years later often mentioned prior experiences of social marginality (London, 1970). Likewise, in qualitative interviews with outgroup activists, many reported a past of ostracism and marginality within the social ingroup (Borshuk, 2004). These findings correspond to archival data, showing that various kinds of social stigma were prevalent among leaders of a professional association of psychologists engaged in social activism; and that ‘‘positive marginality’’ was more frequent in this group than among a control group of academic leaders not similarly engaged in social activism (Unger, 2000). Altruism Born of Suffering Not Caused Intentionally or Through Human Agency Individually experienced suffering that has not been caused intentionally and through human agency includes illness or disability (of self or close family), and bereavement. In this category, several examples of altruism born of suffering exist that are mostly interpersonal in nature and focused on those suffering from the same event or event type. Generally, studies among individuals with these experiences have reported increased compassion and concern about other individuals’ suffering as a perceived growth outcome (e.g., McMillen & Fisher, 1998). Actions that are based on these motivations have positive effects on the well-being of the person who is suffering, as reported earlier for other contexts. For example, a longitudinal study of bereaved spouses with high levels of grief showed that helping friends,

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relatives, and neighbors (with tasks such as housework, errands, and childcare) predicted a decline in depressive symptoms, even when controlling for variables such as received support (Brown, Brown, House, & Smith, 2008). Parallel to what was described for the context of collective violence, several studies among children with chronic illness also suggest that suffering creates external conditions that may stimulate prosocial behavior. For example, children with a disabled sibling exhibited higher levels of helping family members compared to children with healthy siblings; presumably because of the greater exposure to situations of need and more frequent opportunities (as well as expectations) to help (Hannah & Midlarsky, 2005; McHale & Gamble, 1989). Among children who were chronically ill themselves, it was found that children who had been treated for cancer described themselves as more prosocial than a healthy control group, and that they were rated by teachers as less aggressive (Reiter-Purtill, Vannatta, Gerhardt, Correll, & Noll, 2003). Longitudinal data from this study also show that chronically ill children remained more prosocial over time than the healthy control group, and that those who had received more intense treatment were perceived by peers as more prosocial 2 years later. Similarly, Seagle, Jessee, and Nagy (2002) found that chronically ill, hospitalized children made significantly more altruistic choices in a story-task than non-hospitalized children did. The authors suggest that these differences may be explained in part by the exposure to altruistic role models (e.g., nurses and doctors), as well as to other ill children they can relate to. As adults, individuals who experienced chronic illnesses often dedicate themselves to helping others with the same disease. On the interpersonal level, altruism and especially ‘‘helping others with HIV’’ has been reported as one of the proactive coping mechanisms among a sample of HIV-positive individuals (Reeves, Merriam, & Courtnenay, 1999). Similarly, altruism was perceived by stroke patients as one of the growth outcomes of their illness, and it often involved working toward the prevention of illness among family members and friends, and ‘‘helping others with the same problem’’ (Gillen, 2005, p. 349). The principle of caring for others who suffer in the same way is also the basis of self-help groups, where altruism is one of the highest-ranking therapeutic factors (Magen & Glajchen, 1999). This phenomenon is brought to the collective level through self-advocacy groups of chronically ill patients (Hermansen-Kobulnicky, 2008); and with sufficient resources the motivation to help others who are suffering from the same disease can even result in the creation of large-scale campaigns and foundations, such as the Lance Armstrong Foundation (http://www.livestrong.org/) that is dedicated to cancer prevention, or the Michael J. Fox Foundation (http://www.michaeljfox.org/) for Parkinson research. Collectively experienced suffering that has not been caused by human beings includes natural disasters such as hurricanes, floods, and earthquakes. Due to the immediacy and scope of these events, they give rise to many possibilities to help those experiencing common fate. Consequently, high levels of prosocial behavior have been observed widely among victims of such disasters, both during the event and in their immediate aftermath (Eranen & Liebkind, 1993; Kaniasty & Norris, 1995a, b). This has been referred to as the ‘‘altruistic community’’, which is characterized by higher levels of cooperation and solidarity than usual (Kaniasty &

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Norris, 1995a). It includes tangible support (e.g., cleaning property of others, sharing shelter, lending tools or money) and emotional support, the most frequent prosocial behavior in this context. The increased opportunities and requirements to help in this situation presumably explain the results of a structured interview study with 1000 participants, including a control group. This study revealed that victims of Hurricane Hugo demonstrated significantly more prosocial behavior than nonvictims, particularly tangible support (Kaniasty & Norris, 1995b). Furthermore, controlling for several crucial variables, higher levels of suffering (physical harm and material loss) predicted increased levels of helping other victims. Based on the general effects of common fate described earlier, it seems likely that increased helping in this situation would also benefit outgroup members. It has even been suggested that in natural disasters ‘‘the experience of the same fate increases identification among victims, and previous class, race, ethnic, and social class barriers temporarily disappear’’ (Eranen & Liebkind, 1993, p. 958). However, empirical studies show that in fact the ‘‘altruistic community’’ does not include all community members, and that structurally disadvantaged groups such as ethnic minorities, the elderly, and the less educated are still less likely to receive help (Kaniasty & Norris, 1995b; Norris, Baker, Murphy, & Kaniasty, 2005). Thus, more research is needed in order to specify the conditions under which common fate trumps social categories in determining recipients of help in the context of suffering.

Integration of Empirical Findings with the Proposed Theoretical Model Dimensions of Suffering and Prosocial Behavior The review of empirical findings of altruism born of suffering reveals that this phenomenon occurs in a wide range of contexts, among individuals who suffered from adverse events in all categories of suffering specified in the proposed model: intentional and non-intentional harm, experienced collectively or individually. Likewise, the review provides evidence of all proposed forms of prosocial behavior, ranging from interpersonal helping of ingroup members in the immediate situation of suffering (e.g., assisting the wounded or donating blood after an attack) to collective helping of outgroup members in the aftermath (e.g., protesting for other victim groups). The reviewed studies are summarized in Table 1. While the number of reviewed studies in each category of suffering cannot be seen as indicative of their overall and relative prevalence, a comparison of the types of reported helping behavior in each category provides several interesting observations that should be followed up in future research. For example, altruism born of suffering often appears to be specifically linked to recipients with the same or similar fate. This was observed among victims of collective violence (e.g., Holocaust survivors: Kahana et al., 1985), interpersonal violence (e.g., victims of rape or armed assaults: Shakespeare-Finch & Copping, 2006), as well as non-intentional violence (e.g., chronic illness: Gillen, 2005; Reeves et al., 1999). However, while this form is particularly frequent, altruism born of suffering is not limited to these cases, but may also be directed to individuals and groups suffering from different types of

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adversity (e.g., victims of terrorist attacks helping children with birth defects: Kleinman, 1989; rape victims helping homeless people or ostracized children: Grossman et al., 2006); moreover, this can also include outgroup members (e.g., Borshuk, 2004; London, 1970). Not surprisingly, most of these cases were in the aftermath rather than in the immediate situation of own suffering and distress. It seems plausible that regained psychological and material resources (Hobfoll, 1991), temporal distance from the events (Kay, 1998; Trope & Liberman, 2003), and psychological closure (Skitka et al., 2004) are necessary in order to enable more inclusive forms of altruism born of suffering. But more interestingly, most reviewed cases of altruism toward other disadvantaged groups and outgroups followed suffering that was caused intentionally, by other human beings (either on a collective or interpersonal level), whereas altruism born of suffering after nonintentional harmdoing (natural disasters or illness) was more often limited to helping close others or those suffering from the same event type. Motivational Processes and Volitional Factors Since most of the reviewed findings are exploratory and part of other research questions, the underlying motivations are usually not tested directly. Nevertheless, several of the reviewed examples provide initial evidence in support of the motivational processes and volitional factors proposed in the theoretical model, and therefore they are promising starting point for future research. The clinical perspective of helping as coping is supported by several studies that show a relief of fear, grief, depressive symptoms or PTSD through helping. This was demonstrated for soldiers (Rachman, 1979), Vietnam Veterans (Kishon-Barash et al., 1999), Americans in the aftermath of 09/11 (Wayment, 2004), Holocaust survivors (Kahana et al., 1988), bereaved spouses (Brown et al., 2008), and HIVpositive individuals (Reeves et al., 1999). A specific form of coping was found among Holocaust survivors, who reported that helping was a way of maintaining humanity in times of atrocities (Kahana et al., 1988). The equally reflective motivation of finding meaning in one’s suffering and in life after trauma has been viewed in the literature both as a coping mechanism (e.g., Midlarsky, 1991) and as a dimension of post-traumatic growth (e.g., Tedeschi et al., 1998), depending on the authors’ theoretical viewpoint. This process is evidenced in the studies of victims of child sexual abuse (Grossman et al., 2006), Holocaust survivors (e.g., Kahana et al., 1988), and people who experienced repression and political violence (Hernandez, 2001, 2002). Altruism and compassion as a self-perceived growth outcome is also mentioned in studies among stroke survivors (Gillen, 2005) and for other nonintentional suffering (McMillen & Fisher, 1998) as well as injury through serious, human-caused accidents (McMillen & Cook, 2003). Overall, the theoretical explanation that prosocial behavior may fulfill certain needs among those who have suffered and increase the help-provider’s well-being is empirically well supported. Of course, this motivation is not necessarily conscious, nor does it exclude other, more altruistic (i.e., other-directed) motivations. These motivations are evident in the proposed social-psychological explanations of altruism born of suffering. First of all, this involves a situational perspective that

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considers the situational demands and norms surrounding the experience of suffering. Suffering that is experienced collectively gives rise to increased opportunities and the perceived responsibility as well as social expectations to help. This is suggested in the studies of soldiers in war (Blake, 1978; Rachman, 1979), Holocaust survivors (Kahana et al., 1985), individuals present during a terrorist attack (Kleinman, 1989), siblings of disabled children (Hannah & Midlarsky, 2005; McHale & Gamble, 1989), and survivors of natural disasters (Kaniasty & Norris, 1995b). Moreover, individuals who suffer and depend on help encounter altruistic role models (e.g., during war: Raboteg-Sˇaric et al., 1994; in hospitals: Seagle et al., 2002), and the reciprocity norm of helping can explain high levels of mutual support in times of human-made and natural disasters (e.g., in concentration camps: Kahana et al., 1985; during natural disasters: Kaniasty & Norris, 1995b). Importantly, these situational factors can generalize over time and to the collective level, leading to long-term forms of altruism born of suffering as well as collective or societal manifestations. Specifically, some of the reviewed studies suggest that required helpfulness and familiarity with suffering early in life can result in a particular interest in and identification with the helper role, leading to the choice of a helping profession later in life (Grossman et al., 2006; ShakespeareFinch & Copping, 2006). Likewise, the perceived responsibility to help can lead to the long-term motivation to prevent suffering of the same kind as oneself has experienced, indicated in samples as diverse as among survivors of severe health conditions (e.g., Gillen, 2005), of nuclear bombs (Lifton, 1967), and of genocide (Kay, 1998; Suedfeld et al., 2005). This has been referred to as an ‘‘alternative survivor mission’’ (Errante, 1997; Lifton, 2003). It can also occur on the collective level, when an entire society perceives the moral responsibility to help other victim groups because of its own history of suffering (Haaretz, 2007a, b). The second set of social psychological explanations proposed in the model is the relief of distress through helping, and increased empathy or perspective-taking with others in need. The relief of personal distress is shown in several of the reviewed studies of increased prosocial behavior in the immediate aftermath of 09/11 (Piferi et al., 2006; Wayment, 2004), as well as in the studies that support the coping perspective. Interestingly, several studies in various contexts that compared groups with different levels of exposure to the events or subjective levels of stress show that altruism born of suffering was actually higher among those who have suffered more from a given event (see Schuster et al., 2001, for 9/11; Kay, 1998, for the Holocaust; Macksoud & Aber, 1996, for war; Reiter-Purtill, 2003, for chronically ill children; and Kaniasty & Norris, 1995b, for survivors of Hurricanes). This seems to additionally support the explanation of altruism born of suffering as a relief of distress. Empathy and perspective-taking has been mentioned in studies among victims of sexual abuse (Grossman et al., 2006; Shakespeare-Finch & Copping, 2006; see also Barnett et al., 1986, 1987); and anecdotal evidence of these processes is also available for collectively experienced suffering, namely genocide and ethnic conflict (Haaretz, 2007a, b; Messinger, 2004). These examples are also closely related to the third set of proposed social psychological processes, identification with other victims based on (perceived)

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similarity and shared fate. Not surprisingly, this was found among victims experiencing the same event collectively, namely natural disasters (Eranen & Liebkind, 1993) and human-caused suffering such as war, terrorism, and genocide (Leaning & Briton, 2004; Penner et al., 2005; Volpato & Contarello, 1999). However, the sense of shared suffering also motivates prosocial behavior among those who suffer from individual, non-intentional harm such as illnesses (Gillen, 2005; Reeves et al., 1999). In sum, the reviewed research supports the motivational processes that are proposed as mediators in the present model of altruism born of suffering. Importantly, not only already existing theories within clinical psychology are supported by these findings, but also more general theories in social psychology that have been applied to this phenomenon. Overall, there is a considerable amount of theory and empirical evidence to suggest that and why individuals who have suffered may be particularly motivated to engage in prosocial behavior. At the same time, suffering can lead to such a severe limitation of psychological and material resources that these motivations are not carried out. Therefore, the model proposes several volitional processes that can strengthen the motivation to help in light of hindering circumstances. Drawing on the volitional processes introduced by Kuhl (1987), these are used here to organize potential moderators of altruism born of suffering that emerged from the review of empirical findings. Selective attention facilitates the processing of information that supports a motivational intention. Among individuals who have experienced adversity, and for whom suffering is chronically salient, enhanced moral sensibility (Coles, 2000; Garbarino et al., 1991) and heightened awareness of suffering and injustice (Macksoud & Aber, 1996) may reinforce prosocial responses. Enhanced perspective-taking due to experiences with similar situations will also strengthen prosocial responses to other victims (Grossman et al., 2006; Kleinman, 1989; ShakespeareFinch & Copping, 2006). However, some may be too preoccupied with their own suffering to notice others’ distress (see Kay, 1998; Lifton, 2003). Encoding control reinforces motivational intentions by selectively encoding features of a stimulus that are related to the intention. The perception of similarity with other victims and the resulting superordinate categorization based on shared fate is likely to enhance prosocial behavior (Eranen & Liebkind, 1993; Gillen, 2005; Leaning & Briton 2004; Reeves et al., 1999; Volpato & Contarello, 1999). While similarity is most easily perceived with victims of the same event (type), the individual’s construal level of suffering will likely influence whether altruism born of suffering is also directed toward victims of different event types; and temporal as well as psychological distance presumably facilitate a more abstract and inclusive encoding (see Kay, 1998; Trope & Liberman, 2003). Emotion control reinforces motivational tendencies by regulating emotional states that undermine the translation of motivation to action. Among those who have suffered or are undergoing adverse situations, helping others reduces negative affect, including fear (Rachman, 1979), post-traumatic stress (Kishon-Barash et al., 1999), depression (Brown et al., 2008) and survivor guilt and grief (Wayment, 2004). Thereby, it is an effective coping mechanism (Midlarsky, 1991) that is associated with well-being (Kahana et al., 1988) and is likely to give rise to positive

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emotions that increase prosocial behavior. However, when individuals are too distressed and focused on their own situation, overarousal may inhibit prosocial behavior in the first place (Fabes et al., 1993; see also Wakslak et al.,2007). Several of the reviewed studies showed that helping was actually higher among those who had suffered more, which suggests an inverse U-function—such that more intense suffering may initially give rise to stronger motivations to help, but only to the point where inward-focused distress becomes too strong and emotion control fails, thereby decreasing the willingness to help others in need. Motivational control refers to processes that strengthen the current motivational base. This is especially important when the intentions are not very strong. Structured intervention programs and opportunities to help may reinforce prosocial motivation among individuals and groups who have undergone traumatic experiences. For example, altruism has been included and recommended as an explicit element in therapeutic programs for Vietnam veterans (Johnson, Feldman, Southwick, & Charney, 1991; Kishon-Barash et al., 1999), torture victims (Mollica, 2004), survivors of the Cambodian genocide (Mollica, Cui, McInnes, & Massagli, 2002), at-risk youth (Canale & Beckley, 1999), and children who have been exposed to community violence (Errante, 1997). However, only a few who have suffered have access to such programs. Environmental control refers to enhancing characteristics of the environment that facilitate the motivational intention. In situations of experienced harm, this includes required helpfulness (Rachman, 1979; see also Hannah & Midlarsky, 2005; McHale & Gamble, 1989), and the reciprocity norm of mutual helping that is apparent in the ‘‘altruistic community’’ (Kaniasty & Norris, 1995a, b). After the traumatic event, environmental control includes altruistic role models (Seagle et al., 2002) and support from others (Kishon-Barash et al., 1999), especially supportive relationships with survivors of similar events (Kleinman, 1989; see also Magen & Glajchen, 1999). Conversely, in the absence of a supportive environment, altruism born of suffering may be inhibited (Kishon-Barash et al., 1999). In conclusion, the reviewed studies provide general support for the proposed model, which integrates explanations and theoretical perspectives concerning how an individual’s own experiences of suffering may give rise to specific motivations to help others in need—not only despite, but precisely because of these negative experiences, which can range from unintentional, individual suffering to collective violence. The model addresses affective and cognitive processes as well as situational factors that might mediate (motivational stage) and moderate (volitional stage) the motivation to engage in prosocial behavior during or after the experienced traumatic event. It should be noted that several factors are relevant for both the motivational and the volitional stage. This is because processes that give rise to the intention to act must also remain activated until the intention is implemented. For example, while perceived common fate can motivate help, it is also necessary that this aspect is salient when the intention to act is implemented (see encoding control). Whereas it is unlikely that all reinforcing factors will be present in a given situation, their specific combination may predict, together with the type of the event, whether prosocial behavior occurs and whom it benefits.

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Methodological Limitations and Future Research Directions In sum, this overview reveals initial empirical evidence of altruism born of suffering across various populations and adverse events, and involving prosocial behavior on a continuum of increasing inclusiveness and scope. Due to the lack of established terminology, it is likely that more relevant work exists that has not been discovered through keyword searches. Hence, rather than claiming to be exhaustive, the purpose of this review is to draw attention to the phenomenon in its different manifestations, and identify which additional research is needed. Future research should address, first and foremost, the methodological limitations of this evidence. It must be kept in mind that only few of the reviewed studies were actually designed to explicitly test the research question that is posed in this paper. Exceptions include Hannah and Midlarsky (2005), Kahana et al. (1985), Penner et al. (2005), Raboteg-Sˇaric et al. (1994), and Seagle et al. (2002), which have been reviewed in detail. In all other studies, the relevant piece of evidence is often an exploratory finding, or embedded in other research questions, and it is therefore not surprising that methodological requirements for testing the altruism born of suffering hypothesis have not been met adequately. Thus, while the reviewed studies provide valuable preliminary evidence, their limitations call for caution in interpreting the findings. For example, many of the reviewed studies did not include a control group, making it impossible to say whether the observed helping behavior differed significantly from the general population (exceptions are pointed out throughout the review). Likewise, the lack of longitudinal measures often does not permit an adequate evaluation of whether altruism and prosocial behavior have actually increased after the adverse life event. In addition, more objective, behavioral measures are frequently missing. Instead, studies often rely on retrospective selfreports, such as all interviews, which could be distorted by memory and self-serving biases and are therefore difficult to interpret (for a discussion of this general problem in research of post-traumatic growth, see Zoellner & Maercker, 2006). A great deal of the reviewed research uses qualitative methods and small samples, even case studies, resulting in a lack of control over potentially confounding variables and making it impossible to infer causality. Given the nature of the topic, these methodological limitations are, in part, unavoidable. For example, while experimental studies would address many of the limitations, randomization and manipulation of suffering as the independent variable is obviously neither possible nor ethical. Several practical problems in conducting this research also naturally arise, such as finding relevant control groups that are not confounded with cultural variables or cohort effects; planning longitudinal studies with a base-line measure of prosocial behavior when it is impossible to predict a disaster or outbreak of violence; ethical issues as well as mistrust or shame when people are asked about experiences of violence, which creates difficulties in the recruitment of sufficiently large sample sizes; and the limited possibilities of conducting studies in the immediate context of violence. Nevertheless, these restrictions do not rule out the use of quasi-experimental designs and experimentally manipulated stimulus materials, such as the systematic

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variation of different types of helping opportunities, or recipients with different group memberships and fate. Moreover, the reviewed body of research does reveal examples of studies with control groups (see Table 1) and big sample sizes (e.g., Kahana et al., 1988; Kaniasty & Norris, 1995b), longitudinal data (Raboteg-Sˇaric et al., 1994; Reiter-Purtill, 2003), as well as behavioral data, such as from document analyses (e.g., Penner et al., 2005; Unger, 2000) or observational measures from external actors who were unaware of the hypothesis (Hannah & Midlarsky, 2005; McHale & Gamble, 1989; Raboteg-Sˇaric et al., 1994). Thus, systematic and methodologically rigorous research is possible within a research program on altruism born of suffering, and it can be furthered in the future to provide more stringent tests of the hypotheses, replicate the findings, and rule out alternative explanations. In addition, it will be important to study an even wider range of populations and events in order to examine the generalizability (versus context-specificity) of the phenomenon. The increased use of longitudinal measures would provide knowledge about the prevalence and trajectory of the phenomena, examining changes in underlying processes over time—for example, whether helping performed in the situation of suffering leads to changes in the self-concept that can give rise to long-term effects, such as enhanced self-efficacy or even a helper identity. The classification of findings along relevant dimensions of suffering and prosocial behavior give rise to several interesting research questions, such as the relation between the type of suffering and the type of helping. For example, an emerging hypothesis that arises from the present review is that the experience of non-intentional suffering may motivate interpersonal rather than collective forms of helping; and perceived similarity with victims of other event types seems more common among those who experienced human-caused suffering (rather than nonintentional harm). Future research should examine further conditions under which advocacy for those suffering from the same fate is more likely, and when activism on behalf of other disadvantaged groups becomes possible. Here, social psychological research is valuable and can clarify how social categorization and cognitive construal may explain altruism born of suffering toward members of other social groups and those suffering from events that differ from one’s own experiences. For example, future research could investigate the hypothesis that a high-level construal of suffering would facilitate perceived similarity with those experiencing different event types, creating the bond of common fate and enhancing empathy and prosocial behavior toward outgroup members. Knowing which conditions facilitate the inclusion of outgroups in a common ingroup based on perceived similarity of fate across groups—such as the experience of ethnic violence—has important theoretical and practical implications for intergroup relations. Likewise, it will be important to examine the effects of the severity of harm, following the findings revealed in this review that the intensity of suffering may actually lead to higher levels of prosocial behavior. Replications of this effect are necessary, as well as further investigations of the threshold and possible tipping point of this effect. In regard to the time point of suffering, an interesting question is whether the different types of motivations proposed in the model may explain altruism born of suffering at different stages. Specifically, the clinical perspective

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explains how helping may fulfill certain needs among those who have suffered; therefore it may be particularly relevant in earlier stages. Several social psychological explanations, in contrast, require the ability to perceive others’ needs and associate them with one’s own experiences, which may only be possible with temporal and psychological distance from the events. To summarize, future research on altruism born of suffering should utilize quasiexperimental studies with equivalent control groups, longitudinal designs, systematic replications, and more behavioral measures in order to examine the prevalence and manifestations of these phenomena, and specify the conditions under which prosocial responses are more likely to occur than destructive ones.

Discussion and Conclusion The review presented in this paper demonstrates that ‘‘altruism born of suffering’’ exists and is an important phenomenon on the individual as well as societal level. In some individuals who have endured adverse or traumatic life events, prosocial behavior can occur not only despite, but even because of the negative experiences that may give rise to specific altruistic motivations. These processes broaden our views regarding the pathways leading to prosocial behavior that have been studied extensively in social psychology (see Penner et al., 2005). Moreover, the review shows that prosocial behavior stemming from adverse experiences is not uncommon, and occurs in a variety of contexts and among diverse populations after various forms of suffering. This empirical evidence is in direct contrast to the large body of research demonstrating the negative societal impact of trauma and adversity, specifically how such experiences lead to destructive, antisocial outcomes and cycles of violence. The review demonstrates that this response is not inevitable, and may even be transformed to a prosocial outcome that benefits society and contributes to positive intra- and intergroup relations and social justice. Phenomena related to altruism born of suffering have been observed primarily in clinical psychology, psychiatry, and social work. Still, the possibility that previous adverse life experiences could motivate altruism and prosocial behavior, even toward outgroup members, has not been studied systematically, nor has it been recognized in research on prosocial behavior within social psychology. However, as the review and application of relevant theories shows, social psychological theories are necessary to understand and predict the phenomena more completely. Social psychology is uniquely positioned to study the link between events on the macrolevel, such as intergroup violence, and individual outcomes such as prosocial behavior (see Doise, 1986; Stangor & Jost, 1997). Social psychological approaches can contribute by examining underlying motivational, cognitive, and affective processes of altruism born of suffering, including those rooted in processes of social identity, and social categorization. A remaining, crucial question is which factors will increase the likelihood of a prosocial, rather than defensive or revengeful response to suffering. Clinical research provides valuable perspectives that address this question. An important characteristic of altruism born of suffering is that it has bidirectional effects, such

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that it benefits both the recipient and the provider of help. This is evidenced in studies revealing the positive effects of helping behavior on coping, such as decreased levels of depression and post-traumatic stress (Brown et al., 2008; Kishon-Barash et al., 1999; Midlarsky, 1991). In contrast, revengeful tendencies among those who have suffered are associated with increased levels of PTSD (Orth, Montada, & Maercker, 2006). Although altruism obviously is not the only acceptable response to violence, and defensive violence is understandable and at times necessary, these findings illustrate the importance of altruism born of suffering as a potential, constructive response to adversity and trauma that has benefits on the individual and on the societal level: altruism born of suffering increases individual well-being, benefits other victims and disadvantaged members of society, and can break the cycle of violence. The therapeutic potential of altruism and helping behavior has been utilized in a number of intervention programs for individuals and groups who have undergone traumatic experiences (e.g., Errante, 1997; Johnson et al., 1991; Mollica et al., 2002; see also Mollica, 2004). Future research is needed to further develop and evaluate similar intervention programs that are designed to facilitate altruism born of suffering. These interventions should ideally provide structured opportunities to help, assisting with resources that are needed to reinforce and implement prosocial motivations that may be present already. Therefore, the relation between motivational tendencies and the proposed reinforcing factors in the volitional stage has important practical implications for interventions. Contact with others who suffer (from similar or from different events, including outgroups and members of other disadvantaged groups) may also be an important element in these interventions: by creating awareness of others’ suffering that may distract from one’s own, encouraging perceived similarity and empathy, and giving opportunities to help. These interventions may have a two-fold effect. Specifically, by replacing the passive, weak role of the victim and recipient of help with the active, strong role of the helper, self-efficacy and self-esteem are enhanced. In result, altruism in the aftermath of victimization may be an attractive alternative to destructive and revengeful coping ideologies that victimized groups and their members are at risk of developing (Errante, 1997). Therefore, knowing how negative experiences may be transformed is crucial not only for enhancing individual well-being after victimization, but also to prevent future violence and reinforce a path to positive social change. In conclusion, research on altruism born of suffering will bring attention to an important social phenomenon, and contribute to a more balanced view of the lives of those who have suffered than what has been traditionally the focus of research (Bonanno et al., 2006). The alternative view involves recognizing not only their victimization and pain, but also their agency, strength, experience, and expertise on related interpersonal and social issues (see Kahana et al., 1988; Martıń-Baro´, 1994; Midlarsky, 1991; Staub, 2005; Suedfeld, 1997; Tedeschi, 1999). This perspective may not only contribute to relieving some of the stigma associated with victimization, but also to enhancing victimized individuals’ and groups’ awareness of their potentially crucial contribution to the reduction and even prevention of future suffering.

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Acknowledgments The author is indebted to Ervin Staub for initiating the idea for this paper and for many stimulating discussions about the topic. A special thanks also goes to Linda Tropp for her many helpful suggestions and comments on earlier drafts. I would also like to thank Icek Aizen, Ronnie JanoffBulman, Paula Pietromonaco, as well as the two anonymous reviewers for their valuable comments.

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